Patients with primary hypothyroidism have a fault in the functioning of their thyroid, so in your case, damage can be caused by your autoimmune condition. Patients with central hypothyroidism have either a failure of the anterior pituitary to secrete thyroid stimulating hormone (TSH), known as secondary hypothyroidism; or failure of the hypothalamus to secrete thyroid releasing hormone (TRH), known as tertiary hypothyroidism. In some very rare cases, a genetic TSH deficiency can occur with no other pituitary or hypothalamus abnormality but as that creates severe inate intellectual deficit that clearly won't be the cause of your central hypothyroidism. Another very rare cause of isolated TSH deficiency is drug-induced TSH deficiency in patients treated with a retinoid X receptor ligand (bexarotene), which inhibits TSH secretion. But as you've been advised, for the majority of patients with TSH deficiency hypothyroidism, the cause will originate in the pituitary gland. Have you had this investigated?
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