Central hypothyroidism

Central Hypothyrodism (CeH) is the hypothyroid condition due to an insufficient stimulation by thyrotropin (TSH) of an otherwise normal thyroid gland. CeH is about 1,000-fold more rare than primary hypothyroidism and raises several challenges for the clinicians, mainly because they cannot rely on the systematic use of the “reflex TSH strategy” for diagnosis or therapy monitoring. Therefore, CeH diagnosis is suspected and detectable in patients with known hypothalamic-pituitary diseases, whereas it can be frequently missed in those with a previously unknown pituitary involvement. L-thyroxine replacement in CeH should rely on the combined evaluation of several biochemical and clinical parameters in order to overcome the lack of accuracy of the single index. The management of CeH patients is further complicated by the frequent combination with other pituitary deficiencies and their specific replacement.