11 doctors weighed in:

Why does thyroid replacement therapy in hypoadrenalism cause adrenal crisis?

11 doctors weighed in
Dr. Soumya Adhikari
Pediatrics - Endocrinology
6 doctors agree

In brief: Great question!

Even people with adrenal problems often make a little bit of cortisol.
This little bit can be enough to keep them from getting very sick. In hypothyroidism the body's need for cortisol goes down and the little bit you make lasts longer. So if a person has both thyroid and adrenal disease, treating the thyroid without treating the adrenal problem first causes the little cortisol to run out quicker.

In brief: Great question!

Even people with adrenal problems often make a little bit of cortisol.
This little bit can be enough to keep them from getting very sick. In hypothyroidism the body's need for cortisol goes down and the little bit you make lasts longer. So if a person has both thyroid and adrenal disease, treating the thyroid without treating the adrenal problem first causes the little cortisol to run out quicker.
Dr. Soumya Adhikari
Dr. Soumya Adhikari
Thank
1 comment
Dr. Quang Nguyen
great answer above! I agree completely.
Dr. Cayce Jehaimi
Pediatrics - Endocrinology
2 doctors agree

In brief: Increased catabolism

Good question. It is believed that thyroxine supplementation will increase urinary cortisol excretion in addition to stimulating the enzyme that converts cortisol, the active form, to cortisone, the inactive form. The opposite is true of this fascinating phenomenon as there had been several case reports of hypothyroidism bein reversed with steroids in individuals with ai.

In brief: Increased catabolism

Good question. It is believed that thyroxine supplementation will increase urinary cortisol excretion in addition to stimulating the enzyme that converts cortisol, the active form, to cortisone, the inactive form. The opposite is true of this fascinating phenomenon as there had been several case reports of hypothyroidism bein reversed with steroids in individuals with ai.
Dr. Cayce Jehaimi
Dr. Cayce Jehaimi
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Dr. Chaitanya Mamillapalli
Internal Medicine

In brief: Increased metabolism

in patients with new diagnosis of hypoadrenalism, cortisol replacement should be initiated before starting on levothyroxin replacement.
If not done in the sequence, levothyroxin we will increase the metabolism of cortisol in the body and can precipitate adrenal crisis.
in patients who are already on steroid treatment, starting on levothyroxin does not cause adrenal crisis

In brief: Increased metabolism

in patients with new diagnosis of hypoadrenalism, cortisol replacement should be initiated before starting on levothyroxin replacement.
If not done in the sequence, levothyroxin we will increase the metabolism of cortisol in the body and can precipitate adrenal crisis.
in patients who are already on steroid treatment, starting on levothyroxin does not cause adrenal crisis
Dr. Chaitanya Mamillapalli
Dr. Chaitanya Mamillapalli
Thank
Dr. Vered Lewy-Weiss
Pediatrics - Endocrinology

In brief: Adequate replacement

Thyroid hormone speeds up metabolism and therefore puts more stress on adrenal glands if they're not making enough cortisol to begin with.
As long as you are getting adequate steroid replacement for the adrenal insufficiency, adding any necessary thyroid hormone replacement will be ok.

In brief: Adequate replacement

Thyroid hormone speeds up metabolism and therefore puts more stress on adrenal glands if they're not making enough cortisol to begin with.
As long as you are getting adequate steroid replacement for the adrenal insufficiency, adding any necessary thyroid hormone replacement will be ok.
Dr. Vered Lewy-Weiss
Dr. Vered Lewy-Weiss
Thank
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