Sheehan syndrome — postpartum pituitary infarction — can impair the pituitary's ability to stimulate the thyroid gland, resulting in central hypothyroidism (CH). Managing this complication requires a specific therapeutic approach distinct from primary thyroid disease.
Central hypothyroidism in the context of Sheehan syndrome arises from insufficient TSH stimulation of an otherwise normal thyroid gland, driven by inadequate secretion or action of TSH-releasing hormone and/or TSH — a direct consequence of hypothalamic–pituitary injury.
The established approach involves thyroid hormone replacement with L-T4, with dosing individualised according to clinical context. Standard TSH-based monitoring is not applicable in CH; treatment is instead titrated to a specific serum fT4 target.
Clinical target: serum fT4 levels in the mid to upper half of the reference range. The complete dosing algorithm and individualisation criteria are in the full protocol.
DOI: 10.1210/jc.2016-2118