Endocrine Abstracts

: Autoimmune polyglandular syndrome (APS) type 3 – is a rare orphan disease, which is a combination of autoimmune thyroid disease and diabetes mellitus (DM) type 1 and/or pernicious anemia, vitiligo, alopecia. Due to the rare occurrence in pediatric patients we give our own observation of early manifestation of APS type 3 A in a girl 10 years. Complaints in the primary treatment: sweating, irritability, cardiopalmus, weight loss. Survey results: ultrasound examination of the thyroid gland: expressed diffuse changes, the increase in volume −22.0 cm³ (normal 2.74–6.76). Indicators: thyroid-stimulating hormone (TSH) 0.05 mkIE/ml (normal 0.27–4.2), free thyroxine (T4) >100.0 pmol/l (normal 12.0–22.0), free triiodothyronine (T3) 43.1 pmol/l (normal 3.1–6.8), TSH receptor antibodies 18.0 IU/l (normal 0–1.75). Ophthalmologist: ophthalmopathy low degree of both eyes. Primary diagnosis: Graves’ disease (GD), goiter grade 2, thyrotoxicosis of medium gravity, decompensation. Autoimmune ophthalmopathy. Starting treatment: tiamazol 20 mg/day; metoprolol 25 mg/day. 6 months later the patient was hospitalized with complaints during the month of thirst, frequent urination, weight loss of 4.5 kg, weakness. Survey results: blood glucose level 34.1 mmol/l. Acid-base balance: metabolic acidosis. Indicators: C-peptide 155.6 pmol/l (normal 160–1100), antibody titer to glutamic acid decarboxylase 93.2 U/ml (normal 0–1.0), glycated hemoglobin 9.5%. The metabolic compensation of thyrotoxicosis was observed on maintenance therapy (tiamazol 5 mg/day): T4 17.16 pmol/l, TSH <0.05 mkIE/ml. There was a volume reduction 16.2 cm³ on thyroid ultrasound. Final diagnosis: APS type 3 A: DM, type 1, decompensation. GD, medical euthyroidism. Autoimmune ophthalmopathy. Treatment: insulin therapy 22 U/day; tiamazol 5 mg/day. 2 months later a child was hospitalized due to worsening indicators of thyroid hormones and severe fluctuations in blood glucose on the treatment of human genetic engineering insulins. Survey results: thyroid ultrasound: negative dynamics – increase to 21.08 cm³. Indicators: TSH 0.009 mkIE/ml, T4 24.8 pmol/l, T3 10.06 pmol/l. Correction of therapy: increasing the dose of tiamazol to 20 mg/day and using insulin analogs. The simultaneous presence of two or more autoimmune diseases of the endocrine glands (thyroid and DM) aggravates the symptoms of each of them, leads to the decompensation of patients.