Euthyroid sick syndrome in children with diabetic ketoacidosis

Hu, Yaomin; Li, Guimei; Wang, Wei

doi:10.15537/smj.2015.2.10304

Cited by 26 publications

(32 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The exact underlying causes have not yet been clari ed although many hypothesis have been proposed [12,18,23,24]. In previous research, FT3 and FT4 levels were positively correlated with bicarbonate levels and negatively correlated with HbA1c and AG levels [13]. In the present study, we evaluated the role of more parameters including acute phase reactants and metabolic parameters in the speci c situation.…”

Section: Discussionmentioning

confidence: 85%

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

Shao

Guo

et al. 2020

Preprint

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 85%

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

Shao

Guo

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This state is connected with acute or chronic disorders of various organs and systems and is characterized by total T3 and free triiodothyronine (FT3) concentrations below and thyroid-stimulating hormone (TSH) concentration within normal range. A previously conducted study in T1DM patients with diabetic ketoacidosis (DKA) was focused on demonstration of temporary and slight changes of total T3 [ 4 ]. Only a few studies were focused on thyroid function and microvascular complications of diabetes.…”

Section: Introductionmentioning

confidence: 99%

Higher free triiodothyronine concentration is associated with lower prevalence of microangiopathic complications and better metabolic control in adult euthyroid people with type 1 diabetes

et al. 2018

View full text Add to dashboard Cite

PurposeType 1 diabetes mellitus (T1DM) is a disorder of insulin deficiency but with a wide range of hormones simultaneously disturbed. The study was performed to explore relation of free triiodothyronine (FT3) with metabolic control and occurrence of microangiopathic complications.MethodsA total of 266 adult T1DM participants [56% men; 32 (interquartile range, IQR: 25–39) years and disease duration 13 (IQR: 8–19) years] in euthyroid state with negative history for hypothyroidism were included to the study. Participants were screened for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and FT3. Moreover, microangiopathic complications (retinopathy, diabetic kidney disease, peripheral and autonomic neuropathy), markers of metabolic control such as glycated hemoglobin (HbA1c) were evaluated.ResultsA total of 114 (42.9%) people had diagnosed at least one microangiopathic complication. In multivariable linear regression higher HbA1c was statistically significant independent predictor of lower FT3 (β = −0.25; p < 0.0001) after adjustment for sex, T1DM duration, HbA1c, waist-to-hip ratio (WHR) (R2 = 0.15, p < 0.0001). Higher FT3 was simultaneously a predictor of lower prevalence of microangiopathy in multivariate logistic regression analysis (odds ratio, 0.51; 95% confidence interval, 0.27–0.98; p = 0.04) after an adjustment for: age, hypertension, HbA1c, WHR and total cholesterol (TC).ConclusionsFT3 as tissue active hormone plays a clinically important role in T1DM people. The higher FT3 concentration is related to the lower prevalence of microangiopathy and better metabolic control of the disease in adult euthyroid people with T1DM.

show abstract

“…Multiple factors may contribute to the development of ESS [11,15,16]. In previous research, FT3 and FT4 levels were positively correlated with bicarbonate levels and negatively correlated with HbA1c and AG levels [7]. In the present study, we apprised more number of parameters including some acute phase reactants and nutritional markers in addition to metabolic parameters.…”

Section: Discussionmentioning

confidence: 83%

“…A study by Hu et al showed that children with T1DM diagnosed with DKA and were found to have ESS had a higher level of HbA1c, anion gap, and plasma glucose, whilst having a lower level of bicarbonate in comparison with those without ESS [7]. However, it was a retrospective case-control study, which is potentially susceptible to recall and selection bias.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Shao

Guo

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Sick euthyroid syndrome is frequent in children admitted with diabetic ketoacidosis (DKA). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children admitted for management of DKA.Methods: 194 children admitted for management of DKA were selected from hospital records. Children on thyroxine replacement or those with overt hypothyroidism or anti-TPO antibody positive were excluded. Tests for liver function, renal function, lipid profile, serum osmolarity, thyroid function, c-peptide levels, and glycosylated hemoglobin were done for all. Children were divided into a euthyroid group (n=88) and an euthyroid sick syndrome（ESS）group (n=106).Results:The ESS group had a higher WBC, PG, β-HB, TG, AG, and HbA1c and lower HCO3-, PA, and ALB levels compared with the euthyroid group (P<0.05). 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) 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 adjudication to euthyroid or ESS group 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 is associated with a higher degree of acidosis in children admitted with DKA. Lower levels of markers of nutrition such as serum albumin and pre-albumin levels are associated with lower levels of free thyroid hormone concentrations in children with DKA.

show abstract

Euthyroid sick syndrome in children with diabetic ketoacidosis

Cited by 26 publications

References 13 publications

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

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

Higher free triiodothyronine concentration is associated with lower prevalence of microangiopathic complications and better metabolic control in adult euthyroid people with type 1 diabetes

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

Contact Info

Product

Resources

About