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Secondary hypothyroidism is caused by impaired function of the hypothalamus or pituitary gland and can lead to serious complications. It is diagnosed through physical exams, blood tests, and imaging. Treatment involves hormone replacement therapy and surgery in some cases. Early diagnosis and continued treatment are important for a good prognosis. Complications can include infertility, heart disease, and myxedema coma.
Reduced thyroid activity resulting from impaired function of the hypothalamus or pituitary gland is known as secondary hypothyroidism. Frequently diagnosed in women 50 years of age and older, this form of hypothyroidism is manageable with appropriate treatment. There are serious complications associated with secondary hypothyroidism, including heart disease, coma, and death. Treatment for this condition centers on restoring proper hormone levels and proper thyroid function.
There are two classifications of hypothyroidism: primary and secondary. Primary hypothyroidism is a disruption of proper hormone production that originates from the thyroid gland. Secondary hypothyroidism occurs when the thyroid gland is negatively affected by an impairment of the pituitary or hypothalamus.
The thyroid gland produces the hormones triiodothyronine (T3) and thyroxine (T4) which act directly to help regulate metabolism. When T3 and T4 production is disrupted, the pituitary gland and hypothalamus increase hormone production to compensate for the loss. Thyroid disorders, such as hypothyroidism, occur when the function of one of these organs is inhibited. Secondary hypothyroidism occurs when communication in the pituitary gland and hypothalamus is disrupted and there is a failure to release thyroid stimulating hormone (TSH) or thyrotropin-releasing hormone (TRH).
Several situations can contribute to the development of secondary hypothyroidism. Individuals who have had radiation therapy or whose brains have otherwise been exposed to radiation may develop secondary hypothyroidism. Tumors that develop in the pituitary gland or hypothalamus can also contribute to the development of hypothyroid disorder. Those who develop inflammation or infection of the pituitary gland, due to excessive blood loss or disease, may be diagnosed with hypothyroidism.
There are several signs and symptoms of secondary hypothyroidism that can directly and negatively affect an individual’s ability to function. Varying in severity, symptoms develop over time and tend to gradually impair one’s mental and physical abilities. An individual in the early stages of developing hypothyroidism may experience signs that include joint discomfort, weight gain, and fatigue. Additional symptoms may include thinning hair, physical weakness, and cold intolerance. Signs that occur as the disorder progresses may include a stoppage of menstruation in women, excessive peeling or dryness of the skin, and speech or hearing impairment.
A physical exam conducted in combination with blood and imaging tests can be used to confirm a diagnosis of hypothyroidism. Preliminary signs seen during a physical exam that may indicate the presence of a thyroid problem include a low heart rate, blood pressure, and temperature. Imaging tests, including X-rays and magnetic resonance imaging (MRI), may be conducted to evaluate the condition of the individual’s heart and pituitary gland. Additional laboratory tests may be conducted to evaluate cholesterol and hormone levels, as well as liver function.
Treatment of secondary hypothyroidism generally focuses on compensating for the hormone deficiency and restoring proper thyroid function. A drug may be recommended to artificially compensate for the hormone deficiency, a process known as hormone replacement therapy. In some cases, lifelong hormone replacement therapy may be required. Treatment for a tumor-induced hypothyroidism may require surgery to remove the mass and postoperative hormone replacement therapy.
Proper thyroid function can be restored with early diagnosis. A good prognosis depends on appropriate and continued treatment. Individuals with hypothyroidism who stop HRT are at risk of recurrence and worsening of symptoms.
Complications associated with hypothyroidism can include infertility and heart disease. A potentially life-threatening complication of hypothyroidism is a rare condition known as myxedema coma. Symptoms of this serious condition include loss of consciousness, shortness of breath and low blood pressure. Individuals showing signs of suspected myxedema coma should see a doctor immediately. Treatment for this complication includes intravenous administration of steroid drugs and replacement therapy.
