Медицинская литература. Новинки

 

 

 

 

 

 

РАСПРОСТРАНЕННОСТЬ ГИПОТИРЕОЗА В ГРУППЕ ДЕТЕЙ И ПОДРОСТКОВ С САХАРНЫМ ДИАБЕТОМ ПО РЕЗУЛЬТАТАМ СЕЛЕКТИВНОГО СКРИНИНГА

Вы можете загрузить полный текст статьи в формате pdf

Цель исследования: установить распространенность гипотиреоза в группе детей и подростков с сахарным диабетом 1-го типа по результатам селективного скрининга. Материал и методы. Обследовано 132 ребенка (64 девочки, 68 мальчиков) в возрасте от 1 года до 17,5 лет. Проведено УЗИ ЩЖ с определением тиреоидного объема и структуры, а также определение ТТГ, АТТПО и св. Т4, при уровне ТТГ, выходящем за референсные интервалы. Результаты. Распространенность явного гипотиреоза (7,6%) в исходе АИТ у детей с СД оказалась выше, чем в общей популяции, что подтверждает эффективность селективного скрининга в этой группе детей и диктует необходимость его внедрения в рутинную клиническую практику; высокая частота антителоносительства к ТПО (12,8%) требует уточнения их прогностического значения в процессе длительного динамического наблюдения, а также пересмотра точки разделения между патологией и нормой.

Ключевые слова:
гипотиреоз, сахарный диабет 1-го типа, дети

Литература:
1. Дедов И.И., Шестакова М.В. Сахарный диабет. Руководство
для врачей. М.: Универсум Паблишинг, 2003. 456 с.
2. Kordonouri O., Klinghammer A., Lang E.B. et al. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care. 2002; 24: 1346–1350.
3. De Block C.E., De Leeuw I.H., Vertommen J.J. et al. Betacell, thyroid, gastric, adrenal and coeliac autoimmunity and HLADQ
types in type 1 diabetes. Clin. Exp. Immunol. 2001; 126: 236–241.
4. Van den Driessche A., Eenkhoorn V., Van Gaal L. et al. Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review.
J. Med. 2009; 67: 376–387.
5. Kota S.K., Meher L.K., Jammula S. et al. Clinical profile of coexisting conditions in type 1 diabetes mellitus patients. Diabetes
Metab. Syndr. 2012; 6: 70–76.
6. Kabelitz M., Liesenkotter K.P., Stach B. et al. The prevalence of
antithyroid peroxidase antibodies and autoimmune thyroiditis in
children and adolescents in an iodine replete area. Eur. J.
Endocrinol. 2003; 148 (3): 301–307.
7. Loviselli A., Velluzzi F., Mossa P. et al. The Sardinian Autoimmunity Study: 3. Studies on circulating antithyroid antibodies in
Sardinian schoolchildren: relationship to goiter prevalence and
thyroid function. J. Thyroid. 2001; 11 (9): 849–857.
8. Gopalakrishnan S., Singh S.P., Prasad W.R. et al. Prevalence of
goitre and autoimmune thyroiditis in schoolchildren in Delhi,
India, after two decades of salt iodisation. J. Pediatr. Endocrinol.
Metab. 2006; 19 (7): 889–893.
9. Marhawa R.K., Tandon N., Karak A.K. et al. Hahimoto’s thyroiditis countrywide screening of goitrous healthy girls in postiodization
phase in India. J. Clin. Endocrinol. Metab. 2000; 85: 3798–3802.
10. Zois C., Stavrou I., Kalogera C. et al. High prevalence of autoimmune thyroiditis in schoolchildren after elimination of iodine deficiency in northwestern Greece. J. Thyroid. 2003; 13 (5): 485–489.
11. Jaruratanasirikul S., Leethanaporn K., Khuntigij P. et al. The clinical course of Hashimoto's thryoiditis in children and adolescents:
6 years longitudinal followup. J. Pediatr. Endocrinol. Metab.
2001; 14 (2): 177–184.
12. Radetti G., Gottardi E., Bona G. et al. The natural history of euthyroid Hashimoto's thyroiditis in children. J. Pediatr. 2006; 149 (6):
827–832.
13. Dittmar M., Kahaly G.J. Polyglandular autoimmune syndromes:
immunogenetics and longterm followup. J. Clin. Endocrinol.
Metab. 2003; 88 (7): 2983–2992.
14. Levin L., Tomer Y. The etiology of autoimmune diabetes and thyroiditis: evidence for common genetic susceptibility. Autoimmun.
Rev. 2003; 6 (2): 377–386.
15. Kordonouri O., Deiss D., Danne T. et al. Predictivity of thyroid
autoantibodies for the development of thyroid disorders in children
and adolescents with Type 1 diabetes. Diabet. Med. 2002; 19 (6):
518–521.
16. Valerio G., Maiuri L., Troncone R. et al. Severe clinical onset of diabetes and increased prevalence of other autoimmune diseases in
children with coeliac disease diagnosed before diabetes mellitus.
J. Diabetologia. 2002; 45 (12): 1719–1722.
17. FrohlichReiterer E.E., Hofer S., Kaspers S. et al. Screening frequency for celiac disease and autoimmune thyroiditis in children
and adolescents with type 1 diabetes mellitus – data from
a German/Austrian multicentre survey. Pediatr. Diabetes. 2008;
9 (6): 546–553.
18. ISPAD Consensus guidelines for the management of type 1 diabetes mellitus in children and adolescents / ISPAD 2000
Consensus Guidelines.
19. Severinski S., Banac S., Severinski N.S. et al. Epidemiology and
clinical characteristics of thyroid dysfunction in children and adolescents with type 1 diabetes. Coll. Antropol. 2009; 33 (1): 273–279.
20. Umpierrez G.E., Latif K.A., Murphy M.B. Thyroid dysfunction in
patients with type 1 diabetes: a longitudinal study. Diabetes Care.
2003; 26 (4): 1181–1185.
21. Hansen D., Bennedbaek F.N., HoierMadsen M. A prospective
study of thyroid function, morphology and autoimmunity in young
patients with type 1 diabetes. Eur. J. Endocrinol. 2003; 148 (2):
245–251.
22. Silverstein J., Klingensmith G., Copeland K. et al. Care of children
and adolescents with type 1 diabetes: a statement of the American
Diabetes Association. J. Diabetes Care. 2005; 28 (1): 186–212.
23. Prazny M., Skrha J., Limanova Z. et al. Screening for associated
autoimmunity in type 1 diabetes mellitus with respect to diabetes
control. J. Physiol Res. 2005; 54 (1): 41–48.
24. Abdulmoein AlAgha, Ali Ocheltree, Amr Hakeem. Thyroid dysfunction in children and adolescents with type 1 diabetes mellitus. J. of
Pediatric Sciences. 2011; 93 (3): 1–5.
25. Mohn A., Di Michele S., Di Luzio R. et al. The effect of subclinical
hypothyroidism on metabolic control in children and adolescents
with Type 1 diabetes mellitus. Diabet. Med. 2002; 19 (1): 70–73.
26. ISPAD Consensus guidelines for the management of type 1 diabetes mellitus in children and adolescents / ISPAD 2011
Consensus Guidelines.
27. Дедов И.И., Петеркова В.А., Кураева Т.Л. Российский консенсус по терапии сахарного диабета у детей и подростков.
Сахарный диабет. 2010; (спецвыпуск): 1–8.

Prevalence of Hypothyroidism Among Children and Adolescents with Diabetes Mellitus by Results of Selective Screening

Establish the prevalence of hypothyroidism among children with diabetes mellitus (DM) as a result of selective screening. During the examination period 132 children (64 f/68 m) aged from 1.0 to 17.5 years were examined. Ultrasonography evaluation, including measurement of thyroid volume, was performed in all volunteers as well as analysis of TSH, TPO-Ab and fT4 when TSH was out of reference range. The prevalence of overt hypothyroidism (7,6%) in the outcome of AIT in children with DM was above the population level, which confirms the effective of selective screening in this group of children and demands to its introduction into routine clinical practice; high incidence of TPO-Ab (12.8%) need to clarify their prognostic value having regard to long-term followup, as well as revising of dividing cut-of-point

Keywords:
hypothyroidism, diabetes mellitus, children.