INTERACTION BETWEEN TSH, FREE T4 AND CORTISOL, A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/arev7n8-198Keywords:
Type 1 Diabetes Mellitus, TSH, Free Thyroxine, Cortisol, Pediatric EndocrinologyAbstract
Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease frequently associated with other endocrine disorders, particularly thyroid dysfunction and alterations in the hypothalamic-pituitary-adrenal axis. The interaction between thyroid hormones and cortisol has a direct impact on energy metabolism, stress response, and glycemic control, being especially relevant in pediatric patients with T1DM. The aim of this systematic review was to critically analyze the available evidence regarding the relationship between TSH, free T4, and cortisol in children and adolescents with T1DM. A comprehensive search was conducted in the PubMed database using specific descriptors related to T1DM, thyroid function, and adrenal function. A total of 181 studies were identified, of which, after applying filters and screening titles and abstracts, nine articles met the eligibility criteria and were included in the qualitative synthesis. The evaluated studies showed heterogeneous results but converged on the observation that changes in cortisol levels may interfere with the interpretation of thyroid function tests, particularly in situations of metabolic decompensation such as hypoglycemia, hyperglycemia, or diabetic ketoacidosis. Furthermore, an association was observed between hormonal variability and the risk of adverse clinical outcomes, including worsening of glycemic control and increased susceptibility to complications. In conclusion, the interaction between TSH, free T4, and cortisol in pediatric patients with T1DM represents an area of great clinical relevance that has not yet been sufficiently explored in an integrated manner. Further research is needed to elucidate the underlying mechanisms and to support more accurate diagnostic and therapeutic strategies.
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