Thyroid diseases in patients with active endogenous Cushing’s syndrome

Yıl 2022, Cilt: 35 Sayı: 3, 257 - 262, 31.10.2022

Tayfur Toptas Kubra Bercem Kahraman Zilan Topcu Hayri Bostan Pinar Kadıoglu

https://doi.org/10.5472/marumj.1186788

Öz

Objective: Data about the impact of Cushing’s syndrome (CS) on thyroid is scarce. We aimed to identify the prevalence of thyroid
diseases in patients with CS.
Patients and Methods: Nineteen patients with CS and 40 healthy participants were included in the study. All patients were tested
for free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), anti-thyroglobulin (anti-Tg), and antithyroid
peroxidase (anti-TPO) levels, and thyroid ultrasonography (US).
Results: Overt hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was evident in 5.3%, 5.3%, and 21.1% of
patients with CS; and 2.5%, 7.5%, and 15% of healthy subjects, respectively. fT3 and fT4 levels were lower in patients with CS. None
of the patients with CS and 27.5% of the control group had autoimmune thyroid disease (AITD), which was demonstrated by both
US findings and anti-TPO positivity (P=0.01). Frequency of thyroid nodule was 52.6% and 52.5% in patients with CS and controls,
respectively (P=0.99).
Conclusion: The prevalence of thyroid dysfunction, nodular thyroid disease, and goiter is comparable to healthy population. However,
AITD is less prevalent among patients with CS. Although, hypercortisolism has an impact on hypothalamic-hypophyseal-thyroid
axis, its clinical implication does not seem to be significant.

Anahtar Kelimeler

Cushing’s syndrome, Thyroid diseases, Thyroid nodule, Hypercortisolism, Autoimmune thyroid disease

Kaynakça

• Dogansen SC, Yalin GY, Canbaz B, Tanrikulu S, Yarman S. Dynamic changes of central thyroid functions in the management of Cushing’s syndrome. Arch Endocrinol Metab 2018 ;62:164-71. doi: 10.20945/2359.399.7000000019. PMID: 29641732.
• Nicoloff JT, Fisher DA, Appleman MD Jr. The role of glucocorticoids in the regulation of thyroid function in man. J Clin Invest 1970;49:1922-9. doi: 10.1172/JCI106411.
• Roelfsema F, Pereira AM, Biermasz NR, et al. Diminished and irregular TSH secretion with delayed acrophase in patients with Cushing’s syndrome. Eur J Endocrinol 2009 ;161:695- 703. doi: 10.1530/EJE-09-0580.
• Shimokaze T, Toyoshima K, Shibasaki J, et al. TSH suppression after intravenous glucocorticosteroid administration in preterm infants. J Pediatr Endocrinol Metab 2012;25:853-7. doi: 10.1515/jpem-2012-0075.
• Bános C, Takó J, Salamon F, Györgyi S, Czikkely R. Effect of ACTH-stimulated glucocorticoid hypersecretion on the serum concentrations of thyroxine-binding globulin, thyroxine, triiodothyronine, reverse triiodothyronine and on the TSH-response to TRH. Acta Med Acad Sci Hung 1979; 36:381-94.
• Shekhar S, McGlotten R, Auh S, Rother KI, Nieman LK. The hypothalamic-pituitary-thyroid axis in Cushing syndrome before and after curative surgery. J Clin Endocrinol Metab 2021; 106:e1316-e1331. doi: 10.1210/clinem/dgaa858.
• da Mota F, Murray C, Ezzat S. Overt immune dysfunction after Cushing’s syndrome remission: a consecutive case series and review of the literature. J Clin Endocrinol Metab; 96(10):E1670-4 2011. doi: 10.1210/jc.2011-1317.
• Russo L, Vitti P, Pinchera A, Marinò M. Exacerbation of autoimmune thyroiditis following bilateral adrenalectomy for Cushing’s syndrome. Thyroid 2010; 20:669-70. doi: 10.1089/ thy.2010.0040.
• Arikan E, Guldiken S, Altun BU, Kara M, Tugrul A. Exacerbations of Graves’ disease after unilateral adrenalectomy for Cushing’s syndrome. J Endocrinol Invest 2004;27:574-6. doi: 10.1007/BF03347482.
• Takasu N, Komiya I, Nagasawa Y, Asawa T, Yamada T. Exacerbation of autoimmune thyroid dysfunction after unilateral adrenalectomy in patients with Cushing’s syndrome due to an adrenocortical adenoma. N Engl J Med 1990; 322:1708-12. doi: 10.1056/NEJM199.006.143222404.
• Onal ED, Sacikara M, Saglam F, Ersoy R, Cakir B. Primary thyroid disorders in patients with endogenous hypercortisolism: an observational study. Int J Endocrinol 2014:732736 . doi: 10.1155/2014/732736.
• Invitti C, Manfrini R, Romanini BM, Cavagnini F. High prevalence of nodular thyroid disease in patients with Cushing’s disease. Clin Endocrinol (Oxf) 1995; 43(3):359-63. doi: 10.1111/j.1365-2265.1995.tb02044.x.
• Niepomniszcze H, Pitoia F, Katz SB, Chervin R, Bruno OD. Primary thyroid disorders in endogenous Cushing’s syndrome. Eur J Endocrinol 2002; 147:305-11, 2002. doi: 10.1530/eje.0.1470305.
• Colao A, Pivonello R, Faggiano A, et al. Increased prevalence of thyroid autoimmunity in patients successfully treated for Cushing’s disease. Clin Endocrinol (Oxf) 2000;53:13-9. doi: 10.1046/j.1365-2265.2000.01018.x.
• ICH Topic E 6 (R1). Guideline for Good Clinical Practice. ICH Harmonised Tripartite Guideline. Version of July 1996 including post step errata of July 2002 [Internet]. London:Emea;2002. Available from: http://www.emea.europa. eu/pdfs/human/ich/013595en.pdf. Accessed on 07.05.2019
• Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet 2006;367:1605-17. doi: 10.1016/ S0140-6736(06)68699-6.
• Seker S, Tas I. Determination of thyroid volume and its relation with isthmus thickness. Eur J Gen Med 2010;7:125-9. doi.org/10.29333/ejgm/82838.
• Schott M, Scherbaum WA. Autoimmune Schilddrüsenerkrankungen. Dtsch Arztebl 2006;103:A3023-A3032.
• American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper, DS, Doherty, GM, Haugen, BR et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid : Official Journal of the American Thyroid Association; 2009;19:1167- 214. doi: 10.1089/thy.2009.0110.
• World Health Organization. Indicators for assessing iodine deficiency disorders and their control through salt iodization. Geneva, Switzerland: World Health Organization,1994 [Document No. WHO/NUT94.6]
• Tasker JG, Herman JP. Mechanisms of rapid glucocorticoid feedback inhibition of the hypothalamic-pituitary-adrenal axis. Stress 2011;14:398-406. doi: 10.3109/10253.890.2011.586446.
• Paragliola RM, Corsello A, Papi G, Pontecorvi A, Corsello SM. Cushing’s syndrome effects on the thyroid. Int J Mol Sci 2021;22:3131. doi: 10.3390/ijms22063131.
• Bartalena L, Martino E, Petrini L, et al. The nocturnal serum thyrotropin surge is abolished in patients with adrenocorticotropin (ACTH)-dependent or ACTHindependent Cushing’s syndrome. J Clin Endocrinol Metab 1991;72:1195-9. doi: 10.1210/jcem-72-6-1195.
• Xiang B, Tao R, Liu X, et al. A study of thyroid functions in patients with Cushing’s syndrome: a single-center experience. Endocr Connect 2019; 8:1176-85. doi: 10.1530/EC-19-0309.
• Laurberg P, Pedersen KM, Hreidarsson A, Sigfusson N, Iversen E, Knudsen PR. Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark. J Clin Endocrinol Metab 1998;83:765-9. doi: 10.1210/jcem.83.3.4624.
• Nishiyama S, Takada K, Tada H, Takara T, Amino N. Effect of interleukin-6 on cell proliferation of FRTL-5 cells. Biochem Biophys Res Commun 1993;92: 319-23. doi: 10.1006/ bbrc.1993.1416.
• Jones TH. Interleukin 6 and endocrine cytokine. Clin Endocrinol (Oxf) 1994;40: 703-13, . doi: 10.1111/j.1365- 2265.1994.tb02502.x.
• Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764-71. doi: 0.1056/NEJMcp031436.
• Knudsen N, Bulow I, Jorgensen T, Laurberg P, Ovesen L, Perrild H. Goitre prevalence and thyroid abnormalities at ultrasonography: a comparative epidemiological study in two regions with slightly different iodine status. Clin Endocrinol (Oxf) 2000;53: 479-85. doi: 10.1046/j.1365-2265.2000.01121.x.