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Hyperthyroidism in 276 Children and Adolescents with Type 1 Diabetes from Germany and Austria
Axel Dost1, Tilman R Rohrer, Elke Fröhlich-Reiterer
1Department of Pediatrics, Medical University of Graz, Graz, Austria.
Insights
Hyperthyroidism is uncommon in children with type 1 diabetes mellitus (T1DM), affecting 0.46%. It increases risks for diabetic ketoacidosis, hypoglycemia, and high blood pressure, but doesn't worsen long-term diabetes control.
Area of Science:
- Endocrinology
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- The incidence and clinical impact of hyperthyroidism in pediatric patients with type 1 diabetes mellitus (T1DM) are not well-established.
- Understanding this comorbidity is crucial for comprehensive diabetes management in children.
Purpose of the Study:
- To determine the prevalence of hyperthyroidism in pediatric T1DM patients.
- To investigate the effects of hyperthyroidism on metabolic control (HbA1c), acute diabetes complications (DKA, hypoglycemia), blood pressure, and long-term microvascular complications.
- To explore associations between hyperthyroidism and organ-specific autoantibodies in this population.
Main Methods:
- Analysis of the Diabetes Prospective Follow-Up Registry (DPV) database.
- Inclusion of pediatric patients diagnosed with T1DM.
- Comparison of patients with and without comorbid hyperthyroidism, assessing clinical outcomes and autoantibody status.
Main Results:
- Hyperthyroidism was diagnosed in 0.46% of pediatric T1DM patients, higher than in non-diabetic children.
- Associated factors included younger age, shorter diabetes duration, female sex, and lower BMI.
- Increased frequency of diabetic ketoacidosis (DKA) and hypoglycemia observed; elevated blood pressure and hypertension rates noted.
- Long-term metabolic control (HbA1c) and rates of microalbuminuria/retinopathy were similar between groups.
- Thyroid-specific antibodies and thyroid abnormalities (volume, cysts, nodules) were more prevalent in hyperthyroid patients.
Conclusions:
- Hyperthyroidism is a low but increased prevalence comorbidity in pediatric T1DM.
- It is linked to acute diabetes complications like DKA and hypoglycemia, and impacts blood pressure regulation.
- Hyperthyroidism does not appear to negatively affect long-term metabolic control or insulin requirements in pediatric T1DM.
Background/Aims:
Little is known about the incidence and clinical consequences of hyperthyroidism in pediatric patients with type 1 diabetes mellitus (T1DM).
Methods:
We analyzed the DPV database (Diabetes Prospective Follow-Up Registry) to investigate the rate of hyperthyroidism in pediatric T1DM patients, its impact on metabolic control, and potential associations with organ-specific autoantibodies.
Results:
Hyperthyroidism was found in 276/60,456 patients (0.46%) and was associated with younger age, shorter diabetes duration, female sex, and reduced body mass index. Diabetic ketoacidosis (DKA) and hypoglycemia were more frequent in T1DM with comorbid hyperthyroidism, while long-term metabolic control (HbA1c) was similar in both groups. Absolute blood pressure and arterial hypertension rate were elevated in the hyperthyroid patients. Rates of microalbuminuria and diabetic retinopathy were not different. Thyroid-specific antibodies (thyroid peroxidase, thyroglobulin, thyroid receptor) were associated with hyperthyroidism. Thyroid volume and rates of cysts and nodules were higher, and echogenicity was decreased.
Conclusion:
Prevalence of hyperthyroidism is low in diabetic children with T1DM but increased compared to children <18 years without diabetes. Hyperthyroidism is primarily associated with acute diabetes complications (DKA and hypoglycemia) and affects blood pressure regulation. Long-term metabolic control or insulin requirement were not different.
