Thyroid Dysfunction in Patients With Type 1 Diabetes

Umpiérrez, Guillermo E.; Latif, Kashif; Murphy, Mary Beth; Lambeth, Helen; Stentz, Frankie B.; Bush, Andrew; Kitabchi, Abbas E.

doi:10.2337/diacare.26.4.1181

Cited by 175 publications

(166 citation statements)

References 28 publications

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“…In our study there was no difference between HbA 1c levels in the group with and without autoantibodies. The results are in accordance with reports from the literature, which also do not reveal this association [17,18,21]. One of the reasons for the lack of the differences might be the presence of good metabolic control in the phase when only autoantibodies are detected and thyroid function deterioration is not yet observed.…”

Section: Discussionsupporting

confidence: 82%

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Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

et al. 2015

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Background. Type 1 diabetes (DM 1) is frequently associated with autoimmune thyroid diseases (AITD). Screening for AITD in adults is rarely performed. The aim of this study was to evaluate the prevalence of anti-thyroid peroxidase (anti-TPO) and thyroid function and their association with metabolic control in adults participating in Poznan Prospective Study (PoProStu). Material and Methods. The analysis included 74 patients (26 women and 48 men) aged 38.5 (IQR: 34.5-42.5), who have had diabetes for 15.0 (14-16) years. All patients have been treated with intensive functional insulin therapy (IFIT) from the onset of the disease. Anti-TPO and thyroid-stimulating hormone (TSH) were determined. The concentration of anti-TPO ≥ 5.61 IU/mL was considered positive. Based on the levels of anti-TPO the patients were divided into two groups: anti-TPO positive and anti-TPO negative. Metabolic control was assessed by the level of glycated hemoglobin (HbA 1c ). Results. Anti-TPO was positive in 32 (43.2%) patients. Prevalence of autoantibodies was significantly higher in women (53% vs 21%; p = 0.009). There was no significant difference in HbA 1c levels [median (IQR): 7.6% (7.1-8.6) vs 7.6% (7.1-8.8); p = 0.82] and TSH levels [median (IQR): 2.05 µIU/mL (1.23-3.15) vs 1.62 µIU/mL (1.00-2.10); p = 0.06] between anti-TPO positive and negative patients. After excluding patients with a thyroid dysfunction, a significant difference in TSH levels between anti-TPO positive and negative group was found [median (IQR): 2.11 µIU/mL (1.29-3.31) vs 1.66 µIU/mL (1.29-3.31); p = 0.04]. Conclusions. High anti-TPO prevalence is found in adult patients with long-standing DM 1, and autoantibodies occur more often in women. Therefore, screening for asymptomatic thyroid dysfunction should be performed in this group, as already recommended by the joint statement of Polish Society of Endocrinology and Diabetes Poland (Adv Clin Exp Med 2015, 24, 1, 79-84).

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Section: Discussionsupporting

confidence: 82%

“…The positive correlation between the duration of diabetes and the presence of anti-TPO has been described by Kakleas K. and Umpierrez GE. [17,18]. Higher prevalence of anti-TPO presented in our study might result from a longer mean diabetes duration.…”

Section: Fig 1 Prevalence Of Anti-tpo According To Tsh After Excludmentioning

confidence: 78%

Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

et al. 2015

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“…This correlates with reports involving adults wherein women with type 1 diabetes are more prone to autoimmune thyroiditis than men [34].…”

Section: Discussionsupporting

confidence: 79%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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Aims/hypothesis The aim of this work was to investigate, in children newly diagnosed with type 1 diabetes: (1) the prevalence of autoantibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TGAb); and (2) the association between TPOAb, TGAb or both, with either islet autoantibodies or HLA-DQ genes. Methods Blood samples from 2,433 children newly diagnosed with type 1 diabetes were analysed for TPOAb and TGAb in addition to autoantibodies against arginine zinc transporter 8 (ZnT8RA), tryptophan zinc transporter 8 (ZnT8WA), glutamine zinc transporter 8 (ZnT8QA), glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma-associated protein-2 (IA-2A), HLA-DQA-B1 genotypes, thyroid-stimulating hormone (TSH) and free thyroxine (T4). Results At type 1 diabetes diagnosis, 12% of the children had thyroid autoantibodies (60% were girls; p<0.0001). GADA was positively associated with TPOAb (p<0.001) and with TGAb (p<0.001). In addition, ZnT8A was associated with both TPOAb (p=0.039) and TGAb (p=0.015). DQB1*05:01 in any genotype was negatively associated with TPOAb (OR 0.55, 95% CI 0.37, 0.83, p value corrected for multiple comparisons (p c )=0.012) and possibly with TGAb (OR 0.55, 95% CI 0.35, 0.87, p c =0.07). Thyroid autoimmunity in children newly diagnosed with type 1 diabetes was rarely (0.45%) associated with onset of clinical thyroid disease based on TSH and free T4. Conclusions/interpretation GADA and ZnT8A increased the risk for thyroid autoimmunity at the time of clinical diagnosis of type 1 diabetes, while HLA-DQB1*05:01 reduced the risk. However, the associations between thyroid autoimmunity and HLA-DQ genotype were weak and did not fully explain the co-occurrence of islet and thyroid autoimmunity.

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“…Both conditions frequently coexist and up to one-third of patients with T1DM develop thyroid dysfunction during long-term follow-up (1). AITD is characterised by the presence of circulating antibodies to thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) (2).…”

Section: Introductionmentioning

confidence: 99%

Restricted thyroglobulin antibody epitope specificities in subjects with type 1 diabetes mellitus

Okosieme¹,

Wijeyaratne²,

Lazarus³

et al. 2009

European Journal of Endocrinology

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Objectives: Following iodisation in Sri Lanka we observed a high prevalence of thyroglobulin antibodies (TgAbs) in type 1 diabetic (T1DM) patients. The clinical significance of these TgAbs is uncertain. We sought to obtain a detailed epitope analysis of TgAbs in T1DM patients recruited from diabetes clinics and to compare these with TgAb epitope specificities in patients with autoimmune thyroid disease (AITD) and healthy individuals in that country. Design and methods: We used a panel of 10 Tg-MAbs in competitive ELISA reactions in a prospective study of subjects recruited from Colombo, to determine the epitopes recognised by TgAb-positive patients with T1DM (nZ58, 34F:24M, median age 16 years), AITD patients (nZ42, 33F:9M, median age 37 years) and healthy subjects (nZ50, 39F:11M, median age 27 years). The outcomes were a comparison of reactivity with six Tg clusters (I-VI) in these subjects, and the relation of epitope specificity patterns with free thyroxine and TSH. Results: Patients with T1DM and AITD but not healthy control subjects preferentially recognised the immunodominant clusters, I, III and IV. Patients with these narrow epitope specificities had higher median TSH levels (1.60 vs 1.06; PZ0.01), and were more frequently positive for antibodies to thyroid peroxidase than those with broad specificities (52.3 vs 7.1%; PZ0.004). Conclusions: The TgAb epitope specificities in euthyroid Sri Lankans with T1DM are similar to AITD patients. TgAb epitope studies may potentially identify T1DM patients at risk of thyroid dysfunction.

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Thyroid Dysfunction in Patients With Type 1 Diabetes

Cited by 175 publications

References 28 publications

Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

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

Restricted thyroglobulin antibody epitope specificities in subjects with type 1 diabetes mellitus

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