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March 8, 2004

A1c (Glycohemoglobin, HgbA1c), Thyroid

Question from Annandale, New Jersey, USA:

I have a seven year old son who was diagnosed with type 1 diabetes two and a half years ago. We have been having trouble with control even though he is on an insulin pump. His A1cs have rarely been below 9. At his recent check up, some of his thyroid results came back abnormal. Antithyroglobulin Antibody was 1.30. Thyroid Perox. AB AMA was 2.2. TSH elevated; I do not have the specific number, but I think it was 1.9, and a Gliadin Serum was 45. In your opinion, does this represent true thyroid disease? The only other symptom I can add is that, lately he has had a terrible rash that the pediatrician believes is a contact dermatitis, but it is only on half his body. I have read much about hyperthyroidism, but am confused because his T3 and T4 results were normal.

Answer:

A TSH of 1.9 is normal so, perhaps your numbers are not correct. A high TSH with normal T4 is called compensated hypothyroidism and most of us treat this since the thyroid hormone is needed for optimum growth and development, brain function, heart function etc.

However, this would not explain the very high A1c levels especially on a pump. Are boluses forgotten? Is there much overeating? I would go back to your diabetes team and ask the key question: what do they think is the reason for such chronic high glucose levels since many kids on pumps can achieve A1c levels in the 6-7 percent range quite safely.

SB