Thyroid function in adrenocortical insufficiency during withdrawal and re-administration of glucocorticoid substitution

Abstract

The regulatory function of glucocorticoids on thyroid hormone concentrations was studied in patients with adrenocortical insufficiency (ACI, n = 8) and in healthy subjects (n = 6). In patients with ACI withdrawal of glucocorticoid substitution for 84 h led to an increase in serum concentrations of total triiodothyronine (TT3) from 110 .+-. 20 to 133 .+-. 22 ng/dl and a decrease of serum reverse-T3 (rT3) from 23 .+-. 6 to 18 .+-. 6 ng/dl, whereas subsequent administration of dexamethasone (0.5 mg orally, 4 times daily for 3 days) induced a fall in TT3 (129 .+-. 22 to 88 .+-. 16 ng/dl) and a rise in rT3 (17 .+-. 5 to 37 .+-. 11 ng/dl) concentrations. Serum levels of total thyroxine (TT4) were unchanged by either withdrawal or re-administration of glucocorticoids. Basal plasma thyrotropin. (TSH) concentration were unchanged by glucocorticoid withdrawal and fell from 2.2 .+-. 1.5 to 1.1 .+-. 0.8 mU/l during subsequent dexamethasone therapy. In healthy subjects, a decrease of TT3 (89 .+-. 8 to 69 .+-. 8 ng/dl) and an increase in rT3 (19 .+-. 5 to 32 .+-. 8 ng/dl) concentrations were seen after stimulation of endogenous cortisol production by prolonged infusion of ACTH1-24 (0.5 mg, for 8 h on 2 consecutive days), whereas concentrations of TT4 remained unchanged. During subsequent administration of dexamethasone serum level of both, TT3 and rT3 returned to basal levels. Thus, changes in thyroid hormone concentrations are induced by alteration of substitution therapy in patients with ACI. In healthy subjects, the application of 2 mg dexamethasone/day following prolonged maximal stimulation of endogenous cortisol by i.v. ACTH may represent a state of relative glucocorticoid deficiency, thus explaining the observed hormonal changes, which are inverse to those generally induced in healthy man by endogenous or exogenous glucocorticoids.