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Michael H Augenbraun, MD, FACP  Professor of Medicine and Preventive Medicine and Community Health, Director of 3rd Year Medical Clerkship, State University of New York Downstate College of Medicine; Hospital Epidemiologist and Director, Department of Epidemiology, University Hospital of Brooklyn; Medical Director of Sexually Transmitted Diseases Clinic, Director of Lumbar Puncture Clinic, Kings County Hospital Center

Michael H Augenbraun, MD, FACP is a member of the following medical societies: American College of Physicians , Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Hypothalamic disorders cause reduced TSH secretion by impairing the production or transport of TRH to the pituitary gland. Hypothyroidism may occur because the pituitary secretes TSH in insufficient quantities, or secretes TSH with an abnormal glycosylation pattern which reduces the biologic activity of TSH 1,2,3 . Treatment with oral TRH restores the biologic activity of TSH, suggesting that deficient hypothalamic TRH release induces both quantitative and qualitative abnormalities of TSH secretion. TSH molecules with reduced biologic activity may retain their immunologic reactivity in TSH immunoassays, explaining the sometimes observed slightly increased values of serum TSH (up to 10 mU/l) in central hypothyroidism 18, 23 .

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