The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus

Mohn, Angelika; Michele, Silvia Di; Luzio, Raffaella Di; Tumini, Stefano; Chiarelli, Francesco

doi:10.1046/j.1464-5491.2002.00635.x

Cited by 124 publications

(88 citation statements)

References 11 publications

(13 reference statements)

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“…We confirmed this observation in our study: insulin demand was found to be higher in anti-TPO positive group with the presence of low-grade inflammation process. Alternative explanation for our results might be the fact that patients with AITD and DM 1 are more apt to have poorer metabolic control reflected in hypo-and hyperglycaemias due to labile thyroid function [27,29]. Poor metabolic control might contribute to greater insulin demand in such patients.…”

Section: Fig 1 Prevalence Of Anti-tpo According To Tsh After Excludmentioning

confidence: 74%

“…On the other hand, another reason might be the fact that HbA 1c value points only to mean glycaemia value from the previous 3 months, not distinguishing between the actual good metabolic control and significant glycaemic fluctuations. Mohn et al showed [29] that patients with hypothyroidism have more symptomatic hypoglycaemic episodes during 12 months preceding the diagnosis of hypothyroidism which might be the reason for lowering HbA 1c level in patients with poor metabolic control, falsely indicating good metabolic control in this group.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

et al. 2015

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Background. Type 1 diabetes (DM 1) is frequently associated with autoimmune thyroid diseases (AITD). Screening for AITD in adults is rarely performed. The aim of this study was to evaluate the prevalence of anti-thyroid peroxidase (anti-TPO) and thyroid function and their association with metabolic control in adults participating in Poznan Prospective Study (PoProStu). Material and Methods. The analysis included 74 patients (26 women and 48 men) aged 38.5 (IQR: 34.5-42.5), who have had diabetes for 15.0 (14-16) years. All patients have been treated with intensive functional insulin therapy (IFIT) from the onset of the disease. Anti-TPO and thyroid-stimulating hormone (TSH) were determined. The concentration of anti-TPO ≥ 5.61 IU/mL was considered positive. Based on the levels of anti-TPO the patients were divided into two groups: anti-TPO positive and anti-TPO negative. Metabolic control was assessed by the level of glycated hemoglobin (HbA 1c ). Results. Anti-TPO was positive in 32 (43.2%) patients. Prevalence of autoantibodies was significantly higher in women (53% vs 21%; p = 0.009). There was no significant difference in HbA 1c levels [median (IQR): 7.6% (7.1-8.6) vs 7.6% (7.1-8.8); p = 0.82] and TSH levels [median (IQR): 2.05 µIU/mL (1.23-3.15) vs 1.62 µIU/mL (1.00-2.10); p = 0.06] between anti-TPO positive and negative patients. After excluding patients with a thyroid dysfunction, a significant difference in TSH levels between anti-TPO positive and negative group was found [median (IQR): 2.11 µIU/mL (1.29-3.31) vs 1.66 µIU/mL (1.29-3.31); p = 0.04]. Conclusions. High anti-TPO prevalence is found in adult patients with long-standing DM 1, and autoantibodies occur more often in women. Therefore, screening for asymptomatic thyroid dysfunction should be performed in this group, as already recommended by the joint statement of Polish Society of Endocrinology and Diabetes Poland (Adv Clin Exp Med 2015, 24, 1, 79-84).

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Section: Fig 1 Prevalence Of Anti-tpo According To Tsh After Excludmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

et al. 2015

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“…Measuring thyroid autoantibodies is used to identify thyroid autoimmunity, and measurement of TSH may be the most sensitive way to identify patients with thyroid dysfunction (190,194). Subclinical hypothyroidism has been associated with an increased risk of symptomatic hypoglycemia (195) and with reduced linear growth (196). …”

Section: Thyroid Diseasementioning

confidence: 99%

Care of Children and Adolescents With Type 1 Diabetes

Klingensmith²,

et al. 2005

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“…From the clinical perspective, patients with epitoperestricted TgAbs will benefit from close monitoring and prompt correction of thyroid dysfunction. It is recognised that undiagnosed thyroid dysfunction in diabetic patients could impair glycaemic control and increase cardiovascular risk through adverse effects on body weight and lipid metabolism (18).…”

Section: Discussionmentioning

confidence: 99%

Restricted thyroglobulin antibody epitope specificities in subjects with type 1 diabetes mellitus

Okosieme¹,

Wijeyaratne²,

Lazarus³

et al. 2009

European Journal of Endocrinology

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Objectives: Following iodisation in Sri Lanka we observed a high prevalence of thyroglobulin antibodies (TgAbs) in type 1 diabetic (T1DM) patients. The clinical significance of these TgAbs is uncertain. We sought to obtain a detailed epitope analysis of TgAbs in T1DM patients recruited from diabetes clinics and to compare these with TgAb epitope specificities in patients with autoimmune thyroid disease (AITD) and healthy individuals in that country. Design and methods: We used a panel of 10 Tg-MAbs in competitive ELISA reactions in a prospective study of subjects recruited from Colombo, to determine the epitopes recognised by TgAb-positive patients with T1DM (nZ58, 34F:24M, median age 16 years), AITD patients (nZ42, 33F:9M, median age 37 years) and healthy subjects (nZ50, 39F:11M, median age 27 years). The outcomes were a comparison of reactivity with six Tg clusters (I-VI) in these subjects, and the relation of epitope specificity patterns with free thyroxine and TSH. Results: Patients with T1DM and AITD but not healthy control subjects preferentially recognised the immunodominant clusters, I, III and IV. Patients with these narrow epitope specificities had higher median TSH levels (1.60 vs 1.06; PZ0.01), and were more frequently positive for antibodies to thyroid peroxidase than those with broad specificities (52.3 vs 7.1%; PZ0.004). Conclusions: The TgAb epitope specificities in euthyroid Sri Lankans with T1DM are similar to AITD patients. TgAb epitope studies may potentially identify T1DM patients at risk of thyroid dysfunction.

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The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus

Abstract: These data suggest that subclinical hypothyroidism is associated with an increased risk of symptomatic hypoglycaemia. The prompt introduction of substitution therapy is recommended as it reduces its frequency.

Cited by 124 publications

References 11 publications

Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

Care of Children and Adolescents With Type 1 Diabetes

Restricted thyroglobulin antibody epitope specificities in subjects with type 1 diabetes mellitus

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