Endocrine Abstracts

Introduction: Acquired primary hypothyroidism is the most common autoimmune endocrine disorder associated with Type 1 Diabetes (T1D). It is associated with presence of antibodies called Thyroid peroxidase (TPO) and requires lifelong supplementation with Levothyroxine. NICE guidelines (NG145) ¹ recommends regular surveillance of thyroid levels for primary hypothyroidism every 4-6 months until puberty and then annually. Children and young people (CYP) with diabetes and hypothyroidism may not have the latter problem adequately assessed at clinics due to the complex nature of diabetes management.

Aims: To audit our practice of managing CYP with primary hypothyroidism at the T1D clinics across the Southern Health and Social Care Trust (SHSCT). This comprised both quantitative and qualitative aspects of care.

Methods: This was a retrospective chart review of CYP with T1D and thyroid disease. The management of thyroid disease in the T1D clinic was recorded and compared against national guidelines. Families were asked about their experience of thyroid management at clinics.

Results: The prevalence of hypothyroidism among children with T1D aged 0-16yrs was 3.3% with a female to male ratio of 4.1. Three out of six relevant NICE recommendations were fully met while 3 were only partially met. TFTs were checked in all CYP with T1D, FT3 was appropriately checked and all diagnosed with primary hypothyroidism and treated with levothyroxine. Criteria not fully met included TPO antibody measurements as recommended, 4-6 monthly TFT checks for prepubertal and annual checks for pubertal CYP and 6-12 weekly check post dose adjustments. Families were satisfied with information regarding medication but would like more information on risks of over or under treatment.

Conclusion: We are only partially compliant with NICE recommendation for monitoring of TFTs in CYP with hypothyroidism at T1D clinics. Valuable recommendations regarding frequency of monitoring and offering parental information as above have been made.