Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece.
Medical School, National and Kapodistrian University of Athens, Athens, Greece.
J Med Case Rep. 2022 Aug 3;16(1):297. doi: 10.1186/s13256-022-03523-3.
Latent autoimmune diabetes in adults is an infrequent form of autoimmune diabetes mellitus, while Hashimoto's thyroiditis, the most common thyroid disease in adults, rarely manifests as thyrotoxicosis. The concurrent initial presentation of these two autoimmune disorders is extremely rare.
A 29-year-old male of Albanian descent presented after being hospitalized owing to diabetic ketoacidosis. The diagnosis of type 1 diabetes mellitus was placed, and intensified insulin therapy was initiated. Medical history was not of significance except a 5 kg weight loss within 2 months. The patient presented with recurrent episodes of hypoglycemia, and the doses of preprandial and basal insulin were reduced. The differential diagnosis included type 1 diabetes mellitus "honeymoon" period or another type of diabetes mellitus. His serological tests only revealed positive autoantibodies against glutamic acid decarboxylase 65 and C-peptide. The diagnosis leaned toward latent autoimmune diabetes in adults, and the therapeutic approach involved cessation of preprandial insulin therapy, regulation, and subsequent discontinuation of basal insulin and introduction of metformin. Two years later, basal insulin was reintroduced along with a glucagon-like peptide-receptor agonist and metformin. Further physical examination during the initial visit disclosed upper limb tremor, lid lag, excessive sweating, increased sensitivity to heat, and tachycardia. Laboratory tests were indicative of hashitoxicosis (suppressed level of thyroid-stimulating hormone, high levels of total and free thyroid hormones, positive anti-thyroglobulin and anti-thyroid peroxidase, and negative anti-thyroid-stimulating hormone receptor). Thyroid-stimulating hormone level was spontaneously restored, but an increase was observed during follow-up. Levothyroxine was administrated for 2 years until the patient had normal thyroid function.
The prevalence of thyroid autoantibodies in patients with latent autoimmune diabetes in adults ranges from 20% to 30%. This correlation can be attributed to genetic involvement as well as disorders of immune tolerance to autoantigens. Hence, this report gives prominence to the holistic approach and consideration of comorbidities in patients with diabetes mellitus.
成人隐匿性自身免疫性糖尿病是一种罕见的自身免疫性糖尿病，而成年人最常见的甲状腺疾病桥本甲状腺炎很少表现为甲状腺毒症。这两种自身免疫性疾病同时首发的情况极为罕见。
一位 29 岁的阿尔巴尼亚裔男性，因糖尿病酮症酸中毒住院。诊断为 1 型糖尿病，并开始强化胰岛素治疗。除了 2 个月内体重减轻 5 公斤外，无其他重要病史。患者出现反复发作的低血糖，减少了餐前和基础胰岛素的剂量。鉴别诊断包括 1 型糖尿病“蜜月期”或其他类型的糖尿病。他的血清学检查仅显示谷氨酸脱羧酶 65 和 C 肽自身抗体阳性。诊断倾向于成人隐匿性自身免疫性糖尿病，治疗方法包括停止餐前胰岛素治疗、调整，随后停止基础胰岛素并引入二甲双胍。两年后，重新开始使用基础胰岛素、胰高血糖素样肽-1 受体激动剂和二甲双胍。在初次就诊时进一步体检发现上肢震颤、眼睑下垂、多汗、对热敏感和心动过速。实验室检查提示桥本甲状腺毒症（促甲状腺激素水平抑制、总甲状腺激素和游离甲状腺激素水平升高、抗甲状腺球蛋白和抗甲状腺过氧化物酶阳性、促甲状腺激素受体抗体阴性）。促甲状腺激素水平自发恢复，但在随访中观察到升高。给予左甲状腺素治疗 2 年，直至患者甲状腺功能正常。
成人隐匿性自身免疫性糖尿病患者的甲状腺自身抗体阳性率为 20%至 30%。这种相关性可归因于遗传参与以及对自身抗原的免疫耐受紊乱。因此，本报告强调了对糖尿病患者进行整体治疗和考虑合并症的重要性。
