Endocrine Abstracts

Introduction: LADA (Latent Autoimmune Diabetes in Adults), is defined by the association of diabetes after 30 years, the presence of antibodies against pancreatic beta cells and the non-use of insulin therapy within 6 months of diagnosis. Graves’ disease is the first cause of hyperthyroidism associating thyrotoxicosis, goiterand exophthalmos with a prevalence 5 times higher in women.

Case report: 37-year-old female patient with no notable history, labeled type 2 diabetes, put on oral antidiabetics with good clinical and biological evolution. One (1) year later faced with a glycaemic imbalance, weight loss amounting to 20 kg (Patient was overweight with BMI at 28 kg/m²) and signs of thyrotoxicosis without orbitopathy, a thyroid assessment was made (TSH<0.05 FT4= 1.92 FT3=7.15), TSH receptor antibodies were positive confirming the diagnosis of Graves’ disease. Faced with autoimmunity, weight loss and glycemic imbalance, a dosage of antibodies anti-GAD (glutamic acid decarboxylase) was done and came back positive, confirming the diagnosis of LADA in our patient for which she was put on insulin therapy with a good clinical and biological evolution.

Discussion: Epidemiological studies show that 10% of all subjects with diabetes have the characteristics of LADA. Screening with anti-GAD auto antibodies can identify with certainty. The frequency of thyroid autoimmunity in LADA varies in the literature between 20 et 30%. In the cases of patients without goiter or orbitopathy (like our patient), the dosage of TSH receptor antibodies (TRAb) or scintigraphy are useful to confirm the diagnosis of Graves’ disease. This work highlights the association of LADA and Graves’ disease suggesting an autoimmune polyendocrinopathy type 2.

Conclusion: In any patient with autoimmune disease, regular monitoring is indicated to detect the outbreak of a possible autoimmune polyendocrinopathy.References1. Hawa, M. and all. (2013). Adult-onset autoimmune diabetes in Europe is prevalent with a broad clinical phenotype: Action LADA 7. Diabetes Care, 36(4), 908–913.2. Joubert, M. (2019). DT1 lent, 1–4.