Aspects of hormonal testing of thyroid function in patients with type 1 diabetes mellitus and chronic kidney disease

Background. Chronic kidney disease (CKD) is known to affect the thyroid axis, including thyroid hormone metabolism. It has been established that a decrease in renal function can be combined with changes in thyroid function. Thyroid dysfunction also has implications for renal blood flow, glomerular filtration rate (GFR), tubular transport, electrolyte homeostasis, and glomerular structure. The purpose of the study was to determine the features of thyroid function in patients with type 1 diabetes mellitus (T1DM) and CKD and develop recommendations for hormonal testing of thyroid pathology. Materials and methods. One hundred and twenty-one patients with T1DM with CKD were divided into 3 groups: group 1 — 78 individuals with GFR ≤ 60 ml/min/1.73 m2, group 2 — 20 people receiving renal replacement therapy (RRT), group 3 — 23 patients after renal transplantation (RT) with adequate graft function (the duration of the renal transplant is 3.62 (1.47; 4.28) years). Results. In T1DM and CKD group, the diagnostic value of thyroid-stimulating hormone is reduced due to the absence of differences in its values with a decrease in T4 and T3. Free T3 is the most sensitive marker of thyroid dysfunction in CKD. Thyroid disorders in T1D and CKD patients have a non-immune genesis. T1DM patients on RRT after hemodialysis (HD) procedure have an increase in total and free T4 and free T3, consequently, monitoring of thyroid disorders should be done immediately after the HD session. The restoration of normal values of peripheral conversion index and free T3 occurs within 1–2 years after TR, depending on the duration of RRT receiving. After more than 3 post-transplantation years, there is an increase in peripheral conversion index, which characterizes the imbalance of peripheral thyroid hormones towards a decrease in free T3 with relatively stable free T4. Conclusions. Thyroid dysfunctions are typical for all stages of the pathological process in CKD in patients with type 1 diabetes mellitus, including patients at the terminal stage and after successful kidney transplantation. The changes in thyroid hormones are associated with the RRT experience and can potentially affect the survival of patients.

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Study of thyroid dysfunction in patients with type 1 diabetes mellitus

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20173677 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1241

Author(s):

Rajesh V. Gosavi ◽

Bhushan R. Mishal

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Thyroid Dysfunction ◽

Thyroid Peroxidase ◽

Free T4 ◽

Autoimmune Thyroid ◽

Free T3 ◽

Serum Tsh

Background: The association of autoimmune thyroid disease with type 1 diabetes mellitus has been well documented across populations, with it being most prevalent immunological disease in patients with type 1 diabetes. The aim of this study was to ascertain the association between type 1 diabetes and thyroid dysfunction clinically, biochemically and immunologically.Methods: Serum TSH, free T3 and free T4 values were compared between cases of type 1 diabetes mellitus and non-diabetic age and sex matched controls. Cases of type 1 diabetes mellitus were further divided in two groups, depending upon the presence or absence of antibodies against thyroid peroxidase (Anti-TPO antibodies). Mean serum TSH, free T3, free T4 levels were compared between these two groups to find or refute any association.Results: Abnormal thyroid function was reported in total 6 (14.63%) cases. Comparison of TSH, T3 and T4 levels showed statistically insignificant differences (p<0.05) in TSH levels (µIU/ml) (Cases- 3.44±2.41, controls- 3.34±0.78); T3 levels (pg/ml) (cases- 3.31±1.06, controls- 3.36±0.52) and T4 levels (ng/dl) (cases- 0.92±0.31, controls- 0.95±0.23). Total of 6 cases (14.63%) cases of type 1 diabetes mellitus were positive for anti-TPO antibodies (4- females, 2- males).Conclusions: Thyroid dysfunction is more common amongst type 1 diabetics, especially females. Estimation of anti-TPO antibodies is valuable in detecting thyroid dysfunction in type 1 diabetics.

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Type 1 diabetes mellitus and thyroid diseases: relationship between glycometabolism and thyroid function

Minerva Endocrinologica ◽

10.23736/s0391-1977.19.02996-1 ◽

2020 ◽

Vol 45 (1) ◽

Author(s):

Valeria Tromba ◽

Francesca Silvestri ◽

Francesco Costantino

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Thyroid Function ◽

Thyroid Diseases

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Monitoring Thyroid Function Tests in Patients With Type 1 Diabetes Mellitus: Adherence to Recommended Guidelines and Comparison of Practice Patterns in a Health Care System

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1739 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A852-A852

Author(s):

Ling Cui ◽

Madeleine Walsh ◽

Sai Deepika Potluri ◽

Nawar Suleman ◽

Pamela Schroeder

Keyword(s):

Diabetes Mellitus ◽

Primary Care ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Thyroid Function ◽

Primary Care Physicians ◽

Practice Patterns ◽

Care Physician ◽

Screening Rate

Abstract Approximately 1.7 million people in the U.S. have type 1 diabetes mellitus. Autoimmune thyroid disease occurs in 17 to 30% of patients with type 1 diabetes. The American Diabetes Association recommends that thyroid function be assessed at diagnosis of type 1 diabetes and repeated every 1 to 2 years thereafter or sooner if clinically indicated. With Centricity, our former electronic medical records (EMR) system, an EMR aid automatically imported key diabetes metrics including the TSH test. Our new EMR system, MedConnect, does not have an EMR aid that imports these metrics. We hypothesized that the screening rate for thyroid dysfunction in type 1 diabetic patients would be higher with the previous EMR system than with the new EMR system. We also hypothesized that the screening rate in patients followed by an endocrinologist would be higher than in those followed by a primary care physician. Methods: We compared practice patterns with Centricity (from June 1, 2013, to May 30, 2016) versus MedConnect (from January 1, 2017, to December 31, 2019) in both primary care and endocrinology clinics. A total of 502 patients (271 Centricity, 231 MedConnect) were identified by chart review with age ≥18 years and ICD 9/10 codes for type 1 diabetes mellitus in outpatient clinics in our multicenter system. Results: Baseline TSH was done in 253 of 271 (93.4%) Centricity patients and in 181 of 231 (78.4%) MedConnect patients. The odds of baseline TSH with Centricity was 3.88 times higher compared to MedConnect (OR = 3.88, 95% CI=2.19,6.88). Of the 214 patients with normal baseline TSH, 135 (63.1%) had repeat TSH done in 1-2 years; and of the 136 MedConnect patients with normal baseline TSH, 86 (63.2%) had repeat TSH done in 1-2 years. Of 434 patients with baseline TSH, 81 (18.6%) had abnormal TSH. Of these patients, 67 (82.7%) had hypothyroidism, 1 (1.2%) had hyperthyroidism, 8 (9.8%) had subclinical hypothyroidism, and 5 (6.1%) had subclinical hyperthyroidism. Of the total 502 patients, 380 (75.7%) were followed by an endocrinologist and 122 (24.3%) were followed by a primary care provider. Among patients followed by an endocrinologist, 348 (91.6%) had a baseline TSH result. Only 86 of 122 (70.5 %) patients followed by a primary care physician had a baseline TSH. Endocrinologists had 4.6 times higher odds of TSH screening at baseline compared with primary care physicians (p <0.0001). Conclusion: Thyroid function was not assessed at baseline in all patients with type 1 diabetes mellitus and was not followed at the recommended intervals per the guidelines. Higher screening rates were seen with an EMR aid. Endocrinologists screened significantly more patients than primary care physicians. Education of providers regarding the guidelines is needed, and addition of an EMR aid may help to improve detecting thyroid dysfunction in patients with type 1 diabetes mellitus.

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