Thyroid replacement
Caution in patients with adrenal insufficiency
Primary hypothyroidism may be associated with immunologic destruction of the adrenal cortex (Schmidt syndrome). Secondary hypothyroidism may be associated with and may mask reduced adrenal function.
✖ Thyroid replacement without adrenal replacement in patients with adrenal insufficiency (as may occur in panhypopituitarism) may precipitate adrenal crisis (thus giving ≈ 300– 400 mg hydrocortisone IV over 24 hrs in addition to thyroid replacement).