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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