Autoimmune thyroid dysfunction in children with type 1 diabetes mellitus: screening guidelines based on a retrospective analysis

Abstract

Individuals with type 1 diabetes mellitus (DM1) have an increased risk of developing autoimmune thyroid dysfunction (AITD). We measured the prevalence of AITD in a pediatric DM1 population in order to examine the best combination of markers for predicting the development of AITD. A database of 1,254 patients with DM1 under 21 years of age was retrospectively screened for abnormalities in antithyroglobulin antibody (ATA), thyroid peroxidase antibody (TPO) and thyroid stimulating hormone (TSH). Charts on all 134 who had any of these serologic abnormalities were reviewed. 4.2% of the DM1 population was clinically diagnosed with AITD. Thirty-nine percent of the AITD diagnoses came within 1 year of DM1 diagnosis. Based upon evidence-based medicine statistics, TPO and TSH measurements are the most efficient and cost-effective combination of screening tests for AITD prediction and detection. The positive predictive value (of TPO and TSH) is 90%, with a positive likelihood ratio of 131.