Background: Screening for autoimmune thyroid disease in children and adolescents with type 1 diabetes lacks consensus. Optimal screening methods should benefit the patients and reduce costs to healthcare.
Objective and hypotheses: To, at diagnosis of type 1 diabetes, determine the predictive value of thyroid autoantibodies, thyroid function, islet autoantibodies, and HLA-DQ for autoimmune thyroid disease.
Method: At diagnosis of type 1 diabetes, children (n=2433) were analysed for autoantibodies against thyroid peroxidase (TPOAb), thyroglobulin (TGAb), glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma-associated protein-2 (IA-2A), and the three variants of the zinc transporter 8 (ZnT8A) as well as HLA-DQA1-B1 genotypes and thyroid function. After 5.19.5 years disease duration children treated with thyroxine were identified in the Swedish National Board of Health and Welfare Prescribed Drug Register.
Results: Thyroxine had been prescribed to 6% (147/2433; 66% girls). In patients below 5 years, female gender (HR=4.60 CI: 1.5014.45, P=0.008) and GADA (HR=5.80, CI: 1.3225.4, P=0.02) were significant predictors. In patients 510 years, TPOAb (HR=20.56, CI: 8.4050.35, P<0.0001), TGAb (HR=3.40, CI: 1.428.13, P=0.006) and thyrotropin outside the reference limit (HR=3.64, CI: 1.727.69, P<0.001) were predictors while in the 1015 year olds, TPOAb (HR=17.00, CI: 8.4034.44, P<0.001) and thyrotropin outside the reference limit (HR=4.11, CI: 2.417.03, P<0.001) predicted future thyroxine prescription.
Conclusion: In this large nationwide study we found that TPOAb and thyrotropin in addition to GADA in the very young, analyzed at diagnosis of type 1 diabetes, were predictive of autoimmune thyroid disease. Since hypothyroidism in children and adolescents is important to recognize, we suggest that all children below 18 years of age would benefit to be tested for those parameters at clinical diagnosis of type 1 diabetes, and thereby optimize individualized screening during follow-up.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology