Thyroid and Islet Autoantibodies Predict Autoimmune Thyroid Disease at Type 1 Diabetes Diagnosis

Context:Screening of autoimmune thyroid disease in children with type 1 diabetes is important but varies between clinics.Objective:To determine the predictive value of thyroid autoantibodies, thyroid function, islet autoantibodies, and HLA-DQ at diagnosis of type 1 diabetes for autoimmune thyroid di...

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Published in:The journal of clinical endocrinology and metabolism Vol. 102; no. 4; pp. 1277 - 1285
Main Authors: Jonsdottir, Berglind, Larsson, Christer, Carlsson, Annelie, Forsander, Gun, Ivarsson, Sten Anders, Lernmark, Åke, Ludvigsson, Johnny, Marcus, Claude, Samuelsson, Ulf, Örtqvist, Eva, Larsson, Helena Elding
Format: Journal Article
Language:English
Published: Washington, DC Endocrine Society 01.04.2017
Copyright Oxford University Press
Oxford University Press
Subjects:
Adolescent
Autoantibodies
Autoantibodies - blood
Autoimmune Diseases - blood
Autoimmune Diseases - diagnosis
Autoimmune Diseases - immunology
Child
Child, Preschool
Children
Clinical s
Diabetes
Diabetes mellitus
Diabetes mellitus (insulin dependent)
Diabetes Mellitus, Type 1 - blood
Diabetes Mellitus, Type 1 - diagnosis
Diabetes Mellitus, Type 1 - immunology
Diagnosis
DQA1 protein
Endocrinology
Female
Genotypes
Glutamate decarboxylase
Glutamic acid
Health risk assessment
Histocompatibility antigen HLA
Humans
Insulin
Insulin - immunology
Insulinoma
Iodide peroxidase
Iodide Peroxidase - immunology
Islets of Langerhans - immunology
Male
Neuroendocrine tumors
Patients
Pediatrics
Peroxidase
Protein transport
Sex ratio
Thyroglobulin
Thyroglobulin - immunology
Thyroid
Thyroid diseases
Thyroid Diseases - blood
Thyroid Diseases - diagnosis
Thyroid Diseases - immunology
Thyroid-stimulating hormone
Thyroxine
Thyroxine - therapeutic use
Zinc transporter
ISSN:0021-972X, 1945-7197, 1945-7197
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Summary:Context:Screening of autoimmune thyroid disease in children with type 1 diabetes is important but varies between clinics.Objective:To determine the predictive value of thyroid autoantibodies, thyroid function, islet autoantibodies, and HLA-DQ at diagnosis of type 1 diabetes for autoimmune thyroid disease during follow-up.Setting:Forty-three Swedish pediatric endocrinology units.Design, Patients, and Main Outcome Measures:At diagnosis of type 1 diabetes, autoantibodies against thyroid peroxidase (TPOAb), thyroglobulin (TGAb), glutamic acid decarboxylase (GADA), insulin, insulinoma-associated protein-2, and 3 variants of zinc transporter 8 (ZnT8W/R/QA) HLA-DQA1-B1 genotypes and thyroid function were analyzed in 2433 children. After 5.1 to 9.5 years, information on thyroxine treatment was gathered from the Swedish National Board of Health and Welfare’s Prescribed Drug Register.Results:Thyroxine was prescribed to 6% of patients. In patients <5 years of age, female sex [hazard ratio (HR) = 4.60; P = 0.008] and GADA (HR = 5.80; P = 0.02) were predictors. In patients 5 to 10 years old, TPOAb (HR = 20.56; P < 0.0001), TGAb (HR = 3.40; P = 0.006), and thyroid-stimulating hormone (TSH) (HR = 3.64; P < 0.001) were predictors, whereas in 10 to 15 year olds, TPOAb (HR = 17.00; P < 0.001) and TSH (HR = 4.11; P < 0.001) predicted thyroxine prescription.Conclusion:In addition to TPOAb and TSH, GADA at diagnosis of type 1 diabetes is important for the prediction of autoimmune thyroid disease in children <5 years of age.We studied whether markers at type 1 diabetes diagnosis were predictive of later autoimmune thyroid disease. We found that TPOAb and TSH as well as GADA were predictive in girls ˂5 years old at diagnosis.
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Members of the Better Diabetes Diagnosis study group are listed in the Appendix.
ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/jc.2016-2335