title: The role of autoimmunity at diagnosis of type 1 diabetes in the development of thyroid and celiac disease and microvascular complications.
abstract: OBJECTIVE
  The purpose of this study was to explore whether the presence of thyroid and endomysial autoantibodies at diagnosis of type 1 diabetes in children predicts development of thyroid and celiac disease, respectively, and whether diabetes-associated autoantibodies at diagnosis predict development of microvascular complications up to 13 years later.
  
  
  METHODS
  Autoantibodies were measured at diagnosis of type 1 diabetes in 173 children aged 0-15 years and included thyroperoxidase antibody (TPOA), endomysial antibody (EMA), islet cell autoantibody, GAD antibody (GADA), and insulin autoantibody. Thyroid disease was defined as thyroid stimulating hormone level > or = 5 microU/ml. Celiac disease was confirmed by small-bowel biopsy. Assessment of microvascular complications included stereoscopic fundal photography, pupillometry, thermal threshold, and albumin excretion rate (AER).
  
  
  RESULTS
  The incidence rates for thyroid and celiac disease were 0.9 and 0.7 per 100 patient-years, respectively. Within 13 years, 6 of 13 children with positive TPOA tests at diagnosis developed thyroid disease compared with 5 of 139 children with negative TPOA tests (P < 0.001). All four patients with positive EMA titers at diagnosis had biopsy-proven celiac disease. Five of 11 patients who developed thyroid disease and 4 of 8 who developed celiac disease had negative TPOA and EMA tests at diagnosis, respectively. Retinopathy was detected in 39% and elevated AER in 36%. The presence of diabetes-associated autoantibodies at diagnosis did not predict microvascular complications though GADA titer levels predicted pupillary abnormality.
  
  
  CONCLUSIONS
  Elevated TPOA and EMA levels at diagnosis of type 1 diabetes predict the development of thyroid and celiac disease, respectively. In children with negative antibody titers at diagnosis, screening at 2-year intervals is recommended.
authors.affiliation: Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia. swatzlaf@gmp.usyd.edu.au
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Glastras
authors.forename: Maria E
authors.initials: ME
authors.lastname: Craig
authors.forename: Charles F
authors.initials: CF
authors.lastname: Verge
authors.forename: Albert K
authors.initials: AK
authors.lastname: Chan
authors.forename: Janine M
authors.initials: JM
authors.lastname: Cusumano
authors.forename: Kim C
authors.initials: KC
authors.lastname: Donaghue
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D002446:Celiac Disease / Q000276:immunology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis* / Q000276:immunology* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000276:immunology* / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007453:Iodide Peroxidase / Q000276:immunology*; D016019:Survival Analysis; D013959:Thyroid Diseases / Q000276:immunology* / Q000401:mortality
chemical_list: D001323:Autoantibodies; D007453:Iodide Peroxidase