My daughter is 11 and was just diagnosed with Hashimoto’s disease due to a goiter and antibodies. She can’t get in to see a pediatric endocrinologist for seven weeks and I am very concerned that this is also the onset of type 1 diabetes. Her sister is 20 and last year she was diagnosed with type 1 and has had cataract surgery, is taking Altace and also has Hashimoto’s disease and a goiter.

While waiting to get into the endocrinologist, should I have her pediatrician do more blood work on her to check for diabetes and what tests should be done? If this is the onset of diabetes, I want to catch it as early as possible. What are the statistics between the connection of thyroid disease and diabetes? From what I have been reading, it seems like diabetes shows up first and then thyroid. Is this unusual for an 11 year old to get thyroid disease? Do you have any suggestions of what I should do?

If the T4 is not very low and the TSH is only somewhat elevated, then there is no thyroid emergency. If those values are very abnormal, then you pediatrician should call the endocrinologist directly since they will arrange for a more urgent consultation and assessment.

There is a connection between thyroiditis and hypothyroidism with both type 1 and type 2 diabetes. The type 2 connection is not very well understood except that both type 2 diabetes and thyroid disorders are common. The type 1 diabetes connection and thyroid connection reflect the fact that both are autoimmune disorders with common genetic factors in the HLA region. So, one does not cause the other but both “travel” together as far as predispositions. Celiac disease is a third such autoimmunopathy. In most studies of youngsters with type 1 diabetes, thyroid antibodies are abnormal in about 20% (sometimes as high as 40%). There can be normal thyroid function with small goiters, hypothyroidism and more rarely hyperthyroidism. Celiac is present in about 8% of those with type 1 diabetes. Exact numbers of those with thyroid disease or celiac disease who then have type 1 diabetes are not so well known but not very dramatic. Why this “direction” is also unknown.

Testing for diabetes with a sibling with diabetes and thyroid disorders would involve blood work for antibodies. You can do some blood glucose testing at home as well and this would be interesting to share with the endocrinologist.

SB