Hypothyroidism among pediatric patients with type 1 diabetes mellitus, from patients’ characteristics to disease severity

Fatourechi, Ali; Ardakani, Hossein Malekafzali; Sayarifard, Fatemeh; Sheikh, Mahdi

doi:10.1297/cpe.26.73

Cited by 23 publications

(16 citation statements)

References 21 publications

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“…The high prevalence of low T3 syndrome, which is comparable to previous studies in T1DM, may be explained by the relatively high proportions of patients with DK or DKA (29.7%) in this study. TD including low T3 syndrome and hypothyroidism was more common in patients with DKA [3,[22][23][24]. The presence of low T3 syndrome was associated with poor glycemic control [3,22] and free thyroid hormones were correlated with the severity of DKA [22], which was in accordance with our ndings.…”

Section: Discussionsupporting

confidence: 85%

Association between thyroid hormones and diabetic complications in patients with newly diagnosed type 2 diabetes: A cross-sectional study

Y¹,

Mou²,

Deng³

et al. 2021

Preprint

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Background Diabetes mellitus (DM) and thyroid dysfunction (TD) are two closely associated disorders. The coexistence of TD could adversely influence metabolic control and even increase the long-term mortality in patients with DM. The objective of the present study was to investigate the thyroid status and the relationship between thyroid hormones, diabetic complications and metabolic parameters in patients with newly diagnosed type 2 DM (T2DM). Methods This is an observational cross-sectional study, conducting on 340 patients with newly diagnosed T2DM who were admitted to ward of endocrinology department and 120 matched nondiabetic subjects. Clinical characteristics were collected and laboratory measurements were conducted. Results Levels of free T3 (FT3), free T4 (FT4) and TSH were significantly lower in patients with T2DM as compared to nondiabetic subjects. The prevalence of TD was 21.2% in patients with diabetes, higher than that of controls (4.2%). The low T3 syndrome was the most frequent TD, shown in 14.7% of patients. The presence of diabetic complications (diabetic nephropathy (DN), diabetic ketosis), metabolic and demographic factors, including age, glycemic control and insulin resistance were factors associated with levels of thyroid hormones. FT3 level was inversely correlated with the level of urinary total protein (mg/24h) and the presence of DN. Multivariate analysis indicated low FT3 level as a strong independent risk factor (OR = 0.364, P < 0.001) for DN. Conclusions TD is not rarely seen in patients with newly diagnosed T2DM. Diabetic complications and diabetes-related metabolic and demographic factors are related to TD. Decreased FT3 is strongly correlated with the presence of DN.

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Section: Discussionsupporting

confidence: 85%

Association between thyroid hormones and diabetic complications in patients with newly diagnosed type 2 diabetes: A cross-sectional study

Y¹,

Mou²,

Deng³

et al. 2021

Preprint

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“…Among patients with T1DM, autoimmune thyroid disorder (AITD) is the most frequent autoimmune comorbidity that can manifest as autoimmune-induced hypothyroidism (Hashimoto's thyroiditis) or hyperthyroidism (Grave's disease) [ 5 ]. AITD is seen in 17%–30% of adults and in 25% of children with T1DM [ 2 , 6 – 8 ]. Patients who are positive for thyroperoxidase antibodies (anti-TPO) are 18 times more likely to develop hypothyroidism [ 2 ].…”

Section: Metabolic Dysfunctionsmentioning

confidence: 99%

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.

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“…In a study by Fatourechi et al, it was documented that children who had both TID and hypothyroidism had significantly higher HbA1c levels at enrollment, presented at younger age and most of them experienced DKA as the first presentation. 15 Balsamo et al, and Lin et al, also observed the association of severe metabolic derangement and impaired thyroid function in subjects with newly diagnosed TID. 6,16 There are many interpretations to explain the disease severity of T1D with thyroid dysfunction.…”

Section: Discussionmentioning

confidence: 90%

Thyroid dysfunction in subjects with type 1 diabetes at a tertiary care unit of Karachi, Pakistan

Sajid

Riaz

Fawwad

et al. 2019

Clinical Epidemiology and Global Health

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Background: Genetic factors are involved in the development of T1D and studies have shown that the development of T1D also increases the risk of development of other autoimmune diseases. Objective: To assess the frequency of thyroid dysfunction in subjects with type 1 diabetes. Methodology: This study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes center of Karachi Pakistan from January 2005 to March 2017. Subject with type 1 diabetes (T1D) of all ages and both genders were included in the study. T1D was diagnosed on the basis of History, physical examination and relevant laboratory tests. The data of all registered patients was entered in a specially designed software. Thyroid stimulating hormone (TSH) was used as a screening test to assess thyroid dysfunction in subjects with type 1 diabetes. Further evaluation included FT4, T3 and thyroid antibodies where indicated. The data was analyzed on SPSS version 20. Results: A total of 153 T1D subjects (67 male and 86 female) were included in the study. Out of 153 subjects, 23 (15.0%) had thyroid dysfunction of which 17 (11.1%) were found to have hypothyroidism (subclinical or clinical), 6 (3.9%) were hyperthyroid while 130(84.96%) subjects were having normal thyroid function. Statistical differences were found in body mass index and serum creatinine level among the different categories of thyroid dysfunction. The required dose of insulin was higher (but not significant) in subjects having hypothyroidism as compared to hyperthyroid or subjects with normal thyroid function. Conclusion: High frequency of thyroid dysfunction was observed in subjects with T1D. Hypothyroidism was more common than hyperthyroidism. All subjects with T1D should be screened with TSH to evaluate for thyroid dysfunction.

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Hypothyroidism among pediatric patients with type 1 diabetes mellitus, from patients’ characteristics to disease severity

Cited by 23 publications

References 21 publications

Association between thyroid hormones and diabetic complications in patients with newly diagnosed type 2 diabetes: A cross-sectional study

Association between thyroid hormones and diabetic complications in patients with newly diagnosed type 2 diabetes: A cross-sectional study

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Thyroid dysfunction in subjects with type 1 diabetes at a tertiary care unit of Karachi, Pakistan

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