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Shorten: Loss of thyroid function in primary hypothyroidism leads to a decreased production of TH and increased secretion of TSH and TRH. The most common causes in adults include autoimmune thyroiditis (Hashimoto disease), iatrogenic loss of thyroid tissue after surgical or radioactive treatment for hyperthyroidism, head and neck radiation therapy, medications, and endemic iodine deficiency. Infants and children may present with hypothyroidism because of congenital defects in the pituitary or thyroid glands. Central (secondary) hypothyroidism is caused by the pituitary’s failure to synthesize adequate amounts of TSH or a lack of TRH. Pituitary tumors that compress surrounding pituitary cells or the consequences of their treatment are the most common causes of secondary hypothyroidism. Other causes include traumatic brain injury, subarachnoid hemorrhage, or pituitary infarction. Hypothalamic dysfunction results in low levels of TRH, TSH, and TH (Fig. 22.10). Subclinical hypothyroidism is mild thyroid failure and is estimated to occur in 4% to 8% of U.S. adults. It is defined as an elevation in TSH level with normal levels of circulating TH

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