Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes
King Sun Leong, Maureen Wallymahmed, John Wilding, Ian MacFarlane
University
Clinical Departments at Aintree, University Hospital Aintree, Lower
Lane, Liverpool L9 7AL, UK
Accepted 17 March 1999
In a clinic population of 509 type 1 diabetic patients aged
16-45 years, 5.5% had received treatment for thyroid disorders (20 hypothyroid, three males; eight thyrotoxicosis, four males), and
Addison's disease was present in four patients (0.8%, one male). In
all patients, type 1 diabetes preceded the diagnosis of the other
autoimmune disorder. The clinical presentation of hypothyroidism was
usually insidious with few symptoms, although an increased frequency of
hypoglycaemic symptoms and/or raised serum cholesterol levels often
prompted thyroid function testing. In contrast, the patients with
thyrotoxicosis had florid symptoms, weight loss (mean 8.12 kg),
palpable goitres, increasing insulin requirements, and low cholesterol
levels. Six patients did not achieve remission or had recurrent
thyrotoxicosis after oral antithyroid treatment and required
131I or thyroid surgery. A family history of autoimmune
disease was present in 25% of patients with thyroid disorders (seven
thyrotoxic and one hypothyroid) and in three of the four patients
with Addison's disease. In this population of young adult type 1 diabetic patients, appropriate tests for thyroid dysfunction and
Addison's disease should be carried out if there is clinical suspicion
and/or unexplained changes in diabetic metabolic control or serum
cholesterol. Careful follow-up of patients with a family history of
these conditions is recommended.
Keywords: hypothyroidism; thyrotoxicosis; Addison's disease; diabetes; autoimmune disorders
© 1999 by The Fellowship of Postgraduate Medicine
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