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CPE-001 · Safety patterns
PR-HT-03: Possible Central Hypothyroidism Pattern
Possible Central Hypothyroidism Pattern. Safety critical pattern. Requires FT4 below laboratory lower reference limit.
Required to fire
- FT4 < laboratory lower reference limit
- TSH low or normal or mildly elevated inappropriately for low FT4
Supportive, not required
- Pituitary or hypothalamic disease
- TBI
- Pituitary surgery or radiation
- Headache or visual symptoms
- Other pituitary hormone deficits
Exclusions the engine asks you to review
- Acute severe systemic illness
- Drug effect
- Analytical interference
What it reports
- Functional state: possible central hypothyroidism pattern
- Etiology: pituitary or hypothalamic cause possible
- Safety alert: adrenal insufficiency must be assessed before levothyroxine
Recommended next steps (for physician review)
- Assess morning cortisol/ACTH and adrenal safety before thyroid hormone replacement in suspected central disease.
- Evaluate additional pituitary axes as clinically appropriate.
- Consider pituitary MRI when pituitary disease is suspected or supported by the clinical context.
Evidence
- EV-ENDO-HYPOPIT-2016Fleseriu M et al. Hormonal Replacement in Hypopituitarism in Adults. J Clin Endocrinol Metab. 2016;101(11):3888-3921.Supports: FT4 low with low, normal or mildly elevated TSH in pituitary disease supports central hypothyroidism; adrenal safety review.
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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