Coexistence of Hyperthyroidism and Type 1 Diabetes in a Child with Down Syndrome: A Rare Autoimmune Endocrine Disorder
DOI:
https://doi.org/10.63682/jns.v14i8.6532Keywords:
Autoimmune Polyendocrinopathy, Pediatric Endocrine Screening, Insulin and Antithyroid Therapy, Glutamic Acid Decarboxylase AntibodiesAbstract
Down syndrome (DS) is a common chromosomal disorder associated with intellectual disability and various medical issues, including autoimmune endocrinopathies. The prevalence of Type 1 diabetes mellitus (T1DM) in DS is higher than in the general population, with thyroid disorders commonly observed. Hyperthyroidism, although rare, can occur in children with DS, and its coexistence with T1DM is an uncommon but important clinical phenomenon. A 10-year-old girl with DS presented with progressive anterior diffuse struma, weight loss, increased thirst, and frequent urination. Laboratory tests confirmed T1DM with elevated glucose and HbA1c levels, and hyperthyroidism with elevated thyroglobulin and anti-TPO antibodies. The presence of glutamic acid decarboxylase 65 antibodies further supported the diagnosis. The patient was started on insulin therapy and thiamazole for hyperthyroid management, with stable clinical progress during hospitalization. The association between autoimmune disorders, including T1DM and thyroid dysfunction, is well-documented in DS. Children with DS have a heightened risk of developing multiple autoimmune conditions, making early screening for thyroid dysfunction crucial at the time of T1DM diagnosis. This case emphasizes the need for vigilant monitoring of endocrine function in DS patients, particularly for concurrent autoimmune diseases. Early detection and management of autoimmune endocrinopathies are essential in children with DS, especially when T1DM and hyperthyroidism coexist. Regular thyroid monitoring, including TSH and TPO antibodies, can prevent complications and promote optimal health outcomes. Early intervention is key to supporting the overall development of affected children.
Downloads
Metrics
References
E. J. Mayer-Davis et al., “ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents,” Pediatr Diabetes, vol. 19, no. Suppl 27, pp. 7–19, 2018, doi: 10.1111/pedi.12773.
I. Marques, A. Silva, S. Castro, and L. Lopes, “Down syndrome, insulin-dependent diabetes mellitus and hyperthyroidism: a rare association,” BMJ Case Rep., vol. 2015, p. bcr2014208166, 2015, doi: 10.1136/bcr-2014-208166.
M. Szatkowska, D. Zimny, and E. Barg, “Down syndrome and hyperthyroidism–two case reports,” Pediatr. Endocrinol. Diabetes Metab., vol. 21, no. 2, pp. 93–6, 2016, doi: 10.18544/PEDM-21.02.0030.
G. L. Mortimer and K. M. Gillespie, “Early onset of autoimmune diabetes in children with Down syndrome—two separate aetiologies or an immune system pre-programmed for autoimmunity?,” Curr. Diab. Rep., vol. 20, no. 47, pp. 1–9, 2020, doi: 10.1007/s11892-020-01318-8.
E. Firhat, K. L. Dhyta, T. Tusy, and S. Fransisca, “Comparison Of The Length Of Stay Of Covid-19 Patients With Comorbid Diabetes Mellitus By Gender At Natar Medika Hospital South Lampung In 2021,” Pharmacol. Med. Reports, Orthop. Illn. Details, vol. 1, no. 2 SE-Articles, pp. 47–52, Apr. 2022, doi: 10.55047/comorbid.v1i2.155.
H. Borg, A. Gottsater, P. Fernlund, and G. Sundkvist, “A 12-year prospective study of the relationship between islet antibodies and β-cell function at and after the diagnosis in patients with adult-onset diabetes,” Diabetes, vol. 51, no. 6, pp. 1754–1762, 2002, doi: 10.2337/diabetes.51.6.1754.
A. B. Pulungan, D. Annisa, and S. Imada, “Diabetes melitus tipe-1 pada anak: Situasi di Indonesia dan tata laksana,” Sari Pediatr., vol. 20, no. 6, pp. 392–400, 2019.
J. J. Couper et al., “ISPAD Clinical Practice Consensus Guidelines 2018: Stages of type 1 diabetes in children and adolescents.,” Pediatr. Diabetes, vol. 19, no. Suppl. 27, pp. 20–27, 2018, doi: 10.1111/pedi.12734.
A. L. Olinder et al., “ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents,” Pediatr. Diabetes, vol. 23, no. 8, p. 1229, 2022, doi: 10.1111/pedi.13418.
Z. Xie, C. Chang, and Z. Zhou, “Molecular mechanisms in autoimmune type 1 diabetes: a critical review,” Clin. Rev. Allergy Immunol., vol. 47, pp. 174–192, 2014, doi: 10.1007/s12016-014-8422-2.
S. K. Ardestani, A. H. Keshteli, N. Khalili, M. Hashemipour, and R. Barekatain, “Thyroid disorders in children and adolescents with type 1 diabetes mellitus in Isfahan, Iran,” Iran. J. Pediatr., vol. 21, no. 4, p. 502, 2011.
T. Danne et al., “ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes.,” Pediatr. Diabetes, vol. 19, no. Suppl. 27, pp. 115–135, 2018, doi: 10.1111/pedi.12718.
S. Romagnani, “Immunological tolerance and autoimmunity,” Intern. Emerg. Med., vol. 1, pp. 187–196, 2006, doi: 10.1007/BF02934736.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
