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  • 1 Faculty of Medicine, Semmelweis University 1st Department of Pediatrics Bókay János u. 53. H-1083 Budapest Hungary
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Introduction: It is well known that patients suffering from an autoimmune disease are more prone to develop another one, too. The authors have previously shown frequent occurrence of celiac disease in patients with type 1 diabetes mellitus compared to the background population. Autoimmune thyroid disease, the most common autoimmune disorder, associated with type 1 diabetes mellitus, generally occurs after the manifestation of diabetes, in the second decade of life. The aim of the study was to investigate the prevalence of thyroid autoimmunity as well as the frequency of autoimmune thyroid disease in patients with type 1 diabetes mellitus. Its aim was also to compare the prevalence of autoimmune thyroid disease in patients with type 1 diabetes mellitus and in those with type 1 diabetes mellitus and celiac disease. Methods: Screening was performed in 268 patients with type 1 diabetes mellitus alone and in 48 children with type 1 diabetes mellitus and celiac disease, with the aid of anti-peroxidase and anti-thyroglobulin antibody. In case of autoantibody positivity testing of thyroid function and ultrasonography confirmed the autoimmune thyroid disease. According to the results, the frequency of autoantibody positivity was significantly higher in diabetic patients suffering from celiac disease (type 1 diabetes mellitus: 43 (16%), type 1 diabetes mellitus + celiac disease: 16 (33.3%, p < 0.01). Hypothyroidism due to thyroiditis was also more prevalent in patients with type 1 diabetes mellitus and celiac disease. Conclusions: Due to increased risk, the authors emphasize the need of frequent screening for autoimmune thyroid disorder in patients with type 1 diabetes mellitus and celiac disease.

  • Ehrlich, P., Morgenroth, J.: Ueber Haemolysine. Dritte Mitteilung. Berl. Klin. Wochenschr., 1900, 37 , 453.

    Morgenroth J. , 'Ueber Haemolysine. Dritte Mitteilung ' (1900 ) 37 Berl. Klin. Wochenschr. : 453 -.

    • Search Google Scholar
  • Cuoco, L., Cammarota, G., Tursi, A. et al.: Disappearance of gastric mucosa-associated lymphoid tissue in coeliac patients after gluten withdrawal. Scand. J. Gastroenterol., 1998, 33 , 401–405.

    Tursi A. , 'Disappearance of gastric mucosa-associated lymphoid tissue in coeliac patients after gluten withdrawal ' (1998 ) 33 Scand. J. Gastroenterol. : 401 -405.

    • Search Google Scholar
  • Paulsen, G., Lundin, K. E., Gjertsen, H. A. et al.: HLA DQ2-restricted T-cell recognition of gluten-derived peptides in celiac disease. Influence of aminoacid substitution in the membrane distal domain of DQ beta 1*0201. Hum. Immunol., 1995, 42 , 145–153.

    Gjertsen H. A. , 'HLA DQ2-restricted T-cell recognition of gluten-derived peptides in celiac disease. Influence of aminoacid substitution in the membrane distal domain of DQ beta 1*0201 ' (1995 ) 42 Hum. Immunol. : 145 -153.

    • Search Google Scholar
  • Reunula, T., Salmi, J., Karvonen, J.: Dermatitis herpetiformis and celiac disease associated with Addison’s disease. Arch. Dermatol., 1987, 123 , 930–932.

    Karvonen J. , 'Dermatitis herpetiformis and celiac disease associated with Addison’s disease ' (1987 ) 123 Arch. Dermatol. : 930 -932.

    • Search Google Scholar
  • Vartdal, F., Johansen, B. H., Rammensee, H. G. et al.: The peptide binding motif of the disease-associated HLA DQ (α1*0501, β1*0201) molecule. Eur. J. Immunol., 1996, 26 , 2764–2772.

    Rammensee H. G. , 'The peptide binding motif of the disease-associated HLA DQ (α1*0501, β1*0201) molecule ' (1996 ) 26 Eur. J. Immunol. : 2764 -2772.

    • Search Google Scholar
  • Yu, L., Brewer, K. W., Gates, S. et al.: DR B1*04 and DQ alleles. Expression of 21-hydroxylase autoantibodies and risk of progression to Addison’s disease. J. Clin. Endocrinol. Metab., 1999, 84 , 328–335.

    Gates S. , 'DR B1*04 and DQ alleles. Expression of 21-hydroxylase autoantibodies and risk of progression to Addison’s disease ' (1999 ) 84 J. Clin. Endocrinol. Metab. : 328 -335.

    • Search Google Scholar
  • Arató, A., Körner, A., Veres, G. et al.: Frequency of coeliac disease in Hungarian children with diabetes mellitus. Eur. J. Pediatr., 2003, 162 , 1–5.

    Veres G. , 'Frequency of coeliac disease in Hungarian children with diabetes mellitus ' (2003 ) 162 Eur. J. Pediatr. : 1 -5.

    • Search Google Scholar
  • McLachlan, S. M., Rapaport, B.: The molecular biology of thyroid peroxidase: cloning, expression and role as autoantigen in autoimmun thyroid disease. Endocr. Rev., 1992, 13 , 192–206.

    Rapaport B. , 'The molecular biology of thyroid peroxidase: cloning, expression and role as autoantigen in autoimmun thyroid disease ' (1992 ) 13 Endocr. Rev. : 192 -206.

    • Search Google Scholar
  • Rapaport, B., Chazenbalk, G. D., Jaume, J. C. et al.: The thyrotropin receptor: interaction with thyrotropin and autoantibodies. Endocr. Rev., 1998, 19 , 673–716.

    Jaume J. C. , 'The thyrotropin receptor: interaction with thyrotropin and autoantibodies ' (1998 ) 19 Endocr. Rev. : 673 -716.

    • Search Google Scholar
  • Rapaport, B., McLachlan, S. M.: Thyroid autoimmunity. J. Clin. Invest., 2001, 108 , 1253–1259.

    McLachlan S. M. , 'Thyroid autoimmunity ' (2001 ) 108 J. Clin. Invest. : 1253 -1259.

  • Velluzzi, F., Caradonna, A., Boy, M. F. et al.: Thyroid and celiac disease. Clinical, serologic and ecographic study. Am. J. Gastroenterol., 1998, 93 , 976–979.

    Boy M. F. , 'Thyroid and celiac disease. Clinical, serologic and ecographic study ' (1998 ) 93 Am. J. Gastroenterol. : 976 -979.

    • Search Google Scholar
  • Kordonouri, O., Klinghammer, A., Lang, E. B. et al.: Thyroid autoimmunity in children and adolescents with type 1 diabetes. Diabet. Care, 2002, 25 , 1346–1350.

    Lang E. B. , 'Thyroid autoimmunity in children and adolescents with type 1 diabetes ' (2002 ) 25 Diabet. Care : 1346 -1350.

    • Search Google Scholar
  • Szegedi, Gy.: Az autoimmun betegségek sajátosságai. (Characteristics of autoimmune diseases.)(In Hungarian). LAM, 2004, 14 , 739–746.

    Szegedi Gy. , 'Az autoimmun betegségek sajátosságai. (Characteristics of autoimmune diseases.)(In Hungarian) ' (2004 ) 14 LAM : 739 -746.

    • Search Google Scholar
  • Herrath, M.: Insulin trigger for diabetes. Nature, 2005, 435 , 151–152.

    Herrath M. , 'Insulin trigger for diabetes ' (2005 ) 435 Nature : 151 -152.

  • Redondo, M. J., Eisenbarth, G. S.: Genetic control of autoimmunity in type 1 diabetes and associated disorders. Diabetologia, 2002, 45 , 605–622.

    Eisenbarth G. S. , 'Genetic control of autoimmunity in type 1 diabetes and associated disorders ' (2002 ) 45 Diabetologia : 605 -622.

    • Search Google Scholar
  • Rose, N. R.: Autoimmune disease 2002. An overview. J. Invest. Dermatol., 2004, 9 , 1–4.

    Rose N. R. , 'Autoimmune disease 2002. An overview ' (2004 ) 9 J. Invest. Dermatol. : 1 -4.

  • Korányi, L., Pánczél, P.: A diabetes mellitus genetikája. (Genetics of diabetes mellitus.) (In Hungarian). LAM, 2004, 14 , 495–505.

    Pánczél P. , 'A diabetes mellitus genetikája. (Genetics of diabetes mellitus.) (In Hungarian) ' (2004 ) 14 LAM : 495 -505.

    • Search Google Scholar
  • Hermann, R., Knip, M., Veijola, R. et al.: Temporal changes in the frequencies of HLA genotypes in patients with type 1 diabetes–indication of an increased environmental pressure. Diabetologia, 2003, 46 , 420–425.

    Veijola R. , 'Temporal changes in the frequencies of HLA genotypes in patients with type 1 diabetes–indication of an increased environmental pressure ' (2003 ) 46 Diabetologia : 420 -425.

    • Search Google Scholar
  • Concannon, P., Gogolin-Ewens, K. J., Hinds, D. A. et al.: A second generation screen of the human genome for susceptibility to insulin-dependent diabetes mellitus. Nat. Gen., 1998, 19 , 292–296.

    Hinds D. A. , 'A second generation screen of the human genome for susceptibility to insulin-dependent diabetes mellitus ' (1998 ) 19 Nat. Gen. : 292 -296.

    • Search Google Scholar
  • Guo, D., Li, M., Zhang, Y. et al.: A functional variant of SUMO4, a new IκB a modifier, is associated with type 1 diabetes. Nat. Gen., 2004, 36 , 837–841.

    Zhang Y. , 'A functional variant of SUMO4, a new IκBa modifier, is associated with type 1 diabetes ' (2004 ) 36 Nat. Gen. : 837 -841.

    • Search Google Scholar
  • Gylvin, T., Bergholdt, R., Nerup, J. et al.: Characterization of a nuclear-factor-kappa B (NFκB) genetic marker in type 1 diabetes (T1DM) families. Nat. Gen. Immunol., 2002, 3 , 430–432.

    Nerup, J. , 'Characterization of a nuclear-factor-kappa B (NFκB) genetic marker in type 1 diabetes (T1DM) families ' (2002 ) 3 Nat. Gen. Immunol. : 430 -432.

    • Search Google Scholar
  • Pociot, F., McDermott, M. F.: Genetics of type 1 diabetes mellitus. Gen. Immun., 2002, 3 , 235–249.

    McDermott M. F. , 'Genetics of type 1 diabetes mellitus ' (2002 ) 3 Gen. Immun. : 235 -249.

  • Yokoi, N., Komeda, K., Wang, H-Y. et al.: C blb is a major susceptibility gene for rat type 1 diabetes mellitus. Nat. Gen., 2002, 31 , 391–394.

    Wang H-Y. , 'Cblb is a major susceptibility gene for rat type 1 diabetes mellitus ' (2002 ) 31 Nat. Gen. : 391 -394.

    • Search Google Scholar
  • Onengut-Gumuscu, S., Ewens, K. G., Spielman, R. S. et al.: A functional polymorphism (1858 C/T) in the PTPN22 gene is linked and associated with type 1 diabetes in multiplex families. Nat. Gen. Immunol., 2004, 5 , 676–680.

    Spielman R. S. , 'A functional polymorphism (1858 C/T) in the PTPN22 gene is linked and associated with type 1 diabetes in multiplex families ' (2004 ) 5 Nat. Gen. Immunol. : 676 -680.

    • Search Google Scholar
  • Sollid, L., Thorsby, E.: HLA susceptibility genes in celiac disease: genetic mapping and role in pathogenesis. Gastroenterology, 1993, 105 , 910–922.

    Thorsby E. , 'HLA susceptibility genes in celiac disease: genetic mapping and role in pathogenesis ' (1993 ) 105 Gastroenterology : 910 -922.

    • Search Google Scholar
  • Kumar, V., Rayadhiaksha, M., Wortsman, J.: Celiac disease-associated autoimmune endocrinopathies. Clin. Diagn. Lab. Immunol., 2001, 8 , 678–685.

    Wortsman J. , 'Celiac disease-associated autoimmune endocrinopathies ' (2001 ) 8 Clin. Diagn. Lab. Immunol. : 678 -685.

    • Search Google Scholar
  • Alessio, F.: Celiac disease: the past, the present, the future. Pediatrics, 2001, 107 , 768–770.

    Alessio F. , 'Celiac disease: the past, the present, the future ' (2001 ) 107 Pediatrics : 768 -770.

    • Search Google Scholar
  • Wandstrat, A., Wakeland, E.: The genetics of complex autoimmune diseases: non-MHC susceptibility genes. Nat. Immunol., 2001, 2 , 802–809.

    Wakeland E. , 'The genetics of complex autoimmune diseases: non-MHC susceptibility genes ' (2001 ) 2 Nat. Immunol. : 802 -809.

    • Search Google Scholar
  • Siminovitch, K. A.: PTPN22 and autoimmune disease. Nat. Gen., 2005, 36 , 1248–1249.

    Siminovitch K. A. , 'PTPN22 and autoimmune disease ' (2005 ) 36 Nat. Gen. : 1248 -1249.

  • Soltész, G.: Diabetes in the young: a pediatric and epidemiological perspective. Diabetologia, 2003, 46 , 447–454.

    Soltész G. , 'Diabetes in the young: a pediatric and epidemiological perspective ' (2003 ) 46 Diabetologia : 447 -454.

    • Search Google Scholar
  • Atkinson, M. A.: Thirty years of investigating the autoimmune basis for type 1 diabetes. Diabetes, 2005, 54 , 1253–1263.

    Atkinson M. A. , 'Thirty years of investigating the autoimmune basis for type 1 diabetes ' (2005 ) 54 Diabetes : 1253 -1263.

    • Search Google Scholar
  • Noelle, V., Raile, K., Schmidt, H., Schwarz, H. P.: Autoimmune thyreoiditis in children and adolescents with type 1 diabetes. Clinical presentation and suggestion for sensible and cost-efficient screening. Monatschr. Kinderheilk., 2002, 150 , 619–624.

    Schwarz H. P. , 'Autoimmune thyreoiditis in children and adolescents with type 1 diabetes. Clinical presentation and suggestion for sensible and cost-efficient screening ' (2002 ) 150 Monatschr. Kinderheilk. : 619 -624.

    • Search Google Scholar
  • Umpierrez, G. E., Latif, K. A., Murphy, M. B. et al.: Thyroid dysfunction in patients with type 1 diabetes. Diabet. Care, 2003, 26 , 1181–1185.

    Murphy M. B. , 'Thyroid dysfunction in patients with type 1 diabetes ' (2003 ) 26 Diabet. Care : 1181 -1185.

    • Search Google Scholar
  • Lazarus, J. H., Obuobie, K.: Thyroid disorders. Postgrad. Med. J., 2000, 76 , 529–536.

    Obuobie K. , 'Thyroid disorders ' (2000 ) 76 Postgrad. Med. J. : 529 -536.

  • Hollowell, J. G., Stachling, N. W., Flanders, W. D. et al.: Serum TSH, T4 and thyroid antibodies in the United States population (1988–1994). National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab., 2002, 87 , 489–499.

    Flanders W. D. , 'Serum TSH, T4 and thyroid antibodies in the United States population (1988–1994). National Health and Nutrition Examination Survey (NHANES III). J. Clin ' (2002 ) 87 Endocrinol. Metab. : 489 -499.

    • Search Google Scholar
  • Tunbridge, W. M., Evered, D. C., Hall, R. et al.: The spectrum of thyroid disease in a community: the Wickham survey. Clin. Endocrinol., 1977, 7 , 481–493.

    Hall R. , 'The spectrum of thyroid disease in a community: the Wickham survey ' (1977 ) 7 Clin. Endocrinol. : 481 -493.

    • Search Google Scholar
  • Perros, P., McCrimmon, R. J., Shaw, G. et al.: Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet. Med., 1995, 12 , 622–627.

    Shaw G. , 'Frequency of thyroid dysfunction in diabetic patients: value of annual screening ' (1995 ) 12 Diabet. Med. : 622 -627.

    • Search Google Scholar
  • Mouradian, M., Abourizk, N.: Diabetes mellitus and thyroid disease. Diabet. Care, 1983, 6 , 512–520.

    Abourizk N. , 'Diabetes mellitus and thyroid disease ' (1983 ) 6 Diabet. Care : 512 -520.

  • Bonamico, M., Anastasi, E., Calvani, L.: Endocrine autoimmunity and function in adolescent celiac patients: importance of the diet. J. Pediatr. Gastroenterol. Nutr., 1997, 24 , 467–469.

    Calvani L. , 'Endocrine autoimmunity and function in adolescent celiac patients: importance of the diet ' (1997 ) 24 J. Pediatr. Gastroenterol. Nutr. : 467 -469.

    • Search Google Scholar
  • Ventura, A., Magazzu, G., Greco, G. et al.: Autoimmune disorders in celiac disease. Relation with duration of gluten exposure. Gastroenterology, 1999, 117 , 303–310.

    Greco G. , 'Autoimmune disorders in celiac disease. Relation with duration of gluten exposure ' (1999 ) 117 Gastroenterology : 303 -310.

    • Search Google Scholar
  • Not, T., Tommasini, A., Tonini, G. et al.: Undiagnosed coeliac disease and risk of autoimmune disorders in subjects with type 1 diabetes mellitus. Diabetologia, 2001, 44 , 151–155.

    Tonini G. , 'Undiagnosed coeliac disease and risk of autoimmune disorders in subjects with type 1 diabetes mellitus ' (2001 ) 44 Diabetologia : 151 -155.

    • Search Google Scholar