The interaction between growth hormone and the thyroid axis in hypopituitary patients

Summary Alterations in the hypothalamo‐pituitary‐thyroid axis have been reported following growth hormone (GH) administration in both adults and children with and without growth hormone deficiency. Reductions in serum free thyroxine (T4), increased tri‐iodothyronine (T3) with or without a reduction...

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Bibliographic Details
Published in:Clinical endocrinology (Oxford) 2011-03, Vol.74 (3), p.281-288
Main Authors: Behan, Lucy Ann, Monson, John P., Agha, Amar
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Child
Endocrinopathies
Fundamental and applied biological sciences. Psychology
Growth hormones
Hormone Replacement Therapy
Human Growth Hormone - therapeutic use
Humans
Hypopituitarism - blood
Hypopituitarism - drug therapy
Hypopituitarism - physiopathology
Hypothalamus. Hypophysis. Epiphysis (diseases)
Hypothyroidism
Hypothyroidism - blood
Medical sciences
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Pituitary gland
Thyroid Gland - drug effects
Thyroid Gland - physiology
Thyroxine - blood
Triiodothyronine - blood
Vertebrates: endocrinology
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Summary:Summary Alterations in the hypothalamo‐pituitary‐thyroid axis have been reported following growth hormone (GH) administration in both adults and children with and without growth hormone deficiency. Reductions in serum free thyroxine (T4), increased tri‐iodothyronine (T3) with or without a reduction in serum thyroid‐stimulating hormone secretion have been reported following GH replacement, but there are wide inconsistencies in the literature about these perturbations. The clinical significance of these changes in thyroid function remains uncertain. Some authors report the changes are transient and revert to normal after a few months or longer. However, in adult hypopituitary patients, GH replacement has been reported to unmask central hypothyroidism biochemically in 36–47% of apparently euthyroid patients, necessitating thyroxine replacement and resulting in an attenuation of the benefit of GH replacement on quality of life in those who became biochemically hypothyroid after GH replacement. The group at highest risk are those with organic pituitary disease or multiple pituitary hormone deficiencies. It is therefore prudent to monitor thyroid function in hypopituitary patients starting GH therapy to identify those who will develop clinical and biochemical features of central hypothyroidism, thus facilitating optimal and timely replacement.
ISSN:0300-0664
1365-2265
DOI:10.1111/j.1365-2265.2010.03815.x