secondary hypothyroidism guidelines

[Carsey2411]

hi, are there any uk guidrlines on secondary hypothyroidism? I’ve looked online at NICE but not able to locate. Thanks

[SeasideSusie Remembering]

cks.nice.org.uk/topics/hypo...

Arrange urgent referral to an endocrinologist for specialist assessment of the underlying cause, if secondary hypothyroidism is suspected.

Then click where secondary hypothyroidism is highlighted to link to

cks.nice.org.uk/topics/hypo...

Secondary (or central) hypothyroidism

Secondary hypothyroidism is the result of insufficient thyroid stimulation due to a pituitary or hypothalamic disorder [Weetman, 2010; Garber et al, 2012; Chaker, 2017; Persani, 2018].

TSH levels may be inappropriately low or normal (or rarely raised), but FT4 is below the normal reference range [Persani, 2018].

Just a starting point for you, I don't have time at the moment to look any further I'm afraid. At least it says refer to endo if suspected. By looking around the NICE website and finding further references to secondary or central hypothyroidism you may find more.

[Carsey2411 in reply to SeasideSusie]

thanks this is super useful.

[helvella Administrator]

The full NICE guidance NG145 does mention it a few times.

Download the PDF and search it for "secondary". Sometimes the word is used in relation to other things but it seems reasonably clear.

nice.org.uk/guidance/ng145/...

[Jazzw]

Some of the guidance talks about pituitary failure (which is the underlying cause) rather than secondary (or central) hypothyroidism.

Or hypopituitarism (underactive pituitary) patient.info/doctor/hypopit...

[Jazzw]

The stats in that article I quoted are interesting:

The incidence of hypopituitarism is estimated to be 4·2 per 100,000 per year.

The prevalence of hypopituitarism is estimated to be 29-45 per 100,000.

I have a funny feeling it might be very under-diagnosed…

[userotc in reply to Jazzw]

I also find it interesting that several articles such as the one you linked do not include drugs as a possible cause whereas others do eg link below. And I believe further drugs could also cause it for the same reason (inflammation of pituitary). msdmanuals.com/home/hormona...

[Wua13262348]

If you insert in Google box : Lanarkshire Health Board Guidelines for Primary Care for Central Hypothyroidism, you can view what they have to say. It says on internet it is due for review 4/3/23.