Background: Most of autoimmune disease such as type 1 diabetes (T1DM), autoimmune thyroiditis (AIT) and coeliac disease (CD) often coexist in the same patient. Although there are a lot of number of studies on autoimmunity against the thyroid glands and small bowel in patients with type 1 diabetes, little is known about pancreatic β-cell immunity in patients with AIT and CD.
Objective and hypotheses: We studied autoimmune markers in children patients with AIT, CD and T1DM and investigated interactions between three autoimmune diseases in the terms of sex based clinical and immunogenetic characteristics.
Method: Children (n=227) diagnosed with T1DM were screened for thyroid peroxidase autoantibodies (TPOAb) and thyroglobulin autoantibodies (TgAb), tissue transglutaminase autoantibodies (TTGAb) HLA DQ, HLADR alleles and children (n=148) diagnosed with autoimmune thyroiditis and patients with celiac (n: 112) were screened for glutamic acid decarboxylase antibodies (GADAb), islet cell antibodies (ICA), insulin antibodies (IA), TTGAb and HLA DQ, HLADR alleles.
Results: Of the 227 children (115 boys and 112 girls) with diabetes had at least one-islet cell antibodies, 55 had at least one-thyroid autoantibodies (TPOAb and TgAb). There were 52 who were positive for TTGAb, of whom had T1DM. There were thyroid antibodies in 21 of children with diabetes at onset of diabetes. HLA DRB1*03 allele was significantly higher than the others. In GAD Ab positive patients, the average of TPOAb level was higher than negative patients groups. Of the 148 children (110 girls and 38 boys) with autoimmune thyroiditis, 52 associated with diabetes, 14 had at TTGAb positive. Six patients with autoimmune thyroiditis had at least one-islet cell antibodies. Of the all girl with autoimmune thyroid disease (n=110), 28(25%) had patients with autoimmune thyroiditis associated diabetes. Of the 38 boys with autoimmune thyroiditis, 27(69.2%) had diabetes. HLA DQB1*03 and HLA DRB1*11 were higher than the others. There were three organ specific autoimmune antibodies positivity in 11 patients at the same time.
Conclusion: Most of autoimmune antibody positive patients coexist with additional autoimmune diseases. Children with autoimmune thyroid disease in particular male gender are prone to T1DM. We recommend to screen islet cell antibody in particularly GAD Ab in autoimmune thyroid disease and celiac disease.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology