Thyroid Hormone to Induce Non-Insulin Mediated Glucose Disposal in People With Insulin Receptor Mutations
Condition: Insulin Resistance; Diabetes Mellitus; Abnormal Glucose Metabolism
MeSH terms: Insulin Resistance
Intervention: Liothyronine
Intervention description: Oral supplement given every 8 hours
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 7.0
Sex: All
Minimum age: 12 Years
Maximum age: 65 Years
Healthy volunteers: No
Keywords: Brown Adipose Tissue; Liothyronine; Insulin Receptors

Summary:

      Background:

      - Insulin receptor mutation causes high blood sugars and sometimes diabetes complications.
      Researchers want to see if thyroid hormone helps.

      Objectives:

      - To see if thyroid hormone treatment changes how the body handles sugar in people with
      insulin receptor mutation and improves blood sugar in people with diabetes.

      Eligibility:

      - People ages 12 65 with an insulin receptor mutation.

      Design:

        -  Study part 1:19-day clinic stay. Participants will be monitored for 4 days. Then for 15
           days they will take a thyroid hormone pill 3 times a day. Participants will have:

        -  Blood tests.

        -  Heart rate and skin temperature monitored.

        -  All their food provided.

        -  Two 5-hour sessions in a special room. They will wear special clothes and sometimes sit
           still.

        -  Two small tubes inserted in veins. One will deliver tiny amounts of sugar and fat with a
           non-radioactive tracer. Participants will also drink water with a tracer. The other tube
           will collect blood.

        -  A sweet drink. Participants may have finger stick blood sugar tests.

        -  Glucose-monitoring device inserted into body fat for two 24-hour periods.

        -  Adults may have samples of fat and muscle taken.

        -  Heart ultrasound.

        -  PET-CT scan in a machine. An intravenous catheter will be placed in an arm vein. A small
           amount of radioactive substance will be injected.

        -  DEXA scan of body fat and bone density.

        -  Participants with poorly controlled diabetes will then take thyroid hormone at home for
           6 months. They will have blood drawn and sent to the study team monthly.

        -  After about 3 months, they will have an overnight visit. After 6 months, they will have
           a 4-day visit.
    

Eligibility criteria:

        -  2 WEEKS STUDY:

        INCLUSION CRITERIA:

        1. Mutation of the insulin receptor (either recessive or dominant negative). If mutation
        status is not known prior to enrollment, subjects will undergo genotyping at enrollment. In
        the unanticipated event that a patient does not have a mutation of the insulin receptor, he
        or she will not complete the study and his or her data will not be included in the
        analysis.

        EXCLUSION CRITERIA:

          1. Changes in doses of diabetes medications (including metformin, insulin, sulfonylureas,
             thiazolidinediones, leptin, GLP-1 agonists, DPP4 inhibitors, etc.) in the preceding 10
             weeks.

          2. Any medical condition or medication that will increase risk to the subject (e.g.
             ischemic or structural heart disease, congestive heart failure, uncontrolled
             hypertension, or arrhythmia) or that will interfere with interpretation of study data.

          3. Disorders that would lead to erratic gastrointestinal absorption or loss of thyroid
             hormone from the gut (severe diarrhea, celiac disease, use of bile acid sequestrants,
             excessive consumption of soybean products).

          4. Any form of endogenous hyperthyroidism or hypothyroidism at baseline.

          5. Current or recent (past 8 weeks) use of thyroid hormone or anti-thyroid drugs.

          6. Extreme disorders of thyroid hormone binding to thyroid binding globulin (excess or
             deficiency) or protein loss (nephrotic range proteinuria) that would lead to
             difficulties achieving a consistent thyroid hormone level for study.

          7. Known presence of a rare clinical disorder that leads to thyroid hormone insensitivity
             (known T3 receptor mutations, selenocysteine insertion sequence-binding protein 2
             (SBP2) abnormalities, monocarboxylate transporter defects).

          8. Current use of beta blockers

          9. Pregnancy or breast feeding

         10. Any EKG abnormality that could increase risk of T3 treatment (resting sinus
             tachycardia (age adjusted norms), atrial fibrillation, myocardial ischemia, left or
             right ventricular excitation block, left ventricular hypertrophy or extrasystoles)

         11. Known allergy or hypersensitivity to any form of thyroid hormone

         12. Known adrenal insufficiency

         13. Dependence on oral anticoagulant medications (adults only)

         14. Use of tricyclic anti-depressants, as transient cardiac arrhythmias have been observed
             with the concomitant use of thyroid hormone.

         15. Use of cholestyramine.

         16. History of clinically significant osteoporosis per investigator judgment (e.g.
             previous fragility fracture)

        6 MONTHS STUDY:

        Patients must meet all inclusion and exclusion criteria for the short-term study, plus have
        poorly controlled diabetes, defined as a hemoglobin A1c greater than or equal to 7%.