Endocrine Abstracts

JOINT1142

Introduction: Thyroid autoimmunity and adrenal disease are two of the most frequently observed endocrine disorders that often coexist in clinical practice. The interplay between these conditions is particularly evident in autoimmune polyglandular syndromes (APS). The coexistence of thyroid autoimmunity, most commonly Hashimoto’s thyroiditis (HT) or Graves’ disease (GD), where in first can be seen thyroid function declining and in second case thyroid function increased with toxicity. Whereas Addison’s disease (AD) is associated with declining function of adrenal cortex. Coexisting thyroid and adrenal autoimmune disorders in most cases can produce significant diagnostic and therapeutic challenges.

Materials and Methods: Published data from the past two decades from sources such as MEDLINE, PubMed, Scopus, and Web of Science were systematically analyzed to evaluate the coexistence of GD or HT with AD in APS. Data were extracted on laboratory findings, blood pressure patterns, and clinical presentations.

Results: The frequency of coexistence of GD or HT with primary adrenal insufficiency (AD) in the context of APS is summarized as follows. GD is less commonly associated with AD compared to HT. The prevalence of GD in patients with AD is estimated to be around 5-10%. HT is more frequently observed in patients with AD. The prevalence of HT in patients with AD is approximately 40-50%. Conversely, adrenal insufficiency is found in about 2-5% of patients with established autoimmune thyroid disease, including HT. According to literature coexistence of GD and AD, as seen in APS. Interestingly, coexistence both thyroid autoimmune diseases like GD or HT and AD high level TRab/TSI detected in 50-70% cases, mostly stimulating type, the TPOab were registered in 50-70% cases, 21-Hydroxylase autoantibody were positive in 85-90% cases. Clinical parameters in combination of GD with AD showed higher blood pressure than only GD. Heart rate also were elevated in combination than seen in AD without GD. Blood ACTH level were elevated, blood pressure, heart rate, blood sugar levels were more lower than in AD.

Conclusion: Coexistence of HT and AD is marked by elevated TSH, low Free T4, positive TPOAb, and low cortisol with elevated ACTH. AD contributes to electrolyte imbalances and hypotension. In contrast, GD with AD presents suppressed TSH, elevated Free T4/Free T3, positive TRAb, and similar adrenal insufficiency findings. Tachycardia from GD and hypotension from AD complicated management. Early diagnosis and treatment of both thyroid and adrenal dysfunction are essential to prevent severe complications like adrenal crisis or myxedema coma.