Alam Ahmad, Singh Surya Kumar, Kumar Ritesh, Mannan Raihan
Endocrinology, Diabetes, and Metabolism, Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND.
Endocrinology, Diabetes, and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
Cureus. 2024 Jun 13;16(6):e62307. doi: 10.7759/cureus.62307. eCollection 2024 Jun.
Type 1 diabetes mellitus (T1DM) is frequently associated with other autoimmune disorders that are characterized by the presence of organ-specific autoantibodies. Autoimmune thyroid disease (AIT) is the most frequent autoimmune disorder associated with T1DM. Thyroid peroxidase antibodies (TPOAb) serve as a marker for diagnosing AIT. Prior research indicates that thyroid dysfunction can negatively impact linear growth and glycemic control in subjects with T1DM. The present study was done to determine the impact of thyroid autoimmunity on the clinical and biochemical characteristics of patients with newly diagnosed T1DM.
In this single-center, hospital-based, observational cross-sectional study, we enrolled 70 patients with newly diagnosed T1DM ≤18 years of age. Type 1 diabetes mellitus was diagnosed based on the acute onset of osmotic symptoms with or without diabetic ketoacidosis (DKA), severe hyperglycemia (blood glucose >13.9 mmol/l (>250 mg/dl)), and insulin requirement from the onset of diabetes. Secondary diabetes, pancreatic diabetes (Type 3c), and maturity-onset diabetes of the young (MODY) were excluded. Participants were screened for AIT disease using TPOAb testing. Based on the presence or absence of TPOAb, the participants were categorized into two groups: Group A comprised individuals with T1DM who tested positive for TPOAb, while Group B consisted of those who tested negative for TPOAb.
Out of 70 patients, 41.4% were girls and 58.6% were boys, with a mean age of 9.8±4.4 years. The prevalence of TPOAb among the cohort was 18.6%. A significant majority of patients (71.4%), presented with DKA. Group A showed significantly lower mean height standard deviation scores (SDS) compared to Group B (-0.3±0.6 vs. -0.8±0.5, p = 0.004), but no differences in weight SDS or BMI SDS. Hemoglobin A1C (HbA1c) levels, C-peptide levels, and frequency of DKA did not differ between groups. Group A had higher mean thyroid-stimulating hormone (TSH) levels (4.8±3.7 µU/ml vs. 2.6±1.5 µU/ml, p = 0.001) and a greater proportion of patients with TSH levels above the upper limit of normal compared to Group B (38.4% vs. 7.1%, p = 0.008). Additionally, Group A exhibited a higher frequency of glutamic acid decarboxylase antibody (GADA) positivity compared to Group B (46.1% vs. 17.5%, p = 0.04).
Patients positive for TPOAb exhibited significantly lower height SDS compared to TPOAb-negative patients. Additionally, T1DM patients with TPOAb positivity showed an increased frequency of GADA compared to those without TPOAb. However, no significant differences were found in HbA1c levels, C-peptide levels, or hematological parameters between TPOAb-positive and TPOAb-negative patients. These findings emphasize the impact of TPOAb on growth parameters in T1DM and advocate for routine screening of TPOAb in all T1DM patients, starting at the time of diabetes diagnosis.
1型糖尿病（T1DM）常与其他自身免疫性疾病相关，这些疾病的特征是存在器官特异性自身抗体。自身免疫性甲状腺疾病（AIT）是与T1DM相关的最常见自身免疫性疾病。甲状腺过氧化物酶抗体（TPOAb）可作为诊断AIT的标志物。先前的研究表明，甲状腺功能障碍会对T1DM患者的线性生长和血糖控制产生负面影响。本研究旨在确定甲状腺自身免疫对新诊断的T1DM患者临床和生化特征的影响。
在这项基于医院的单中心观察性横断面研究中，我们纳入了70例年龄≤18岁的新诊断T1DM患者。1型糖尿病根据有无糖尿病酮症酸中毒（DKA）、严重高血糖（血糖>13.9 mmol/l（>250 mg/dl））以及糖尿病发病时即需要胰岛素治疗的渗透性症状急性发作来诊断。排除继发性糖尿病、胰腺性糖尿病（3c型）和青少年成年起病型糖尿病（MODY）。通过检测TPOAb对参与者进行AIT疾病筛查。根据TPOAb的有无，将参与者分为两组：A组包括TPOAb检测呈阳性的T1DM个体，而B组由TPOAb检测呈阴性的个体组成。
70例患者中，41.4%为女孩，58.6%为男孩，平均年龄为9.8±4.4岁。队列中TPOAb的患病率为18.6%。绝大多数患者（71.4%）出现DKA。与B组相比，A组的平均身高标准差评分（SDS）显著更低（-0.3±0.6 vs. -0.8±0.5，p = 0.004），但体重SDS或BMI SDS无差异。两组之间的糖化血红蛋白（HbA1c）水平、C肽水平和DKA发生率无差异。与B组相比，A组的平均促甲状腺激素（TSH）水平更高（4.8±3.7 µU/ml vs. 2.6±1.5 µU/ml，p = 0.001），且TSH水平高于正常上限的患者比例更高（38.4% vs. 7.1%，p = 0.008）。此外，与B组相比，A组谷氨酸脱羧酶抗体（GADA）阳性频率更高（46.1% vs. 17.5%，p = 0.04）。
与TPOAb阴性患者相比，TPOAb阳性患者的身高SDS显著更低。此外，与无TPOAb的T1DM患者相比，TPOAb阳性的T1DM患者GADA频率增加。然而，TPOAb阳性和TPOAb阴性患者之间在HbA1c水平、C肽水平或血液学参数方面未发现显著差异。这些发现强调了TPOAb对T1DM生长参数的影响，并提倡在所有T1DM患者糖尿病诊断时即开始常规筛查TPOAb。
