Aiken, South Carolina, USA:
My nine year old daughter has had type 1 diabetes for a year and vitiligo about the age of one and a half. At her last visit, her endocrinologist noticed that her thyroid was larger than it was four months ago, and he said that this may indicate the beginning of thyroid disease. (Blood work to test thyroid function will be done at next visit in three to four months.) I know that thyroid disease is fairly common in people with diabetes, but I'm concerned since she also has vitiligo. Also, from her mood swings, we feel that her pancreas was probably malfunctioning since she was very young.
How many autoimmune diseases have you ever seen one person have? Is there research being done on the autoimmune process and how to stop it? Are there any diseases more likely to occur than others or could it stop at this?
While the research on diabetes is promising, I'm starting to worry that it won't be enough for our child if it keeps moving from one part of her body to another. Any information you could give on multiple autoimmune diseases would be appreciated.
In those in whom type 1A (autoimmune) diabetes is the presenting feature, by far the most common additional component is hypothyroidism. The test for hypothyroidism(TSH) is simple and inexpensive as is the treatment if needed, so I would try to persuade your daughter's doctor not to wait several months. About 8% of these children with diabetes also have a positive anti-glutamyltranferase antibody; this test will indicate the possibility of celiac syndrome, although this may not be symptomatic. Vitiligo is another fairly commonly associated condition as is dermatitis herpetiformis. A rarely involved gland, about 2%, is the suprarenal which can be detected finding anti 21-hydroxylase antibodies in the serum. It is seldom important clinically, but perhaps useful to have as background information.
I would end by saying that you should not be overwhelmed by this diagnosis. Hypothyroidism and diabetes are common, and, in many centers, routinely checked for and rather uncommonly do you encounter three of this group of conditions together, and the diabetes remains the main challenge. It would be important though for you to discuss your concerns with your daughter's doctor.
Finally, an enormous amount of good research is being devoted to the whole problem of autoimmunity and its management, but I am afraid that even trying to summarise it is beyond the scope of an e-mail.
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