August 26, 2009
Question from Imboden, Arkansas, USA:
My nine-year-old daughter was diagnosed with type 1 about two years ago. Her blood sugars still fluctuate a lot. Recently, she had her check-up with her specialist and they checked her thyroid. They said it may be failing. The results just came back and it said that her thyroid wasn’t failing but she did have thyroid disease. I’m puzzled as to why they said they weren’t going to do anything until it fails. To me, that just don’t seem right. Is there anything they can do before it fails? Also, what is thyroid disease and what does it mean if it fails? I’m very worried about my daughter.
Type 1 diabetic children and adolescents often present with autoimmune thyroid disorders. Patients with one organ-specific autoimmune disease, such as type 1 diabetes, are at high risk of developing other autoimmune disorders such as celiac disease, and thyroid disorders, especially females. It is not surprising that up to 30% of female type 1 diabetic patients have thyroid disease. Regular screening for thyroid abnormalities in all type 1 diabetic patients will allow early treatment of subclinical thyroid dysfunction. A sensitive serum TSH assay is the gold standard screening test of choice. In type 1 diabetic patients, it is helpful to determine whether anti-TPO antibodies are present. If these are present, then annual TSH screening is warranted. Otherwise, a TSH assay should be done every two to three years. Treatment of eventual subclinical hypothyroidism should be considered only if 1) patients have elevated serum LDL cholesterol that is worsened by the hypothyroidism, or 2) they have high level of serum anti-TPO antibodies, because the progression to frank hypothyroidism is high in this group, or 3) they are symptomatic. In the case of your daughter, it seems to me that your physician has advised the right approach.
[Editor’s comment: For more information, see the U.S. National Library of Medicine’s page on Thyroid Diseases.