Thyroid Function in Children with Newly Diagnosed Type 1 Diabetes Mellitus

為評詁診斷時第1型糖尿病病童的甲狀腺功能，我們將138位病童分為兩組：糖尿病酮酸症組，有76位病童；無糖尿病酮酸症組，有62位病童。對照組有35位，由病童的兄弟姊妹組成，全部無糖尿病或甲狀腺疾病。這些病童在剛發病的3天內接受甲狀腺功能檢查（包括甲促素、三碘甲狀腺素、甲狀腺素和游離甲狀腺素指標），且在接受胰島素治療後1個月至兩年間，再一次接受甲狀腺功能檢查。結果：糖尿病酮酸症組在三碘甲狀腺素、甲狀腺素、游離甲狀腺素和游離甲狀腺素指標都比其他兩組呈有意義的低。無糖尿病酮酸症組僅三碘甲狀腺素較對照組低，而這三組在甲促素方面，沒有顯著的差異。甲狀腺功能的後續追蹤在胰島素的有效治療之後均為正常。結論：糖尿病酮酸症會影響甲狀腺功能檢查的結果，而這些不正常的甲狀腺功能在給予適當的胰島素治療下會恢復正常：我們建議除非臨床上有懷疑，甲狀腺功能評估在第1型糖尿病初診斷時並不合宜，應經胰島素治療，病情穩定後再做。

關鍵字

甲狀腺功能檢查；第1型糖尿病；糖尿病酮酸症；非甲狀腺疾病

並列摘要

Evaluation of thyroid hormone indices was performed in 138 children with newly diagnosed type 1 diabetes, with their siblings serving as controls. The DKA group consisted of 76 children who had diabetic ketoacidosis (DKA) at initial diagnosis. The non-DKA group consisted of 62 children and the control group of 35. The thyroid function tests of the patients were measured within 3days of the initial diagnosis of diabetes and at least one follow-up test one month to two years after adequate treatment of diabetes. The DKA group had significantly lower levels of T3, T4, Free T4 and FTI than did the other two groups (p＜0.0001,p＜0.0001,p＜0.0001,and p,0.0001,respectively). T3 concentration was lower in non-DKA subjects than in controls (p=0.0003), but the two groups did not significantly differ in terms of T4, free T4, and FTI. The TSH level did not differ among the three groups. We conclude that DKA changes thyroid function measurements. In the absence of true thyroid disease, abnormal thyroid function tests are reversible after institution of good diabetic control. We suggest that thyroid function tests should be restricted to those patients suspected of having thyroid disorders at the initial diagnosis of type 1 diabetes.

並列關鍵字

thyroid function test ； type 1diabetes ； diabetic ketoacidosis ； nonthyroidal illness

國際替代計量

Thyroid Function in Children with Newly Diagnosed Type 1 Diabetes Mellitus

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