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Is Under Active Thyroid Gland Possible When Suffering From Addison's Disease?

Posted on Mon, 1 Dec 2014

Question: If you have XXXXXXX Disease what are the dangers of an under active thoride gland

Answered by Dr. Binu Parameswaran Pillai (1 hour later)

Brief Answer:
They can co exist

Detailed Answer:
Good day,

Noted your concern.
Addison's disease is mostly an auto immune disorder and other autoimmune diseases may be associated with it. Hashimotos's thyroiditis is an auto immune disorder of thyroid gland which can lead to under activity of thyroid ( hypothyroidism). Hence people with Addison's may develop hypothyroidism and vice versa.
If you are worried about underactivity of thyroid, please get an "ANti TPO" blood test. This will tell you the chances of developing hypothyroidism
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (4 hours later)

Contacted Histoplasmosis 7yrs ago which left both Adrenal Glands to become dysfunctional

A recent blood test showed

Free T4 13 pmo1/L
TSH 0.18 mU/L

Prior to this test levels were in the normal range.

Is this a dangerous level?

Answered by Dr. Binu Parameswaran Pillai (12 minutes later)

Brief Answer:
Steroids can change TSH values

Detailed Answer:
Hi,
Noted the thyroid blood reports. In your case, the addison;s was not due to auto immune disease, but due to histoplasmosis.
I presume you are taking steroids for Addisons. What types of steroid do you take? Steroids can reduce TSH levels. Have you ever got a FreeT4 test done?

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (15 minutes later)

Taking Cortate 25mg 3 per day & Florinef 1 per day

Yes the FreeT4 test recently was 13 which I believe is in the normal range.

Answered by Dr. Binu Parameswaran Pillai (9 minutes later)

Brief Answer:
TSH supressed by Cortate

Detailed Answer:
Cortate ( cortisone acetate) 25 mg three times a day is a fairly large dose. Most people only require 25 mg AM abd 12.5 mg by around 5 PM. You may discuss with endocrinologist why you are on such high dose

The high dose of Cortate itself can cause low TSH by suppressing the pituitary production of TSH.

Since Free T4 is normal, not to worry.

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (11 minutes later)

Thank you for a better understanding.
Just before I go could you let me know which blood test reading is for the levels the cortate is controlling.

Answered by Dr. Binu Parameswaran Pillai (6 minutes later)

Brief Answer:
Steroid replacement

Detailed Answer:
Cortate and florinef re given to replace the missing adrenal hormones ( Cortisol and aldoserone). We adjust the dose based on patient's sense of well being, blood pressure and blood levels of sodium and potassium.

High dose of these steroid drugs can cause low TSH. One other problem with high dose of Cortate is weakening of bones ( osteoporosis).

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (8 minutes later)

Last sodium level was 141 which I believe is normal
Last potassium level was test was unsuitable for analysis.
Blood pressure was normal
Feeling OK
Should I be concerned about a high dosage of cortate?

Answered by Dr. Binu Parameswaran Pillai (5 minutes later)

Brief Answer:
Right dose of cortate.

Detailed Answer:
Okay.
If the sodium levels are normal, if repeat potassium is normal and if you feel good otherwise, you may discuss with your endocriologist about lowerig the dose of Cortate to 25 mg AM and 12.5 mg at 5 pm. However, in stressful situations like in a fever etc, you may need to increase the dose for few days.

We aim to keep the right dose of cortate so that you dont develop bad effects of steroid excess
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (6 minutes later)

Thank you so much you have certainly made my mind at ease. We live in a caravan & continually travel therefore it is difficult to find Doctors with a care factor.
In saying that the flying doctors of Western Australia are wonderful.
Much appreciate your time

Answered by Dr. Binu Parameswaran Pillai (8 minutes later)

Brief Answer:
Hi

Detailed Answer:
I do realize your difficulty in getting a medical care. ( I worked in Fremantle hospital and Rockingham hospital in WA before).
The steroid adjustment is simple.

Cortate 25mg AM and 12.5 evening if all well .
Florinef 0.1 mg or lower in the morning based on sodium and potassium levels.

If you have fever of > 100 degree etc, take double to triple dose of Cortate few days ( and you wil need three times a day during those days). You may lower the dose to previous dose once you are better.

Also you may wear a bracelet about the Addiosn;s disease so that docs in the periphery will know what to do in an emnergency.

It is recommended to take sufficient calcium and Vitamin D while you taking these steroids.

Please feel free to ask further if you need any help.

Regards'
Binu

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar