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

Abstract

Background: Euthyroid sick syndrome (ESS) frequently arises in children admitted with diabetic ketoacidosis/diabetic ketosis (DKA/DK). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children suffering from DKA/DK.Methods: 98 DKA and 96 DK pediatric patients were selected from hospital records. Those on thyroxine replacement, with overt hypothyroidism, or with positive anti-thyroperoxidase (TPO) antibody were excluded. Tests for liver function, renal function, lipid profile, serum osmolarity, thyroid function, c-peptide levels, and glycosylated hemoglobin were done on all patients. Children were divided into euthyroid (n=88) and ESS groups (n=106).Results: The ESS group had a higher level of white blood cell count (WBC), plasma glucose (PG), beta-hydroxybutyric acid (β-HB), triglyceride (TG), anion gap (AG), glycosylated hemoglobin (HbA1c) and a lower level of HCO3-, prealbumin (PA), and albumin (ALB) compared with the euthyroid group (P<0.05). Free T3 (FT3) levels were significantly correlated to β-HB, HCO3-, AG, PA, and HbA1c (r=-0.642, 0.681, -0.377, 0.581, -0.309, respectively; P<0.01). Free T4 (FT4) levels were significantly correlated to β-HB, HCO3-, and ALB levels (r=-0.489, 0.338, 0.529, respectively; P<0.01). TSH levels were significantly affected by HCO3– only (r=-0.28; P<0.01). HCO3– level was the most important factor deciding euthyroid or ESS on logistic regression analysis (OR=0.844, P=0.004, 95%CI=0.751-0.948).Conclusions: Lower levels of free thyroid hormones and occurrence of ESS were associated with a higher degree of acidosis in children with DKA/DK.

The prevalence, hospitalization outcomes and risk factors of euthyroid sick syndrome in patients with diabetic ketosis/ketoacidosis

“…Serum albumin levels were shown to be reduced in ESS pediatric patients with DK/DKA [24]. Besides the aforementioned in uencing factors, the de ciency of insulin can also cause a drop in albumin in DK/DKA, since albumin synthesis in hepatocytes depends on su cient insulin secretion [9,45]. In the present research, albumin de ciency was also indicated to be an independent risk factor for ESS, and its reduction might present a worse prognosis in DK/DKA patients.…”

“…The reduction of FT3 is an adaptive response to stress during the acute phase response in critical illness [21][22] and the serum level of FT3 could return to normal with treatment and recovery of illness [23]. Shao et al found that the ESS patients with DKA in children had lower serum FT3, FT4 and TSH, accompanied with worse glucose control [9]. Previous studies demonstrated high prevalence of thyroid dysfunction in DKA patients [19,24].…”

“…The scale of the decrease in serum concentration of thyroid hormones is indicated to re ect the severity of the disorder and as a result, is associated with prognosis [7]. Previously, some researchers have pointed out that the reduction of serum FT3 is positively associated with the severity of DKA in children with T1DM [8,9]. However, fewer studies investigated the thyroid status and the associated veri ed outcomes in older patients and in patients with T2DM during DK/DKA, while these patients constitute the majority in our clinical practice.…”

Risk Factors, Trends, and Preventive Measures for 30-Day Unplanned Diabetic Ketoacidosis Readmissions in the Pediatric Population

“…In one study, it was noted that there may be an interplay of factors for diabetes mellitus and thyroid disorder that put these children more at risk. A higher degree of acidosis was associated with children who had lower levels of free thyroid hormones and euthyroid sick syndrome [ 36 ]. In one pediatric study, the prevalence of hypothyroidism was higher in children and adolescents with T1DM [ 37 ].…”

Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis

“…Osmotic diuresis depletes fluid and electrolytes and increases free fatty acids, consequently eliciting severe dehydration and acidemia, sometimes resulting in fatal conditions. In DKA pathophysiology, the consequence of metabolic decompensation has been negatively associated with various endocrine functions, including thyroid [ 6 , 7 ] and growth hormone [ 8 ] functions. Although Hu et al [ 9 ] recently reported that patients with DKA and euthyroid sick syndrome were shown to have poor glycemic control during the initial days of treatment, the long-term prognosis related to endocrinologic derangement in DKA patients has not yet been well documented.…”