This Article Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by CARON, P. J. Articles by NISULA, B. C. Search for Related Content PubMed PubMed Citation Articles by CARON, P. J. Articles by NISULA, B. C.

Deficient Nocturnal Surge of Thyrotropin in Central Hypothyroidism

Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health Bethesda, Maryland 20205

Address all correspondence and requests for reprints to: Dr. Bruce Nisula, Building 10, Room 10N262, National Institutes of Health, Bethesda, Maryland 20205.

In normal individuals, serum TSH concentrations have a circadian pattern characterized by a nocturnal surge which begins in the late afternoon and reaches its peak after midnight. We assessed the nocturnal surge of TSH in 16 patients with pituitary and/or hypothalamic diseases, 6 of whom were judged to be hypothyroid. To assess themagnitude of the nocturnal surge in individual patients, TSH was measured in 5 serum samples obtained during the normal time of the TSH nadir in the late afternoon and in 5 samples obtained during the normal time of the peak of serum TSH after midnight. A significantnocturnal surge of TSH was defined as a significantly greater mean nighttime TSH level than the mean daytime TSH concentration. The nocturnal TSH surge was absent in the 6 patients with central hypothyroidism, while it was present in the 10 euthyroid patients with central lesions. In 6 hypothyroid patients who did not have pituitary or hypothalamic lesions, the nocturnal TSH surge was intact, indicating that hypothyroidism per se does not account for the deficient nocturnal TSH surge in central hypothyroidism. We conclude that central hypothyroidism is characterized by a deficient nocturnal surge of TSH, and accordingly, we suggest that evaluation of the circadian pattern of TSH may be a useful adjunctin making the diagnosis of hypothyroidism in patients with diseases involving the pituitary or hypothalamus.

Received September 30, 1985.

This article has been cited by other articles:

				H. Filipsson and G. Johannsson GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies Eur. J. Endocrinol., November 1, 2009; 161(S1): S85 - S95. [Abstract] [Full Text] [PDF]

				H. Filipsson, E. Nystrom, and G. Johannsson Exploring the use of recombinant human TSH in the diagnosis of central hypothyroidism Eur. J. Endocrinol., August 1, 2008; 159(2): 153 - 160. [Abstract] [Full Text] [PDF]

				K. H. Darzy and S. M. Shalet Circadian and Stimulated Thyrotropin Secretion in Cranially Irradiated Adult Cancer Survivors J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6490 - 6497. [Abstract] [Full Text] [PDF]

				C. S. Mantzoros, M. Ozata, A. B. Negrao, M. A. Suchard, M. Ziotopoulou, S. Caglayan, R. M. Elashoff, R. J. Cogswell, P. Negro, V. Liberty, et al. Synchronicity of Frequently Sampled Thyrotropin (TSH) and Leptin Concentrations in Healthy Adults and Leptin-Deficient Subjects: Evidence for Possible Partial TSH Regulation by Leptin in Humans J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 3284 - 3291. [Abstract] [Full Text] [PDF]

				N. Yamakita, T. Komaki, T. Takao, T. Murai, K. Hashimoto, and K. Yasuda Usefulness of Thyrotropin (TSH)-Releasing Hormone Test and Nocturnal Surge of TSH for Diagnosis of Isolated Deficit of TSH Secretion J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 1054 - 1060. [Abstract] [Full Text]

				D. N. Orth, R. C. Shelton, W. E. Nicholson, P. Beck-Peccoz, A. J. Tomarken, L. Persani, and P. T. Loosen Serum Thyrotropin Concentrations and Bioactivity During Sleep Deprivation in Depression Arch Gen Psychiatry, January 1, 2001; 58(1): 77 - 83. [Abstract] [Full Text] [PDF]

				K. Yonemura, T. Nakajima, T. Suzuki, S. Ando, R. Genma, H. Nakamura, and A. Hishida Low free thyroxine concentratios and deficient nocturnal surge of thyroid-stimulating hormone in haemodialysed patients compared with undialysed patients Nephrol. Dial. Transplant., May 1, 2000; 15(5): 668 - 672. [Abstract] [Full Text] [PDF]