Steroid Hypothyroidism

Severe and prolonged hypothyroidism In severe and prolonged hypothyroidism, supplemental adrenocortical steroids may be necessary. 

Secondary hyperlipidaemias results from liver and biliary disease, obesity, hypothyroidism, diabetes, diet, alcohol excess, renal disease (nephrotic syndrome) and drugs (including etretinate, HIV protease ir hibitors, thiazide diuretics, oral contraceptive steroids, glucorticosteroids, (3-adrenoceptor antagonists, ciclosporin). 

The natural history of Graves disease is of alternating remission and relapse. Progression to hypothyroidism can occur, especially after 1 treatment. Such patients should have long-term follow-up, and are likely to require thyroid hormone replacement therapy Severe forms of thyroid eye disease should be treated with steroids and immunosuppresants or low-dose radiotherapy. Urgent surgical decompression can be required for eyophthalmos. 

Treat with adrenocortical steroids before thyroid therapy in coexisting hypothyroidism and hypoadrenalism. 

Other effects of PCBs on endocrine function that have been observed in experimental animals include effects on the adrenal glands and serum adrenal steroid levels (Byrne et al. 1988 Kato et al. 1982a Miller et al. 1993b Rao ad Banerji 1993 Sanders et al. 1974 Wasserman et al. 1973). Studies that have shown depressed levels of adrenal cortical steroids in PCB-exposed animals are also relevant because depressed levels of adrenal steroids have been associated with hypothyroidism in humans (Dluhy 2000). In hypothyroidism, this effect is thought to result from decreases in both secretion and metabolism of adrenal steroids. 

In hypothyroidism, the fecal steroids tended to contain relatively more bile acids (38 %) than normally (31%), while in hyperthyroidism quite normal values were obtained. This indicates that the hypercholesterolemia found consistently in hypothyroidism is caused by a defect in the elimination of cholesterol itself, the catabolism of cholesterol via bile acids being less significantly affected. 

The activities of the reductases vary depending upon the physiological and the pathological conditions. In the reduction of the double bond of the A ring of cortisone in liver cirrhosis is inhibited, but the reduction of the double bond of other steroids remains unimpaired. In other liver diseases or in hypothyroidism, reduction of the double bond of the A ring of cortisol and 11-deoxycortisol is inhibited. zl", a-reductases are found only in liver of male rats, in association with... 

Chao SL, Wang TL, Chong CF, lin LW. Steroid psychosis in an adrenal insufficiency and hypothyroidism patient. J Ac Med 2012 2(4) 121-4. Kang HM, Kim YM, Koh HJ. Five-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy. Am J Orhth 2013 155(3) 438-47. 

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