Thyroid Autoimmunity in Children and Adolescents With Type 1 Diabetes
A multicenter survey
- Olga Kordonouri, MD1,
- Albrecht Klinghammer, MD2,
- Egbert B. Lang, MD3,
- Annette Grüters-Kieslich, MD1,
- Matthias Grabert, PHD4,
- Reinhard W. Holl, MD5 and
- On behalf of the DPV-Initiative of the German Working Group for Pediatric Diabetology
- 1Clinic for General Pediatrics, Otto-Heubner Centrum, Charité, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany
- 2Klinikum Chemnitz GmbH, Children’s Hospital, Chemnitz, Germany
- 3St. Vincenz Hospital, Children’s Hospital, Coesfeld, Germany
- 4Department of Applied Information Technology, Ulm University, Ulm, Germany
- 5Department of Biomedical Engineering, Ulm University, Ulm, Germany
OBJECTIVE—To investigate thyroid autoimmunity in a very large nationwide cohort of children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Data were analyzed from 17,749 patients with type 1 diabetes aged 0.1–20 years who were treated in 118 pediatric diabetes centers in Germany and Austria. Antibodies to thyroglobulin (anti-TG) and thyroperoxidase (anti-TPO) were measured and documented at least once in 7,097 patients. A total of 49.5% of these patients were boys, the mean age was 12.4 years (range 0.3–20.0 years), and the mean duration of diabetes was 4.5 years (range 0.0–19.5 years). A titer exceeding 100 units/ml or 1:100 was considered significantly elevated.
RESULTS—In 1,530 patients, thyroid antibody levels were elevated on at least one occasion, whereas 5,567 were antibody-negative during the observation period. Patients with thyroid antibodies were significantly older (P < 0.001), had a longer duration of diabetes (P < 0.001), and developed diabetes later in life (P < 0.001) than those without antibodies. A total of 63% of patients with positive antibodies were girls, compared with 45% of patients without antibodies (P < 0.001). The prevalence of significant thyroid antibody titers increased with increasing age; the highest prevalence was in the 15- to 20-year age group (anti-TPO: 16.9%, P < 0.001; anti-TG: 12.8%, P < 0.001). Thyroid-stimulating hormone (TSH) levels were higher in patients with thyroid autoimmunity (3.34 μU/ml, range 0.0–615.0 μU/ml) than in control subjects (1.84 μU/ml, range 0.0–149.0 μU/ml) (P < 0.001). Even higher TSH levels were observed in patients with both anti-TPO and anti-TG (4.55 μU/ml, range 0.0–197.0 μU/ml).
CONCLUSIONS—Thyroid autoimmunity seems to be particularly common in girls with diabetes during the second decade of life and may be associated with elevated TSH levels, indicating subclinical hypothyroidism.
- anti-TG, thyroglobulin antibodies
- anti-TPO, thyroperoxidase antibodies
- TSH, thyroid-stimulating hormone
Address correspondence and reprint requests to Olga Kordonouri, MD, Klinik für Allgemeine Pädiatrie, Otto-Heubner-Centrum, Charité, CVK, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail:.
Received for publication 24 October 2001 and accepted in revised form 18 April 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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