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Question:

From Brooklyn, New York, USA:

Is it true that my 11 year old son who was diagnosed with Type 1 about seven months ago will be more at risk for other autoimmune diseases? If so, which ones and how much more of a risk is it than the rest of the population? Is this something that we will have to be concerned with for the rest of his life?

Answer:

Yes, it is true that if you have Type 1A autoimmune diabetes you are more likely to have to deal with other autoimmune conditions; but this still uncommon. About 5% of children with this kind of diabetes have clinical hypothyroidism that need treatment. It is more common in girls that in boys and if you look at thyroid antibodies (rather than the less expensive and more useful TSH test) there is evidence of autoimmunity in as many as three times the above number.

Beyond this, there are a number of other autoimmune conditions that are rarely associated with Type 1 diabetes: myasthenia gravis, pernicious anemia, other thyroid disorders and polyarticular juvenile rheumatoid arthritis to name some. There are two others that can be easily tested for and where there is some advantage in knowing the answer. About 5% of Type 1A diabetics have anti-transglutaminase antibodies which makes them vulnerable to the coeliac syndrome. Those that test positive usually need a small intestine mucosal biopsy and if this is positive too, they should be put on a gluten free diet to remain symptom free. About 1% of this group also have anti-21hydoxylase antibodies. This is an indication of involvement of the adrenal cortex, They may not need treatment; but Addison's disease may have a sudden onset and forewarned is forearmed. I think you should ask your son's doctor to discuss all this with you and do remember that what is now called Autoimmune Polyglandular Syndromes, Type 2, is rare apart from hypothyroidism, which most clinics test for routinely and which is easy to treat.

This grouping of autoimmune disorders has only been recognised fairly recently and because they are rare there is very little information about their frequency in both diabetic children or the population as a whole. Nor is there much known about the frequency of various associations or about the basic changes in the immunology that brings this about. Diabetes incidentally is not always a component of this syndrome.

DO'B

Original posting 14 Sep 1998
Posted to Other Illnesses

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