Associated conditions and other complications

Thyroid disease

• Thyroid autoantibodies (TAAB), particularly microsomal antibodies, occur in up to 20–30% of young people with type 1 diabetes
• A palpable or visible goiter may be present in 10–20%
• Most young people with a goiter and positive TAAB have (Hashimoto’s) thyroiditis but the majority are euthyroid
• Absence of TAAB does not preclude later development of thyroid disease

Hypothyroidism

• Overt hypothyroidism occurs in 1–5% of young people with type 1 diabetes
• Compensated hypothyroidism — asymptomatic, normal thyroxine level, modestly raised thyroid-stimulating hormone (TSH) — occurs in 1–10%

Diagnostic pointers

• Goiter
• Increased weight gain (facial fullness)
• Decreased growth rate
• Tiredness, lethargy

Definitive diagnosis

Treatment

Thyrotoxicosis

• Diagnosed less frequently than hypothyroidism in association with diabetes
• May be transient and occasionally precedes hypothyroidism (or vice versa)

Diagnostic pointers

• Agitation
• Tachycardia
• Weight loss
• Heat intolerance
• Tremor
• Possibly increasingly unstable metabolic control

Definitive diagnosis

Treatment

Regular clinical examination of the thyroid gland in all young people with diabetes for detection of goiter Close to the time of diagnosis of diabetes, thyroid function and thyroid antibody tests should be performed as a baseline or to uncover asymptomatic thyroid disease Repeat thyroid function tests should be performed if a child with diabetes develops a goiter, has slow growth velocity, has symptoms suggestive of thyroid disease or has high titers of thyroid antibodies Many centers repeat the thyroid function tests as part of an annual review