In patients presenting with lack of adrenarche, hypoglycemia, pubertal delay, and a history of autoimmune disease who have biochemical evidence of adrenal insufficiency and mild hypothyroidism, it may be prudent to wait before initiation of levothyroxine replacement therapy, inasmuch as the thyroid dysfunction may be transient. Clinical signs and symptoms of adrenal insufficiency could be subtle, and the discovery of TSH elevation might deflect the caregiver from attending to the true diagnosis. Hence, physicians should contemplate the hypothalamicpituitary-adrenal axis in patients with mild hypothyroidism or compensated hypothyroidism, regardless of evidence of autoimmunity. It could be inferred that physiologic levels of glucocorticoids and mineralocorticoids are essential for normal thyroid responsivity and hormone synthesis.
ACTH = Adrenocorticotropic Hormone (Corticotropin); FT4 = Free Thyroxine; T3 = Triiodothyronine; T4 = Thyroxine; TPO = Thyroid Peroxidase; TSH = Thyroid-stimulating Hormone (Thyrotropin)
Dr. Hussein D. Abdullatif, Division of Pediatric Endocrinology and Metabolism, Children's Hospital of Alabama, University of Alabama, 1600 Seventh Avenue South, ACC-608, Birmingham, AL 35233.
Endocr Pract. 2006;12(5):572-575. © 2006 American Association of Clinical Endocrinologists
Cite this: Reversible Subclinical Hypothyroidism in the Presence of Adrenal Insufficiency - Medscape - Sep 01, 2006.