Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes

Leong, King Sun; Wallymahmed, M; Wilding, John; MacFarlane, I. A.

doi:10.1136/pgmj.75.886.467

Cited by 43 publications

(34 citation statements)

References 15 publications

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“…Autoimmune thyroiditis or Hashimoto’s thyroiditis, as defined by the presence of positive thyroid antibodies, occurs in up to 15–20% [1, 2] of pediatric patients with type 1 diabetes (T1D) and leads to hypothyroidism in approximately 3% [3], potentially compromising glycemic control [4]. Guidelines from the American Diabetes Association (ADA) [5] and the International Society for Pediatric and Adolescent Diabetes (ISPAD) [6] recommend thyroid function screening at diagnosis of T1D.…”

Section: Introductionmentioning

confidence: 99%

Practice Variance in Thyroid Screening of Youth with Type 1 Diabetes Mellitus

2018

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Background: Variance between current American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines and in clinical practice exists for the use of thyroid antibody and thyroid function screening in pediatric patients with new-onset type 1 diabetes (T1D). Methods: North American Pediatric Endocrine Society (PES) members were surveyed regarding their thyroid screening practices of euthyroid youth with T1D. An institutional analysis of the ability of antithyroid peroxidase (aTPO) and antithyroglobulin antibodies (aTG) to predict the subsequent use of levothyroxine was performed. Results: Forty-eight percent of 374 survey respondents tested both aTPO and aTG at diagnosis of T1D, but 35% performed no baseline antibody testing. If antibodies were positive, 89% of the respondents would perform annual thyroid function testing, but if antibodies were negative, 62% would follow thyroid function annually and 29% biannually. Institutionally, aTPO had significantly greater sensitivity (p = 0.04) but lower specificity (p = 0.008) than aTG for predicting the use of levothyroxine. Conclusions: Variance exists among North American PES members regarding thyroid disease screening for pediatric patients diagnosed with T1D, and this appears to reflect differences between ADA and ISPAD guidelines. A prospective multicenter observational study which shares electronic medical record data and compares aTPO and TSH as primary screening tests may allow for more uniform guidelines and address the possibility of using TSH alone.

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Section: Introductionmentioning

confidence: 99%

Practice Variance in Thyroid Screening of Youth with Type 1 Diabetes Mellitus

2018

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“…Hypothyroidism may lead to recurrent attacks of hypoglycemia [8], growth retardation, increase body weight, dyslipidemia, and cardiovascular disorder in diabetic patients [9]. Hyperthyroidism affects the glucose metabolism and may worsen diabetic complications, leading to uncontrolled diabetes and increased susceptibility to diabetic ketoacidosis [10].…”

Section: Introductionmentioning

confidence: 99%

Thyroid Dysfunction and Morphological Abnormalities in Patients with Type 1 Diabetes Mellitus

Al-Din¹,

Mohamed²,

El-Sawy³

et al. 2015

AJIM

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Background: Type 1 diabetes mellitus is an autoimmune disease. Several studies have documented great variations in the prevalence of thyroid dysfunction and autoimmune thyroid disease (AITD) in type 1 diabetic patients. Undiagnosed thyroid dysfunction has negative impact on the metabolic control and will aggravate the cardiovascular disorders. Objectives: We aimed to investigate the presence of thyroid dysfunction and the associated morphological abnormalities in type 1 diabetes mellitus. Methods: 80 type 1 diabetic patients without overt thyroid disease attending the outpatient clinic of diabetes at Kasr Al Aini hospital, faculty of medicine, Cairo University were enrolled in the study. Thyroid functions (TSH, FT4, FT3), anti thyroid peroxidase (anti-TPO) and anti thyroglobulin (anti-TG) antibodies were measured in all patients. Thyroid ultrasound was performed in all patients and in 50 healthy control subjects. The data was analyzed and expressed in terms of mean ± SD. Pearson correlation was performed to establish the relationship between different variables. Results: 52 of 80 patients (65%) showed high TSH levels with mean (12.37±3.9 mIU/ml) and 25 patients (31.3%) showed positive anti-TG anti-TPO levels with mean (906 ± 184.3, 628 ±137.5 IU/ml) respectively. The high TSH levels were statistically significantly associated with high anti-TG levels and anti-TPO levels with (mean 570.23± 372.41, 366.52±281.34 IU/ml) respectively with P-value < 0.001. There was significant increase in the gland volume in diabetic patients with mean (3.4±1.5 ml) versus (2.9±0.9 ml) in the control group, P-value <0.046. Also 25% of patients showed heterogenous hypoechogenic gland texture versus 6 % in the control group which was statistically significantly different, P-value = 0.008 and 50% of the patients showed increase in gland vascularity versus 12% in the control group which was statistically significantly different with P-value <0.001. These morphological abnormalities were associated with high (TSH, anti-TPO and anti-TG) levels but weren't significant. High TSH levels were strongly positively correlated with anti-TPO and anti-TG, r = (0.84, 0.83) respectively, P-value <0.001. Conclusions: Type 1 diabetic patients had high incidence of thyroid dysfunction and AITD associated with morphological abnormalities of the thyroid gland. So we recommend screening for thyroid dysfunction in all patients with type 1 DM to avoid additional cardiovascular risk factors.

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“…In der Literatur wird ein Screening auf NNR-AAK (21-Hydroxylase-Antikörper) bei Patienten mit Diabetes mellitus Typ 1 vorgeschlagen [37,38]. Weder nach unseren Daten noch anderen vorliegenden Untersuchungen [36,[39][40][41] scheint ein generelles Screening bei Diabetes mellitus Typ 1 aufgrund der geringen Prävalenz < 2% sinnvoll, jedoch stellen Patienten, die zusätzlich eine Autoimmunthyreopathie aufweisen, eine Risikopopulation dar [42][43][44].…”

Section: Endokrine Autoimmunerkrankungenunclassified

Prävalenz eines polyglandulären Autoimmunsyndroms bei Patienten mit Diabetes mellitus Typ 1

et al. 2009

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In this study, more than half of the patients with diabetes mellitus type 1 had at least one pathologically increased antibody titer apart from diabetes without clinical sign of an additional AIEK. 31% of patients with increased antibodies presented with symptoms of another AIEK (increase by 3.6% within 1 year). Patients with diabetes mellitus type 1 should be screened for other AIEKs. Thyropathy had the greatest prevalence and increased by 3.5% within 1 year's time.

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Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes

Cited by 43 publications

References 15 publications

Practice Variance in Thyroid Screening of Youth with Type 1 Diabetes Mellitus

Practice Variance in Thyroid Screening of Youth with Type 1 Diabetes Mellitus

Thyroid Dysfunction and Morphological Abnormalities in Patients with Type 1 Diabetes Mellitus

Prävalenz eines polyglandulären Autoimmunsyndroms bei Patienten mit Diabetes mellitus Typ 1

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