What does this research mean for the field?

Persistently elevated TSH despite levothyroxine therapy in children with autoimmune thyroiditis may indicate coexisting autoimmune adrenal insufficiency. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe a rare pediatric presentation of autoimmune adrenal insufficiency discovered during investigation for levothyroxine-refractory thyroid-stimulating hormone elevation.

September 5, 2026

Persistent Elevation of Thyroid-Stimulating Hormone Despite Levothyroxine Therapy Revealing Autoimmune Adrenal Insufficiency in an Adolescent With Autoimmune Thyroiditis: A Case Report and Review of Literature.

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Authors

JBJanvi Biju SPSabitha Sasidharan PillaiUniversity of Southern California

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Implication

Case report and review reveals autoimmune adrenal insufficiency causing persistent elevated TSH in an adolescent, highlighting the risk of undiagnosed autoimmune polyglandular syndrome.

Key Points

To describe a rare pediatric presentation of autoimmune adrenal insufficiency discovered during investigation for levothyroxine-refractory thyroid-stimulating hormone elevation.
Evaluated an adolescent male with autoimmune thyroiditis presenting with persistently elevated thyroid-stimulating hormone despite levothyroxine dose escalation up to 125 µg daily (2.2 µg/kg/day).
Performed endocrine, biochemical, and antibody testing, complemented by a literature review identifying 20 pediatric patients from 19 published case reports.
Diagnostic testing confirmed primary adrenal failure with sodium 128 mEq/L, potassium 6.7 mEq/L, cortisol 0.3 mcg/dL, ACTH 1184 pg/mL, aldosterone < 1 ng/dL, renin 10.0 ng/mL/h, and positive 21-hydroxylase antibodies.
Initiation of intravenous fluids, stress-dose hydrocortisone, fludrocortisone, and continued levothyroxine led to normalization of thyroid function.
Literature synthesis revealed that autoimmune adrenal insufficiency often remains unrecognized in pediatric thyroiditis patients until severe clinical deterioration occurs.

Cite This Study

Biju et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd4536b95aff0620ebf60 https://doi.org/10.1159/hrp/adaag015

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Implication

Case report and review reveals autoimmune adrenal insufficiency causing persistent elevated TSH in an adolescent, highlighting the risk of undiagnosed autoimmune polyglandular syndrome.

Persistent Elevation of Thyroid-Stimulating Hormone Despite Levothyroxine Therapy Revealing Autoimmune Adrenal Insufficiency in an Adolescent With Autoimmune Thyroiditis: A Case Report and Review of Literature.

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Implication

Key Points

Cite This Study

Persistent Elevation of Thyroid-Stimulating Hormone Despite Levothyroxine Therapy Revealing Autoimmune Adrenal Insufficiency in an Adolescent With Autoimmune Thyroiditis: A Case Report and Review of Literature.

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