Anti-pancreatic autoimmunity and Graves' disease: study of a cohort of 600 Caucasian patients

Abstract

The aim of this study was to investigate the frequencies of clinical diabetes and humoral markers of anti-pancreatic autoimmunity in a homogeneous population of 600 Caucasian patients with recently diagnosed Graves' disease (GD), in order to characterize the specific features of this group of endocrine patients among subjects at risk of diabetes.Ten were already diabetic at GD diagnosis. Among the 590 non-diabetic patients, 29 had islet cell antibodies (ICA), including 15 with low titre ICA and only 1 ICA-positive subject with a familial history of diabetes. Twenty-four patients had insulin autoantibodies, including three in association with ICA. Glutamic acid decarboxylase (GAD)/64 kDa antibodies were found in 16 of the 150 tested sera, including 13 of the 29 ICA-positive sera. Four ICA-positive patients displayed 37/40 kDa antibodies, including three in association with GAD/64 kDa antibodies. During follow-up, one of the ICA-positive patients developed insulin-dependent diabetes, 14 years after the GD diagnosis.To summarize, this anti-pancreatic autoimmunity study was focused on a large but specific and homogeneous group of subjects at risk for diabetes: recently diagnosed GD patients. This population was characterized by a high prevalence of GAD/64 kDa antibodies but also by a low frequency of evolution towards diabetes and the slowness of the process which could be due to the fact that only a minority of subjects possessed a sufficient combination of anti-pancreatic markers at the same time.

Occurrence of Type 1 Diabetes in Graves' Disease Patients Who Are Positive for Antiglutamic Acid Decarboxylase Antibodies: An 8-Year Followup Study

“…In this study, the prevalence of GADA in Graves' patients without previously diagnosed diabetes was high, similar to those in previous reports [15–17]. Furthermore, the prevalence was high in the treated patients but the difference of the prevalence between treated patients and treatment-naïve patients was not statistically significant.…”

“…In these patients, titers of GADA tend to be high [14], which may indicate powerful ability of producing autoimmune process to islet antigens. On the other hand, GADA is sometimes positive in Graves' patients without diabetes [15–17]. In these patients, GADA may exist independently from β -cell destruction.…”

Prevalence of Glutamic Acid Decarboxylase Antibody Positivity and its Association with Insulin Secretion and Sensitivity in Autoimmune Thyroid Disease: A Pilot Study

“…Vardi et al demonstrated the presence of specific IAA in autoimmune thyroiditis without any aggressive beta cell destruction (Vardi et al, 1993). The hypothesis that claims that autoimmune thyroiditis itself creates an insulin resistant state has not been supported by any other studies (Hallengren et al, 1996;Maugendre et al, 1997). Along with the findings that the antibody related to pancreatic autoimmunity, which is found to be elevated in autoimmune thyroid disease group, is GAD-Ab but not ICA (Seino et al, 1974;Kawasaki et al, 1995;Bakker et al, 1999), the tendency toward diabetes in autoimmune thyroiditis -if present -should not be determined depending on GAD-Ab alone but other pancreas specific antibodies or GAD-Ab with epitope analysis.…”

Anti-CD38 autoantibodies in type? diabetes

“…Anti-CD38 aAbs have been found in 7.7% of patients with Graves' disease and in 10.4% of patients with chronic thyroiditis [72]. Similar frequencies (6-13%) are also found in Graves' disease [73][74][75] and Hashimoto's thyroiditis [73] for anti-GAD aAbs. Whether anti-CD38 aAbs have any functional effects on the thyroid remains to be established.…”