Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Frequently Asked Questions
The hypothalamus and pituitary gland are at the center of thyroid hormone control. The hypothalamus releases thyrotropin-releasing hormone (TRH), which triggers the pituitary gland to release thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid to produce and release two major hormones:Thyroxine(T4) andtriiodothyronine(T3) into the bloodstream.
Thyroid hormonesplay an important role in virtually every aspect of your health, including metabolism, heart rate, energy expenditure, body temperature, skin, hair, and nail growth.
The three endocrine glands, known as the hypothalamic-pituitary-thyroid axis, work together on a feedback loop to keep thyroid hormone production within a normal range. If the hypothalamus and/or pituitary gland are dysfunctional or damaged, an otherwise healthy thyroid will produce insufficient thyroid hormone levels.
This article explores central hypothyroidism symptoms, causes, diagnosis, and treatments.
Central Hypothyroidism Symptoms
Centralhypothyroidism symptomsvary from person to person, depending on the severity of thyroid hormone deficiency. Common symptoms of central hypothyroidism include:
Central hypothyroidism may be congenital (present at birth) or acquired in childhood or adulthood due tohypothalamicor pituitary disease or injury.
Causesof central hypothyroidism include:
How Common Is Central Hypothyroidism?An estimated 1 in 13,000 people have central hypothyroidism. About 60% are part of combined pituitary hormone deficiencies.
How Common Is Central Hypothyroidism?
An estimated 1 in 13,000 people have central hypothyroidism. About 60% are part of combined pituitary hormone deficiencies.
Todiagnose central hypothyroidism, your healthcare provider will ask about your medical history and perform a physical examination to check your vital signs, including your body temperature, heart rate, and reflexes. They may palpate (feel) your neck to check yourthyroid gland’ssize, location, and texture.
Important information to tell your healthcare provider includes:
Blood tests are the best way to accurately diagnose central hypothyroidism.Thyroid blood testsinclude:
Low TSH levels are often associated withprimary hyperthyroidism, whereas low T4 with low-to-normal TSH levels are hallmark indicators of central hypothyroidism.
Your healthcare provider may order imaging tests, such as a magnetic resonance imagingMRIof the hypothalamus and/or pituitary gland, to check for tumors or defects that may be the cause of CeH.They may perform genetic testing if the cause is unknown or you have a family history of the disease.
The standardtreatmentfor central hypothyroidism is an oral medication called Synthroid, Levoxyl, Unithroid, or Levothroid (levothyroxine).This synthetic version of the thyroid hormone, thyroxine (T4), is taken daily to restore T4 to normal levels. Your healthcare provider will choose your initial dosage based on your body weight and the severity of your symptoms.
Routine bloodwork is required frequently (every four to eight weeks) at the start of the medication to check thyroid hormone levels. Dosage adjustments will be made as needed based on test results and symptoms. Once your thyroid hormone levels are stabilized within normal ranges, monitoring will be required one to two times a year.
If a pituitary and/or hypothalamic disorder is the cause of central hypothyroidism, you may start treatment for the underlying cause before starting thyroid hormone replacement therapy.There is no cure for central hypothyroidism, so lifelong treatment may be required.
How to Take Thyroid Medication Including Levothyroxine
Summary
People with CeH may experience mild symptoms of hypothyroidism (e.g., fatigue) along with other symptoms such as recurrent headaches and vision disturbances (e.g., double vision). Symptoms of pituitary dysfunction may also be present.
A thorough physical examination and thyroid blood tests are required to diagnose central hypothyroidism accurately. Low T4 levels, with low, inappropriately normal TSH levels, are hallmark indicators of the condition. Thyroid hormone replacement therapy is the most common treatment for CeH. Levothyroxine, a synthetic version of thyroid hormone T4, is taken daily to restore and balance thyroid hormone levels and reduce symptoms.
A Word From Verywell
Central hypothyroidism symptoms can interfere with your quality of life, but getting treatment can help manage the condition and improve your overall well-being. Talk to your healthcare provider if you have symptoms of hypothyroidism. They may refer you to anendocrinologist—a healthcare specializing in diagnosing and treating thyroid diseases—to provide an accurate diagnosis and recommend the best course of treatment.
Central hypothyroidism is rare. An estimated 1 in 13,000 people (including infants, children, and adults) are diagnosed with the condition.
Thyroid blood tests that measure thyroid hormone levels in the bloodstream are used to diagnose central hypothyroidism. The condition is associated with low levels of thyroxine (T4) and low-to-normal thyroid-stimulating hormone (TSH) levels.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Society for Endocrinology.Thyrotropin-releasing hormone.Government of Western Australia.The thyroid gland.Benvenga S, Klose M, Vita R, et al.Less known aspects of central hypothyroidism: part 1 - acquired etiologies.J Clin Transl Endocrinol. 2018;14:25-33. doi:10.1016/j.jcte.2018.09.003Persani L, Cangiano B, Bonomi M.The diagnosis and management of central hypothyroidism in 2018.Endocr Connect. 2019;8(2): R44-R54. doi:10.1530/EC-18-0515American Thyroid Association.Hypothyroidism during cancer therapy with tyrosine kinase inhibitors.Lauffer P, Zwaveling-Soonawala N, Naafs JC, et al.Diagnosis and management of central congenital hypothyroidism.Front Endocrinol (Lausanne). 2021;12:686317. doi:10.3389/fendo.2021.686317U.S. Department of Health and Human Services.Thyroid disease.American Thyroid Association.Hypothyroidism (underactive thyroid).Sheehan MT.Biochemical testing of the thyroid: tsh is the best and, oftentimes, only test needed - a review for primary care.Clin Med Res. 2016;14(2):83-92. doi:10.3121/cmr.2016.1309Persani L, Brabant G, Dattani M, et al.Guidelines on the diagnosis and management of central hypothyroidism.Eur Thyroid J. 2018;7(5):225-237. doi:10.1159/000491388Merck Manual: Professional Version.Hypothyroidism.The Pharmaceutical Journal.Hypothyroidism: causes, diagnosis and treatment.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Society for Endocrinology.Thyrotropin-releasing hormone.Government of Western Australia.The thyroid gland.Benvenga S, Klose M, Vita R, et al.Less known aspects of central hypothyroidism: part 1 - acquired etiologies.J Clin Transl Endocrinol. 2018;14:25-33. doi:10.1016/j.jcte.2018.09.003Persani L, Cangiano B, Bonomi M.The diagnosis and management of central hypothyroidism in 2018.Endocr Connect. 2019;8(2): R44-R54. doi:10.1530/EC-18-0515American Thyroid Association.Hypothyroidism during cancer therapy with tyrosine kinase inhibitors.Lauffer P, Zwaveling-Soonawala N, Naafs JC, et al.Diagnosis and management of central congenital hypothyroidism.Front Endocrinol (Lausanne). 2021;12:686317. doi:10.3389/fendo.2021.686317U.S. Department of Health and Human Services.Thyroid disease.American Thyroid Association.Hypothyroidism (underactive thyroid).Sheehan MT.Biochemical testing of the thyroid: tsh is the best and, oftentimes, only test needed - a review for primary care.Clin Med Res. 2016;14(2):83-92. doi:10.3121/cmr.2016.1309Persani L, Brabant G, Dattani M, et al.Guidelines on the diagnosis and management of central hypothyroidism.Eur Thyroid J. 2018;7(5):225-237. doi:10.1159/000491388Merck Manual: Professional Version.Hypothyroidism.The Pharmaceutical Journal.Hypothyroidism: causes, diagnosis and treatment.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Society for Endocrinology.Thyrotropin-releasing hormone.Government of Western Australia.The thyroid gland.Benvenga S, Klose M, Vita R, et al.Less known aspects of central hypothyroidism: part 1 - acquired etiologies.J Clin Transl Endocrinol. 2018;14:25-33. doi:10.1016/j.jcte.2018.09.003Persani L, Cangiano B, Bonomi M.The diagnosis and management of central hypothyroidism in 2018.Endocr Connect. 2019;8(2): R44-R54. doi:10.1530/EC-18-0515American Thyroid Association.Hypothyroidism during cancer therapy with tyrosine kinase inhibitors.Lauffer P, Zwaveling-Soonawala N, Naafs JC, et al.Diagnosis and management of central congenital hypothyroidism.Front Endocrinol (Lausanne). 2021;12:686317. doi:10.3389/fendo.2021.686317U.S. Department of Health and Human Services.Thyroid disease.American Thyroid Association.Hypothyroidism (underactive thyroid).Sheehan MT.Biochemical testing of the thyroid: tsh is the best and, oftentimes, only test needed - a review for primary care.Clin Med Res. 2016;14(2):83-92. doi:10.3121/cmr.2016.1309Persani L, Brabant G, Dattani M, et al.Guidelines on the diagnosis and management of central hypothyroidism.Eur Thyroid J. 2018;7(5):225-237. doi:10.1159/000491388Merck Manual: Professional Version.Hypothyroidism.The Pharmaceutical Journal.Hypothyroidism: causes, diagnosis and treatment.
Society for Endocrinology.Thyrotropin-releasing hormone.
Government of Western Australia.The thyroid gland.
Benvenga S, Klose M, Vita R, et al.Less known aspects of central hypothyroidism: part 1 - acquired etiologies.J Clin Transl Endocrinol. 2018;14:25-33. doi:10.1016/j.jcte.2018.09.003
Persani L, Cangiano B, Bonomi M.The diagnosis and management of central hypothyroidism in 2018.Endocr Connect. 2019;8(2): R44-R54. doi:10.1530/EC-18-0515
American Thyroid Association.Hypothyroidism during cancer therapy with tyrosine kinase inhibitors.
Lauffer P, Zwaveling-Soonawala N, Naafs JC, et al.Diagnosis and management of central congenital hypothyroidism.Front Endocrinol (Lausanne). 2021;12:686317. doi:10.3389/fendo.2021.686317
U.S. Department of Health and Human Services.Thyroid disease.
American Thyroid Association.Hypothyroidism (underactive thyroid).
Sheehan MT.Biochemical testing of the thyroid: tsh is the best and, oftentimes, only test needed - a review for primary care.Clin Med Res. 2016;14(2):83-92. doi:10.3121/cmr.2016.1309
Persani L, Brabant G, Dattani M, et al.Guidelines on the diagnosis and management of central hypothyroidism.Eur Thyroid J. 2018;7(5):225-237. doi:10.1159/000491388
Merck Manual: Professional Version.Hypothyroidism.
The Pharmaceutical Journal.Hypothyroidism: causes, diagnosis and treatment.
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