ESPE Abstracts

Background: The correlation between free thyroid hormones and poor diabetic control in children with diabetic ketoacidosis (DKA) and the effects of thyroid hormone therapy on euthyroid sick syndrome (ESS) remain unclear.

Objective and hypotheses: To investigate characteristics of ESS in children with DKA and the effects of thyroid hormone therapy on ESS. In children with DKA, free thyroid hormones may be associated with the severity of DKA and thyroid hormone therapy may have effects on ESS.

Method: Children with DKA were divided into two groups: euthyroidism (group 1, n=25) and ESS (group 2, n=30). All children were treated with insulin, and levothyroxine was added in 21 children in group 2. C-peptide, insulin, HbA1c, bicarbonate, anion gap (AG), free triiodothyronine (FT₃), free thyroxine (FT₄), and TSH levels were measured before and after 7 days of treatment. Daily blood glucose (BG) profiles were recorded.

Results: HbA1c, AG and the mean daily BG levels were higher and bicarbonate, FT₃, FT₄, and TSH levels were lower in group 2 than in group 1 (all P<0.05). FT₃ and FT₄ levels were positively correlated with bicarbonate (r=0.409, P=0.002, r=0.324, P=0.016) and negatively correlated with HbA1c (r=−0.561, P<0.0001, r=−0.302, P=0.025) and AG (r=−0.344, P=0.010, r=−0.428, P=0.001). There were no statistically differences in laboratory parameters between ESS with and without levothyroxine after treatment (all P>0.05). However, fasting blood glucose (FBG) levels were lower in ESS with levothyroxine than without levothyroxine (P=0.007). The coefficient of variation of the mean daily BG and FBG levels were lower in ESS with levothyroxine than in ESS without levothyroxine (P=0.037, P=0.037).

Conclusion: DKA children with ESS have a poor diabetic control. Free thyroid hormones are associated with the severity of DKA. Thyroid hormone therapy may improve glycemic control for ESS.