Tip 1 Diyabetli Hastalarda Otoimmün Tiroid Hastaliği Sıklığı

Yıl 2020, Cilt: 18 Sayı: 2, 251 - 262, 01.08.2020

Edip Ünal Meliha Demiral Murat Öcal Birsen Baysan Mehmet Nuri Özbek

Öz

GİRİŞ ve AMAÇ: Bu çalışmada, kliniğimizde tip 1 diyabetes mellitus (T1DM) tanısıyla izlenen çocuk ve ergen hastalarda otoimmün tiroid hastalığı (OİTH) sıklığının belirlenmesi ve diğer parametrelerle olan ilişkisinin değerlendirilmesi amaçlanmıştır.

YÖNTEM ve GEREÇLER: Son 10 yıldır tip 1 DM tanısıyla izlenen 722 hastanın dosyası retrospektif olarak incelendi. Hastaların yaş, cinsiyet, ortalama HbA1c, tiroid uyarıcı hormon (TSH), serbest tiroksin (sT4), anti-tiroid peroksidaz (anti-TPO) ve anti-tiroglobülin(anti-Tg) düzeyi, vücut ağırlığı standart deviasyon skoru (SDS), boy SDS ve vücut kitle indeksi (VKİ) SDS değerleri kaydedildi.

BULGULAR: Çalışmaya alınan 722 hastanın 607’sine en az bir kez tiroid otoantikorları bakılmış ve 72’sinde (% 11,9) anti-TPO ve/veya anti-Tg pozitifliği saptanmıştı. Bu hastaların 57’isi (% 79,2) ötiroid, 7’isinde ( % 9,7) aşikar hipotiroidi, 5’inde ( % 6,9) subklinik hipotiroidi ve 3’ünde ( % 4,2) hipertiroidi mevcuttu. Hashimoto tiroiditli(HT) olguların 48’i (% 66,7) pubertal iken, 24’ü (% 33,3) prepubertal idi. OİTH’li olguların 50’si ( % 69,4) kız, 22’isi ( % 30,6) erkek idi. Ayrıca OİTH tespit edilen 72 hastanın 12’sinde ( % 16,6) çölyak hastalığı(ÇH) mevcut idi. Ki-kare analizine göre OİTH kızlarda (p: 0,01) ve ÇH’si olanlarda ( p: 0,02) daha fazla görülmekteydi. Yaş ve diyabet süresi uzadıkça OİTH prevalansı artmaktaydı.

TARTIŞMA ve SONUÇ: T1DM’li hastalarda yaş ve diyabetin süresi arttıkça HT sıklığı artmaktadır. Hashimoto tiroiditi özellikle kız cinsiyette ve pubertal dönemde daha sık görülmektedir. Tip 1 DM’li hastalarda çölyak varlığı HT riskini artırmaktadır. Tiroid disfonksiyonun metabolik kontrol, büyüme ve gelişme üzerindeki olumsuz etkilerinin önlenmesi açısından belli aralıklarla tiroid fonksiyon testleri ve otoantikorların bakılması gerekmektedir.

Anahtar Kelimeler

tip 1 DM,, otoimmunite,, tiroid,

Kaynakça

• 1. Hughes JW, Riddlesworth TD, DiMeglio LA, Miller KM, Rickels MR, McGill JB. Autoimmune diseases children and adults with type 1 diabetes from the T1D exchange clinic registry. J Clin Endocrinol Metab. 2016;101(12):4931-7.
• 2. Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, et al. Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care. 2018;41(9):2026-44
• 3. Lee HJ, Li CW, Hammerstad SS, Stefan M, Tomer Y. Immunogenetics of autoimmune thyroid diseases: A comprehensive review.J Autoimmun. 2015;64:82-90
• 4. Villanueva R, Greenberg DA, Davies TF, Tomer Y. Sibling recurrence risk in autoimmune thyroid disease. Thyroid: official journal of the American Thyroid Association. 2003;13:761–4. [PubMed: 14558919]
• 5. Glastras SJ, Craig ME, Verge CF, Chan AK, Cusumano JM, Donaghue KC. The role of autoimmunity at diagnosis of type 1 diabetes in the development of thyroid and celiac disease and microvascular complications. Diabetes Care. 2005;28(9):2170-5.
• 6. Shun CB, Donaghue KC, Phelan H, Twigg SM, Craig ME. Thyroid autoimmunity in type 1 diabetes: systematic review and meta-analysis. Diabet Med. 2014;31(2):126-35.
• 7. Mahmud FH, Elbarbary NS, Fröhlich-Reiterer E, Holl RW, Kordonouri O, Knip M, 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 Suppl 27:275-286. doi: 10.1111/pedi.12740
• 8. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014 Jun;3(2):76-94. doi:10.1159/000362597. Epub 2014 Jun 7.
• 9. Catli G, Abaci A, Büyükgebiz A, Bober E. Subclinical hypothyroidism in childhood and adolescense. J Pediatr Endocrinol Metab. 2014 Nov;27(11-12):1049-57. doi: 10.1515/jpem-2014-0089.
• 10. Simsek DG, Aycan Z, Özen S, Cetinkaya S, Kara C, Abalı 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(1):20-6. doi: 10.4274/Jcrpe.893. Epub 2013 Feb 19.
• 11. Hatun Ş, Demirbilek H, Darcan Ş, Yüksel A, Binay C, Şimşek DG, 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
• 12. 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. doi: 10.11604/pamj.2014.19.137.5115. eCollection 2014
• 13. Kordonouri O, Hartmann R, Deiss D, Wilms M, Grüters-Kieslich A. Natural course of autoimmune thyroiditis in type 1 diabetes: association with gender, age, diabetes duration, and puberty. Arch Dis Child. 2005;90(4):411-4.
• 14. Kochummen E, Marwa A, Umpaichitra V, Perez-Colon S, Chin VL. Screening for autoimmune thyroiditis and celiac disease in minority children with type 1 diabetes. J Pediatr Endocrinol Metab. 2018;28;31(8):879-885. doi: 10.1515/jpem-2017-0254.
• 15. Karavanaki K, Kakleas K, Paschali E, Kefalas N, Konstantopoulos I, Petrou V, et al. Screening for associated autoimmunity in children and adolescents with type 1 diabetes mellitus (T1DM).Horm Res. 2009;71(4):201-6. doi: 10.1159/000201108. Epub 2009 Mar 4.
• 16. Kordonouri O, Klinghammer A, Lang EB, Grüters-Kieslich A, Grabert M, Holl RW.Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care. 2002;25(8):1346-50.
• 17. Triolo TM, Armstrong TK, McFann K, Yu L, Rewers MJ, Klingensmith GJ, Eisenbarth GS, Barker JM. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes Care. 2011;34(5):1211-1213. doi: 10.2337/dc10-1756. Epub 2011 Mar 23.
• 18. Riquetto ADC, de Noronha RM, Matsuo EM, Ishida EJ, Vaidergorn RE, Soares Filho MD, et al. Thyroid function and autoimmunity in children and adolescents with Type 1 Diabetes Mellitus.Diabetes Res Clin Pract. 2015;110(1):e9-e11. doi: 10.1016/j.diabres.2015.07.003 Epub 2015 Jul 17.
• 19. Soyucen E, Yilmaz S, Çeltık C, Vatansever U, Öner N, Karasalıhoğlu S.Seroprevalence of autoimmune thyroiditis and celiac disease in children with insulin-dependent diabetes mellitus in the Thrace region of Turkey.Turk J Gastroenterol. 2010;21(3):231-5.
• 20. Karagüzel G, Simşek S, Değer O, Okten A. Screening of diabetes, thyroid, and celiac diseases-related autoantibodies in a sample of Turkish children with type 1 diabetes and their siblings.Diabetes Res Clin Pract. 2008;80(2):238-243. doi: 10.1016/j.diabres.2007.12.007 Epub 2008 Jan 31.
• 21. Ergür AT, Oçal G, Berberoğlu M, Adıyaman P, Sıklar Z, Aycan Z, et al. Celiac disease and autoimmune thyroid disease in children with type 1 diabetes mellitus: clinical and HLA-genotyping results. J Clin Res Pediatr Endocrinol. 2010;2(4):151-4.
• 22. Fatourechi V. Demystifying autoimmune thyroid disease. Postgrad Med 2000;107:127-34.
• 23. Engler H, Staub JJ, Kunz M, Althaus B, Ryff A, Viollier E, et al. Does isolated TSH elevation need treatment? Study of risk factors for the development of manifest hypothyroidism. Schweiz Med Wochenschr 1992;122:66–9.
• 24. Chase HP, Garg SK, Cockerham RS, Wilcox WD, Walravens PA.Thyroid hormone replacement and growth of children with subclinical hypothyroidism and diabetes. Diabet Med. 1990;7(4):299-303.
• 25. Lorini R, d’Annunzio G, Vitali L, Scaramuzza A. IDDM and autoimmune thyroid disease in the pediatric age group. J Pediatr Endocrinol Metab 1996;9(Suppl 1):89–94.
• 26. Bilimoria KY, Pescovitz OH, DiMeglio LA. Autoimmune thyroid dysfunction in children with type 1 diabetes mellitus: screening guidelines based on a retrospective analysis. J Pediatr Endocrinol Metab 2003;16:1111–7.
• 27. Dost A, Rohrer TR, Frohlich-Reiterer E, Bollow E, Karges B, Böckmann A, et al. Hyperthyroidism in 276 children and adolescents with type 1 diabetes from Germany and Austria. Horm Res Paediatr 2015;84:190–8.
• 28. Lombardo F, Messina MF, Salzano G, Rabbone I, Lo Presti D, Calcaterra V, et al. Prevalence, presentation and clinical evolution of Graves’ disease in children and adolescents with type 1 diabetes mellitus.Horm Res Paediatr 2011;76:221–5.
• 29. Skarpa V, Kousta E, Tertipi A, Anyfandakis K, Vakaki M, Dolianiti M,et al. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones (Athens). 2011;10(3):207-14.
• 30. Bai JC, Fried M, Corazza GR, Schuppan D, Farthing M, Catassi C, et al. World Gastroenterology Organisation global guidelines on celiac disease. Journal of Clinical Gastroenterology 2013;47:121–6.
• 31. Larsson K, Carlsson A, Cederwall E, Jönsson B, Neiderud J, Jonsson B, et al. Annual screening detects celiac disease in children with type 1 diabetes. Pediatric Diabetes 2008;9: 354–9.
• 32. Salardi S, Volta U, Zucchini S, Fiorini E, Maltoni G, Vaira B & Cicognani A. Prevalence of celiac disease in children with type 1 diabetes mellitus increased in the mid-1990s: an 18-year longitudinal study based on anti-endomysial antibodies. Journal of PediatricGastroenterology and Nutrition 2008;46:612–4.
• 33. Pham-Short A, Donaghue KC, Ambler G, Chan AK & Craig ME. Coeliac disease in Type 1 diabetes from 1990 to 2009: higher incidence in young children after longer diabetes duration. Diabetic Medicine 2012;286–9.
• 34. Fröhlich-Reiterer EE, Huber J, Katz H, Suppan E, Obermayer- Pietsch B, Deutschmann A, et al. Do children and adolescents with type 1 diabetes mellitus have a higher frequency of parietal cell antibodies than healthy controls? Journal of Pediatric Gastroenterology and Nutrition 2011;52: 558–62.
• 35. Greco D, Pisciotta M, Gambina F, Maggio F.Celiac disease in subjects with type 1 diabetes mellitus: a prevalence study in western Sicily (Italy). Endocrine. 2013;43(1):108-11. doi: 10.1007/s12020-012-9718-8
• 36. Lenzi L, Mirri S, Generoso M, Guasti M, Barni F, Pepe R, et al. Thyroid autoimmunity and type 1 diabetes in children and adolescents: screening data from Juvenile Diabetes Tuscany Regional Centre. Acta Biomed. 2009;80(3):203-6.
• 37. Kaspers S, Kordonouri O, Schober E, Grabert M, Hauffa BP, Holl RW; German Working Group for Pediatric Diabetology. Anthropometry, metabolic control, and thyroid autoimmunity in type 1 diabetes with celiac disease: A multicenter survey. J Pediatr. 2004;145(6):790-5.