ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Nat Rev Endocrinol 2017;13:588-598

Central hypothyroidism has received much interest in recent years, partly due to the discovery of new causal gene mutations. This is a comprehensive review on several aspects of central hypothyroidism. It discusses prevalence, and its variation between different countries; pitfalls in diagnosis, including assay interference; concurrent systemic illness and usefulness (or not) of TRH test and SHBG measurements; causes of congenital central hypothyroidism, including new genetic causes such as TLBX1 mutations and acquired hypothyroidism, including various forms of radiation, secondary causes, such as response to certain drugs, and various forms of hypophysitis.

Although acknowledging that this is not a consensus guideline, the paper gives recommendations for treatment, which may be used already in many clinics, such as starting with low dose treatment, keeping FT4 in upper normal range, giving thyroid hormone 30 minutes before breakfast and testing thyroid hormone levels before the thyroid hormone dose. Interestingly, they also suggest that levels of TSH >1.0 should be interpreted as a sign of under-treatment in central hypothyroidism as TSH decreases after initiation of treatment with Levothyroxine.

All in all, this review provides a comprehensive but concise update on central hypothyroidism.