Reversible subclinical hypothyroidism in the presence of adrenal insufficiency

Endocr Pract. 2006 Sep-Oct;12(5):572. doi: 10.4158/EP.12.5.572.

Abstract

Objective: To describe 3 different scenarios of reversible hypothyroidism in young patients with adrenal insufficiency.

Methods: We present 3 case reports of patients with adrenal insufficiency--one with delayed puberty, the second with type 1 diabetes and poor weight gain, and the third with hypoglycemia-related seizures and glucocorticoid deficiency--who had biochemical evidence of hypothyroidism.

Results: Our first patient (case 1) initially had a mildly elevated thyrotropin (thyroid-stimulating hormone or TSH) level and a normal free thyroxine (FT4) level that, on follow-up assessment, had progressed to persistent mild elevation of TSH and low FT4 concentration. The other 2 patients (cases 2 and 3) had low FT4 and mildly elevated TSH values at the time of diagnosis of adrenal insufficiency. In all 3 patients, the results of thyroid function tests normalized with use of physiologic doses of adrenal hormone replacement therapy, without thyroid hormone replacement. All 3 patients remained euthyroid after 4, 3, and 1 year of follow-up, respectively.

Conclusion: These observations add insights into the complexities of the thyroadrenal interactions. These examples are important because thyroid hormone replacement in the setting of adrenal insufficiency could be unwarranted.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenal Insufficiency / complications*
  • Adrenal Insufficiency / drug therapy
  • Child
  • Child, Preschool
  • Drug Administration Schedule
  • Female
  • Humans
  • Hydrocortisone / administration & dosage
  • Hypothyroidism / complications*
  • Hypothyroidism / drug therapy
  • Male
  • Thyrotropin / blood
  • Thyroxine / blood
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Thyrotropin
  • Thyroxine
  • Hydrocortisone