Hypothalamic hypothyroidism with end-organ resistance--further personal observations

Further personal observations are made of the case of hypothalamic hypothyroidism with end organ resistance described in an earlier report. The course of the disorder on replacement therapy appears to be a relapsing one, with relapses provoked by seasonal changes and physical stresses. The relapses remit with increased doses of thyroid replacement. There is some evidence of increased levels of reverse T3 prior to T3 replacement and also evidence suggestive of a parallel hypothalamic hypoadrenal deficit.