Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison’s disease with primary hypothyroidism
Open accessAbstract
BACKGROUND: Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism. MATERIALS AND METHODS: This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (<83 nmol/L) with high plasma adrenocorticotropic hormone (>22 pmol/L) and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical) was defined as high thyroid stimulating hormone (TSH) with/without low free thyroxine (fT4). TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them. RESULTS: Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status. CONCLUSIONS: The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Addison's disease is treated with corticosteroids.
“Treatment for TSH-omas involves neurosurgical intervention, and corticosteroid therapy is used to treat Addison's disease.69,71,85”
From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [85]
Treatment for TSH-omas involves neurosurgical intervention.
“Treatment for TSH-omas involves neurosurgical intervention, and corticosteroid therapy is used to treat Addison's disease.69,71,85”
From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [85]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
2013 ETA Guideline: Management of Subclinical Hypothyroidism
Pearce, S. H. S., Brabant, G., Duntas, L. H., Monzani, F., Peeters, R. P., Razvi, S., & Wemeau, J.-L. (2013) · European Thyroid Journal · doi:10.1159/000356507 · Cited by 877 · see citing works
Neuroendocrine regulation of autoimmune/inflammatory disease
Sternberg, E. (2001) · Journal of Endocrinology · doi:10.1677/joe.0.1690429 · Cited by 308 · see citing works
Ré, R. N., KOURIDES, I. A., Ridgway, E. C., Weintraub, B. D., & Maloof, F. (1976) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-43-2-338 · Cited by 300 · see citing works
Takasu, N., Komiya, I., Nagasawa, Y., Asawa, T., & Yamada, T. (1990) · New England Journal of Medicine · doi:10.1056/nejm199006143222404 · Cited by 139 · see citing works
Thyrotropin secretion patterns in health and disease
Roelfsema, F., & Veldhuis, J. D. (2013) · Endocrine Reviews · doi:10.1210/er.2012-1076 · Cited by 113 · see citing works
Mota, F., Murray, C. E., & Ezzat, S. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1317 · Cited by 65 · see citing works
Diagnosis and classification of Addison's disease (autoimmune adrenalitis)
Neto, R. A. B., & de Carvalho, J. F. (2014) · Autoimmunity Reviews · doi:10.1016/j.autrev.2014.01.025 · Cited by 63 · see citing works
George, T. M., Burke, J. M., Sobotka, P. A., Greenberg, H. S., & Vinik, A. I. (1984) · New England Journal of Medicine · doi:10.1056/nejm198406073102306 · Cited by 50 · see citing works
Increased prevalence of thyroid autoimmunity in patients successfully treated for Cushing's disease
Colao, A., Pivonello, R., Faggiano, A., Filippella, M., Ferone, D., Somma, C. D., Cerbone, G., Marzullo, P., Fenzi, G., & Lombardi, G. (2000) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2000.01018.x · Cited by 48 · see citing works
Barnett, A. H., Donald, R. A., & Espiner, E. A. (1982) · BMJ · doi:10.1136/bmj.285.6336.172-a · Cited by 38 · see citing works
Mathioudakis, N., Thapa, S., Wand, G. S., & Salvatori, R. (2012) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2012.04442.x · Cited by 30 · see citing works
Reversible Subclinical Hypothyroidism in the Presence of Adrenal Insufficiency
Abdullatif, H., & Ashraf, A. P. (2006) · Endocrine Practice · doi:10.4158/ep.12.5.572 · Cited by 28 · see citing works
Nayer, P. D., Dozin, B., Vandeput, Y., BOTTAZZO, F. C., & Crabbé, J. (1987) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.1987.tb02388.x · Cited by 14 · see citing works
Addison’s disease and corticosteroid-reversible hypothyroidism
CANDRINA, R., & Giustina, G. (1987) · Journal of Endocrinological Investigation · doi:10.1007/bf03348185 · Cited by 12 · see citing works
Reversible hypothyroidism in idiopathic adrenal insufficiency and in isolated ACTH deficiency
Proto, G., & Bertolissi, F. (1988) · Journal of Endocrinological Investigation · doi:10.1007/bf03350143 · Cited by 10 · see citing works
Gürlek, A., Nar, A., & Gedik, O. (2001) · Endocrine Practice · doi:10.4158/ep.7.2.102 · Cited by 9 · see citing works
Cortisone‐Induced Remission of Hypothyroidism in Schmidt's Syndrome
Petersen, H. D., & Bergman, M. (1980) · Acta Medica Scandinavica · doi:10.1111/j.0954-6820.1980.tb01164.x · Cited by 9 · see citing works
Reversible hypothyroidism in adrenal insufficiency.
Jeffcoate, W. J., & Davis, J. R. (1982) · BMJ · doi:10.1136/bmj.285.6342.651-c · Cited by 8 · see citing works
Increased prevalence of thyroid autoimmunity in patients successfully treated for Cushing's disease
Kasperlik‐Zatuska, A. A., & Zgliczyński, W. (2001) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2001.01216.x · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
A study of thyroid functions in patients with Cushing’s syndrome: a single-center experience
Xiang, B., Tao, R., Liu, X., Zhu, X., He, M., Ma, Z., Yang, Y., Zhang, Z., Li, Y., Yao, Z., et al. (2019) · Endocrine Connections · doi:10.1530/ec-19-0309 · Cited by 20 · see citing works
Refractory hypothyroidism: unraveling the complexities of diagnosis and management
Quiroz-Aldave, J. E., Concepción-Zavaleta, M. J., Durand-Vásquez, M. D. C., Concepción-Urteaga, L. A., Gamarra-Osorio, E. R., Suárez-Rojas, J., Rafael-Robles, L. D. P., Paz-Ibarra, J., & Román-González, A. (2023) · Endocrine Practice · doi:10.1016/j.eprac.2023.09.003 · Cited by 14 · see citing works
Aging of the adrenal gland and its impact on the stress response
Yiallouris, A., Filippou, C., Themistocleous, S., Menelaou, K., Kalodimou, V. E., Michaeloudes, C., & Johnson, E. O. (2024) · Vitamins and hormones · doi:10.1016/bs.vh.2023.12.004 · Cited by 8 · see citing works
The Influence of Hypo - and Hyperthyroidism on Morphogenesis and Histophysiology of Adrenal Glands
Yashchenko, А. М. (2018) · Journal of Embryology & Stem Cell Research · doi:10.23880/jes-16000107 · Cited by 4 · see citing works
Unusual manifestations of adrenal insufficiency
Hsu, C.-C., Lin, H.-D., Huang, C., & Chiang, Y.-L. (2022) · Medicine · doi:10.1097/md.0000000000029274 · Cited by 4 · see citing works
Refractory hypothyroidism in children: an overview
Metwalley, K. A., & Farghaly, H. S. (2024) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2024-0306 · Cited by 1 · see citing works
Zorina, I. I., Pechalnova, A. S., Chernenko, E. E., Avrova, D. K., Derkach, K. V., & Shpakov, A. O. (2025) · Journal of Evolutionary Biochemistry and Physiology · doi:10.1134/s0022093025030056 · Cited by 1 · see citing works
Mulya, D. P., Leo, B., Ikhsan, M. R., & Hutajulu, S. H. (2023) · SAGE Open Medical Case Reports · doi:10.1177/2050313x231190006 · Cited by 1 · see citing works
Thyroid Emergencies in Critically Ill Cancer Patients
Salgado, S. A., & Thosani, S. (2019) · Springer eBooks · doi:10.1007/978-3-319-74588-6_83
Thyroid Emergencies in Critically Ill Cancer Patients
Salgado, S. A., & Thosani, S. (2019) · Springer eBooks · doi:10.1007/978-3-319-74698-2_83-1
Thyroid Emergencies in Critically Ill Cancer Patients
Chaudhri, A., Salgado, S. A., & Thosani, S. (2026) · Springer eBooks · doi:10.1007/978-3-319-74698-2_83-2
- Authors
- Sahoo, J., Selviambigapathy, J., Kamalanathan, S., Nagarajan, K., & Vivekanandan, M.
- Affiliations
- Jawaharlal Institute of Post Graduate Medical Education and Research (IN)
- Venue
- Indian Journal of Endocrinology and Metabolism
- Published
- 2016
- Volume
- 20
- Issue
- 2
- Pages
- 162
- ISSN
- 2230-8210 (ISSN-L)
- PMC
- PMC4792014
- OpenAlex
- W2275081587
- Cited by
- 11
- References
- 19
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2019: 3 · 2018: 1
- FWCI
- 1.34
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Indian Journal of Endocrinology and Metabolism (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- Addison's disease, primary hypothyroidism, cortisol replacement, thyroid function tests, thyroid autoimmunity, thyroid peroxidase antibodies, thyroid-stimulating hormone, free thyroxine, ACTH
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
