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Endocrine Abstracts (2014) 34 CMW2.2 | DOI: 10.1530/endoabs.34.CMW2.2

1University of Milan, Milan, Italy; 2IRCCS Istituto Auxologico Italiano, Milan, Italy.


The central hypothyroidism (CeH) is a hypothyroid condition due to an insufficient stimulation by TSH of an otherwise normal thyroid gland. CeH is about 1000-fold rarer than primary hypothyroidism (PH). Differently to PH, the CeH is most frequently characterized by low/normal TSH levels and thyroid hormone replacement is associated with the suppression of residual TSH secretion even during low thyroxine regimen.

Thus, CH management often represents a clinical challenge because physicians cannot rely on the systematic use of the reflex TSH determination which complicates the diagnosis of milder or subclinical CeH forms and the fine tuning of replacement therapy to the individual needs. The clinical challenge of CH is further amplified by the frequent combination with other pituitary deficiencies that may mask the CeH manifestations. In the presence of hypothalamic/pituitary lesions, the replacement of gonadotrope or somatotrope functions can in turn uncover a subclinical or partial thyrotrope defect.

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