title: Uncertainties in endocrine substitution therapy for central endocrine insufficiencies: hypothyroidism.
abstract: In patients with primary hypothyroidism (PH), L-T4 replacement therapy can safely be adjusted to the individual needs by testing serum thyrotropin (TSH) concentration exclusively. Central hypothyrodism (CeH) is a particular hypothyroid condition due to an insufficient stimulation by TSH of an otherwise normal thyroid gland. CeH is about 1000-fold rarer than PH and raises several challenges for clinicians, mainly because they cannot rely on the systematic use of the reflex TSH strategy for diagnosis or therapy monitoring. Therefore, L-T4 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 replacement is further complicated by the frequent combination with other pituitary deficiencies and their treatment.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Division of Endocrine and Metabolic Diseases, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. Electronic address: luca.persani@unimi.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Persani
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Division of Endocrine and Metabolic Diseases, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bonomi
mesh_terms: D000818:Animals; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D013961:Thyroid Gland / Q000378:metabolism; D013972:Thyrotropin / Q000097:blood
chemical_list: D013972:Thyrotropin
keywords: Central hypothyroidism; L-T4 replacement therapy; TSH; combined pituitary hormone deficiency; free thyroxine; hormone replacement therapy; pituitary; subclinical hypothyroidism