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Primary thyroid disorders in endogenous Cushing's syndrome.
Hugo Niepomniszcze1, Fabian Pitoia, Silvia B Katz
1División de Endocrinología, Hospital de Clínicas José de San Martín, Piso, Argentina.
European Journal of Endocrinology
|September 6, 2002
Summary
Patients with Cushing's syndrome have a high prevalence of thyroid disorders, including goiter and hypothyroidism. Resolution of hypercortisolism may trigger autoimmune thyroid conditions in susceptible individuals.
Area of Science:
- Endocrinology
- Thyroidology
- Internal Medicine
Background:
- Endogenous hypercortisolism, commonly known as Cushing's syndrome (CS), is a condition characterized by prolonged exposure to high cortisol levels.
- The relationship between CS and thyroid function is not fully understood, but hormonal imbalances can affect various endocrine systems.
- Primary thyroid disorders, such as goiter, hypothyroidism, and hyperthyroidism, are common endocrine conditions that may be influenced by or co-exist with CS.
Purpose of the Study:
- To investigate the prevalence of primary thyroid disorders in patients diagnosed with endogenous Cushing's syndrome.
- To determine if the resolution of hypercortisolism impacts the development or manifestation of thyroid abnormalities.
- To assess the frequency of goiter, thyroid antibodies, and thyroid dysfunction in a cohort of CS patients.
Main Methods:
- Retrospective analysis of 59 patients with confirmed Cushing's syndrome, evaluating medical records for thyroid palpation, TSH, T3, T4 levels, TRH-TSH tests, and anti-thyroid antibodies.
- Comparison with two age- and gender-matched control groups: 118 healthy subjects for goiter assessment and 40 blood bank donors for antibody analysis.
- Diagnosis of primary thyroid disorders included goiter, positive anti-thyroid antibodies, and abnormal thyroid function tests.
Main Results:
- A significant prevalence of primary thyroid disorders was observed in CS patients: 30.5% had goiter, 23.7% had subclinical hypothyroidism, and 8.4% had hyperthyroidism.
- Anti-thyroid antibodies were detected in 56.1% of evaluated CS patients.
- The prevalence of positive thyroid autoantibodies increased significantly from 26.7% before to 86.7% after resolution of hypercortisolism (P=0.001), indicating a potential link to disease resolution.
Conclusions:
- Patients with endogenous Cushing's syndrome exhibit a substantially high frequency of primary thyroid diseases.
- The findings suggest that the resolution of hypercortisolism may act as a trigger for the onset of autoimmune thyroid disorders in predisposed individuals.
- Routine thyroid evaluation is recommended for patients with Cushing's syndrome due to the high comorbidity.