Pituitary-thyroid relationships in hypothyroidism.

The pituitary gland is undoubtedly a target for thyroid hormone. It is the tissue with the highest density of T3 receptors and contains Type II T4 5' deiodinase which are involved in the secretion of TSH and other pituitary hormones. In the case of TSH, this knowledge has resulted in a better understanding of a number of conditions such as the adaptation to reduced thyroid reserve, and in an improvement in the way we treat hypothyroidism. But the pituitary being a target tissue for thyroid hormones has additional consequences. A direct effect of T3 on various secretions of the gland has been documented, and in the case of other pituitary hormones, directly or indirectly, thyroid hormone has some effect. T3 has a broad spectrum of metabolic and physiological effects that may, by themselves, account for a large proportion of the variability of the clinical presentation of hypothyroidism. The multiplicity of pituitary hormones and the multiplicative action of these various hormones through their target glands make the pituitary gland another key element in the variability of clinical manifestations of hypothyroidism. While this variability poses a diagnostic challenge in that hypothyroidism should be considered in a large number of conditions, the abnormalities resulting from the lack of thyroid hormone in the pituitary are equally challenging from a therapeutic point of view, since they respond promptly to the correction of the hypothyroidism. We should try to identify and treat those that are both life-threatening and not corrected rapidly by the administration of thyroid hormone.