Kochummen Elna, Marwa Albara, Umpaichitra Vatcharapan, Perez-Colon Sheila, Chin Vivian L
Division of Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA.
Department of Pediatrics, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA.
J Pediatr Endocrinol Metab. 2018 Aug 28;31(8):879-885. doi: 10.1515/jpem-2017-0254.
Hashimoto's thyroiditis (HT) and celiac disease (CD) are commonly associated with type 1 diabetes (T1DM). There is no consensus on screening, however, the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend testing for thyroid function (TFT), thyroid antibodies and anti-tissue transglutaminase antibodies (TTG) IgA soon after diagnosis. TFT should be repeated every 1-2 years while TTG IgA should be tested for within 2 and 5 years. We hypothesize that the rate of HT and CD in our T1DM children is lower, so screening may need to be revised to reflect their underlying risk.
An Institutional Review Board (IRB)-approved retrospective chart review was conducted on children with T1DM in the past 10 years. Age, sex, race, A1C, TFT, thyroid and celiac antibodies were obtained. t-Tests, the Wilcoxon-Mann-Whitney test and stepwise regression were performed.
Of 222 children with T1DM, with a mean age of 15.8±5.53 years, followed for 6.1±4.0 years, 53% female, mean A1C 11.1±1.9% and 87% African American (AA). Three had Graves' disease (1.3%), three had HT (1.3%) and 97% were euthyroid. TFT were assessed on average every 1.3 years and thyroid antibodies every 2.5 years. Positive thyroid antibody was found in 11%, negative in 57% and unknown in 32%. The positive antibody group had higher mean A1C and TSH. No biopsy confirmed cases of CD (0%) were found when screened every 2.3 years.
The number of individuals who screened positive for hypothyroid HT and CD was lower than expected in our population. Further studies are needed to assess the optimal screening frequency for HT and CD in minority children with T1DM.
桥本甲状腺炎（HT）和乳糜泻（CD）通常与1型糖尿病（T1DM）相关。然而，关于筛查尚无共识，不过美国糖尿病协会（ADA）和国际儿童及青少年糖尿病学会（ISPAD）建议在诊断后不久检测甲状腺功能（TFT）、甲状腺抗体和抗组织转谷氨酰胺酶抗体（TTG）IgA。TFT应每1 - 2年复查一次，而TTG IgA应在2至5年内检测。我们推测我们的T1DM儿童中HT和CD的发生率较低，因此可能需要修订筛查方案以反映其潜在风险。
对过去10年中患有T1DM的儿童进行了一项经机构审查委员会（IRB）批准的回顾性病历审查。获取了年龄、性别、种族、糖化血红蛋白（A1C）、TFT、甲状腺和乳糜泻抗体等信息。进行了t检验、威尔科克森 - 曼 - 惠特尼检验和逐步回归分析。
在222例T1DM儿童中，平均年龄为15.8±5.53岁，随访6.1±4.0年，53%为女性，平均A1C为11.1±1.9%，87%为非裔美国人（AA）。3例患有格雷夫斯病（1.3%），3例患有HT（1.3%），97%甲状腺功能正常。TFT平均每1.3年评估一次，甲状腺抗体每2.5年评估一次。甲状腺抗体阳性者占11%，阴性者占57%，未知者占32%。抗体阳性组的平均A1C和促甲状腺激素（TSH）较高。每2.3年进行筛查时，未发现经活检确诊的CD病例（0%）。
在我们的人群中，甲状腺功能减退性HT和CD筛查呈阳性的个体数量低于预期。需要进一步研究以评估T1DM少数族裔儿童中HT和CD的最佳筛查频率。
