ESPE2023 Poster Category 1 Thyroid (44 abstracts)
Comparison of clinical features, therapy, and disease evolution in a population of children and adolescents with Graves' disease and Type 1 Diabetes compared to Graves' disease alone.
Luca Bernardini 1 , Giulio Maltoni 2 , Maria Cristina Vigone 3 , Roberto Franceschi 4 , Giuliana Cardinale 5 , Chiara Mameli 6 , Alessia Piscopo 7 , Rosalia Roppolo 8 , Silvia Savastio 9 , Federica Ortolani 10 , Emioli Randazzo 11 , Anna Giulia Lambertini 12 & Alessandra Cassio 2,13
1Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy. 2Pediatric Unit, IRCCS AOU di Bologna, Bologna, Italy. 3Department of Paediatrics, IRCCS Ospedale San Raffaele, Milan, Italy. 4Pediatric Diabetology Unit, Pediatric Department S. Chiara General Hospital of Trento, APSS, Trento, Italy. 5Unit of Pediatrics, "Sacro Cuore di Gesu" Hospital, Gallipoli, Italy. 6Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy. 7Regional Centre of Paediatric Diabetology "G. Stoppoloni", Department of Woman, Child and of General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy. 8Regional Center for Pediatric Diabetology, Children Hospital, Palermo, Italy. 9Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy. 10Metabolic Disease and Genetics Unit, Giovanni XXIII Children's Hospital, AOU Policlinico di Bari, Bari, Italy. 11Unit of Pediatric Endocrinology and Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 12Arcispedale S. Anna, Ferrara, Italy. 13University of Bologna, Bologna, Italy
Introduction: About 25% of children and adolescents with Type 1 Diabetes (T1D) have one or more associated autoimmune conditions. Although Graves' disease (GD) rarely occurs, considering the potential severity of manifestations, an early diagnosis and appropriate treatment are essential. The first line treatment is methimazole, whose use is not free from side effects; therefore, it is important to start with the most appropriate dosage.
Patients and Methods: We report preliminary data from a multicenter, retrospective, observational study of patients aged 0-18 years with a diagnosis of T1D and GD (group A, 19 patients) compared to patients with GD alone (group B, 27 patients). The aim is to evaluate differences in methimazole dose, at diagnosis and after 30 days (T1), necessary to restore normal thyroid function and to assess clinical features and developmental course of the disease.
Results: Overall, mean age at presentation of GD was 10,9±3,7 years, with a prevalence of female in group B (81% versus 63%). In 5 cases, GD was diagnosed at the onset of T1D or in the first months. Symptoms of hyperthyroidism occurred 63% in group A and 81% in B. Tachycardia/palpitations were the most common symptoms (26% in group A and 59% in B, P<0,03), followed by weight loss (26% in both groups), fatigue, diarrhea/gastrointestinal symptoms and mood disorders. Goiter occurred in 5% of group A and 15% of group B. TSH at diagnosis was 0,03±0,06 mU/L in A and 0,02±0,01 mU/L in B, fT3 was higher in B (16,1±7,3 pg/ml versus 10,5±7,6 pg/ml, P<0,05), fT4 (38,8±20,6 versus 30,1±14,9, NS). Methimazole attack dose was lower in group A (0,31±0,15) versus B (0,43±0,17) (P=0,02). At first control (30 days±16), TSH was still suppressed in B (0,01±0,01), while it was improved in group A (1,98±4,53). Moreover, the methimazole dose at T1 was lower in group A (0,24±0,13) versus B (0,24±0,13) (P<0,05). Notably, recurrence rates were higher in A (37% versus 26%), with increased recourse to thyroidectomy (16% versus 7%). Conclusions: in subjects with T1D and GD, a lower dose of methimazole at attack and at T1 was needed to normalize TSH value. Cardiological symptoms and fT3 values at diagnosis were higher in group A. A higher recurrence rate, with a greater need for surgery, was found in group B.
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