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Question:

From New York, USA:

Our 12 year old daughter was diagnosed with Type 1 Diabetes about seven months ago. Three months later she was diagnosed with an elevated TSH and has been taking Synthroid [a thyroid hormone replacement medication]. Three months later (6 months from initial diabetes diagnosis) she had a couple of episodes of very stiff and swollen ankle, wrist, elbow, and knee joints. Although these symptoms cleared up we told her doctor (endocrinologist) about them and she tested her for Rheumatoid arthritis. The results showed an elevated ANA.

Although the diabetes is being very well controlled with very low levels of insulin and the Synthroid has the thyroid problem resolved, we still have many questions. Do all of these problems have a relationship? Have you seen this before? It seems too coincidental that within six months a healthy child could contact three diseases. Should we be seeking further medical attention, looking for other autoimmune diseases? Could one virus be causing all these problems?

Answer:

The association of juvenile rheumatoid arthritis, particularly the polyarticular form, with Type 1 Diabetes has been described for nearly twenty years. Both are autoimmune conditions and it is not surprising that they are associated in your daughter with an autoimmune form of hypothyroidism. These combinations have come to be known as Autoimmune Polyglandular Syndromes, Type 2.

There are a number of other autoimmune conditions that can join this cohort including pernicious anemia, hypoparathyroidism and other forms of connective tissue disorders. It would probably be worth discussing with your daughter's endocrinologist the value of getting some additional antibody tests done. About 5% of autoimmune diabetics have celiac disease which can be detected by the presence of anti-transglutaminase antibodies. If these are positive it would be justifiable to take a mucosal biopsy and if this is positive then dietary treatment is all that is required. Anti 21-hydoxylase antibodies likewise occur in about 1% of autoimmune diabetics indicating a vulnerability to adrenal cortical deficiency (also known as Addison's disease). In all probability a positive test might not need treatment now; but it is important to be forewarned since adrenal insufficiency can develop abruptly.

On the whole, the virus theory of autoimmune disease is discounted. Whilst an acute viral infection might have triggered the final development of the clinical stage of the disorder, the evidence is that the damage to the immune system starts many months before the clinical stage.

DO'B

Additional comments from Dr. Lebinger:

Although juvenile rheumatoid arthritis, hypothyroidism, and insulin dependent diabetes can be related as Dr. O'Brien explained, if you live in an area where Lyme disease is common, I would make sure the sudden onset of joint symptoms aren't a manifestation of Lyme disease, which would require treatment with antibiotics to prevent long term problems. Most likely a blood test was done to screen for this disorder, but if hasn't, I would discuss with your child's doctor adding this test.

As far as I know there is no association between susceptibility to Lyme disease and diabetes.

TGL

Original posting 7 Sep 1998
Posted to Other Illnesses and Thyroid

  
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Last Updated: Tuesday April 06, 2010 15:09:00
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