Thyroid function test in diabetic ketoacidosis

Mirboluk, Amir Ahmad; Rohani, Farzaneh; Asadi, Ramin; Eslamian, Mohammad

doi:10.1016/j.dsx.2017.04.015

Cited by 20 publications

(22 citation statements)

References 8 publications

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“…Abnormal serum thyroid hormone levels have been well described in patients admitted with acute critical illness [18,[20][21][22]. 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].…”

Section: Discussionmentioning

confidence: 97%

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

Shao

Guo

et al. 2020

Preprint

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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.

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Section: Discussionmentioning

confidence: 97%

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

Shao

Guo

et al. 2020

Preprint

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“…Hyperglycaemia of longer duration can have a cumulative effect on TD [25]. While interpreting thyroid function tests, it is important to consider that, like other acute systemic illnesses, diabetic ketoacidosis can decrease T3 and T4 levels while TSH levels remain normal [26]. Insulin resistance and hyperinsulinaemia lead to proliferation of thyroid tissues, an increased incidence of nodular thyroid disease, and a larger goitre [21,27].…”

Section: Thyroid Hormones and Glucose Homeostasismentioning

confidence: 99%

Thyroid Dysfunction and Type 2 Diabetes Mellitus: Screening Strategies and Implications for Management

Kalra

Aggarwal²,

Khandelwal

2019

Diabetes Ther

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Diabetes mellitus (DM) and thyroid dysfunction (TD) often tend to coexist in patients. Both hypothyroidism and hyperthyroidism are more common in type 2 diabetes mellitus (T2DM) patients than in their nondiabetic counterparts. Current guidelines are neither clear nor specific about the frequency of thyroid function monitoring in T2DM patients. Circulating thyroid hormones affect several different organs and cells, have a major impact on glucose, lipid, and protein metabolism, and can worsen glycaemic control in T2DM. Hyperthyroidism and thyrotoxicosis can worsen subclinical DM and cause hyperglycaemia in T2DM patients, increasing the risk of diabetic complications. T2DM reduces thyroid-stimulating hormone levels and impairs the conversion of thyroxine (T4) to triiodothyronine (T3) in the peripheral tissues. Poorly managed T2DM can lead to insulin resistance and hyperinsulinaemia, which causes thyroid tissue proliferation and increases nodule formation and goitre size. In addition, while metformin can be beneficial in both T2DM and TD patients, other antidiabetics such as sulfonylureas, pioglitazone, and thiazolidinediones can negatively impact TD. Antithyroid drugs such as methimazole can impair glycaemic control in T2DM patients. Thyrovigilance in T2DM patients and diabetovigilance in TD patients may therefore be necessary to facilitate individualized care and management.

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“…Previous studies have noticed the relationship between acidosis and free thyroid hormones levels [16,17]. Lower T4 and T3 and higher rT3 serum concentrations were found in patients with metabolic acidosis [17].…”

Section: Discussionmentioning

confidence: 84%

“…The exact underlying cause for ESS has not yet been elucidated although many hypothesis have been proposed [11]. 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].…”

Section: Discussionmentioning

confidence: 99%

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.

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Thyroid function test in diabetic ketoacidosis

Cited by 20 publications

References 8 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

Thyroid Dysfunction and Type 2 Diabetes Mellitus: Screening Strategies and Implications for Management

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

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