Recommendations: Pediatric Hypothyroidism (Type 1 Diabetes)
Autoimmune thyroid disease is the most common autoimmune disorder associated with diabetes, occurring in 17-30% of patients with type 1 diabetes1 About one-quarter of children with type 1 diabetes have thyroid autoantibodies at the time of diagnosis;2 presence of these autoantibodies is predictive of thyroid dysfunction, generally hypothyroidism but less commonly hyperthyroidism3 Subclinical hypothyroidism may be associated with increased risk of symptomatic hypoglycemia4 and with reduced linear growth5 Hyperthyroidism alters glucose metabolism, potentially resulting in deterioration of metabolic control6 Children with type 1 diabetes should be screened for thyroid peroxidase and thyroglobulin antibodies at diagnosis (E) TSH concentrations should be measured after metabolic control has been established. If normal, they should be re-checked every 1–2 years, or if the patient develops symptoms of thyroid dysfunction, thyromegaly, or an abnormal growth rate (E)124References Roldán MB, Alonso M, Barrio R. Thyroid autoimmunity in children and adolescents with Type 1 diabetes mellitus. Diabetes Nutr Metab 1999;12:27–31. Triolo TM, Armstrong TK, McFann K, et al. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes Care 2011;34:1211-1213. Kordonouri O, Deiss D, Danne T, Dorow A, Bassir C, Gruüters-Kieslich A. Predictivity of thyroid autoantibodies for the development of thyroid disorders in children and adolescents with Type 1 diabetes. Diabet Med 2002;19:518- 521. Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F. The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus. Diabet Med 2002;19:70-73. Chase HP, Garg SK, Cockerham RS, Wilcox WD, Walravens PA. Thyroid hormone replacement and growth of children with subclinical hypothyroidism and diabetes. Diabet Med 1990;7:299-303. American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S43.