Please enter verification code
Thyroid Dysfunction and Morphological Abnormalities in Patients with Type 1 Diabetes Mellitus
American Journal of Internal Medicine
Volume 3, Issue 4, July 2015, Pages: 185-193
Received: Jun. 28, 2015; Accepted: Jul. 7, 2015; Published: Jul. 17, 2015
Views 4757      Downloads 140
Heba-Allah Moustafa Kamal Al-Din, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Rokaya Abd-Al Aziz Mohamed, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Shereen Sadik El-Sawy, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Noha Adly Sadik, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Rasha Mohamed Abd El Samie, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Mahmoud Ahmed Khatab, National Institute of Diabetes and Endocrinology, Cairo, Egypt
Laila Ahmed Rashed, Biochemistry Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Article Tools
Follow on us
Background: Type 1 diabetes mellitus is an autoimmune disease. Several studies have documented great variations in the prevalence of thyroid dysfunction and autoimmune thyroid disease (AITD) in type 1 diabetic patients. Undiagnosed thyroid dysfunction has negative impact on the metabolic control and will aggravate the cardiovascular disorders. Objectives: We aimed to investigate the presence of thyroid dysfunction and the associated morphological abnormalities in type 1 diabetes mellitus. Methods: 80 type 1 diabetic patients without overt thyroid disease attending the outpatient clinic of diabetes at Kasr Al Aini hospital, faculty of medicine, Cairo University were enrolled in the study. Thyroid functions (TSH, FT4, FT3), anti thyroid peroxidase (anti-TPO) and anti thyroglobulin (anti-TG) antibodies were measured in all patients. Thyroid ultrasound was performed in all patients and in 50 healthy control subjects. The data was analyzed and expressed in terms of mean ± SD. Pearson correlation was performed to establish the relationship between different variables. Results: 52 of 80 patients (65%) showed high TSH levels with mean (12.37±3.9 mIU/ml) and 25 patients (31.3%) showed positive anti-TG anti-TPO levels with mean (906 ± 184.3, 628 ±137.5 IU/ml) respectively. The high TSH levels were statistically significantly associated with high anti-TG levels and anti-TPO levels with (mean 570.23± 372.41, 366.52±281.34 IU/ml) respectively with P-value < 0.001. There was significant increase in the gland volume in diabetic patients with mean (3.4±1.5 ml) versus (2.9±0.9 ml) in the control group, P-value <0.046. Also 25% of patients showed heterogenous hypoechogenic gland texture versus 6 % in the control group which was statistically significantly different, P-value = 0.008 and 50% of the patients showed increase in gland vascularity versus 12% in the control group which was statistically significantly different with P-value <0.001. These morphological abnormalities were associated with high (TSH, anti-TPO and anti-TG) levels but weren’t significant. High TSH levels were strongly positively correlated with anti-TPO and anti-TG, r = (0.84, 0.83) respectively, P-value <0.001. Conclusions: Type 1 diabetic patients had high incidence of thyroid dysfunction and AITD associated with morphological abnormalities of the thyroid gland. So we recommend screening for thyroid dysfunction in all patients with type 1 DM to avoid additional cardiovascular risk factors.
Type 1 Diabetes Mellitus, Thyroid Dysfunction, Thyroid Antibodies, AITD
To cite this article
Heba-Allah Moustafa Kamal Al-Din, Rokaya Abd-Al Aziz Mohamed, Shereen Sadik El-Sawy, Noha Adly Sadik, Rasha Mohamed Abd El Samie, Mahmoud Ahmed Khatab, Laila Ahmed Rashed, Thyroid Dysfunction and Morphological Abnormalities in Patients with Type 1 Diabetes Mellitus, American Journal of Internal Medicine. Vol. 3, No. 4, 2015, pp. 185-193. doi: 10.11648/j.ajim.20150304.16
Liese AD, D'Agostino RB Jr, Hamman RF, Kilgo PD, Lawrence JM, Liu LL, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the search for Diabetes in Youth Study. Pediatrics 2006;118 :1510 –1518.
Dretzke J, Cummins C, Sandercock J, Fry-Smith A, Barrett T, Burls A. Autoantibody testing in children with newly diagnosed type 1 diabetes mellitus. Health Technol Assess 2004;8(22):1-183.
Kakleas K, Paschali E, Kefalas N, Fotinou Aspasia, Kanariou M, et al. Factors for thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Ups J Med Sci 2009;114:214–20
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;33:273-9.
Lorini R, d’Annunzio G, Vitali L, Scaramuzza A. IDDM and autoimmune thyroid disease in the pediatric age group. J Pediatr Endocrinol Metab 1996;9:89–94.
Mantovani RM, Mantovani LM, Dias VM. Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus: Prevalence and risk factors. J Pediatr Endocrinol Metab. 2007;20:669–75.
Kadiyala, R.; Peter, R.& Okosieme OE. Thyroid dysfunction in patients with diabetes:clinical implications and screening strategies. Int J Clin Pract 2010;64:1130-1139
Leong KS, Wallymahmed M, Wilding J, MacFarlane I. Clinical presentation of thyroid dysfunction and Addison’s disease in young adults with type 1 diabetes.Postgraduate Medical Journal. 1999;75:467–470.
Samaneh Khanpour Ardestani, Ammar Hassanzadeh Keshteli, Noushin Khalili, Mahin Hashemipour, Reihaneh Barekatain. Thyroid Disorders in Children and Adolescents with Type 1 Diabetes Mellitus in Isfahan, Iran. Iran J Pediatr 2011; 21:502-508
Hage M, Zantout MS, Azar ST. Thyroid disorders and diabetes mellitus. J Thyroid Res 2011;10:1-7.
Hansen D, Bennedbaek FN, Høier-Madsen M, Hegedüs L, Jacobsen BB.: A prospective study of thyroid function, morphology and autoimmunity in young patients with type 1 diabetes. Eur J Endocrinol 2003; 148(2):245-51.
Pedersen OM, Aardal NP, Larssen TB, et al. The value of ultrasonography in predicting autoimmune thyroid disease. Thyroid 2000;10:251.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2012;35(1):11–63.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2003; 26:5–20.
Spencer CA. Clinical Chemistry,“Interlaboratory/Intermethod differences in Functional Sensitivity of Immunometric Assays of Thyrotropin (TSH) and Impact on Reliability of Measurement of Subnormal Concentrations of TSH”1995;41:367.
Sati, C., Chattor, A.J., Watts, N. Fundamentals of Clinical Chemistry. Ed. Tietz, N.W. 3rd Ed:586. Saunders Press Phila 1987.
Midgeley John, EM. “Direct and Indirect Free Thyroxine Assay Methods. Theory and Practice”. Clin. Chem. 2001;47:1353-1363.
Czarnocka, B., Ruf, J., Ferrand, M. Purification of the human thyroid peroxidase and its identification as the microsomal antigen involved in autoimmune thyroid diseases. FEBS Lett. 1985; 190:147- 152.
Norbert G. Dietmar K and Thomas R. Radiologic evaluation of the neck sonography of the thyroid and parathyroid glands. Radiologic clinics of north America 2000;38:1131.
Gomez JM, Maravall FJ, Gomez N, Guma A, Soler J. Determinants of thyroid volume as measured by ultra¬sonography in healthy adults randomly selected. Clin Endocrinol (Oxf) 2000;53:629-34.
Perros P, McCrimmon RJ, Shaw G, Frier BM. Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet Med 1995;12:622–627.
Sharifi F, Ghasemi L, Mousavinasab N. Thyroid Function and anti-thyroid antibodies in Iranian patients with type 1 diabetes mellitus: influences of age and sex. Iran J Allergy Asthma Immunol 2008;7:31–6.
Frasier SD, Penny R, Snyder R, Goldstein I, Graves D. Antithyroid antibodies in Hispanic patients with type I diabetes mellitus. Prevalence and significance. Am J Dis Child 1986;140:1278–80.
Ghawil M, Tonutti E, Abusrewil S, Visentini D, Hadeed I, Miotti V, et al. Autoimmune thyroid disease in Libyan children and young adults with type 1 diabetes mellitus. Eur J Pediatr. 2011;170:983-7.
Omar M.A, Rizk M.M, ElKafoury A.A, Doaa K. Screening for thyroid disease among children and adolescents with type 1 diabetes mellitus. Alexandria Journal of Medicine (2014) 50, 77–82.
Metwalley KA, El-Saied AA. Thyroid abnormalities in Egyptian children and adolescents with type 1 diabetes mellitus: A single center study from Upper Egypt. Indian J Endocrinol Metab. 2014; 18: 637–641.
Vaidya B, Pearce S. The emerging role of the CTLA-4 gene in autoimmune endocrinopathies. Eur J Endocrinol. 2004;150:619–26.
Golden B, Levin L, Ban Y, Concepcion E, Greenberg DA, Tomer Y. “Genetic analysis of families with autoimmune diabetes and thyroiditis: evidence for common and unique genes,” Journal of Clinical Endocrinology and Metabolism 2005; 90:4904–4911.
Ikegami H, Awata T, Kawasaki E, Kobayashi T, Maruyama T, Nakanishi K, et al. The association of CTLA4 polymorphism with type 1 diabetes is concentrated in patients complicated with autoimmune thyroid disease: a multicenter collaborative study in Japan. Journal of Clinical Endocrinology and Metabolism 2006;91:1087–1092.
Kawasaki E, Awata T, Ikegami H, Kobayashi T, Maruyama T, Nakanishi K, et al., Systematic search for single nucleotide polymorphisms in a lymphoid tyrosine phosphatase gene (PTPN22): association between a promoter polymorphism and type 1 diabetes in Asian populations. American Journal of Medical Genetics 2006;140:586–593.
Villano MJB, Huber AK, Greenberg DA, Golden BK, Concepcion E, Tomer Y. Autoimmune thyroiditis and diabetes: dissecting the joint genetic susceptibility in a large cohort of multiplex families. Journal of Clinical Endocrinology and Metabolism 2009;94:1458–1466.
Ghoraishian SM , Moghaddam SHH, Ardekani MA. Relationship between Anti-Thyroid Peroxidase Antibody and Thyroid Function Test. Iran.J.Immunol.2006;3:146-149.
Kordonouri O, Hartmann R, Deiss D, Wilms M, Gru¨ters-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.
Barker JM, Yu J, Yu L, Wang J, Miao D, Bao F, et al. Autoantibody "subspecificity" in type 1 diabetes: risk for organ-specific autoimmunity clusters in distinct groups. Diabetes Care 2005; 28:850-5.
Phillips D, Prentice L, Upadhyaya M, Lunt P, Chamberlain S, Roberts DF, et al. Autosomal dominant inheritance of autoantibodies to thyroid peroxidase and thyroglobulin--studies in families not selected for autoimmune thyroid disease. J Clin Endocrinol Metab 1991;72:973-5.
Prazny M, Skrha J, Limanova Z, Vanickova Z, Hilgertova J, Prazna J, et al. Screening for associated autoimmunity in type 1 diabetes mellitus with respect to diabetes control. Physiol Res 2005;54:41–8.
Kordonouri O, Klinghammer A, Lang EB, Gruters-Kieslich A, Grabert M, Holl R. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survery. Diabetes Care 2002;25:1346–50.
Glastras S, Craig ME, Verge CF, Chan AK, Cusumano JM, Donaghue KC. The role of autoimmunity at diagnosis of type 1 diabetes in the development of thyroid and celiac disease and microvascular complications. Diabetes Care 2005;28:2170–2175.
Hansen D, Bennedbæk FNL, Hansen LK, Høier-Madsen M, Jacobsen BB, Hegedus L. Thyroid function, morphology and autoimmunity in young patients with insulin-dependent diabetes mellitus .European Journal of Endocrinology 1999;140:512–518.
Darendeliler FF, Kadioglu A, Firdevs B, Bundak R, Gu¨no¨z H,Saka N et al. Thyroid ultrasound in IDDM. Journal of Pediatric Endocrinology 1994;7:33–37.
Bianchi G, Montanari P, Fabbri A, Gamberini A, Zoli M, Marchesini G. Thyroid volume in type 1 diabetes patients without overt thyroid disease. Acta Diabetologica 1995;32 49–52.
Junik R, Kozinski M, Debska K. Thyroid Ultrasound in Diabetic Patients without Overt Thyroid Disease Acta Radiol 2006;47:687–691.
Gomez JM, Maravall FJ, Guma A, Abos R, Soler J, Fernandez-Castaner M. Thyroid volume as measured by ultrasonography in patients with type 1 diabetes mellitus without thyroid dysfunction. Horm Metab Res 2003;35:486–91.
Marcocci C, Vitti P, Cetani F, Catalano F, Concetti R & Pinchera A. Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. Journal of Clinical Endocrinology and Metabolism 1991 72 209– 213.
Sostre S, Reyes MM. Sonographic diagnosis and grading of Hashimoto’s thyroiditis. Journal of Endocrinological Investigation 1991;14:115–121.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186