Levothyroxine replacement before glucocorticoid replacement leading to adrenal crisis in a case of autoimmune polyendocrine syndrome type II (Schmidt syndrome)

Lakhani, Om J; Tripathi, Sudhir; Indu, K. M.; Desai, M.

doi:10.4103/0973-0354.157932

Cited by 7 publications

(7 citation statements)

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“…In patients with both TSH and ACTH deficiency or patients with autoimmune polyendocrine syndrome type II (primary hypothyroidism and Addison's disease), treatment with levothyroxine may precipitate an acute adrenal crisis because thyroxine increases cortisol metabolism [ 29 , 30 ]. Therefore, cortisol replacement should precede thyroid hormone replacement.…”

Section: Treatment Of Aimentioning

confidence: 99%

Pediatric Adrenal Insufficiency: Diagnosis, Management, and New Therapies

Bowden

Henry

2018

International Journal of Pediatrics

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Adrenal insufficiency may result from a wide variety of congenital or acquired disorders of hypothalamus, pituitary, or adrenal cortex. Destruction or dysfunction of the adrenal cortex is the cause of primary adrenal insufficiency, while secondary adrenal insufficiency is a result of pituitary or hypothalamic disease. Timely diagnosis and clinical management of adrenal insufficiency are critical to prevent morbidity and mortality. This review summarizes the etiologies, presentation, and diagnosis of adrenal insufficiency utilizing different dynamic hormone testing and describes current treatment recommendations and new therapies.

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Section: Treatment Of Aimentioning

confidence: 99%

Pediatric Adrenal Insufficiency: Diagnosis, Management, and New Therapies

Bowden

Henry

2018

International Journal of Pediatrics

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“…9 Conversely, treatment with thyroxine for high TSH before addressing AI may precipitate adrenal crisis because of increased clearance of cortisol by thyroxine. 10…”

Section: Discussionmentioning

confidence: 99%

“…9 Conversely, treatment with thyroxine for high TSH before addressing AI may precipitate adrenal crisis because of increased clearance of cortisol by thyroxine. 10 The study by Bleicken et al stated that at least 3 or more physicians were consulted before a diagnosis of AI was made in about 13/20 patients. 1 They also reported that only in 3 out of every 20 patients, the first consulting physician diagnosed this condition accurately.…”

Section: Discussionmentioning

confidence: 99%

Do Vomiting and Diarrhea Always Represent a Gastrointestinal Disorder?

Mittal

Wood

Sabe

et al. 2019

Clin Pediatr (Phila)

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“…autoimmune thyroiditis causes psychiatric issues in itself 151,152 and can complicate the presentation and treatment of AN, as described by Kızılkan et al 153 Hashimoto's can also present with primary adrenal insufficiency in autoimmune polyendocrine syndrome type II (APS II or Schmidt Syndrome), in which adrenal crisis can be precipitated by levothyroxine use. 154 In combination with the induced hypothyroidism of LT3S, these issues could potentially exacerbate any of the mental, psychological, and physical maladies of hypothyroidism, some of which are described earlier.…”

Section: Lt3s Cycle In Eating Disordersmentioning

confidence: 97%

On the Fundamental Efficacy of Thyroid-Hormone Therapy in Eating Disorders: Review of Mechanisms and Case Study

Shames¹,

Wenzel²

2022

JRM

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Context: Calorie restriction reduces circulating triiodothyronine (T3) – the most active thyroid hormone – inducing hypothyroidism, constipation, and reduced appetite that inhibit eating, acting to sustain and sometimes precipitate eating disorders. Thyroid-hormone treatment can be effective but is rarely employed. Case description: A 12-year-old girl experienced chronic nausea and constipation after antibiotics for strep throat, resulting in restricted eating. Energy decreased for 2 months as anxiety and depression increased, culminating in withdrawal and school refusal. Blood tests were normal except for below-range free T3. She began a trial of incremental, 1-μg dose increases of T3 every 3 days using sustained-release capsules added to her established triiodothyronine–levothyroxine (T3–T4) protocol for hypothyroidism. Her energy and mood began improving after 10 days and depression resolved after 7 weeks. An 18-day stay in a hospital eating-disorders unit helped her regain some weight and strength. To address nausea and anxiety, the extended medical team then tried two antidepressants and cyproheptadine – each caused increased nausea and reduced eating – and a 5-day prednisone burst for possible neuroinflammation; all were ineffective and discontinued. After 14 weeks without improvement, we resumed adjusting thyroid-hormone dose. Anxiety, energy, food intake, and weight improved for 5 months. She began attending a new school, developed new friendships, and started menses. The major illness lasted 21 months. T3 intake increased from 5 to 27 μg, T4 from 50 to 110 μg, weight from 36.4 to 52.7 kg, and height from 1.63 to 1.71 m. Conclusions: Thyroid hormones should be studied further as fundamentally effective treatment for eating disorders. Keywords: Eating disorder; Low-triiodothyronine syndrome; Hypothyroidism

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Levothyroxine replacement before glucocorticoid replacement leading to adrenal crisis in a case of autoimmune polyendocrine syndrome type II (Schmidt syndrome)

Cited by 7 publications

References 1 publication

Pediatric Adrenal Insufficiency: Diagnosis, Management, and New Therapies

Pediatric Adrenal Insufficiency: Diagnosis, Management, and New Therapies

Do Vomiting and Diarrhea Always Represent a Gastrointestinal Disorder?

On the Fundamental Efficacy of Thyroid-Hormone Therapy in Eating Disorders: Review of Mechanisms and Case Study

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