Abstract
BackgroundEuthyroid sick syndrome (ESS) frequently arises in children admitted with diabetic ketoacidosis/diabetic ketosis (DKA/DK). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children suffering from DKA/DK.Methods98 DKA and 96 DK pediatric patients were selected from hospital records. Those on thyroxine replacement, with overt hypothyroidism, or with positive anti-thyroperoxidase (TPO) antibody were excluded. Tests for liver function, renal function, lipid profile, serum osmolarity, thyroid function, c-peptide levels, and glycosylated hemoglobin were done on all patients. Children were divided into euthyroid (n = 88) and ESS groups (n = 106).ResultsThe ESS group had a higher level of white blood cell count (WBC), plasma glucose (PG), beta-hydroxybutyric acid (β-HB), triglyceride (TG), anion gap (AG), glycosylated hemoglobin (HbA1c) and a lower level of HCO3−, prealbumin (PA), and albumin (ALB) compared with the euthyroid group (P < 0.05). Free T3 (FT3) levels were significantly correlated to β-HB, HCO3−, AG, PA, and HbA1c (r = − 0.642, 0.681, − 0.377, 0.581, − 0.309, respectively; P < 0.01). Free T4 (FT4) levels were significantly correlated to β-HB, HCO3−, and ALB levels (r = − 0.489, 0.338, 0.529, respectively; P < 0.01). TSH levels were significantly affected by HCO3− only (r = − 0.28; P < 0.01). HCO3− level was the most important factor deciding euthyroid or ESS on logistic regression analysis (OR = 0.844, P = 0.004, 95%CI = 0.751–0.948).ConclusionsLower levels of free thyroid hormones and occurrence of ESS were associated with a higher degree of acidosis in children with DKA/DK.
Highlights
Euthyroid sick syndrome (ESS) frequently arises in children admitted with diabetic ketoacidosis/ diabetic ketosis (DKA/DK)
We evaluated metabolic parameters such as leukocyte count, blood biochemistry, liver function, kidney function, blood lipids, and C-peptide levels in relation to risk of ESS among children with T1DM admitted for management of DKA, diabetic ketoacidosis (DK), or acute hyperglycemia
White blood cell count (WBC), plasma glucose (PG), beta-hydroxybutyric acid (β-HB), triglyceride (TG), anion gap (AG), and glycosylated hemoglobin (HbA1c) levels were significantly higher in the ESS group than in the euthyroid group, whereas serum HCO3−, albumin (ALB), and prealbumin (PA) levels were significantly lower in the ESS group than in the euthyroid group (p < 0.05)
Summary
Euthyroid sick syndrome (ESS) frequently arises in children admitted with diabetic ketoacidosis/ diabetic ketosis (DKA/DK). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children suffering from DKA/DK. In children with T1DM due to insulin deficiency, blood ketone levels are higher than normal. Euthyroid sick syndrome (ESS), known as nonthyroidal illness syndrome, is a transient derangement in thyroid function tests characterized by low T3 levels. Thyroid dysfunction occurs more often in diabetic patients relative to the general population while poor glycemic control coincides with a lower level of free T3 (FT3) in serum [9]. ESS in children with T1DM results in poor metabolic control and ketoacidosis [10, 11]. The potential mechanisms include (but are not limited to) deranged regulation of the hypothalamicpituitary-thyroid axis, inflammatory cytokines effects, and oxidative stress effects [12]
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