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Causes and Laboratory Investigation of Hypothyroidism

Hypothyroidism is the clinical state that develops as a result of the lack of action of thyroid hormones on target tissues. Primary hypothyroidism occurs when inherited or acquired pathogenic events affect thyroid function by reducing the amount of functioning thyroid tissue or by inhibiting thyroid hormone production. Central hypothyroidism is caused by pituitary or hypothalamic abnormalities resulting in an insufficient stimulation of an otherwise normal thyroid gland. Autoimmune thyroiditis is the most common cause of spontaneous hypothyroidism in areas with adequate iodine intake. Severe environmental iodine deficiency is still crucial in the pathogenesis of hypothyroidism in some geographical areas. Permanent central hypothyroidism is rare and usually part of a disorder involving the secretion of other pituitary hormones, while transient functional abnormalities of TSH secretion are relatively common. Hormonal evaluation of hypothyroidism is mainly achieved by measurement of TSH and free thyroid hormones but additional testing may be required to achieve the proper diagnosis.