Determination of the Frequency of Celiac and Autoimmune Thyroid Diseases in Children and Adolescents Diagnosed with Type 1 Diabetes Mellitus

Yıl 2024, Cilt: 6 Sayı: 1, 27 - 31, 31.01.2024

İlknur Kaba , Samet Can Demirbaş , Havva Nur Peltek Kendirci

https://doi.org/10.37990/medr.1373441

Öz

Aim: Celiac disease (CD) and autoimmune thyroid disease (AITD) are more common in individuals with Type 1 diabetes mellitus (T1DM). Hypothyroidism; has been associated with increased risk of hypoglycemia, reduced growth, and untreated CD with reduced bone mineral density has been associated with skeletal problems. It was aimed to screen the frequency of children and adolescents with T1DM in terms of CD and AITD.
Material and Method: The patients diagnosed with T1DM in July 2015-March 2022 were retrospectively analyzed. The patients' age, gender, age at diagnosis, anti-TPO, anti-TG, Islet Cytoplasmic Antibodies (ICA), Insulin Autoantibodies (IAA), Glutamic Acid Decarboxylase (GADA) antibodies and accompanying autoimmune disease were investigated.
Results: Chronological age was 12.5±4.4 (2.5-21.3), diagnosis of T1DM age 8.5±4.3 (1.0-17.5), duration of diabetes 4.0±3, 199 patients with T1DM aged 5 (0.0-18.1) years were included. 52.3% (n=104) of the cases were female. While the frequency of CD is 23.2% (n=10), the presence of anti-TPO and anti-TG antibodies is 6.9% (n=3) in patients whose diabetes diagnosis age is less than 5 years. Both CD and the presence of thyroid autoantibodies were more common in girls (73.3%, 68%).
Conclusion: We found that the frequency of CD and AITD in our patients with T1DM was higher than in the general population, the frequency of CD increased in patients with a younger age at diagnosis of T1DM, anti-TPO antibodies was observed with advancing age at diagnosis, and both conditions were more common in females.

Anahtar Kelimeler

adolescent, autoimmune thyroiditis, celiac disease, child, type 1 diabetes

Etik Beyan

Ethics committee approval for the study was obtained from the Hitit University Faculty of Medicine Clinical Research Ethics Committee decision no: 2022-27 and taken on:31/03/2022.

Destekleyen Kurum

-

Teşekkür

-

Tip 1 Diabetes Mellitus Tanısı Alan Çocuk ve Ergenlerde Çölyak ve Otoimmün Tiroid Hastalıkları Sıklığının Belirlenmesi

Öz

Amaç: Çölyak hastalığı (ÇH) ve otoimmün tiroid hastalığı (OTH) Tip 1 diabetes mellitus(T1DM)’lu bireylerde daha sık görülmektedir. Hipotiroidizm; hipoglisemi riskinin artması ve büyümenin azalmasıyla, tedavi edilmemiş ÇH ise azalmış kemik mineral dansitesiyle seyreden iskelet problemleriyle ilişkilendirilmiştir. Çalışmamızda T1DM tanılı çocuk ve adölesanların ÇH ve OTH açısından sıklığının taranması amaçlanmıştır.
Gereç/Yöntem: Kliniğimizde Temmuz 2015- Mart 2022 arasında T1DM tanısıyla takip edilen hastaların dosyaları retrospektif olarak incelendi, hastaların yaş, cinsiyet, tanı yaşı, anti TPO, anti TG, Adacık Sitoplazmik Antikoru (ICA), İnsülin Otoantikorları (IAA), Glutamik Asit Dekarboksilaz (GADA) antikorları ve eşlik eden otoimmün hastalık varlığı araştırıldı.
Bulgular: Çalışmaya takvim yaşı 12,5±4,4(2,5-21,3), T1DM tanı yaşı 8,5±4,3(1,0-17,5), diyabet süresi 4,0±3,5(0,0-18,1) yıl olan 199 T1DM’li hasta dahil edildi. Olguların %52,3’i (n=104) kız cinsiyetteydi. Diyabet tanı yaşı 5 yıldan küçük olanlarda ÇH sıklığı %23,2(n=10), anti-TPO ve anti-TG antikor varlığı %6,9(n=3) iken; 5 yıl ve üzeri olanlarda ÇH sıklığı %3,3(n=5), anti-TPO antikor varlığı %15,1(n=22), anti-TG antikor varlığı %7,1(n=10) idi. Hem ÇH, hem de tiroid otoantikor varlığının kızlarda daha sık olduğu görüldü (sırasıyla %73,3, %68).
Sonuç: T1DM’li hastalarımızda literatürle uyumlu olarak ÇH ve OTH sıklığının genel popülasyona göre daha sık olduğunu, T1DM tanı yaşı küçük olanlarda ÇH sıklığın arttığını, özellikle anti-TPO antikor varlığının ilerleyen tanı yaşıyla görüldüğü, her iki durumun da kız cinsiyette daha sık olduğunu saptadık. Daha uzun süreli ve daha büyük hasta gruplarıyla yapılacak çalışmalar yeni tarama stratejilerinin geliştirilmesinde yol gösterici olacaktır.

Anahtar Kelimeler

adölesan,, çocuk, çölyak hastalığı, otoimmün tiroidit,, tip1 diabetes mellitus

Kaynakça

• Roldan MB, Alonso M, Barrio R. Thyroid autoimmunity in children and adolescents with Type 1 diabetes mellitus. Diabetes Nutr Metab. 1999;12:27-31.
• Park YS, Kim TW, Kim WB, Cho BY. Increased prevalence of autoimmune thyroid disease in patients with type 1 diabetes. Korean J Intern Med. 2000;15:202-10.
• Kordonouri O, Klinghammer A, Lang EB, et al. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care. 2002;25:1346-50.
• Piatkowska E, Szalecki M. Autoimmune thyroiditis in children and adolescents with type 1 diabetes. Pediatr Endocrinol Diabetes Metab. 2011;17:173-7.
• Triolo TM, Armstrong TK, McFann K, et al. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes Care. 2011;34:1211-3.
• Riquetto ADC, de Noronha RM, Matsuo EM, et al. Thyroid function and autoimmunity in children and adolescents with type 1 diabetes mellitus. Diabetes Res Clin Pract. 2015;110:e9-11.
• Brown RS. Autoimmune thyroiditis in childhood. J Clin Res Pediatr Endocrinol. 2013;5:45-9.
• Villanueva R, Greenberg DA, Davies TF, Tomer Y. Sibling recurrence risk in autoimmune thyroid disease. Thyroid. 2003;13:761-4.
• Lee HJ, Li CW, Hammerstad SS, et al. Immunogenetics of autoimmune thyroid diseases: a comprehensive review. J Autoimmun. 2015;64:82-90.
• Shun CB, Donaghue KC, Phelan H, et al. Thyroid autoimmunity in type 1 diabetes: systematic review and meta-analysis. Diabet Med. 2014;31:126-35.
• Hughes JW, Riddlesworth TD, DiMeglio LA, et al. Autoimmune diseases children and adults with type 1 diabetes from the T1D exchange clinic registry. J Clin Endocrinol Metab. 2016;101:4931-7.
• Ediger TR, Hill ID. Celiac disease. Pediatr Rev. 2014;35:409-15.
• Kliegman RM, ST Geme III JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, Behrman RE. Celiac Disease. Nelson Textbook of Pediatrics. 21st Edition, Elsevier, California 2020;7909-24.
• Mahmud FH, Elbarbary NS, Fröhlich-Reiterer E, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2018;19:275-86.
• Kakleas K, Kossyva L, Korona A, et al. Predictors of associated and multiple autoimmunity in children and adolescents with type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab. 2022;27:192-200.
• Chiang JL, Maahs DM, Garvey KC, et al. Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes Care. 2018;41:2026-44.
• American Diabetes Association. 12. Children and adolescents. Diabetes Care. 2017;40:S105-13.
• Besser REJ, Bell KJ, Couper JJ, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2022;23:1175-87.
• Alaedini A, Green PH. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005;142:289-98.
• Hoffenberg EJ, Bao F, Eisenbarth GS, et al.Transglutaminase antibodies in children with a genetic risk for celiac disease. J Pediatr. 2000;137:356-60.
• Taşkın E, Yılmaz M, Kılıç S, Ertuğrul S. The epidemiological features of the type I diabetes mellitus. F.Ü. Sağ. Bil. Derg. 2007:21:75-9.
• Muhame RM, Mworozi EA, McAssey K, Lubega I. Thyroid autoimmunity and function among Ugandan children and adolescents with type-1 diabetes mellitus. Pan Afr Med J. 2014;19:137.
• Kordonouri O, Hartmann R, Deiss D, et al. Natural course of autoimmune thyroiditis in type 1 diabetes: association with gender, age, diabetes duration, and puberty. Arch Dis Child. 2005;90:411-4.
• Kochummen E, Marwa A, Umpaichitra V, et al. Screening for autoimmune thyroiditis and celiac disease in minority children with type 1 diabetes. J Pediatr Endocrinol Metab. 2018;28;31:879-85.
• Karavanaki K, Kakleas K, Paschali E, et al. Screening for associated autoimmunity in children and adolescents with type 1 diabetes mellitus (T1DM). Horm Res. 2009;71:201-6.
• Hatun Ş, Demirbilek H, Darcan Ş, et al.; Turkish Pediatric Diabetes Research Group. Evaluation of therapeutics management patterns and glycemic control of pediatric type 1 diabetes mellitus patients in Turkey: a nationwide cross-sectional study. Diabetes Res Clin Pract. 2016;119:32-40.
• Unal E, Demiral M, Öcal M, et al. Incidence of Autoimmune Thyroid Disease in Patients with Type 1 Diabetes. JCP. 2020;18:251-62.
• Simsek DG, Aycan Z, Özen S, et al. Diabetes care, glycemic control, complications, and concomitant autoimmune diseases in children with type 1 diabetes in Turkey: a multicenter study. J Clin Res Pediatr Endocrinol. 2013;5:20-6.
• Esen İ, Deveci U, Ökdemir D. The frequency of autoimmune polyendocrinopathy type 3b in children with type 1 diabetes mellitus. Turk J Diab Obes. 2020;2:79-83.
• Lipman TH, Rezvani I, DiGeorge AM. The natural history of thyroid autoimmunity and thyroid function in children with type 1 diabetes. J Pediatr. 2007;151:e10-2.
• Sange I, Mohamed MWF, Aung S, et al. Celiac disease and the autoimmune web of endocrinopathies. Cureus. 2020;12:e12383.
• Unal E, Demiral M, Baysal B, et al. Frequency of celiac disease and spontaneous normalization rate of celiac serology in children and adolescent patients with type 1 diabetes. J Clin Res Pediatr Endocrinol. 2021;13:72-9.
• Siddiqui K, Uqaili AA, Rafiq M, Bhutto MA. Human leukocyte antigen (HLA)-DQ2 and -DQ8 haplotypes in celiac, celiac with type 1 diabetic, and celiac suspected pediatric cases. Medicine (Baltimore). 2021;100:e24954.
• Cohn A, Sofia AM, Kupfer SS. Type 1 diabetes and celiac disease: clinical overlap and new insights into disease pathogenesis. Curr Diab Rep. 2014;14:517.
• Valenzise M, Aversa T, Saccomanno A, et al. Epidemiological and clinical peculiarities of polyglandular syndrome type 3 in pediatric age. Ital J Pediatr. 2017;43:69.
• Larizza D, Calcaterra V, De Giacomo C, et al. Celiac disease in children with autoimmune thyroid disease. J Pediatr. 2001;139:738-40.
• Sari S, Yesilkaya E, Egritas O, et al. Prevalence of celiac disease in Turkish children with autoimmune thyroiditis. Dig Dis Sci. 2009;54:830-2.
• Marwaha RK, Garg MK, Tandon N, et al. Glutamic acid decarboxylase (anti-GAD) & tissue transglutaminase (anti-TTG) antibodies in patients with thyroid autoimmunity. Indian J Med Res. 2013;137:82-6.
• Ventura A, Neri E, Ughi C, et al. Glutendependent diabetes-related and thyroid-related autoantibodies in patients with celiac disease. J Pediatr. 2000;137:263-5.
• Von Herrath MG, Fujinami RS, Whitton JL. Microorganisms and autoimmunity: making the barren field fertile?. Nat Rev Microbiol. 2003;1:151-7.