Levothyroxine and insulin requirement in autoimmune polyglandular type 3 syndrome: a real-life study.

Abstract

PURPOSE:

To evaluate factors influencing the insulin and levothyroxine requirement in patients with autoimmune polyglandular syndrome type 3 (APS-3) vs. patients with type 1 diabetes mellitus (T1DM) and autoimmune hypothyroidism (AH) alone, respectively.

METHODS:

Fifty patients with APS-3, 60 patients with T1DM and 40 patients with AH were included. Anthropometric, clinical and biochemical parameters were evaluated in all patients. Insulin requirement was calculated in patients with APS-3 and T1DM, while levothyroxine requirement was calculated in APS-3 and AH.

RESULTS:

Patients with APS-3 showed higher age (p = 0.001), age of onset of diabetes (p = 0.006) and TSH (p = 0.004) and lower total insulin as U/day (p < 0.001) and U/Kg (p = 0.001), long-acting insulin as U/day (p = 0.030) and U/kg (p = 0.038) and irisin (p = 0.002) compared to T1DM. Patients with APS-3 had higher waist circumference (p = 0.008), duration of thyroid disease (p = 0.020), levothyroxine total daily dose (p = 0.025) and mcg/kg (p = 0.006), triglycerides (p = 0.007) and VAI (p = 0.010) and lower age of onset of thyroid disease (p = 0.007) than AH. At multivariate analysis, levothyroxine treatment and VAI were associated with insulin and levothyroxine requirement in APS-3, respectively. VAI was independently associated with insulin requirement in T1DM. Circulating irisin levels were independently associated with levothyroxine requirement in AH.

CONCLUSION:

Patients with APS-3 show lower insulin requirement and higher levothyroxine requirement than T1DM and AH alone, respectively. Levothyroxine treatment and VAI affect insulin and levothyroxine requirement, respectively, in APS-3. In T1DM, adipose tissue dysfunction, indirectly expressed by high VAI, is associated with an increased insulin requirement, while circulating irisin levels influence the levothyroxine requirement in AH.

• Authors: V Guarnotta, G Pillitteri, G Gambino, S Radellini, E Vigneri, G Pizzolanti, C Giordano
• Journal: Journal of endocrinological investigation (J Endocrinol Invest) Vol. 44 Issue 7 Pg. 1387-1394 (Jul 2021) ISSN: 1720-8386 [Electronic] Italy
• PMID: 33099763 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Blood Glucose
• Hypoglycemic Agents
• Insulin
• Thyroxine

Topics

• Adolescent
• Adult
• Aged
• Biomarkers (blood)
• Blood Glucose (analysis)
• Diabetes Mellitus, Type 1 (drug therapy, metabolism, pathology)
• Female
• Follow-Up Studies
• Hashimoto Disease (drug therapy, metabolism, pathology)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Male
• Middle Aged
• Polyendocrinopathies, Autoimmune (drug therapy, metabolism, pathology)
• Prognosis
• Thyroiditis, Autoimmune (drug therapy, metabolism, pathology)
• Thyroxine (therapeutic use)
• Young Adult