Hypothyroidism in Patients With Type 1 Diabetes
Hypothyroidism in Patients With Type 1 Diabetes
Therefore, for early detection of hypothyroidism in children with type 1 diabetes, it is
 suggested to measure anti-thyroid antibodies and thyroid stimulating hormone at disease onset
 and in yearly intervals after the age of 12 yr. Furthermore, the International Society for
 Pediatric and Adolescent Diabetes Consensus Clinical Guidelines recommend the screening of
 thyroid function by analysing circulating thyroid stimulating hormone at the diagnosis of
 diabetes and, thereafter every 2nd yr. in asymptomatic individuals without goitre and more
 frequent if goitre present .
Type 1 diabetes is an organ-specific autoimmune disease characterized by the selective
 destruction of pancreatic β-cells. The histopathology of type 1 diabetes is defined by a
 decreased β-cell mass infiltration of mononuclear cells into the islets of Langerhans , this
 lesion was later called 'insulitis', and it is the hallmark of the disease .

 Insulitis was observed in 70% of patients with acute onset type 1 diabetes and concluded that
 this disease was caused by a β-cell-specific autoimmune process .

 Furthermore, in a study demonstrated cellular autoimmunity in patients with type 1 diabetes
 using the leukocyte migration test and speculated that cellular hypersensitivity was the
 counter part of lymphocytic infiltration in islets . Therefore, it is speculated that
 cell-mediated immunity could play an important part in the pathogenesis of type 1 diabetes .

 As a view suggesting that type 1 diabetes is an autoimmune disease, there is some evidence
 that type 1 diabetes is often complicated with other autoimmune diseases or that anti-islet
 antibodies precede the clinical onset of the disease.

 So, it is found that type 1 diabetes is frequently associated with other organ-specific
 autoimmune diseases, including hypothyroidism , pernicious anaemia, and idiopathic Addison's
 disease .The most common coexisting organ autoimmune disease is hypothyroidism (>90%), the
 prevalence of anti-thyroid autoantibodies in children with type 1 diabetes at disease onset
 is about 20% .

 It is generally accepted that is a T cell-mediated autoimmune disease and that circulating
 autoantibodies to various islet cell antigens are induced following the destruction of
 pancreatic β cells .

 Furthermore, it is reported that the prevalence of anti-thyroid antibodies increases with
 increasing age and that the presence of anti-thyroid antibodies at diagnosis of type 1
 diabetes predicts the development of future thyroid disease as patients with antithyroid
 antibodies are 18 times more likely to develop thyroid disease than patients without
 anti-thyroid antibodies .

 Therefore, for early detection of hypothyroidism in children with type 1 diabetes, it is
 suggested to measure anti-thyroid antibodies and thyroid stimulating hormone at disease onset
 and in yearly intervals after the age of 12 yr. Furthermore, the International Society for
 Pediatric and Adolescent Diabetes Consensus Clinical Guidelines recommend the screening of
 thyroid function by analysing circulating thyroid stimulating hormone at the diagnosis of
 diabetes and, thereafter every 2nd yr. in asymptomatic individuals without goitre and more
 frequent if goitre present .
Inclusion Criteria:

 - Children with type 1 diabetes aging between 8 - 15 y .

 Exclusion Criteria:

 1. Cases with hyperthyroidism .

 2. Areas known to have endemic goitre due to nutritional iodine deficiency .

 3. History of maternal hypothyroidism and / or congenital hypothyroidism .

 4. Children known to be normoglycaemic with already presented thyroid dysfunction .

 5. Children with multiple endocrinopathies .

 6. Children under treatment with drugs inducing hypothyroidism like amiodarone , lithium
 .

 7. Children under treatment with drugs affecting insulin secretion like steroids , growth
 hormone therapy .