Thyroid dysfunction in patients with type 1 diabetes - A longitudinal study

OBJECTIVE - Cross-sectional studies have reported that the risk of thyroid dysfunction in patients with type I diabetes is two- to threefold higher than in the general population. However, longitudinal studies to determine the natural history of thyroid dysfunction in patients with type I diabetes are lacking. RESEARCH DESIGN AND METHODS - We analyzed the incidence of thyroid dysfunction over time in a cohort of 58 patients (26 men and 32 women) enrolled in the Diabetes Control and Complications Trial at the University of Tennessee Health Science Center in 1983 and prospectively followed for 18 years. Patients underwent measurement of thyroid function tests (thyroid-stimulating hormone [TSH], thyroxine, and triiodothyronine) every year and thyroid peroxidase (TPO) antibodies at 4-year intervals. RESULTS - A total of 18 patients had hypothyroidism, and I patient experienced transient hyperthyroidism. Two subjects developed hypothyroidism 7 and 18 years before the development of diabetes and were excluded from the analysis. The mean age of diagnosis was 19 2 years for type I diabetes and 29 +/- 3 years for hypothyroidism. Hypothyroidism was more common in female (41%) than in male (19%) subjects and in patients with positive TPO antibodies. Patients who were TPO positive were 17.91 times as likely to develop hypothyroidism as patients who were TPO negative (95% Cl 3.89-82.54). There were no differences in BMI, lipid profile, and HbA(1c), between patients with and without thyroid dysfunction. CONCLUSIONS - This longitudinal study confirms the association between autoimmune thyroid dysfunction and type I diabetes. Our results indicate that all subjects with type I diabetes should undergo annual screening by serum TSH measurement to detect asymptomatic thyroid dysfunction, particularly those with positive TPO antibodies.