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Levothyroxine in euthyroid autoimmune thyroiditis and type 1 diabetes: a randomized, controlled trial.
J Clin Endocrinol Metab. 2007 May; 92(5):1647-52.JC

Abstract

CONTEXT

Patients with type 1 diabetes (T1D) have an increased risk of autoimmune thyroiditis (AIT).

OBJECTIVE

Our objective was to determine whether levothyroxine (l-T(4)) treatment prevents the clinical manifestation of AIT in euthyroid subjects with T1D.

DESIGN AND SETTING

We conducted a prospective, randomized, open, controlled clinical trial at six tertiary care centers for pediatric endocrinology and diabetes.

PATIENTS

Of 611 children and adolescents with T1D, 89 individuals (14.5%) were identified with positive thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), or both. Of these, 30 patients (age, 13.3 +/- 2.1 yr) met the inclusion criteria and were randomized to receive l-T(4) (n = 16 patients) or no treatment (n = 14 patients).

INTERVENTION

l-T(4) (1.3 microg/kg daily) was given for 24 months in the treatment group, followed by an additional observation period of 6 months in both groups.

MAIN OUTCOME MEASURES

Thyroid gland volume (as determined by ultrasound), serum levels of TSH, thyroid hormones, TPOAb, and TgAb were assessed every 6 months for 30 months.

RESULTS

Mean thyroid volume decreased in the treatment group after 24 months (-0.60 sd score) and increased in the observation group (+ 1.11 sd score; P = 0.0218). Serum thyrotropin, free T(4), TPOAb, and TgAb levels were not significantly different in both groups during the entire study period. Hypothyroidism developed in three individuals treated with l-T(4) and in four untreated patients (conversion rate, 9.3% per year).

CONCLUSIONS

In this study in euthyroid patients with AIT and T1D, l-T(4) treatment reduced thyroid volume but had no effect on thyroid function and serum autoantibody levels.

Authors+Show Affiliations

Division of Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Ulm, Eythstrasse 24, D-89075 Ulm, Germany. beate.karges@uniklinik-ulm.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17299067

Citation

Karges, Beate, et al. "Levothyroxine in Euthyroid Autoimmune Thyroiditis and Type 1 Diabetes: a Randomized, Controlled Trial." The Journal of Clinical Endocrinology and Metabolism, vol. 92, no. 5, 2007, pp. 1647-52.
Karges B, Muche R, Knerr I, et al. Levothyroxine in euthyroid autoimmune thyroiditis and type 1 diabetes: a randomized, controlled trial. J Clin Endocrinol Metab. 2007;92(5):1647-52.
Karges, B., Muche, R., Knerr, I., Ertelt, W., Wiesel, T., Hub, R., Neu, A., Klinghammer, A., Aufschild, J., Rapp, A., Schirbel, A., Boehm, B. O., Debatin, K. M., Heinze, E., & Karges, W. (2007). Levothyroxine in euthyroid autoimmune thyroiditis and type 1 diabetes: a randomized, controlled trial. The Journal of Clinical Endocrinology and Metabolism, 92(5), 1647-52.
Karges B, et al. Levothyroxine in Euthyroid Autoimmune Thyroiditis and Type 1 Diabetes: a Randomized, Controlled Trial. J Clin Endocrinol Metab. 2007;92(5):1647-52. PubMed PMID: 17299067.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Levothyroxine in euthyroid autoimmune thyroiditis and type 1 diabetes: a randomized, controlled trial. AU - Karges,Beate, AU - Muche,Rainer, AU - Knerr,Ina, AU - Ertelt,Waldemar, AU - Wiesel,Thomas, AU - Hub,Regine, AU - Neu,Andreas, AU - Klinghammer,Albrecht, AU - Aufschild,Julia, AU - Rapp,Andrea, AU - Schirbel,Andreas, AU - Boehm,Bernhard O, AU - Debatin,Klaus M, AU - Heinze,Eberhard, AU - Karges,Wolfram, Y1 - 2007/02/13/ PY - 2007/2/15/pubmed PY - 2007/6/7/medline PY - 2007/2/15/entrez SP - 1647 EP - 52 JF - The Journal of clinical endocrinology and metabolism JO - J. Clin. Endocrinol. Metab. VL - 92 IS - 5 N2 - CONTEXT: Patients with type 1 diabetes (T1D) have an increased risk of autoimmune thyroiditis (AIT). OBJECTIVE: Our objective was to determine whether levothyroxine (l-T(4)) treatment prevents the clinical manifestation of AIT in euthyroid subjects with T1D. DESIGN AND SETTING: We conducted a prospective, randomized, open, controlled clinical trial at six tertiary care centers for pediatric endocrinology and diabetes. PATIENTS: Of 611 children and adolescents with T1D, 89 individuals (14.5%) were identified with positive thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), or both. Of these, 30 patients (age, 13.3 +/- 2.1 yr) met the inclusion criteria and were randomized to receive l-T(4) (n = 16 patients) or no treatment (n = 14 patients). INTERVENTION: l-T(4) (1.3 microg/kg daily) was given for 24 months in the treatment group, followed by an additional observation period of 6 months in both groups. MAIN OUTCOME MEASURES: Thyroid gland volume (as determined by ultrasound), serum levels of TSH, thyroid hormones, TPOAb, and TgAb were assessed every 6 months for 30 months. RESULTS: Mean thyroid volume decreased in the treatment group after 24 months (-0.60 sd score) and increased in the observation group (+ 1.11 sd score; P = 0.0218). Serum thyrotropin, free T(4), TPOAb, and TgAb levels were not significantly different in both groups during the entire study period. Hypothyroidism developed in three individuals treated with l-T(4) and in four untreated patients (conversion rate, 9.3% per year). CONCLUSIONS: In this study in euthyroid patients with AIT and T1D, l-T(4) treatment reduced thyroid volume but had no effect on thyroid function and serum autoantibody levels. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/17299067/Levothyroxine_in_euthyroid_autoimmune_thyroiditis_and_type_1_diabetes:_a_randomized_controlled_trial_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-2493 DB - PRIME DP - Unbound Medicine ER -