Clinical and subclinical organ-specific autoimmune manifestations in Type 1 (insulin-dependent) diabetic patients and their first-degree relatives

Background: The prevalence of thyroid dysfunction in pregnancy and in the first postpartum year (postpartum thyroid dysfunction (PPTD)) in women with diabetes mellitus type 1 (DM1) is known to be higher than in the general population. To assess prevalence, incidence and risk factors in The Netherlands we performed a prospective cohort study. Design: From 1994 to 1998, 126 women with DM1 from eight Dutch clinics were included. TSH, free thyroxine, free tri-iodothyronine and anti-thyroid peroxidase antibodies (TPO-ab) were measured prepregnancy, in the first and last trimester of pregnancy and at 1.5, 3, 6, 9 and 12 months after delivery. Results: Eighty-two women completed the study. Thyroid dysfunction during pregnancy was observed in 22.5% (first trimester) and 18.4% (third trimester), and mostly consisted of subclinical hypothyroidism. Baseline characteristics of women with thyroid dysfunction in pregnancy did not differ from those without thyroid dysfunction. Overt PPTD was seen in 15.9%. Incidence of PPTD was 10%. Patients with PPTD were slightly older than those without PPTD and the prevalence of TPO-ab was higher in these women. Conclusion: In women with DM1 the prevalence of thyroid dysfunction during pregnancy and overt PPTD is 3-fold higher than in the general Dutch population. Risk factors are age and TPO-ab. Given the possible impact on psychomotor development of the offspring and on well-being of the mother these data suggest there is a case for screening (pre-)pregnant women with DM1 for TSH and TPO-ab.

Section: Td In the Postpartum Periodmentioning

confidence: 99%

“…Women with DM1 are found to have anti-thyroid peroxidase antibodies (TPO-ab) in a higher proportion (up to 20%) than the background population (3), and their prevalence of auto-immune hypothyroidism is also higher (4,5).…”

Section: Introductionmentioning

confidence: 99%

Thyroid dysfunction during pregnancy and in the first postpartum year in women with diabetes mellitus type 1

Gallas

Stolk

Bakker

et al. 2002

“…In several studies of both children and adults with IDDM a high prevalence of thyroid autoantibodies (Tab) (8-44%) has been found as an indicator of thyroid autoimmune disease (1)(2)(3)(4)(5)(6)(7). Most of those antibody-positive diabetics were clinically and biochemically euthyroid.…”

Section: Introductionmentioning

confidence: 99%

Thyroid function, morphology and autoimmunity in young patients with insulin-dependent diabetes mellitus

Hansen

Bennedbæk²,

Hansen³

et al. 1999

Objective: An association between insulin-dependent diabetes mellitus (IDDM) and autoimmune thyroid disease is well recognized. We have studied the prevalence of thyroid dysfunction, autoimmunity and morphological abnormalities by ultrasonography in young diabetics. Subjects and methods: Among young IDDM patients less than 18 years old and living in the county of Funen, Denmark, 105 of 116 eligible patients participated. They were compared with 105 healthy children matched for sex and age. Routine thyroid function parameters (thyroxine (T 4 ), tri-iodothyronine (T 3 ), T 3 resin uptake and TSH) and thyroid autoantibodies (anti-thyroid peroxidase, TPOab, and thyroglobulin antibodies, Tgab) were measured. Thyroid size and morphology were determined by ultrasonography. Results: Two of the diabetics had previously diagnosed hypothyroidism and three new cases of subclinical hypothyroidism were found.

“…Type 1 DM is frequently associated with organspecific autoimmune diseases, including autoimmune thyroid disease, pernicious anemia, and idiopathic Addison's disease (44)(45)(46)(47). A significantly higher frequency of ATA/AMiA among anti-GAD-positive than among anti-GAD-negative type 1 DM patients was seen in this investigation (22.8% vs 5.5%, P < 0.05, Table 2).…”

Section: Discussionmentioning

confidence: 99%

Relationship between autoantibodies against glutamic acid decarboxylase, thyroglobulin/thyroid microsome and DNA topoisomerase II in the clinical manifestation of patients with type 1 diabetes mellitus in Taiwan

Shiau¹,

Tsai²,

Hwang

et al. 2000

Objective: In a preliminary cross-sectional study, we discovered that DNA topoisomerase II autoantibodies (anti-TopII) were detected in 49.2% of 195 Chinese type 1 diabetes mellitus (type 1 DM) patients with a mean age of 14.5 years and a mean duration of disease of 4.6 years. In order to demonstrate the relationship between anti-TopII and other immunological characteristics in Chinese type 1 DM patients, and to evaluate its putative prediction efficacy in Chinese patients, we simultaneously examined the frequency of anti-glutamic acid decarboxylase autoantibodies (anti-GAD), anti-TopII, antithyroglobulin/antimicrosomal autoantibodies (ATA/AMiA) and C-peptide concentrations in our patients in the present study. Design and Methods:The frequency of anti-GAD and C-peptide levels, anti-TopII, and ATA/AMiA were examined in our patients by radioimmunoassay, enzyme-linked immunosorbant assay and hemagglutination respectively. Univariate comparisons were performed using Student's t-test for normal distributed data and Chi-square test for diclomatous data. Multivariate analysis was used for interpreting the independent risk factors which increased the incidence of anti-TopII. Results and Conclusions:The positivities for anti-GAD, anti-TopII, ATA/AMiA and C-peptide were 45.8%, 50.2%, 13.4% and 11.4% respectively. Anti-GAD and anti-TopII frequencies in our patients were similar when we stratified the patients by age, age at onset and duration. These observations imply that anti-GAD and anti-TopII remain persistent in Chinese patients with long-term type 1 DM duration. The most interesting finding is that anti-TopII frequency is more persistent than anti-GAD in our patients, especially when the diabetic duration is longer than 11 years. This indicates that antiTopII, rather than anti-GAD, might act as a better indicator for monitoring the pathogenesis of Chinese type 1 DM patients especially in patients with a long-standing duration of disease. The late age of onset (>18 years) is a risk factor which increased the incidence of anti-TopII according to multivariate analysis. We further analyzed different manifestations between the youth-and adult-onset type 1 DM and found that adult-onset type 1 DM is characterized by better preservation of residual b-cell function and higher frequencies of autoantibodies.