My almost seven year old son has had type 1 diabetes since the age of four. He was recently diagnosed with celiac and hypothyroidism, which I suspect he has had for some time and which may have contributed to his erratic blood sugar control. He also has not grown or developed for a year and is losing weight. We are now looking to seek a second opinion and have been advised that there are probably only three specialists in the UK. A friend has suggest that we should come to U.S. How do we find out who are specialists in this area? Can you give me some advice?

Also, there seems to be very little information regarding the number of children that have all three conditions. How can I find out? Is there a national/international database?

There are dozens of pediatric diabetologists in the U.K., so you should not need to travel to the US. Celiac disease is present in about 5 to 8% of the children who have type 1 diabetes; thyroid disease in about 20%. We, and many others, routinely screen for antibodies for both these conditions from diagnosis and about annually since they are so commonly co-existing. The common concurrence most likely reflects agenetic predisposition and shared HLA genotypes. Others in the family should also be screened with such conditions and high likelihood that they will also be present using thyroid antibodies and transglutaminase antibodies.

The treatment for celiac disease is easy to prescribe, strict gluten-free foods and snacks, but difficult to sustain. Most likely, the slow growth and gastrointestinal symptoms will go away in several months. Insulin doses will need to be adjusted since using gluten-free foods often requires higher bolus insulin doses with more rapid glycemic effects seen.

Hypothyroidism is also easy to treat with a single morning hormone preparation containing levothyroxine. The dose is titrated against T4 and TSH levels and should also help promote normal growth and cardiovascular function.

Several of the U.K. specialists would include Peter Swift, Jeremy Wells, Stephen Greene, David Dunger and their colleagues. Contact Diabetes UK or the JDRF office in the U.K.

SB