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The Hypothalamic-Pituitary-Thyroid Axis in Cushing Syndrome Before and After Curative Surgery
Skand Shekhar1, Raven McGlotten2, Sunyoung Auh3
1Section on Genetics and Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
The Journal of Clinical Endocrinology and Metabolism
|November 25, 2020
Summary
Hypercortisolism from Cushing syndrome frequently causes central hypothyroidism. Thyroid function and nocturnal TSH surge normalize after treatment, indicating reversibility.
Area of Science:
- Endocrinology
- Thyroidology
- Neuroendocrinology
Background:
- Hypercortisolism's effect on central hypothyroidism is not fully understood.
- Factors influencing the recovery of the hypothalamic-pituitary-thyroid axis post-treatment are unclear.
Purpose of the Study:
- To evaluate thyroid function during and after the cure of Cushing syndrome (CS).
- To investigate the reversibility of central hypothyroidism and factors affecting thyroid axis recovery.
Main Methods:
- Retrospective cohort study of adult patients with CS (n=123) across two time periods.
- Measurement of urinary free cortisol (UFC), diurnal serum cortisol, T3, FT4, and TSH before and after curative surgery.
- Analysis of hormonal levels and their correlation with clinical parameters and recovery time.
Main Results:
- 53% of patients exhibited central hypothyroidism during hypercortisolism.
- Subnormal FT4 and T3 normalized 6-12 months post-cure; hypogonadism was more frequent in hypothyroid patients.
- Subnormal nocturnal TSH surge normalized post-cure; high UFC predicted slower thyroid hormone recovery.
Conclusions:
- Abnormal thyroid function, linked to subnormal nocturnal TSH, is common in Cushing syndrome.
- Thyroid dysfunction in CS is reversible following successful treatment.
- Urinary free cortisol levels can serve as a prognostic marker for thyroid axis recovery.
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