Kalicka-Kasperczyk Anna, Dziatkowiak Hanna, Bartnik-Mikuta Anna, Pituch-Noworolska Anna, Kasperczyk Krzysztof, Nazim Joanna, Sztefko Krystyna, Starzyk Jerzy
Klinika Endokrynologii Dzieci i Młodziezy Katedry Pediatrii, Polsko-Amerykańskiego Instytutu Pediatrii Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie Były Kierownik Kliniki Endokrynologii Dzieci i Młodziezy.
Przegl Lek. 2002;59(7):509-13.
The objective of the authors was to evaluate the prevalence of TPO Ab and thyroid diseases in children with newly diagnosed type 1 diabetes. The examination included 153 patients (85/55.6% girls) from southeast Poland aged 11 months to do 17.4 years (mean age 9.5 +/- 3.9 years). Apart from clinical assessment, all children had determinations made of serum TPO Ab, FT4 and TSH, while thyroid ultra sound was performed in each patients with abnormal thyroid morphology and/or positive TPO Ab titter. Positive TPO Ab was detected in 45 patients (29.4%). In this group 26 had isolated serum TPO Ab elevation, 18 had Hashimoto's disease, 1 Graves's disease. Another 12 children (7.8%) were demonstrated to have euthyroid goiter. Thyroid abnormalities were thus seen in 37.2% children with newly diagnosed type 1 diabetes. No association was demonstrated between the prevalence of thyroid abnormalities and sex. Children with subclinical stage of autoimmune thyreoiditis were significantly younger in comparison to patients with Hashimoto's disease (8.9 +/- 4.2 vs. 12.0 +/- 3.1 years) and had significantly lower serum TPO Ab and TSH levels (314.2 +/- 232.4 vs. 2076.8 +/- 1300.8 U/ml, 1.7 +/- 0.82 vs. 4.1 +/- 2.9 ulU/ml, respectively). Thyroid dysfunction was detected in 7 (4.6%) children with newly diagnosed type 1 diabetes. In comparison to the entire group with positive serum TPO Ab titer in these 7 children the percentage of patients with thyroid dysfunction was significantly higher (15.5%). Six patients were hypothyroid and 1 had hyperthyreosis. The present results justify the need for comprehensive screening for thyroid disorders in all children with newly diagnosed type 1 diabetes.
作者的目的是评估新诊断的1型糖尿病儿童中甲状腺过氧化物酶抗体(TPO Ab)和甲状腺疾病的患病率。该检查纳入了153名来自波兰东南部的患者(85名/55.6%为女孩),年龄在11个月至17.4岁之间(平均年龄9.5±3.9岁)。除临床评估外,所有儿童均测定了血清TPO Ab、游离甲状腺素(FT4)和促甲状腺激素(TSH),而对甲状腺形态异常和/或TPO Ab滴度呈阳性的每位患者均进行了甲状腺超声检查。45名患者(29.4%)检测到TPO Ab呈阳性。在该组中,26名患者血清TPO Ab单独升高,18名患有桥本氏病,1名患有格雷夫斯病。另有12名儿童(7.8%)被证实患有甲状腺肿但甲状腺功能正常。因此,在新诊断的1型糖尿病儿童中,37.2%的儿童存在甲状腺异常。未发现甲状腺异常患病率与性别之间存在关联。与患有桥本氏病的患者相比,处于自身免疫性甲状腺炎亚临床阶段的儿童明显更年幼(8.9±4.2岁对12.0±3.1岁),且血清TPO Ab和TSH水平明显更低(分别为314.2±232.4对2076.8±1300.8 U/ml,1.7±0.82对4.1±2.9 μlU/ml)。在新诊断的1型糖尿病儿童中,7名(4.6%)儿童检测到甲状腺功能障碍。与这7名血清TPO Ab滴度呈阳性的儿童组成的整个组相比,甲状腺功能障碍患者的百分比明显更高(15.5%)。6名患者为甲状腺功能减退,1名患有甲状腺功能亢进。目前的结果证明有必要对所有新诊断的1型糖尿病儿童进行甲状腺疾病的全面筛查。