Reversible subclinical hypothyroidism in the presence of adrenal insufficiency.
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.
Abdullatif
Hussein D
HD
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.
Ashraf
Ambika P
AP
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
D000305:Adrenal Cortex Hormones; D013972:Thyrotropin; D013974:Thyroxine; D006854:Hydrocortisone