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August 8, 2000

Other Illnesses, Thyroid

Question from New Jersey, USA:

My 14 year old son has had Type 1 diabetes for eight months and his allergies are bad. I pointed out to his doctor that he had an eight pound weight loss since a visit six weeks earlier. Previous weight loss was attributed to playing basketball on two different teams, but now there has been no basketball for five weeks. The doctor told me to my son’s endocrinologist, so I did.

The endocrinologist noticed that my son had sweaty hands, rapid heart beat and another weight loss. He did say he was going to take blood because he told me that my son may have an overactive thyroid. Test results previously for thyroid problems were negative. What do we expect if he does have overactive thyroid? Will this affect his blood sugar (he is in really good control (his last Hemoglobin A1c was 6 persent)? Will my endocrinologist also test for Addison’s Disease, and celiac disease as you had suggested to other questions I have read? Where do we go from here? I know celiac is a wheat allergy and my son last month had two of his visits to an allergist, and so far he is allergic to grass, dust, and dust mites. He had the scratch test and an injection test.

If he had celiac disease would have it shown up at the allergist’s office? What is Addison’s Disease?


From: DTeam Staff

Communication by e-mail cannot substitute for a personally taken history and physical examination. You do not say how much weight your son has lost and whether at the same time he has not grown in height. Certainly, the first thing to think about would have been a thyroid problem; but the normal tests and the absence of any thyroid enlargement rules this out. There could of course be a simple explanation. If, for instance, he was overweight before starting basketball, the exercise may have accounted for his weight loss; but there would have been no change in height. It is possible too, especially in view of his excellent control, that he thinks of food as in some way causing his diabetes and that he has been limiting what he eats at a time when he would normally be in a growth spurt. This is fairly common in girls but rare in boys but if there is a dietitian on his diabetes care team it would be a help to have her evaluate this.

I think that the allergies are a separate issue; but that celiac disease, which is another autoimmune condition often linked to diabetes is still a possibility and needs to be tested for by doing an anti-transglutaminase antibody test rather than a skin test. For the rest, I think that the next step, if his weight loss continues, is a thorough examination and some simple routine tests like a routine blood count. Addison’s disease is a disorder of the adrenal gland and whilst it is a recognizable accompaniment to Type 1A diabetes it is a relatively uncommon one; but also one that is easy to test for when looking for other antibodies. Nothing in what you have told me so far would suggest this.

If he seems well, is exercising hard has a normal appetite and remains in good control, I would be inclined to feel that not much is wrong; but I think he needs to be watched carefully by his pediatrician or endocrinologist.