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Thyroid Autoimmunity in Children and Adolescents with Type 1 Diabetes: A Multicenter Survey. Diabetes Care. 25(8): 1346-1350. August 2002.

This article reports on a study undertaken to investigate thyroid autoimmunity in a very large nationwide cohort of children and adolescents with type 1 diabetes. Data were analyzed from 17,749 patients with type 1 diabetes aged 0.1 to 20 years who were treated in 118 pediatric diabetes centers in Germany and Austria. A total of 49.5 of these patients were boys, the mean age was 12.4 years and the mean duration of diabetes was 4.5 years. In 1,530 patients, thyroid antibody levels were elevated on at least one occasion, whereas 5,567 were antibody-negative during the observation period. Patients with thyroid antibodies were significantly older, had a longer duration of diabetes, and developed diabetes later in life than those without antibodies. A total of 63 percent of patients with positive antibodies were girls, compared with 45 percent of patients without antibodies. The authors conclude that thyroid autoimmunity seems to be particularly common in girls with diabetes during the second decade of life and may be associated with elevated TSH (thyroid-stimulating hormone) levels, indicating subclinical hypothyroidism. 3 figures. 1 table. 20 references.

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Thyroid Disease and Diabetes. Diabetes Spectrum. 15(3): 143. 2002.

Diabetes and thyroid disease are both endocrine, or hormone, problems. This patient education handout reviews the interplay of thyroid disease, mostly hypothyroidism, and diabetes. When thyroid disease occurs in someone with diabetes, it can make blood glucose control more difficult. The handout reviews the symptoms of hyperthyroidism and hypothyroidism, the effects of each on diabetes, diagnostic tests used to confirm these conditions, and treatment options.

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Endocrine Regulation of Calcium and Phosphate Metabolism. In: Porterfield, S.P. Endocrine Physiology. 2nd ed. St. Louis, MO: Mosby, Inc. 2001. p. 107-129.

This chapter, which is part of a textbook on endocrine physiology, focuses on endocrine regulation of serum calcium and phosphate. The chapter begins with an examination of the role of calcium and phosphate in the body. This is followed by a discussion of serum calcium and phosphate levels and serum calcium and phosphate balance. The chapter then describes the role of osteoblasts, osteocytes, and osteoclasts in bone metabolism and identifies major growth factors in bone such as insulin like growth factors. These components, which are mitogenic polypeptides that resemble insulin structure and function, are present in bone matrix. They stimulate bone and cartilage growth and increase osteoblast proliferation. Insulin and growth hormone control their production. The chapter next discusses parathyroid hormone, calcitonin, and vitamin D in terms of their structure, control of secretion, and actions on bone and kidney. The actions of other hormones are also highlighted, including estrogens, glucocorticoids, and thyroid hormones. In addition, the chapter describes pathologic disorders of calcium and phosphate balance, including hyperparathyroidism, hypercalcemia of malignancy, pseudohypoparathyroidism, hypothyroidism, vitamin D deficiency, Paget's disease, and bone problems of renal failure. The chapter includes a list of key words and concepts and presents self study problems. 15 figures. 1 table. 11 references.

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Thyroid Disorders and Diabetes. Diabetes Self-Management. 18(3): 6-12. May-June 2001.

This article discusses the occurrence of thyroid disorders among people who have diabetes. The thyroid, a butterfly shaped gland located in the neck, plays a main role in the regulation of metabolism, so abnormal thyroid function can have a major effect on the control of diabetes. Untreated thyroid disorder can increase the risk of certain diabetic complications and aggravate many diabetes symptoms. The thyroid produces thyroxine and triiodothyronine. These hormones enter the bloodstream and affect the metabolism of the heart, liver, muscles, and other organs. Any changes in the blood level of thyroid hormones can affect many body systems and cause various symptoms. The basic disorders of the thyroid are hypothyroidism, or an underactive thyroid gland, and hyperthyroidism, or an overactive thyroid gland. The causes of hypothyroidism include the surgical removal of the thyroid, exposure to radiation, and use of certain drugs. The symptoms and effects of hypothyroidism can vary greatly depending on the age and gender of the affected person. The most common cause of hyperthyroidism in people under 40 years old is Graves disease. Other causes include thyroid nodules and thyroiditis. The symptoms of hyperthyroidism are varied and can be vague. People who have diabetes have an increased risk of developing thyroid disorder. Although both hyperthyroidism and hypothyroidism can affect the course of diabetes, their effects are somewhat different. Hyperthyroidism is usually associated with worsening blood glucose control and increased insulin requirements, whereas hypothyroidism rarely causes significant changes in blood glucose control but is accompanied by various abnormalities in blood lipid levels. Pregnant women who have diabetes have a greater risk of pregnancy related thyroid dysfunction, so they should be monitored closely. The most reliable test to diagnose thyroid disease is the thyroid stimulating hormone blood test. The treatment for hypothyroidism is to replace the missing thyroid hormone with a synthetic thyroid hormone derivative. Hyperthyroidism can be treated with oral antithyroid medicines, radioactive iodine therapy, or surgery to remove the gland. The article includes a list of additional resources.

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Management of Dyslipidemia in Adults with Diabetes. Diabetes Care. 23(Supplement 1): S57-S60. January 2000.

This position statement provides recommendations for managing dyslipidemia in adults who have diabetes. The most common pattern of dyslipidemia in people who have type 2 diabetes is elevated triglyceride levels and decreased high density lipoprotein cholesterol levels. Lipid levels may be affected by factors unrelated to glycemia or insulin resistance, including renal disease, hypothyroidism, and the frequent occurrence of genetically determined lipoprotein disorders. The position statement discusses the prevalence of dyslipidemia in people who have type 2 diabetes, lipoprotein risk factors for coronary heart disease (CHD), clinical trials of lipid lowering in people who have diabetes, and risk factors versus markers. Other topics include the modification of lipoproteins by nutritional therapy and physical activity, the modification of lipoproteins by glucose lowering agents, treatment goals for lipoprotein therapy, and lipid lowering agents. In addition, the position statement considers issues in the treatment of adults with type 1 diabetes. The statement concludes that aggressive therapy of diabetic dyslipidemia will probably reduce the risk of CHD in patients who have diabetes. Primary therapy should be directed at lowering low density lipoprotein levels by using statin therapy with the addition of a resin if needed. 4 tables. 8 references.

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