Endocrine Abstracts

Background and Aims: The concurrent presentation of Type 1 diabetes mellitus (T1DM) with other autoimmune disorders, notably autoimmune thyroiditis and celiac disease, has been substantiated in numerous studies. Established guidelines advocate for routine screenings for these disorders at the onset of T1DM diagnosis, followed by periodic evaluations — biennially for thyroid pathologies and every 2-5 years for celiac disease. This research endeavours to elucidate the prevalence of these autoimmune comorbidities in pediatric patients with T1DM receiving care at our Endocrinology and Diabetes Department.

Methods: We engaged in a meticulous retrospective analysis encompassing pediatric patients diagnosed with T1DM and monitored systematically for associated autoimmune pathologies within our facility. Thyroid anomalies were scrutinized through assessments of TSH, anti-thyroid peroxidase antibodies, and antithyroglobulin antibodies, supplemented by examinations for thyroid stimulating hormone receptor antibodies in instances of suppressed TSH to preclude Basedow-Graves disease. Meanwhile, the prevalence of celiac disease was determined through the measurement of anti-transglutaminase IgA antibodies alongside the total IgA level.

Results: The cohort incorporated 565 patients characterized by a median age of 7.3 ± 4 years at the time of T1DM diagnosis, with a slight male predominance (50.8%). A substantial fraction, 25.6%, manifested at least one additional autoimmune disorder, itemized as follows: autoimmune thyroid disease (20%), differentiated further into Hashimoto thyroiditis (19.2%) and Basedow-Graves Disease (0.8%); celiac disease (2.65%); and other autoimmune maladies, including psoriasis and megaloblastic anemia (0.7%). Moreover, a smaller segment encountered dual diagnoses: Hashimoto thyroiditis and celiac disease (2.1%), and a singular case exhibited coexistence of thyroiditis and psoriasis. Of those diagnosed with Hashimoto Disease, a noteworthy 27.6% necessitated substitution therapy with levothyroxine.

Conclusions: The data delineates a significant incidence of autoimmune comorbidities in pediatric patients with T1DM treated at our department, with one in four patients afflicted. The findings underscore the imperative of regular screenings to facilitate timely diagnosis and intervention, a practice integral in fostering the well-being and normative development of pediatric patients.