ESPE Abstracts

Introduction: Type 1 Diabetes(T1) and autoimmune thyroid disease(AITD) can occur concomitantly. Multiple sclerosis(MS), a chronic condition resulting from dysfunction of the immune system, may co-occur with T1D.

Aim: We present a 17-year-old boy presented with AITD at 10y old and within seven years developed T1D and MS.

Subjects and methods: The patient presented at the age of 10y old with Hashimoto’s thyroiditis. Four years later, while on T4, he was admitted to hospital with diabetic ketoacidosis(DKA), treated according to DKA protocol and then with insulin(MDI) injections to date. Three months later he was readmitted with sudden onset of weakness, hypaesthesia, numbness of upper and lower extremities, blurred vision of 24 hours and tinnitus of 10 days. Normal reflexes, left-sided hypaesthesia, right-sided horizontal nystagmus were noted and treated with steroids. He relapsed three months later with gradual recurrence of MS symptoms-blurred vision of the right eye, hypaesthesia of the left side of the chest. He was treated with steroids and subsequently with interferon beta-1a. He has been well since with occasional short periods of recurrence of weakness. His glycaemic control is good, while on T4 and interferon. He recently had positive antinuclear(ANA) antibodies and is now being investigated for rheumatic disease. His eldest brother also presented with MS symptoms without progressing to overt disease. His mother and maternal grandmother suffer from Hashimoto thyroiditis.

Results: Initial TSH was 8.5(NR 0.3-4.0mU/L), FT4 16.0(NR 10.0-25.0pmol/L), anti-TPO 1262.6(NR 0-100IU/ml), anti-TG 811(NR 0-100U/ml).initial HbA1c was 13.1%(NR 4-6%). IA2 antibodies were 459IU/ml(<30 negative), anti-GAD 88.9u/ml(<10 negative), antiZnT8A 64.8(<15RU/ml negative). HLA haplotype was DRB1*04,*07DQB1*02,*03(HLA-DQ2, DQ8). ANA antibodies are positive (1/160), ACE activity 165.00 (NR 13.3-63.9 U/L). Ultrasound of the thyroid gland showed a heterogeneous, hypoechoic parenchymal echo pattern, decreased echogenicity of the lobes, presence of echogenic septa due to Hashimoto's thyroiditis. Brain MRI findings were in favour of MS demyelinating disease, showing focal areas of high signal in the T2/Flair sequences in the white matter of the right upper ventricle, gliosis elements, smaller foci of high signal in the posterior parietal region on the left and occipital right region and cervical spinal cord.

Conclusions: Concomitant auto-immune disease can complicate diabetes management and has various clinical presentations. The pathomechanism behind the co-occurrence of T1D and MS is unclear; the underlying mechanisms may involve genetic and environmental causes.T1D-MS male patients have a higher rate of thyroid-specific antibodies. Further research is needed.