Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis/diabetic ketosis

Shao, Pengfei; Guo, Shujuan; Li, Guimei; Qin, Daogang; Li, Sen; Li, Ying

doi:10.1186/s12902-020-00616-2

Cited by 12 publications

(15 citation statements)

References 33 publications

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“…Our results were not inconsistent with those of Shao et al, 37 who found that in children with diabetic ketoacidosis, the NTIS group had higher levels of WBC, plasma glucose, β-hydroxybutyric acid, triglyceride, anion gap, glycosylated hemoglobin, and lower levels of prealbumin, albumin, and bicarbonate than the euthyroid group. In addition, FT3 levels were significantly correlated to β-hydroxybutyric acid, HCO3 − , anion gap, prealbumin, and glycosylated hemoglobin.…”

Section: Discussionsupporting

confidence: 59%

Correlation of Nonthyroidal Illness Syndrome with Extubation Outcome in Mechanically Ventilated Children: A Prospective Cohort Study

Abdelaziz

Romih

Ismail

et al. 2022

J Pediatr Intensive Care

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This study aimed to assess the relationship between non-thyroidal illness syndrome (NTIS) and extubation outcomes in pediatric patients requiring mechanical ventilation. This prospective cohort study included 59 patients who underwent mechanical ventilation in the pediatric intensive care unit of a tertiary care university hospital from July 2020 to June 2021. Each patient underwent laboratory testing including serum levels of thyroid-stimulating hormone (TSH), free T3 (fT3), free T4 (fT4), and reverse T3 (rT3) on the first and third days of mechanical ventilation. On the first day of mechanical ventilation, 62.7% of patients had low fT3, which significantly increased to 78% of patients on the third day. In comparison to values on day one, median levels of fT3 and fT4 significantly decreased and rT3 significantly increased on day three. However, no significant differences were found in the median TSH levels over the same time span. Thirty-five patients (59%) survived while 24 patients (41%) did not survive. Compared with survivors, non-survivors had significantly higher median serum TSH levels on day one, while all other thyroid function tests assays did not significantly differ between days one and three. Of note, serum TSH, fT3, fT4, and rT3 levels, on the first and third days, did not differ significantly between patients who experienced extubation failure and extubation success. To the best of our knowledge, this is the first study to examine thyroid function values in mechanically ventilated children to determine their correlation with extubation outcomes. In this study, NTIS did not correlate with extubation outcomes in critically ill children undergoing mechanical ventilation.

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Section: Discussionsupporting

confidence: 59%

Correlation of Nonthyroidal Illness Syndrome with Extubation Outcome in Mechanically Ventilated Children: A Prospective Cohort Study

Abdelaziz

Romih

Ismail

et al. 2022

J Pediatr Intensive Care

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“…Many severe systemic disorders, such as heart failure, respiratory failure, renal insufficiency, and aging, can disrupt the function of the HPT axis, which is technically known as euthyroid-sick-syndrome (ESS), non-thyroid illness syndrome, because the thyroid is not directly or organically impaired. 37 Low T3 syndrome, 38 which is characterized by a lower level of T3 and an increased level of reverse T3 (rT3), 39 but an average level of TSH, is a common clinical condition. After the original condition was corrected, the ESS would decrease.…”

Section: Discussionmentioning

confidence: 99%

The Comparative Study on the Status of Bone Metabolism and Thyroid Function in Diabetic Patients with or without Ketosis or Ketoacidosis

Xu¹,

Gong²,

Su³

et al. 2022

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Purpose This study aims to identify changes in bone turnover markers and thyroid function in diabetic ketosis (DK) and diabetic ketoacidosis (DKA). Materials and Methods We compared data from the Department of Endocrinology at Shanghai Pudong Hospital from 2018 to 2020 on the pancreatic status and previous glucose control, bone transformation, calcium homeostasis, and thyroid function in groups with diabetes (DM alone, n=602), DK (n=232), and DKA (n=60). Similar comparisons were made in recurrent DK (A) (n=17) and single DK (A) (n=272). Results The fasting C-peptide level decreased significantly, but hemoglobin A1c (HbA1c) levels were higher in DK or DKA (p<0.05). Blood calcium and 25-hydroxyvitamin D3 (25-OH-VitD3) levels were significantly lower in DKA (p<0.05), but parathyroid hormone (PTH) levels remained constant across all three groups. The N-terminal middle molecular fragment of osteocalcin (N-MID) and β-C terminal cross-linking telopeptide of type 1 collagen (β-CTX) showed significant inverse alterations in DKA, regardless of gender or age (p<0.05). Otherwise, DKA significantly inhibited thyroid function (p<0.05). Furthermore, Spearman correlation analyses revealed a relationship between N-MID and HbA1c in DM alone (r=−0.27, p<0.01), while total triiodothyronine (TT3, r=0.62, p<0.01) or free T3 (FT3, r=0.61, p<0.01) in DK, and DKA (TT3, r=0.45, p<0.01; FT3, r=0.43, p<0.01). Multilinear regression analyses revealed that β-CTX (β=0.564), HbA1c (β=−0.196), TT3 (β=0.183), and 25-OH-VitD3 (β=−0.120) were the only independent determinants of N-MID in DM, whereas FT3 (β=0.491), β-CTX (β=0.315) in DK, and FT3 (β=0.420), β-CTX (β=0.367), TG (β=−0.278) in DKA. Only 25-OH-VitD3 was found to be significantly lower in recurrent DK (A) than in single onset DK (A) (p<0.05), and β-CTX (β=0.745) was found to be significantly independently associated with N-MID. Conclusion Our preliminary findings show a dramatic change in bone turnover markers in DM patients with DK and DKA, and this change may be related to thyroid function.

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“…In this study, we focused on the effect of metabolic disorders related to hyperglycemia on thyroid hormone levels in adult patients. Previous reports of pediatric cases suggested that 3-hydroxybutyrate and albumin may contribute to the development of NTI ( 7 , 9 ). In adult cases, FT3 was correlated with blood glucose level, serum osmolality, ketosis, albumin, renal function, and CRP on admission.…”

Section: Discussionmentioning

confidence: 95%

“…A study reported by Shao et al. showed that pediatric patients with DKA and DK had abnormal thyroid function and that serum FT3 levels were correlated with β-hydroxybutyrate and bicarbonate ions ( 7 ). Although it has been reported that DKA and DK are involved in the pathogenesis of NTI in pediatric cases, there has been only a few case reports of HHS complicated by NTI or systemic inflammatory response syndrome (SIRS) in adult cases.…”

Section: Introductionmentioning

confidence: 99%

Effect of Hyperglycemia-Related Acute Metabolic Disturbance on Thyroid Function Parameters in Adults

et al. 2022

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Non-thyroidal illness (NTI) is a condition in which the hypothalamic-pituitary-thyroid system and thyroid hormone metabolism are abnormal due to non-thyroidal diseases. Although NTI has been reported to occur in hyperglycemic emergencies in children, there have been few studies in adult cases. In this study, we examined adult patients with hyperglycemia regarding the frequency of NTI and its triggers. Adult diabetic patients who were hospitalized for diabetic ketosis (DK), diabetic ketoacidosis (DKA), or hyperglycemic hyperosmolarity syndrome (HHS) were included in the study. Compared with the DK group, the DKA and HHS groups had higher admission blood glucose, Anion Gap, serum osmolality, creatinine, and urea nitrogen, and lower pH and eGFR. The frequency of NTI in the DKA, HHS, and DK groups was 80%, 70%, and 50%, respectively, and thyroid stimulating hormone (TSH) and free thyroxine 3 (FT3) were significantly improved after treatment for hyperglycemia. Multiple regression analysis showed a significant correlation between the decrease in FT3 level and 3-hydroxybutyrate and albumin. Acute metabolic failure associated with hyperglycemia tends to be associated with a high rate of NTI and low FT3 levels at the start of treatment. The data in this study clearly shows that transient NTI is frequently observed in subjects with acute metabolic disorders such as DKA, HHS and DK. In addition, we should bear in mind that thyroid hormone replacement therapy is not necessary in subjects with NTI due to DKA, HHS and DK, especially when overt symptoms of hypothyroidism are not observed.

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Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis/diabetic ketosis

Cited by 12 publications

References 33 publications

Correlation of Nonthyroidal Illness Syndrome with Extubation Outcome in Mechanically Ventilated Children: A Prospective Cohort Study

Correlation of Nonthyroidal Illness Syndrome with Extubation Outcome in Mechanically Ventilated Children: A Prospective Cohort Study

The Comparative Study on the Status of Bone Metabolism and Thyroid Function in Diabetic Patients with or without Ketosis or Ketoacidosis

Effect of Hyperglycemia-Related Acute Metabolic Disturbance on Thyroid Function Parameters in Adults

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