Aim: To investigate whether autoimmune thyroiditis (AIT) in children with type 1 diabetes mellitus (DM1) has any influence on glycemic control, lipid profile or thyroid volume.
Methods: A total of 330 patients with DM1 and AIT (DM1+AIT group) were compared with 309 children with DM1 without AIT (control group). Patients were treated in four Polish academic pediatric diabetes centers from 2008 to 2012: Warsaw, Lodz, Katowice and Gdansk. All patients underwent measurements of thyroid-stimulating hormone (TSH), free thyroxine, anti-thyroid peroxidase (anti-TPO) antibody, anti-thyroglobulin (anti-TG) antibody and HbA1c levels, and thyroid ultrasound examination.
Results: Among AIT+DM1 patients, 62% (n=205) were female, whereas in the control group 60.8% (n=188) were male (p<0.0001). Children with AIT+DM1 had lower a BMI-SDS (mean difference of –0.5, 95% CI –0.68 to –0.33; p<0.0001), had a higher SDS thyroid volume (0.27, 95% CI 0.03–0.51; p=0.014) and needed less insulin (–0.15, 95% CI –0.20 to –0.11 U/kg body weight per day; p<0.0001) in comparison with the control group. AIT patients had higher HbA1c levels (0.66, 95% CI 0.36%–0.96%, p<0.0001), lower HDL-cholesterol levels (–3.68, 95% CI –1.41 to –5.94 mg/dL, p=0.002) and higher triglyceride levels (7.16, 95% CI 1.22–13.10 mg/dL, p=0.02). Patients with positive anti-TPO and anti-TG antibodies were older (by 1.95 years, 95% CI 0.98–2.92 years, p=0.006) and had longer DM1 duration (by 1.64 years, 95% CI 0.76–2.52 years, p=0.006). Presence of anti-TPO antibodies was associated with higher TSH levels (odds ratio 2.34, 95% CI 1.36–4.04; p=0.007).
Conclusion: AIT accompanying DM1 is associated with worse glycemic control and lipid profile as well as a lower daily insulin requirement. The female gender is more likely to develop AIT and hypothyroidism.
Wojciech Fendler and Wojciech Mlynarski received funding from the TEAM programme of the Foundation for Polish Science, funded by the European Union.
1. Kordonouri O, Klinghammer A, Lang EB, Grüters-Kieslich A, Grabert M, et al. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care 2002;25:1346–50.10.2337/diacare.25.8.1346Search in Google Scholar PubMed
2. Lenzi L, Mirri S, Generoso M, Guasti M, Barni F, et al. Thyroid autoimmunity and type 1 diabetes in children and adolescents: screening data from Juvenile Diabetes Tuscany Regional Centre. Acta Biomed 2009;80:203–6.Search in Google Scholar
3. Mantovani RM, Mantovani LM, Dias VM. Thyroid autoimmunity in children and adolescents with type 1 diabetes: prevalence and risk factors. J Pediatr Endocrinol Metab 2007;20:669–75.10.1515/JPEM.2007.20.6.669Search in Google Scholar PubMed
4. Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F. The effect of subclinical hypothyroidism on metabolic control in children and adolescents with type 1 diabetes mellitus. Diabet Med 2002;19:70–3.10.1046/j.1464-5491.2002.00635.xSearch in Google Scholar PubMed
5. Hansen D, Bennedbaek FN, Høier-Madsen M, Hegedüs L, Jacobsen BB. A prospective study of thyroid function, morphology and autoimmunity in young patients with type 1 diabetes. Eur J Endocrinol 2003;148:245–51.10.1530/eje.0.1480245Search in Google Scholar PubMed
7. Holl RW, Bohm B, Loos U, Grabert M, Heinze E, et al. Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Effect of age, gender and HLA type. Horm Res 1999;52:113–8.Search in Google Scholar
8. Karges B, Muche R, Knerr I, Ertelt W, Wiesel T, et al. Levothyroxine in euthyroid autoimmune thyroiditis and type 1 diabetes: a randomized, controlled trial. J Clin Endocrinol Metab 2007;92:1647–52.10.1210/jc.2006-2493Search in Google Scholar PubMed
9. Severinski S, Banac S, Severinski NS, Ahel V, Cvijović K. Epidemiology and clinical characteristics of thyroid dysfunction in children and adolescents with type 1 diabetes. Coll Antropol 2009;33:273–9.Search in Google Scholar
10. Fröhlich-Reiterer EE, Hofer S, Kaspers S, Herbst A, Kordonouri O, et al. Screening frequency for celiac disease and autoimmune thyroiditis in children and adolescents with type 1 diabetes mellitus — date from German/Austrian multicentre survey. Pediatr Diabetes 2008;9:546–53.10.1111/j.1399-5448.2008.00435.xSearch in Google Scholar PubMed
11. Kakleas K, Paschali E, Kefalas N, Fotinou A, Kanariou M, et al. Factors for thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Ups J Med Sci 2009;114:214–20.10.3109/03009730903276381Search in Google Scholar PubMed PubMed Central
12. Kordonouri O, Hartmann R, Deiss D, Wilms M, Grüters-Kieslich A. Natural course of autoimmune thyroiditis in type 1 diabetes: association with gender, age, diabetes duration and puberty. Arch Dis Child 2005;90:411–4.10.1136/adc.2004.056424Search in Google Scholar PubMed PubMed Central
14. Piątkowska E, Szalecki M. Autoimmune thyroiditis in children and adolescents with type 1 diabetes. Pediatr Endocrinol Diabetes Metab 2011;17:173–7.Search in Google Scholar
15. Umpierrez GE, Latif KA, Murphy MB, Lambeth HC, Stentz F, et al. Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. Diabetes Care 2003;26:1181–5.10.2337/diacare.26.4.1181Search in Google Scholar PubMed
©2015 by De Gruyter