THYROID DYSFUNCTION IN DIABETIC PEDIATRIC PATIENTS
Dr. Deman Hunar Najeeb*1, Dr. Fatin Akram Abd AlQader2 and Dr. Azeez Abed Bihaadh Alyakoobi
1M.B.Ch.B, DCH.
2M.B.CH.B, DCH.
3MBChB DCH.
2.1 Design of the study
A case -control study was conducted on 30 diabetic patients registetered in pediatric diabetic center in Sulaimania city.
2.2 Place of the study
Pediatric diabetic Center in Sulaimania city / Iraq.
2.3 Time of the study
One month from 1st April 2015 to 30 April 2015.
2.4 Inclusion criteria
A 30 diabetic patients who were between (5_15 years) old and diagnosed as T1DM for 1 year -6 years duration and had a health profile in Pediatric diabetic Center in Sulaimania city with regular attendance to the Center, were enrolled into this study and they were matched for age and sex with 30 healthy children and adolescents as a control group (who were healthy subjects that attended the emergency department unit in pediatric hospital for acute illness).
A questionnaire had been filled out for the diabetic patients, were include: information about the date of birth, sex, age at onset of DM, duration of diabetic, type of insulin that is used for treatment of DM, history of thyroid disease and drug history. All patients and controls were underwent for growth parameters, signs of thyroid dysfunction and estimation of thyroid size and palpitation.
Thyroid size had been classified according to WHO into
Volume 10, Issue 1, 1190-1195 Research Article ISSN 2278 – 4357
*Corresponding Author Dr. Deman Hunar Najeeb M.B.Ch.B, DCH.
Article Received on 16 Nov. 2020,
Revised on 07 Dec. 2020, Accepted on 28 Dec. 2020
DOI: https://doi.org/10.17605/OSF.IO/TVA9N
Grade 2 / Palpable and visible goiter.[24]
2.5 exclusion criteria
1- Very ill patients with acute complications of diabetes mellitus.
2- Patients with known history of thyroid diseases.
3- Subjects suffering from acute or recent significant medical illness.
4- Subjects receiving any medication influencing thyroid function.
2.6 Sampling method
Three ml of venous blood was taken from all of diabetic patients and controls for estimation of HbA1c, TSH, T4, anti-thyroperoxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-TG Ab) level. HbA1c was checked immediately after taking blood samples by using BIO RAD D_10 device .Total serum T4, TSH levels, serum anti- thyroperoxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-TG Ab) were checked within one month from collecting all samples of blood & centrifuge them to serum and stored them at a temperature below -20 degree, they measured by LIAISON® device type2229, 9450200 REF, SN 2229004719 using starter kit through LIAISON ® device reader. Positivity of at least one antibody was considered as autoimmune thyroid disease (AIT).[4]
2.7 Ethical considerations
Written and oral consent was taken from all parents of patients and controls included in this study after discussing the way of collecting samples and purpose of the study.
Statistical analysis
Data were analyzed using the Statistical Package for social Science (SPSS, version 21).Chi sequare test was used to compare between proportion of tow study groups, when the expected count of more than 20% of the cells of the table was less than 5, Fisher's exact test was used.
Student's t test was used to compare between means of tow study groups. A p value f ≤0.05 was considered statistically significant.
RESULT
Thirty diabetic patients who received insulin treatment were examined clinically and checked by laboratory investigations for thyroid dysfunction.
In this study 57% of diabetics patients were on mixtard insulin twice daily while 43% of them 3 times daily. The proportion of cases that had good glucose control (by measuring their HbA1c level) was 17%, fair glucose control 23% and with poor glucose control was 60%.
Both Table 3.1 shows that mean age of cases and control were 11.24 + 3.35 years which is statistically not significant.
Weight and height were not significantly related in diabetics and control cases.
Table 3.1: Age and growth parameters measurements in diabetes and controls.
Variable Group
(No.) (Mean ± SD) P
Age
Cases
(30) 11.24 ± 2.876
1.00 Controls
(30) 11.24 + 2.876
Weight
Cases
(30) 37.8 ± 12.445
0.654 Controls
(30) 31.13 ± 7.88
Height
Cases
(30) 144.74 ± 21.9
0.190 Controls
(30) 136.1 ± 14.46
Table 3.2 shows that 68% of cases were from urban side while in the control it was 87% so, there is significant relation to residence(P=0.0247).
Table 3.2: Association of residence with diabetes and controls.
Residence Cases % within group Controls % within group
Urban 67.00% 87.00%
Rural 33.00% 13.00%
Total 100.00% 100.00%
Table 3.3 shows that most of the cases had no goiter while goiter was not present in controls and there was no significant association (P=0.057)
Table 3.3: Association of goiter with diabetes and controls.
Goiter Cases % within group Controls % within group
Present 7.00% .0%
Not 93.00% 100.00%
Total 100.00% 100.00%
The patient who had goiter were Euthyroid Statistically significant difference was observed in TSH and T4 values.(P=0.506) in the diabetics and controls despite normal TSH and T4
Table 3.4: Thyroid function test among diabetic and control cases.
TFT Group
(No.) (Mean ± SD) P T4
Level
Cases
(30) 94.033 ± 20.343 .016 Controls
(30) 93.220 ± 27.302
TSH Level
Cases
(30) 3.287 ± 1.812
.027 Controls
(30) 5.933 ± 18.215
In this study, the number of diabetic patients with normal thyroid function test (TFT)was 27/30 versus 29/30 as shown in( table 3.5).
Table 3.5: Prevalence of thyroid disorders among diabetic and control cases.
Thyroid disorder
Cases (30)
Controls (30) p
Normal 27 30
0.043
Euthyroid 2 1
Hypothyroidisim 1 0
Statistically significant difference (P=0.017) was observed in the values of anti TPO Ab of the patients and controls while there was no significant difference in the values of anti TG Ab (0.678) as shown in (table 3.6)
Table (3.6): Distribution of anti TG Ab and anti TPO Ab in diabetics and controls.
Thyroid Ab Group (No.) (Mean ± SD) P Anti- TG Ab Cases (30) 32.370 ± 89.249
.678 Controls (30) 35.713 ± 93.758 Anti- TPB Ab Cases (30) 21.877 ± 83.088
.017 Controls (30) 12.213 ± 35.726
DISCUSSION
In our study, there was no significant risk of developing type 1 diabetes mellitus in regards to sex (male 53% versus female 47%), the same result obtained from study in Iran conducted by Monajemzadeh and Najafian.[24] and other study by Ardestani et al.[18]
Considering growth parameters, this study shows no significant association with type 1 diabetes mellitus, which is also in agreement with the study by Ardestani et al[18] but against a study that conducted by Hyppӧnen et al[25] who showed that taller and obese children have higher risk to develop type 1 diabetes mellitus from early infancy onward than other children with the same age group.
Regarding residence, our study shows a significant difference with type 1 diabetes mellitus (67% from urban side in diabetes versus 87% in control group), which is agreement with Miller et al's study[26] and another study conducted by Kalra and Sharma.[27]
In this study most of the cases had no goiter while goiter was not present at all in all controls and there was no significant association. The same result was obtained from study conducted by Monajemzadeh and Najafian.[24] where as against a study by Ardestani et al[18] who showed the prevalence of goiter was higher in the control group than the diabetic patients (38% versus 21%)and it was significant.
Considering thyroid function test, our study shows significant increased total serum T4 & low TSH in diabetes patient as compare with non diabetes controls, these finding were in accordance with a study as; Palanisamy et al[28] showed TSH to be lower in diabetics than non_diabetics, because of TRH synthesis decreases in diabetes, and this could be responsible for occurrence of low thyroid hormone levels in diabetics. But another tow studies was reported by a Ditta et al[29] in the Diabetic Clinic, Mayo Hospital, Lahore, and Soliman et al's study in Egypt.[30] These two studies showed significantly elevated serum TSH concentrations in type 1 diabetes as compared to the normal controls. The likely explnation for this association with thyroid abnoramalities is a common underlying predisposition leading to coexisting autoimmune destruction of pancriatec islet cells and autoimmune attack on thyrocytes.[30] and total T4 conentration was significantly lower in diabetics group than the control group in A.Ditta et al[32] andanother study by Nonajemzadeh and Najafian[24], In our study the prevalence of thyroid dysfunction was 10% which is higher than controls and it was significantly significant, these finding were in accordance with other studies as:
Monajemzadeh and Najfian[24], Larijani[31], Radaideh[32], Hansen[33] and another study by Perros.[34]
In this study, statistically significant difference was observed in the values of anti TPO Ab of diabetic patients and the controls while there was no significant difference in values of anti TG Ab, our result was comparable with previous studies conducted by Ardestani et al[18], Sharifi et al[35], Shiva and Behbahani[36], Hadaegh e al[37], Laruani et al[38], and another study by Karavanaki et al[39], that showed anti TPO Ab and also anti TG Ab levels(or even one of these Abs) were higher in type 1 diabetic patients and statistically significant. The
mediated disease and have similar pathogenesis which involves T-cell infiltration by auto antibodies, this will result in dysfunction of target organ.[39]
CONCLUSION
Children and adolescents with T1DM had
1. Hgher levels of thyroid autoantibodies than non-diabetic ones.
2. Higher T4level and lower TSH levels.
3. It seems to be beneficial to measure thyroid function indices and thyroid antibodies in patients with T1DM regularly for early identification of thyroid dysfunction in T1DM patients without any clinical signs of thyroid disease.
Recommendation
1. Routine assessment of thyroid hormone levels in type 1diabetic patients.
2. Further researches are recommended in the future with larger sample size in correlation with other variables (HbA1c,daily insulin dose).
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