Thyroid autoimmunity in adults with diabetes mellitus type 1. Own experience gained by 11-year monitoring

Česká verzia

Authors: K. Vondra; J. Vrbíková; I. Šterzl
Authors place of work: Endokrinologický ústav, Praha, ředitel doc. MUDr. Vojtěch Hainer, CSc.
Published in the journal: Vnitř Lék 2006; 52(10): 864-872
Category: Original Contributions

Summary

Results of 11-year study presenting prevalence of thyroid autoimmunity and clinical importance of this disorder in 47 adults with diabetes mellitus (DM) type 1. The study proves that females become inflicted with this disease more often as antibodies to thyroid hormones (T-Ab) were statistically found more frequent in females than in males (68 % vs 32 %, p < 0,05). Women had become inflicted with serious forms of thyroid autoimmunity (45 % vs 12 % in men, p < 0,01) as shown by persistance of both tested T-Ab, faster development of subclinical hypothyroidism (TSH > 4,5 mIU/l in 100 % within 4 years after the first manifestation of T-Ab or within 8 years after DM diagnosis, respectively) and diffused hypoechogen picture by ultrasound diagnostics (USG). Also, small thyroid gland was found in these patients (in 77% in the 11th year volume < 25 percentil control) and thyreopathy in family history of first degree.Isolated persistant antibodies to thyroid peroxidasis were evidenced in females and males without significant difference (23 % female, 20 % male), clinical symptoms were milder in these patients (first manifestation TSH > 4,5 mIU/l not early than in the 9th year). Typical for these patients was various USG picture showing focal/difuse hypoecho/non-homogen thyroid gland, and in 50% with volume > 95 percentil control in the 11th year. The group without proven thyroid autoimmunity was represented mainly by males (68 % vs 32 % female, p < 0,01) and the USG picture of thyroid gland in the 11th year was patological in high percentage (volume > 95 % percentil control more than in 60 %, tending to create nodules). The level of THS by all patients except one was not > 4,5 mIU/l. The presented results found in Czech adult population lead us to the recommendation to test thyroid autoimmunity markers by patients with diabetes mellitus type 1 regularly. The most significant diagnostic method, according to our experience as well as studies, is USG, proving symptoms of autoimmunity in a high number of patients even before the first positive T-Ab do manifest. In practical point of view, TSH at least once a year has to be tested, in female patients with diabetes mellitus in fertility period also antibodies to thyroid peroxidasis. In case these laboratory indicators are positive, USG should be done.

Key words:
diabetes mellitus type 1 – thyroid autoimmunity – antibodies to thyroid hormones – autoimmune thyroid inflammation – thyroid function – sonographic thyroid scan

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