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Licensed Unlicensed Requires Authentication Published by De Gruyter September 11, 2014

How does autoimmune thyroiditis in children with type 1 diabetes mellitus influence glycemic control, lipid profile and thyroid volume?

Katarzyna Korzeniowska, Anna Ramotowska, Agnieszka Szypowska, Agnieszka Szadkowska, Wojciech Fendler, Barbara Kalina-Faska, Wojciech Młynarski, Przemyslawa Jarosz-Chobot and Malgorzata Myśliwiec

Abstract

Aim: To investigate whether autoimmune thyroiditis (AIT) in children with type 1 diabetes mellitus (DM1) has any influence on glycemic control, lipid profile or thyroid volume.

Methods: A total of 330 patients with DM1 and AIT (DM1+AIT group) were compared with 309 children with DM1 without AIT (control group). Patients were treated in four Polish academic pediatric diabetes centers from 2008 to 2012: Warsaw, Lodz, Katowice and Gdansk. All patients underwent measurements of thyroid-stimulating hormone (TSH), free thyroxine, anti-thyroid peroxidase (anti-TPO) antibody, anti-thyroglobulin (anti-TG) antibody and HbA1c levels, and thyroid ultrasound examination.

Results: Among AIT+DM1 patients, 62% (n=205) were female, whereas in the control group 60.8% (n=188) were male (p<0.0001). Children with AIT+DM1 had lower a BMI-SDS (mean difference of –0.5, 95% CI –0.68 to –0.33; p<0.0001), had a higher SDS thyroid volume (0.27, 95% CI 0.03–0.51; p=0.014) and needed less insulin (–0.15, 95% CI –0.20 to –0.11 U/kg body weight per day; p<0.0001) in comparison with the control group. AIT patients had higher HbA1c levels (0.66, 95% CI 0.36%–0.96%, p<0.0001), lower HDL-cholesterol levels (–3.68, 95% CI –1.41 to –5.94 mg/dL, p=0.002) and higher triglyceride levels (7.16, 95% CI 1.22–13.10 mg/dL, p=0.02). Patients with positive anti-TPO and anti-TG antibodies were older (by 1.95 years, 95% CI 0.98–2.92 years, p=0.006) and had longer DM1 duration (by 1.64 years, 95% CI 0.76–2.52 years, p=0.006). Presence of anti-TPO antibodies was associated with higher TSH levels (odds ratio 2.34, 95% CI 1.36–4.04; p=0.007).

Conclusion: AIT accompanying DM1 is associated with worse glycemic control and lipid profile as well as a lower daily insulin requirement. The female gender is more likely to develop AIT and hypothyroidism.


Corresponding author: Katarzyna Korzeniowska, MD, PhD, Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Dębinki Street 7, 80-952 Gdańsk, Poland, Phone: +48 583492890, Fax: +48 583492848, E-mail:

Acknowledgments

Wojciech Fendler and Wojciech Mlynarski received funding from the TEAM programme of the Foundation for Polish Science, funded by the European Union.

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Received: 2013-12-3
Accepted: 2014-8-14
Published Online: 2014-9-11
Published in Print: 2015-3-1

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