title: Reversible subclinical hypothyroidism in the presence of adrenal insufficiency.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, The Children's Hospital of Alabama, University of Alabama School of Medicine, Birmingham, Alabama 35233, USA.
authors.forename: Hussein D
authors.initials: HD
authors.lastname: Abdullatif
authors.forename: Ambika P
authors.initials: AP
authors.lastname: Ashraf
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000309:Adrenal Insufficiency / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007037:Hypothyroidism / Q000150:complications* / Q000188:drug therapy; D008297:Male; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D013972:Thyrotropin; D013974:Thyroxine; D006854:Hydrocortisone