Autoimmune Thyroid Disease in Type 1 Diabetes — RACP Paediatrics MCQ

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ModerateEndocrinologyAutoimmune Thyroid Disease in Type 1 DiabetesRACP Paediatrics

A 9-year-old girl with type 1 diabetes has elevated anti-thyroid peroxidase (anti-TPO) antibodies. Her TSH is 12 mIU/L and free T4 is at the lower end of normal. She is asymptomatic. What is the most appropriate management?

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Correct answer: E — Commence levothyroxine

Autoimmune thyroid disease is common in children with type 1 diabetes (approximately 20–25% develop thyroid autoantibodies). A TSH persistently >10 mIU/L with positive antibodies warrants treatment with levothyroxine, even if the child is asymptomatic, as subclinical hypothyroidism may affect growth and cognitive development. Annual thyroid screening is recommended in T1DM.

Reference: ISPAD – 2024 – Clinical Practice Consensus Guidelines: Associated Autoimmune Conditions in Type 1 Diabetes