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June 4, 1999

Thyroid

Question from Raleigh, North Carolina, USA:

Our 10-year-old daughter was diagnosed with Type 1 Diabetes exactly one year ago today. During our daughter's last two clinic visits with our Pediatric Endocrinology Team, it was observed that her thyroid gland is enlarged, and subsequently a thyroid panel has been completed to screen for possible thyroid problems. At this time, her thyroid appears to be functioning normally; however, because of the enlargement and the recent observation of increased firmness of the thyroid gland, her pediatric endocrinologist had her thyroid antibody level tested. The results of this test showed an extremely high level of antibodies against the thyroid gland. While her doctor has indicated that this is not a guaranteed indicator that the thyroid is going to fail, it was pointed out that she now falls into the high-risk category. Is it recommended that children with Type 1 Diabetes and an extremely elevated thyroid antibody level begin thyroid treatment immediately or should this treatment be withheld until there are significant changes in the TSH levels? Should we insist that she be screened for other antibody levels or is this unnecessary?

Answer:

You can read a lot about diabetes-associated autoimmune diseases, such as autoimmune endocrinopathies, on this website. To sum up: thyroid and adrenal antibodies as well as antiendomisial-transglutaminase antibodies (celiac disease) are nowadays frequently screened as part of the first admission as well as routine follow up procedures among our type 1 children and adolescents. In case of high levels of anti-TPO antibodies (thyroid) we start therapy with low dose L-thyroxine even before TSH rises to possibly halt or retard the ongoing autoimmune process, as is being done with exogenous insulin, either orally or subcutaneously, for pre-type1 autoimmune diabetes in the DPT-1 study.

MS