Iodine status, thyroid function, thyroid volume and thyroid autoimmunity in patients with type 1 diabetes mellitus in an iodine-replete area

• Published in: Diabetes & metabolism 2006-09, Vol.32 (4), p.323-329
• Main Authors: Okten, A, Akcay, S, Cakir, M, Girisken, I, Kosucu, P, Deger, O
• Format: Article
• Language: English
• Subjects: Adolescent; Antithyroïdienne; Auto-immunité; Autoimmunity; Biological and medical sciences; Body Mass Index; Child; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 1 - urine; Diabetes. Impaired glucose tolerance; Diabète de type 1; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Enfants; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Iodine - urine; Iodine status; Male; Medical sciences; Reference Values; Status iodé; Thyroid autoimmunity; Thyroid Function Tests; Thyroid functions; Thyroid Gland - anatomy & histology; Thyroid Gland - immunology; Thyroid volume; Thyrotropin - blood; Turkey; Type 1 diabetes mellitus
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/S1262-3636(07)70286-0

To analyze the prevalence and clinical significance of thyroid autoimmunity, thyroid volume and iodine status in patients with type 1 diabetes mellitus compared with age and sex matched healthy controls, in an iodine-deficiency improved area. Fifty-eight patients with type 1 DM, 30 female and 28 male, who attended the pediatric endocrinology clinic of Karadeniz Technical University Hospital were included into the study. They were compared with 58 healthy children matched for sex and age. Routine thyroid function parameters, thyroid autoantibodies (TPOAb, TGAb and TRAb) and urinary iodine excretion were measured and thyroid volume was determined by ultrasonography (US). Twenty-six patients (44.8%) in diabetic patients and 20 subjects (34.5%) in the control group had thyroid autoantibody positivity. TPOAb and TGAb positivity were significantly high in diabetic patients (P=0.01 and P=0.032, respectively). Thyroid US revealed a thyroid volume of 6.6±3.5 ml (median 6.4 ml, range 1.1-17.2 ml) in the diabetic patients compared with 3.7±2 ml (median 3.1 ml, range 0.8-8.6 ml) in the control group (P=0.0001). Median urinary iodine levels of both groups were clearly above the threshold level for iodine deficiency, but 26 patients with type 1 DM (44.8%) and 16 controls (27.5%) had urinary iodine excretion below 100 μg/L, and 21 (36.2%) of diabetic patients and two subjects (3.4%) of the control group were consistent with severe iodine deficiency. No significant differences were noted in diabetic patients in terms of age, duration and metabolic control of the disease and thyroid volume when compared according to the autoanti-body presence. Additionally, there were no significant differences between the iodine deficient and iodine sufficient diabetic patients in terms of age, sex, duration of disease, HbA1 c, thyroid hormones and thyroid volumes. Thyroid autoimmunity was lower in patients with iodine deficiency (38.4% vs. 50%), but not statistically significant. We found that type 1 DM patients had larger thyroid volume compared with healthy control groups, and a large portion of them had the markers of autoimmune thyroid disease and iodine deficiency. Surprisingly, we found that a large portion of the healthy children had TRAb positivity. We proposed that TRAb must be considered in community surveys or prevalence studies of autoimmune thyroid disorders in iodine-replete areas. Additionally, prospective longitudinal studies are needed to determine the clinical significa