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January 11, 2000


Question from Garland, Texas, USA:

My daughter was diagnosed with type 1 diabetes almost 2 years ago. She will be eight in a month. We went for her check up today and the doctor said her thyroid was enlarged. He took blood for a thyroid test. All of the information I have read said very little or nothing about problems with the thyroid. Do I need to be concerned? How serious is it and what causes this? Is it associated with the diabetes or just another health problem she has to face? I have seen what hyperthyroidism has done to my cat. Is this what I can expect my daughter to go through?


In the last few years it has come to be recognised that Type�1A insulin dependent autoimmune diabetes is quite frequently associated with other autoimmune conditions; this has even come to be known as the Autoimmune Polyglandular Syndrome Type II. By far the commonest association is a rather mild hypothyroidism [underactive thyroid gland function] and the best test for this is an elevated level of Thyroid Stimulating Hormone (TSH) in the blood. Treatment is easy and can usually be discontinued after a few years; but is important because otherwise there may be some interference with growth. It should not be an added burden but it might also be a good idea to talk to your daughter’s doctor about getting a test for two other much less common accompanying autoimmune conditions that is celiac syndrome by doing an antitransglutaminase test and Addison’s Disease [underactive adrenal glands] by looking for an elevated anti 21-hydroxylase test. It is unlikely that she has either of these; but it might be useful to be forewarned of the later possibility.