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Diabetologie und Stoffwechsel 2012; 7(6): 442-449
DOI: 10.1055/s-0032-1330391
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Autoimmunthyreopathie bei Patienten mit Typ 1 Diabetes mellitus

Autoimmune Thyroiditis in Patients with Diabetes Type 1
W. Hunger-Battefeld
1   Klinik für Innere Medizin III (Direktor: Univ.-Prof. Dr. med. Gunter Wolf), Universitätsklinikum Jena
,
K. Fath
1   Klinik für Innere Medizin III (Direktor: Univ.-Prof. Dr. med. Gunter Wolf), Universitätsklinikum Jena
,
M. Kiehntopf
2   Institut für Klinische Chemie und Laboratoriumsdiagnostik (komm. Direktor: Dr. Dr. Michael Kiehntopf), Universitätsklinikum Jena
,
U. A. Müller
1   Klinik für Innere Medizin III (Direktor: Univ.-Prof. Dr. med. Gunter Wolf), Universitätsklinikum Jena
,
G. Wolf
1   Klinik für Innere Medizin III (Direktor: Univ.-Prof. Dr. med. Gunter Wolf), Universitätsklinikum Jena
› Author Affiliations
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Publication History

Publication Date:
17 December 2012 (online)

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Zusammenfassung

Problemstellung: Bei Patienten mit Diabetes mellitus Typ 1 (Dm1) treten gehäuft weitere endokrine Autoimmunerkrankungen auf, wobei die Autoimmunthyreopathie als die häufigste assoziierte endokrine Autoimmunerkrankung bei Patienten mit Dm1 beschrieben wird. Dieser Zusammenhang sollte in einer nicht selektionierten Patientenpopulation mit Dm1 untersucht werden.

Patienten und Methoden: Es wurden die Prävalenz pathologischer Autoantikörpertiter (Anti-TPO bzw. MAK, TAK, TRAK) und das Auftreten einer klinisch manifesten Autoimmunthyreopathie (AIT) (Hypothyreose bei Autoimmunthyreoiditis oder Hyperthyreose bei Morbus Basedow) bei allen Patienten mit Dm1 untersucht, die sich 2004 und 2009 ambulant in der Diabetessprechstunde der Universität Jena vorstellten.

Ergebnisse: 218 Patienten mit Dm1 (Alter 45 ± 14 J; BMI 26 ± 4 kg/m2, Diabetesdauer 17 J [0 – 67], Manifestationsalter 26 ± 15 J [1 – 66], HbA1c 7,6 ± 1,1 % [NB 3,8 – 5,5]) wurden eingeschlossen. Pathologische Autoantikörpertiter zeigten 50 % (n = 109). Eine manifeste Hypothyreose zeigten 23,9 % und ein Morbus Basedow 7,3 %. Patienten mit AIT zeigten im Vgl. zu Patienten mit Normalbefund keine signifikanten Unterschiede bzgl. Alter, BMI, Diabetesdauer, Dm1-Manifestationsalter, HbA1c. Von den 68 Pat. (31,2 %) mit AIT lag lediglich bei 11,8 % (n = 8) eine AIT vor Diabetesmanifestation (AIT 3 J [0 – 11] vor Dm1-Manifestation) vor. Bei 88,2 % (n = 60) manifestierte sich die AIT erst im Median 16 J (1 – 64) nach dem Dm1, Frauen mit Dm1 zeigten signifikant häufiger eine AIT als Männer (40,3 vs. 19,1 %, p < 0,001). Dabei lag bei Frauen sowohl die Prävalenz einer immunogenen Hypothyreose (29,8 vs. 16,0 %, p < 0,05) als auch die Prävalenz eines Morbus Basedow (15,5 vs. 3,2 %, p < 0,05) signifikant höher als bei Männern.

Zusammenfassung: Die hohe Prävalenz einer AIT bei Dm1 wurde aufgezeigt, wobei die AIT sich in den meisten Fällen erst Jahre nach dem Dm1 manifestierte und Frauen häufiger betroffen waren. Bei Patienten mit DM1 sollte prinzipiell an eine AIT gedacht werden und eine Kontrolle des TSH-Spiegels regelmäßig erfolgen.

Abstract

Background: Patients with diabetes type 1 (Dm1) have a higher prevalence for other endocrine autoimmune diseases. Among these, autoimmune thyroiditis is considered the most frequent concomitant additional endocrine disease. The aim of the following study was, to further examine this connection in an unselected patient sample with Dm1.

Patients and methods: The prevalence of pathological autoantibodies (TPO, MAb, TAb, TRAb) and the incidence of a clinical manifest autoimmune thyropathy (AIT) (hypothyreoidism due to autoimmune thyroid disease or hyperthyroidism due to Grave’s disease) in all patients with Dm1 were examined. Those presented as out-patients in the diabetes clinic in the years 2004 and 2009 at the university Jena.

Results: 218 patients with Dm1 were included (age 45 ± 14 years, BMI 26 ± 4 kg/m2, diabetes duration 17 years [0 – 67], age of diabetes manifestation 26 ± 15 years [1 – 66], HbA1c 7.6 ± 1.1 % [NR 3.8 – 5.5]). Pathologically elevated autoantibody titre showed 50 % (n = 109). A clinically manifest hypothyroidism was present in 23.9 % and Grave’s disease in 7.3 %. Patients with AIT showed in comparison to patients without thyroid abnormalities no significant differences regarding age, BMI, diabetes duration, age of diabetes manifestation or HbA1c. In the 68 (31.2 %) of the patients with overt AIT, the manifestation of AIT had occurred only in 11.8 % (n = 8) prior to the diabetes manifestation (AIT 3 years ([0 – 11] prior to manifestation of Dm1). In 88.2 % (n = 60) AIT manifestation was in the median 16 years [1 – 64] after the manifestation of Dm1. Female patients with Dm1 showed significantly more often an overt AIT than male patients (40.3 vs. 19.1 %, p < 0.001). In females as well the prevalence of autoimmune hypothyroidism (29.8 vs. 16.0 %, p < 0.05) as the prevalence of Grave’s disease was significantly higher (10.5 vs. 3.2 %, p < 0.05).

Conclusion: The high prevalence of AIT in patients with Dm1 was demonstrated, whereas the manifestation of AIT mostly occurred years after the manifestation of Dm1 and female patients were affected more often. In patients with Dm1 the occurrence of an AIT should always be taken into consideration and thyroid stimulating hormone should be checked regularly.

Schlüsselwörter

Diabetes mellitus Typ 1 - Autoimmunthyreoiditis - Morbus Basedow

Key words

diabetes mellitus type 1 - autoimmune thyroiditis - Morbus Basedow
 

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