Severinski Srećko, Banac Srdan, Severinski Neda Smiljan, Ahel Vladimir, Cvijović Katarina
Pediatric Clinic, University Hospital Center "Rijeka", Rijeka, Croatia.
Coll Antropol. 2009 Mar;33(1):273-9.
The aim of the study was to evaluate the natural course and potential risk factors of autoimmune thyroiditis (AIT) and thyroid dysfunction, and their influences on growth and glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). The study comprised 148 subjects (age range 1-21 years; males 51%) with T1D. During the interval of 12 years serum levels of thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG) autoantibodies, thyroid-stimulating hormone (TSH) and tyroksine (T4), were screened annually. Height, weight, body mass index (BMI), glycosylated hemoglobin (HbA1c), insulin dose and the number of severe hypoglycemic episodes, were recorded every 3 months. The mean follow-up was 7 +/- 4.1 years. Prevalence of AIT in subjects with T1D was 15.5%. It was significantly higher in girls (21.9% vs. 9.3%; p = 0.03). The mean age at AIT onset was 11.5 +/- 5.2 years. The mean interval between negative and positive AIT screening was 2.5 +/- 2.3 years. Cumulative incidence of AIT after 6 years of T1D duration was significantly higher in girls (30% vs. 15%; p = 0.03). Prevalence of hypothyroidism was 8.1% with no significant differences in sex distribution. Prevalence of hypothyroidism among subjects with elevated serum thyroid antibodies was 52.2% with significant male preponderance (85.7% vs. 37.5%; p = 0.005). There were no subjects who developed hypothyroidism in absence of thyroid antibodies. Cumulative incidence of hypothyroidism after 3 years from the moment of thyroid antibodies appearance was 55% with significant male preponderance (85% vs. 40%; p = 0.005). The mean interval between T1D onset and hypothyroidism development was 3.3 +/- 2.5 years, and between thyroid antibodies appearance and hypothyreoidism development was 1.7 +/- 1.2 years. The mean age at hypothyroidism onset was 12.7 +/- 5.3 years. There were no differences in growth and metabolic control between patients with and without AIT. The results of the present study confirmed frequent occurrence of AIT and thyroid dysfunction in subjects with T1D. The number of newly diagnosed subjects with AIT reached the peak at the age of puberty. Girls were significantly more predisposed to AIT at any age while amongst subjects with elevated thyroid antibodies boys developed hypothyroidism more frequently. Annual screening of thyroid antibodies in all patients with T1D is recommended, while serum TSH level should be measured in patients with detected thyroid antibodies.
本研究旨在评估自身免疫性甲状腺炎（AIT）和甲状腺功能障碍的自然病程及潜在危险因素，以及它们对1型糖尿病（T1D）儿童和青少年生长发育及血糖控制的影响。该研究纳入了148例T1D患者（年龄范围1 - 21岁；男性占51%）。在12年的随访期间，每年检测血清甲状腺过氧化物酶（抗TPO）和甲状腺球蛋白（抗TG）自身抗体、促甲状腺激素（TSH）和酪氨酸（T4）水平。每3个月记录身高、体重、体重指数（BMI）、糖化血红蛋白（HbA1c）、胰岛素剂量及严重低血糖发作次数。平均随访时间为7±4.1年。T1D患者中AIT的患病率为15.5%。女孩患病率显著更高（21.9%对9.3%；p = 0.03）。AIT发病的平均年龄为11.5±5.2岁。AIT筛查从阴性转为阳性的平均间隔时间为2.5±2.3年。T1D病程6年后AIT的累积发病率在女孩中显著更高（30%对15%；p = 0.03）。甲状腺功能减退的患病率为8.1%，性别分布无显著差异。血清甲状腺抗体升高的患者中甲状腺功能减退的患病率为52.2%，男性占比显著更高（85.7%对37.5%；p = 0.005）。没有甲状腺抗体阴性而发生甲状腺功能减退的患者。甲状腺抗体出现后3年甲状腺功能减退的累积发病率为55%，男性占比显著更高（85%对40%；p = 0.005）。T1D发病至甲状腺功能减退发生的平均间隔时间为3.3±2.5年，甲状腺抗体出现至甲状腺功能减退发生的平均间隔时间为1.7±1.2年。甲状腺功能减退发病的平均年龄为12.7±5.3岁。有无AIT的患者在生长发育和代谢控制方面无差异。本研究结果证实T1D患者中AIT和甲状腺功能障碍频繁发生。新诊断的AIT患者数量在青春期达到峰值。女孩在任何年龄患AIT的易感性均显著更高，而在甲状腺抗体升高的患者中男孩发生甲状腺功能减退更为频繁。建议对所有T1D患者每年筛查甲状腺抗体，对检测到甲状腺抗体的患者应检测血清TSH水平。
