prevalence of overt hypothyroidism was found to be 0.3%;prevalence of sub-clinical hypothyroidism was found to be 4.3%.
A summary of the most common causes of hypothyroidism is given inBox 1.
Resistance to thyroid hormones
Hypothyroidism may be transient or permanent, central, or primary.Central hypothyroidism can accompany disorders of the hypothalamic-pitu-itary axis, leading to reduced TSH secretion or reduced biological activity of TSH. As a result, there is reduction in thyroid stimulation by the TSH and,secondarily, reduced thyroid hormone synthesis and secretion.Primary hypothyroidism refers to a defect in the thyroid gland resultingin reduced synthesis and secretion of thyroid hormones.
Central hypothyroidism is classically divided into secondary hypothy-roidism, where the defect is in the pituitary gland, and tertiary hypothyroid-ism, where the defect is in the hypothalamus. From a practical point of view,
Box 1. Causes of hypothyroidism
Pituitary tumors, metastasis, hemorrhage, necrosis, aneurysmsSurgery, traumaInﬁltrative disordersInfectious diseasesChronic lymphocytic hypophysitisOther brain tumorsCongenital abnormalities, defects in thyrotropin releasinghormone, TSH, or both
Chronic autoimmune thyroiditisSubacute, silent, postpartum thyroiditisIodine deﬁciency, iodine excessThyroid surgery, I-131 treatment, external irradiationInﬁltrative disordersDrugsAgenesis and dysgenesis of the thyroid