Thyroid Autoimmunity in Children and Adolescents With Type 1 Diabetes

Abstract

OBJECTIVE -To investigate thyroid autoimmunity in a very large nationwide cohort of children and adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Data were analyzed from 17,749 patients with type 1 diabetes aged 0.1-20 years who were treated in 118 pediatric diabetes centers in Germany and Austria. Antibodies to thyroglobulin (anti-TG) and thyroperoxidase (anti-TPO) were measured and documented at least once in 7,097 patients. A total of 49.5% of these patients were boys, the mean age was 12.4 years (range 0.3-20.0 years), and the mean duration of diabetes was 4.5 years (range 0.0 -19.5 years). A titer exceeding 100 units/ml or 1:100 was considered significantly elevated.RESULTS -In 1,530 patients, thyroid antibody levels were elevated on at least one occasion, whereas 5,567 were antibody-negative during the observation period. Patients with thyroid antibodies were significantly older (P Ͻ 0.001), had a longer duration of diabetes (P Ͻ 0.001), and developed diabetes later in life (P Ͻ 0.001) than those without antibodies. A total of 63% of patients with positive antibodies were girls, compared with 45% of patients without antibodies (P Ͻ 0.001). The prevalence of significant thyroid antibody titers increased with increasing age; the highest prevalence was in the 15-to 20-year age group (anti-TPO: 16.9%, P Ͻ 0.001; anti-TG: 12.8%, P Ͻ 0.001). Thyroid-stimulating hormone (TSH) levels were higher in patients with thyroid autoimmunity (3.34 U/ml, range 0.0 -615.0 U/ml) than in control subjects (1.84 U/ml, range 0.0 -149.0 U/ml) (P Ͻ 0.001). Even higher TSH levels were observed in patients with both anti-TPO and anti-TG (4.55 U/ml, range 0.0 -197.0 U/ml).CONCLUSIONS -Thyroid autoimmunity seems to be particularly common in girls with diabetes during the second decade of life and may be associated with elevated TSH levels, indicating subclinical hypothyroidism.

Thyroid autoimmunity in relation to islet autoantibodies and HLA-DQ genotype in newly diagnosed type 1 diabetes in children and adolescents

“…As in previous reports, girls and children at older age are more likely to have thyroid autoantibodies [1,13,26,27,29,33]. This correlates with reports involving adults wherein women with type 1 diabetes are more prone to autoimmune thyroiditis than men [34].…”

“…Furthermore, only few children are diagnosed with AITD at the onset of type 1 diabetes [23,26,31], while the risk of AITD increases during follow-up of patients with type 1 diabetes. It has been estimated that 10-33% of adult patients with long-term type 1 diabetes have been diagnosed with clinical AITD [29,[32][33][34] and in patients followed from diagnosis TPOAb predict development of future thyroid disease [35]. It is important to diagnose childhood clinical hypothyroidism due to AITD as it has an impact on growth, intellectual development and metabolic control.…”

MECHANISMS IN ENDOCRINOLOGY: The crosstalk between thyroid gland and adipose tissue: signal integration in health and disease

“…Radetti et al (77) found high levels of TPOAb in nearly 24% of overweight or obese children. This prevalence is similar to that observed in children with type 1 diabetes mellitus (21.6%) (123) and outnumbers current epidemiologic data in iodine-sufficient schoolchildren, which indicate a TPOAb prevalence in the range of 3.4-4.6% (124,125).…”

Organ-specific autoimmunity in relation to clinical characteristics in children with long-lasting type 1 diabetes

“…The recent extensive Ab screening study in patients with T1DM has raised awareness of the association of T1DM with organ-specific autoimmunity [29]. The reported prevalence of thyroid autoimmunity in young T1DM patients ranges between 3% and 50% [10,[30][31][32][33], while it is 3.4%-7% in the general paediatric population [34,35]. The association of T1DM and AITD is highly dependent on age, sex and ethnicity [36].…”