Thyroid & Adrenal Disorders
Interpret paired hormone results and recognise endocrine crises that can resemble common medical illness.
Quick revision ↓ Medical Dictionary
01Interpret thyroid tests together
TSH and free thyroid hormone results should be interpreted with symptoms, treatment and illness context. High TSH with low free T4 suggests primary hypothyroidism; suppressed TSH with raised free hormones suggests thyrotoxicosis. Pituitary disease can produce low free T4 without an appropriately raised TSH. Acute illness and assay interference can distort results, so an unexpected pattern merits review rather than automatic lifelong treatment.
02Assess thyroid presentations
Weight change, heat or cold intolerance, bowel habit, pulse and examination guide the differential. Thyrotoxicosis may present with atrial fibrillation, weakness or heart failure rather than obvious neck symptoms. Determine the cause because increased hormone synthesis and destructive thyroiditis require different approaches. Hypothyroid treatment requires individualisation and monitoring, especially with cardiac disease, pregnancy or frailty, rather than relying on symptom improvement alone.
03Recognise thyroid crises
Fever, marked tachycardia, agitation or delirium with thyrotoxicosis raises concern for thyroid storm, a clinical emergency. Severe hypothyroidism with hypothermia, hypoventilation and altered consciousness also requires urgent care. Do not wait for every classical feature or a particular laboratory magnitude. Management needs monitored specialist treatment, supportive care and investigation of precipitating illness, with attention to possible adrenal dysfunction.
04Think of adrenal insufficiency
Fatigue, weight loss, postural symptoms, gastrointestinal upset and electrolyte abnormalities can suggest adrenal disease. Primary insufficiency may cause hyperpigmentation and hyperkalaemia; secondary disease may not. Long-term glucocorticoid use can suppress the adrenal axis, particularly when abruptly withdrawn. Record oral, injected and other steroid exposure, and use appropriate endocrine testing through the clinical pathway when the patient is stable.
05Act on suspected adrenal crisis
Hypotension or shock with vomiting, weakness and a relevant background demands urgent assessment. Obtain diagnostic samples if this does not delay treatment, then give emergency glucocorticoid and fluid care through the approved pathway with monitoring. Treat the precipitant. Continuing care includes steroid education, sick-day rules, emergency identification and access to an emergency plan. A missed prescription can be consequential for a dependent patient.
High-Yield Revision
- Interpret TSH with free hormone results and clinical context.
- Thyroid storm is a clinical emergency, not just a laboratory threshold.
- Suspected adrenal crisis must not wait for routine confirmatory testing.
Common Pitfalls
- Do not assume normal potassium excludes secondary adrenal insufficiency.
- Do not abruptly stop prolonged glucocorticoid treatment without an appropriate plan.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.