Lazy Adrenals in Severe Hypothyroidism - Myth or Mirage?

IF 1.8 Q3 ENDOCRINOLOGY & METABOLISM

International Journal of Endocrinology and Metabolism Pub Date : 2025-04-30 DOI:10.5812/ijem-158985

Swaraj Waddankeri, Meenakshi Swaraj Waddankeri

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Abstract

Background: Clinical features of hypothyroidism and adrenal insufficiency (AI) often overlap.

Objectives: To assess the morning serum cortisol levels of treatment-naïve patients with severe hypothyroidism.

Methods: In this prospective, case-control study, treatment-naïve adults with severe hypothyroidism [thyroid-stimulating hormone (TSH) > 100 mIU/mL] were compared with age- and sex-matched euthyroid controls. Morning (08:00 AM) serum cortisol, TSH, triiodothyronine (T3), and thyroxine (T4) levels were measured. AI was defined clinically and biochemically as cortisol levels < 4 µg/dL. Correlation coefficients between T3, T4, and cortisol levels were calculated.

Results: The case group (n = 71; women, 88.7%; mean age, 30.0 ± 9.0 years) had significantly lower serum cortisol levels than controls (n = 40; 8.6 ± 4.2 vs 16.0 ± 2.22 µg/dL; P < 0.0001). Six patients (8.5%) in the case group met criteria for AI. Patients with AI had significantly lower T3 and T4 levels than those without AI (P = 0.018 and P = 0.005, respectively). A negative correlation was observed between T3 and cortisol levels (r = -0.243, P = 0.041), while T4 showed no significant correlation (r = -0.103, P = 0.391).

Conclusions: Treatment-naïve patients with severe hypothyroidism may exhibit biochemical evidence of AI. Routine screening for AI in these patients is recommended to avoid missed diagnoses and guide appropriate therapy.

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严重甲状腺功能减退症的懒惰肾上腺-神话还是幻觉？

背景：甲状腺功能减退和肾上腺功能不全（AI）的临床特征经常重叠。目的：评价treatment-naïve严重甲状腺功能减退患者晨间血清皮质醇水平。方法：在这项前瞻性病例对照研究中，treatment-naïve成人严重甲状腺功能减退[促甲状腺激素（TSH） bb0 100 mIU/mL]与年龄和性别匹配的正常甲状腺对照组进行比较。清晨（08:00 AM）测定血清皮质醇、TSH、三碘甲状腺原氨酸（T3）、甲状腺素（T4）水平。AI在临床上和生物化学上被定义为皮质醇水平< 4µg/dL。计算T3、T4与皮质醇水平的相关系数。结果：病例组(n = 71；女性,88.7%;平均年龄（30.0±9.0岁）的患者血清皮质醇水平显著低于对照组(n = 40；8.6±4.2 vs 16.0±2.22µg/dL；P < 0.0001)。病例组中6例患者（8.5%）符合AI标准。AI患者T3、T4水平明显低于未AI患者（P = 0.018、P = 0.005）。T3与皮质醇水平呈负相关（r = -0.243, P = 0.041）， T4与皮质醇水平无显著相关（r = -0.103, P = 0.391）。结论：Treatment-naïve严重甲状腺功能减退患者可表现出AI的生化证据。建议对这些患者进行常规筛查，以避免漏诊并指导适当的治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Endocrinology and Metabolism ENDOCRINOLOGY & METABOLISM-

CiteScore

3.10

自引率

4.80%

发文量

期刊介绍： The aim of the International Journal of Endocrinology and Metabolism (IJEM) is to increase knowledge, stimulate research in the field of endocrinology, and promote better management of patients with endocrinological disorders. To achieve this goal, the journal publishes original research papers on human, animal and cell culture studies relevant to endocrinology.