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Euthyroid sick syndrome in children with diabetic ketoacidosis

Yan-Yan Hu1, Gui-Mei Li, Wei Wang

  • 1Department of Pediatrics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China. E-mail. hyanyansmile@hotmail.com.

Saudi Medical Journal
|February 27, 2015
PubMed

Insights

Children with diabetic ketoacidosis (DKA) and euthyroid sick syndrome (ESS) exhibit poorer glycemic control. Thyroid hormone levels correlate with DKA severity, indicating a link between metabolic derangement and thyroid function in these pediatric patients.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Thyroidology

Background:

  • Euthyroid sick syndrome (ESS) is a non-thyroidal illness condition affecting thyroid hormone levels.
  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus, particularly in children.
  • The relationship between ESS and DKA in pediatric populations requires further elucidation.

Purpose of the Study:

  • To characterize ESS in children diagnosed with DKA.
  • To compare thyroid hormone profiles and glycemic control in DKA patients with and without ESS.
  • To explore the association between thyroid hormone levels and DKA severity.

Main Methods:

  • A retrospective study conducted from May 2010 to April 2013 at Shandong Provincial Hospital, China.
  • Diabetic ketoacidosis patients were categorized into two groups: euthyroid (n=30) and ESS (n=40).
  • Measurements included C-peptide, glycosylated hemoglobin (HbA1c), bicarbonate, anion gap (AG), free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), and daily blood glucose (BG) profiles before and after insulin treatment.

Main Results:

  • Children with ESS (group 2) presented with higher HbA1c, AG, mean daily BG, and fasting blood glucose levels compared to the euthyroid group (group 1).
  • Conversely, bicarbonate, FT3, FT4, and TSH levels were significantly lower in the ESS group.
  • FT3 and FT4 showed negative correlations with HbA1c and AG, and positive correlations with bicarbonate, suggesting a link to DKA severity.

Conclusions:

  • Pediatric patients with DKA and co-existing ESS demonstrate suboptimal glycemic control.
  • Free thyroid hormone levels are significantly associated with the severity of diabetic ketoacidosis in children.
  • These findings highlight the interplay between metabolic dysregulation in DKA and thyroid hormone status.
Abstract

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