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Constantin IONESCU-TIRGOVISTE

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Articles signed on MÆDICA, JCM:

The Autoimmunity’s Footprint in Pediatrics: Type 1 Diabetes, Coeliac Disease, Thyroiditis

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MÆDICA - a Journal of Clinical Medicine | Vol. 12, nr. 2, 2017
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The Autoimmunity’s Footprint in Pediatrics: Type 1 Diabetes, Coeliac Disease, Thyroiditis

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ABSTRACT

Pediatric autoimmune diseases are generally rare and when they occur, they might represent a diagnosis and treatment challenge. Many pediatric systemic autoimmune diseases are different from adults’ diseases, thus turning into a special problem for the physicians and researchers attending the children affected by these diseases. The most frequent autoimmune diseases of children and teenagers are represented by type 1 diabetes mellitus, thyroid disease and coeliac disease. Type 1 diabetes mellitus is the most frequent chronic endocrine-metabolic disease of the child, affecting each race and nationality; its incidence is increasing annually, acquiring a “pandemic” character. Coeliac disease appears more frequently in patients with diabetes mellitus rather than in general population (9% versus 2%) and in 10% of all thyroiditis cases there is an association with type 1 diabetes comparing to 6% on the general population. The family members of children with diabetes are also susceptible of presenting manifestations of certain autoimmune diseases comparing to the general population.
We shall present three cases of patients diagnosed with type 1 diabetes mellitus from an early age, with their disease becoming associated with coeliac disease, thyroiditis and even vitiligo over time. It should be mentioned that in one case, the same autoimmune manifestations were also identified in the father.

Keywords: children, type 1 diabetes, autoimmunity, coeliac disease, thyroiditis

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Type 1 Diabetes and Thyroid Autoimmunity in Children

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MÆDICA - a Journal of Clinical Medicine | Vol. 11, nr. 4, 2016 CNCSIS - CMR - B+ OBBCSSR

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Type 1 Diabetes and Thyroid Autoimmunity in Children

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ABSTRACT

Introduction: Autoimmune thyroid disease and type 1 diabetes (T1DM) are two autoimmune diseases frequently associated, especially in pediatric population.
Aims: we wanted to determine and ilustrate the relationship between type 1 diabetes and autoimmune thyroiditis and also the factors than can influence it, like gender, age, diabetes duration. Glycemic control was also evaluated for all the patients.
Materials and methods: There were studied 256 patients, children and adolescents with T1DM (male/female: 145/115; 55%/45%). Anti-TPO antibodies were detected using the electrohemiluminescence method and glycosylated haemoglobin A1c (HbA1c) was measured through a imunoturbidimetric method. The patients were clinically examined, including thyroid gland palpation, blood pressure measurement and assessment of their pubertal status and growth.
Results: Age distribution at the time of T1DM diagnosis: most of them, 26% were diagnosed between 6 and 9 years, 23% between 1-3 years, 21% between 3-6 years, 19% between 9-12 years, 9% between 12-15 years, and very few of them (2%) were diagnosed between 15 and 18 years. Among these patients, 47/256 (18.3 %) were positive for thyroid antibodies (anti - TPO). In 2 of 47 patients tests for anti TPO antibodies were positive at the time of T1DM diagnosis. Tests for anti – TPO antibodies became positive with an average of 5.09±3.84 ( range 0-13) years after the diagnosis of T1DM. At the time that anti – thyroid antibodies were first seen to be positive all patients were euthyroid with a mean age of 11.3 years (range 4 -16) and a mean diabetes duration of 5.21±3.57 (range 0-9 years). After 5±3.3 years (range 0- 9 years) a progression towards subclinical hypothyroidism due to Hashimoto thyroiditis was observed in 41 from 47 patients (87.2%), while no patient developed clinical hypoythyroidism.
It was observed an 9.2 % ±1.5% mean value of HbA1c in patients with thyroiditis comparative with 7.9 % ± 0.7 % mean HbA1c value in those without thyroiditis.
Conclusions: Thyroid autoimmunity is frequently present among T1DM patients, can be associated with increased age, female gender, long diabetes duration, and can inbalance the glycemic control of T1DM patients.
Keywords: Children, type 1 diabetes, autoimmune thyroiditis, thyroid autoantibodies

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