Background: Globally approximately 8%1 of children have type 1 diabetes mellitus (TIDM) with an incidence of 24.5 in every 100 000 children (014 years)2. TIDM is an autoimmune condition causing the destruction of beta islet cells and is associated with other autoimmune conditions such as coeliac disease (10% of children with TIDM test are positive for TTG) and hypothyroidism (25% have thyroid autoantibodies). We would like to report a case series of patients presenting with all three conditions at diagnosis.
Case 1: A 9 years old girl presented with 3 months history of anxiety and polyuria, polydipsia for a few weeks. She had generalised abdominal tenderness, multiple scabbed skin lesions and was in diabetic ketoacidosis (DKA). Initial TSH 97.5 mU/l (normal range (NR) 0.35.0), fT4 1.3 (NR: 1222). In view of associated thyroid abnormalities with DKA, a repeat blood test was done and this showed a TSH 75.6 mU/l and fT4 of 3.8. Anti-thyroid peroxidase antibody was normal. Tissue Transglutaminase (TTG) >128 U/ml (NR: <7). She was heterozygous for HLA-DQA1*05:01/DQB1*02:01 and negative for HLA-DQ8 (HLA-DQB1*03:02) consistent with a diagnosis of coeliac disease.
Case 2: A 10 years old girl presented with a two week history of polyuria, polydipsia. She had high blood sugars with glycosuria. Diabetic workup screening blood tests show initial TSH 9.2, the repeat blood results a month later 63.3 (NR: 0.35.0). She was also found to have a TTG 170 U/ml and a family history of coeliac disease. Biopsy showed features of villous atrophy confirming coeliac disease.
Conclusion: Currently there is no literature available for all three conditions presenting at diagnosis. Is the increasing incidence of TIDM and autoimmune disorders precipitating the presentation of multiple autoimmune disorders at diagnosis? Furthermore, does the presentation of all three autoimmune conditions affect the diabetic control in these patients?
1. Tamayo T et al. 2014. Diabetes in Europe: an update. Diabetes Research and Clinical Practice. 103:2. 206217.
2. International Diabetes Federation. (Online). Available at: http://www.diabetes.org.uk/About_us/News_Landing_Page/UK-has-worlds-5th-highest-rate-of-Type-1-diabetes-in-children/List-of-countries-by-incidence-of-Type-1-diabetes-ages-0-to-14/. (Accessed on 24th March 2015).
3. Smyth DJ et al. 2008. Shared and Distinct Genetic Variants in Type 1 Diabetes and Coeliac Disease. New England Journal of Medicine. 359: 27672777
4. Roldán MB et al. 1999. Thyroid autoimmunity in children and adolescents with TIDM. Diabetes Nutrition and Metabolism. 12: 2731.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology