Hashimoto's Thyroiditis and Insulin-Dependent Diabetes Mellitus: Differences among Individuals with and without Abnormal Thyroid Function

Abstract

Insulin-dependent diabetes mellitus probands from the Familial Autoimmune and Diabetes Study were evaluated for autoimmune thyroid disease (n = 265). The prevalence of Hashimoto's thyroiditis was 26.6%; 42.0% of these individuals were euthyroid, and 58.0% were hypothyroid. There was a female predominance among hypothyroid and euthyroid Hashimoto's cases compared to those with no thyroid disease (75% vs. 72.4% vs. 41.6%; P < 0.001). Insulin-dependent diabetes mellitus patients with hypothyroid Hashimoto's thyroiditis were more likely to report another autoimmune disease compared to euthyroid Hashimoto's patients or individuals with no thyroid disease (30.8% vs. 17.2% vs. 13.9%; P < 0.01). Sex-specific analysis revealed that this difference was significant for men but not for women. Both euthyroid and hypothyroid Hashimoto's cases were more likely to have a family history of the disease (66.7% vs. 69.2% vs. 47.7%; P < 0.05). No differences were observed in the prevalence of DQA1*0501-DQB1*0201 or DQA1*0301-DQB1*0302 across the three groups. Body mass index, lipid levels, glycemic control, and diabetes complications were also similar. However, euthyroid Hashimoto's women were more likely to report spontaneous abortions than those with hypothyroid Hashimoto's thyroiditis or no thyroid disease (23.8% vs. 61.5% vs. 29.1%; P < 0.05). These data suggest that gender-specific risk factors may be primary determinants of Hashimoto's thyroiditis and other autoimmune diseases among women. However, disease-specific determinants may also increase susceptibility to other autoimmune diseases.

Prevalência de doença tireoideana em pacientes com diabetes tipo 1

“…e McCanlies e cols. (26)(27)(28) encontraram prevalências bem maiores, inclusive de hipertireóideos.…”

Type I Diabetes and Multiple Sclerosis Patients Target Islet Plus Central Nervous System Autoantigens; Nonimmunized Nonobese Diabetic Mice Can Develop Autoimmune Encephalitis

“…Proinsulin (PI), IA2, GAD65 and 67, and islet cell autoantigen of 69 kDa (ICA69) are the major examples (11). These target self-Ags are not islet cell specific, and neither is diabetic autoimmunity; signs of celiac and thyroid autoimmunity are fairly common in patients (12,13), and diabetes-prone NOD mice develop signs of thyroid and Sjögren's disease (14). Occasional islet-reactive T cells are found in almost 10% of the general population (15), but Ͻ0.5% of these subjects are likely to develop overt diabetes.…”

Prevalência de auto-imunidade tireoidiana em um grupo de pacientes com diabetes mellitus tipo 1 em Londrina, PR

“…O achado de uma tendência à prevalência maior de auto-imunidade tireoidiana na faixa etária adulta (>18 anos), embora não tenha sido significante, concorda com os resultados da literatura (7). Lorini e cols.…”

“…Em um artigo de revisão sobre síndrome poliglandular auto-imune recentemente publicado, os autores relatam que cerca de 50% dos pacientes com DM1 que são positivos para anti-TPO evolui para hipotiroidismo dentro de 10 anos de acompanhamento (17). A freqüência de hipertireoidismo relatada na literatura é geralmente baixa, entre 0,5% e 9,3% (7,15), incidindo predominantemente em pacientes adultos, o que está de acordo com os resultados aqui encontrados (9,6%).…”