ISOLATED THYROTROPHIN DEFICIENCY IN DIABETES MELLITUS

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Abstract
Hypothyroidism in patients with diabetes mellitus is usually primary, though secondary hypothyroidism has rarely occurred. An 11 6/12 yr old white female developed diabetes mellitus at 8 6/12 yr of age. She received treatment up to 40 units NPH daily with adequate control and normal growth. Hypothyroidism was diagnosed after a 3 mo. history of lethargy, constipation, dryness of skin and decreasing insulin requirement to 10 units NPH/day. Physical examination was entirely normal, except for dry skin. Serum levels of free thyroxine, thyroxine, T3 [triiodothyronine] resin uptake, were low as was 131I uptake. Primary hypothyroidism was ruled out by the absence of goiter, absent antithyroid antibodies, low basal TSH [thyrotropin] levels and increased 131I uptake after TSH administration. Serum TSH levels rose 4-fold in response to i.v. TRH [thyrotropin releasing hormone] administration. The patient was treated with 0.15 mg daily of L-thyroxine with very good response. This report describes a patient with juvenile diabetes mellitus and isolated TSH deficiency with hypothyroidism of probably hypothalamic origin, an association not previously described in children.