Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.727
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2015, vol. 24, nr 1, January-February, p. 79–84

doi: 10.17219/acem/38149

Publication type: original article

Language: English

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Prevalence of Anti-Thyroid Peroxidase in Adults with Type 1 Diabetes Participating in Poznań Prospective Study

Agata Grzelka1,A,B,C,D,E,F, Aleksandra Araszkiewicz1,A,B,E,F, Aleksandra Uruska1,B,C, Dorota Zozulińska-Ziółkiewicz1,A,E,F

1 Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland

Abstract

Background. Type 1 diabetes (DM 1) is frequently associated with autoimmune thyroid diseases (AITD). Screening for AITD in adults is rarely performed. The aim of this study was to evaluate the prevalence of anti-thyroid peroxidase (anti-TPO) and thyroid function and their association with metabolic control in adults participating in Poznan Prospective Study (PoProStu).
Material and Methods. The analysis included 74 patients (26 women and 48 men) aged 38.5 (IQR: 34.5–42.5), who have had diabetes for 15.0 (14–16) years. All patients have been treated with intensive functional insulin therapy (IFIT) from the onset of the disease. Anti-TPO and thyroid-stimulating hormone (TSH) were determined. The concentration of anti-TPO ≥ 5.61 IU/mL was considered positive. Based on the levels of anti-TPO the patients were divided into two groups: anti-TPO positive and anti-TPO negative. Metabolic control was assessed by the level of glycated hemoglobin (HbA 1c).
Results. Anti-TPO was positive in 32 (43.2%) patients. Prevalence of autoantibodies was significantly higher in women (53% vs 21%; p = 0.009). There was no significant difference in HbA 1c levels [median (IQR): 7.6% (7.1–8.6) vs 7.6% (7.1–8.8); p = 0.82] and TSH levels [median (IQR): 2.05 µIU/mL (1.23–3.15) vs 1.62 µIU/mL (1.00–2.10); p = 0.06] between anti-TPO positive and negative patients. After excluding patients with a thyroid dysfunction, a significant difference in TSH levels between anti-TPO positive and negative group was found [median (IQR): 2.11 µIU/mL (1.29–3.31) vs 1.66 µIU/mL (1.29–3.31); p = 0.04].
Conclusion. High anti-TPO prevalence is found in adult patients with long-standing DM 1, and autoantibodies occur more often in women. Therefore, screening for asymptomatic thyroid dysfunction should be performed in this group, as already recommended by the joint statement of Polish Society of Endocrinology and Diabetes Poland.

Key words

type 1 diabetes, anti-thyroid peroxidase, metabolic control.

References (29)

  1. Barker JM: Clinical review: Type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab 2006, 91, 1210–1217.
  2. Larizza D, Calcaterra V, Klersy C: Common immunogenetic profile in children with multiple autoimmune diseases: the signature of HLA-DQ pleiotropic genes. Autoimmunity 2012, 45, 470–475.
  3. Menconi F, Osman R, Monti MC, Greenberg DA, Concepcion ES, Tomer Y: Shared molecular amino acid signature in the HLA-DR peptide binding pocket predisposes to both autoimmune diabetes and thyroiditis. Proc Natl Acad Sci U S A 2010, 28, 107, 16899–16903.
  4. Pastuszak-Lewandoska D, Sewerynek E, Domańska D, Gładyś A, Skrzypczak R, Brzeziańska E: CTLA-4 gene polymorphisms and their influence on predisposition to autoimmune thyroid diseases (Graves’ disease and Hashimoto’s thyroiditis). Arch Med Sci 2012, 8, 3, 415–421.
  5. Witek P, Witek J, Pańkowska E: Type 1 diabetes-associated autoimmune diseases: screening, diagnostics principles and management. Dev Period Med 2012, 23–25.
  6. Radetti G, Paganini C, Gentili L: Frequency of Hashimoto’s thyroiditis in children with type 1 diabetes mellitus. Acta Diabetol 1995, 32, 121–124.
  7. 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, 411–414.
  8. Kordonouri O, Deiss D, Danne T, Dorow A, Bassir C, Grüters-Kieslich A: Predictivity of thyroid autoantibodies for the development of thyroid disorders in children and adolescents with Type 1 diabetes. Diabet Med 2002, 19, 518–521.
  9. Kalicka-Kasperczyk A, Dziatkowiak H, Bartnik-Mikuta A: Thyroid peroxidase antibodies and thyroid diseases in children and adolescents with newly diagnosed type I diabetes. Przegl Lek 2002, 59, 509–513.
  10. Riley WJ, Maclaren NK, Lezotte DC, Spillar RP, Rosenbloom AL: Thyroid autoimmunity in insulin-dependent diabetes mellitus: the case for routine screening. J Pediatr 1981, 99, 350–354.
  11. Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę, 2012. Stanowisko Polskiego Towarzystwa Diabetologicznego. Diabetol Klin 2012, 1, Suppl A.
  12. Global IDF/ISPAD Guideline for Diabetes in Childhood and Adolescence 2011. www.ispad.org
  13. Statement of the American Diabetes Association-2012. Diabetes Care 2012, 35, Suppl 1, S 11–S 63.
  14. Recommendations of the Polish Society of Endocrinology and Polish Diabetes Association for the management of thyroid dysfunction in type 1 and type 2 diabetes. Endokrynol Pol 2013, 64, 74–77.
  15. Araszkiewicz A, Zozulinska-Ziolkiewicz D, Trepinska M, Wierusz-Wysocka B: Knowledge after five-day teaching program in intensive insulin therapy performed at the onset of type 1 diabetes influence the development of late diabetic complications. Diabetes Res Clin Pract 2008, 81, 61–67.
  16. Barker JM, Yu J, Yu L: Autoantibody “subspecificity” in type 1 diabetes: risk for organ-specific autoimmunity clusters in distinct groups. Diabetes Care 2005, 28, 850–855.
  17. Kakleas K, Paschali E, Kefalas N: Factors for thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Ups J Med Sci 2009, 114, 214–220.
  18. Umpierrez GE, Latif KA, Murphy MB: Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. Diabetes Care 2003, 26, 1181–1185.
  19. Ardestani SK, Keshteli AH, Khalili N, Hashemipour M, Barekatain R: Thyroid disorders in children and adolescents with type 1 diabetes mellitus in Isfahan, Iran. Iran J Pediatr 2011, 21, 502–508.
  20. Chang CC, Huang CN, Chuang LM: Autoantibodies to thyroid peroxidase in patients with type 1 diabetes in Taiwan. Eur J Endocrinol 1998, 139, 44–48.
  21. Madej A, Walczak K, Korzeniowska-Dryl I, Czerniawska E, Moczulski D, Szadkowska A: Prevalence of thyroid autoantibodies and thyroid dysfunction In adults with type 1 diabetes. Diabetol Prakt 2011, 12, 223–228.
  22. Türemen EE, Çetinarslan B, Şahin T, Cantürk Z, Tarkun İ: Endothelial dysfunction and low grade chronic inflammation in subclinical hypothyroidism due to autoimmune thyroiditis. Endocr J 2011, 58, 349–354.
  23. Taddei S, Caraccio N, Virdis A: Low-grade systemic inflammation causes endothelial dysfunction in patients with Hashimoto’s thyroiditis. J Clin Endocrinol Metab 2006, 91, 5076–5082.
  24. Llauradó G, Gallart L, Tirado R: Insulin resistance, low-grade inflammation and type 1 diabetes mellitus. Acta Diabetol 2012, 49, 33–39.
  25. Severinski S, Banac S, Severinski NS, Ahel V, Cvijović K: Epidemiology and clinical characteristics of thyroid dysfunction in children and adolescents with type 1 diabetes. Coll Antropol 2009, 33, 273–279.
  26. Wartofsky L, Dickey RA: The evidence for a narrower thyrotropin reference range is compelling. J Clin Endocrinol Metab 2005, 90, 5483–5488.
  27. Gierach M, Gierach J, Skowrońska A: Hashimoto’s thyroiditis and carbohydrate metabolism disorders in patients hospitalised in the Department of Endocrinology and Diabetology of Ludwik Rydygier Collegium Medicum in Bydgoszcz between 2001 and 2010. Endokrynol Pol 2012, 63, 14–17.
  28. Velija-Asimi Z, Karamehic J: The effects of treatment of subclinical hypothyroidism on metabolic control and hyperinsulinemia. Med Arh 2007, 61, 20–21.
  29. Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F: The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus. Diabet Med 2002, 19, 70–73.