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Hypothyroidism in patients with adrenal insufficiency may disappear with adrenal hormone therapy
The background of the study. Patients with adrenal insufficiency may also have hypothyroidism, which may improve when the former is treated. This article describes three patients with adrenal insufficiency and hypothyroidism in whom treatment with glucocorticoid (cortisol) resulted in normalization of thyroid function.
Patient 1. A 14-year-old boy presented with growth failure and delayed pubertal development. Biochemical studies revealed low testes function, hypothyroidism (high serum thyrotropin [TSH] and low free thyroxine [T4]) (Table), and adrenal insufficiency. He was treated with cortisol. Six weeks later, his serum TSH and free T4 values were normal. (Table). He was later treated with testosterone. He remained euthyroid during a 4-year follow-up period.
Table. Serum TSH and Free T4 Concentrations in Three Patients before and during Treatment for Adrenal Insufficiency. * |
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Before Treatment |
During Treatment |
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Patient |
Serum TSH (mU/L) |
Serum Free T4 (ng/dl) |
Serum TSH (mU/L) |
Serum Free T4 (ng/dl) |
1 |
7.8 |
0.8 |
0.5 |
1.4 |
2 |
7.7 |
0.8 |
2.7 |
1.0 |
3 |
6.2 |
0.8 |
1.7 |
1.4 |
*Normal values: TSH, 0.4–5.8 mU/L; and free T4, 0.9–1.7 ng/dl. |
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Patient 2. A 12-year-old girl presented with type 1 diabetes mellitus. Her serum TSH and free T4 concentrations were normal. Her diabetes was treated effectively, and she grew normally but gained little weight. Two years later, her serum TSH was high and her serum free T4 was low (Table), and she had adrenal insufficiency. She was treated with cortisol. One month later, her serum TSH and free T4 values were normal. She remained euthyroid during a three-year follow-up period.
Patient 3. A 2-year-old girl presented with seizures caused by hypoglycemia. Her growth was normal, but her skin was dark. She had adrenal insufficiency and hypothyroidism (Table). She was treated with cortisol, and one month later her serum TSH and free T4 values were normal. She was still euthyroid one year later.
The conclusions of the study. Patients with adrenal insufficiency may have hypothyroidism that subsides with glucocorticoid-replacement therapy.
The original article. Abdullatif HD, Ashraf AP. Reversible subclinical hypothyroidism in the presence of adrenal insufficiency. Endocr Pract 2006;12:572-5.
 Next Article: Small changes in thyroxine dose do not alter symptoms or well-being in patients with hypothyroidism |
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| Thyroid Digest Index | | | November 2006 Thyroid Digest |
