背景:成人隐匿性自身免疫性糖尿病是一种罕见的自身免疫性糖尿病,而桥本的甲状腺炎,成人最常见的甲状腺疾病,很少表现为甲状腺毒症。这两种自身免疫性疾病的同时初始表现极为罕见。
方法:一名29岁的阿尔巴尼亚裔男性因糖尿病酮症酸中毒住院后出现。诊断为1型糖尿病,并开始强化胰岛素治疗。除了2个月内体重减轻5公斤外,病史没有意义。患者出现反复发作的低血糖,餐前胰岛素和基础胰岛素的剂量减少。鉴别诊断包括1型糖尿病“蜜月期”或其他类型的糖尿病。他的血清学测试仅显示针对谷氨酸脱羧酶65和C肽的阳性自身抗体。诊断倾向于成人隐匿性自身免疫性糖尿病,治疗方法包括停止餐前胰岛素治疗,regulation,以及随后停止基础胰岛素和引入二甲双胍。两年后,基础胰岛素与胰高血糖素样肽受体激动剂和二甲双胍一起被重新引入.初次就诊时进一步体检发现上肢震颤,盖子滞后,出汗过多,增加对热的敏感性,和心动过速.实验室检查表明甲状腺毒素中毒(促甲状腺激素水平抑制,高水平的总和游离甲状腺激素,抗甲状腺球蛋白和抗甲状腺过氧化物酶阳性,和阴性抗甲状腺刺激激素受体)。促甲状腺激素水平自发恢复,但随访期间观察到增加.左旋甲状腺素给药2年,直至患者甲状腺功能正常。
结论:成人隐匿性自身免疫性糖尿病患者甲状腺自身抗体的患病率为20%至30%。这种相关性可归因于遗传参与以及对自身抗原的免疫耐受的紊乱。因此,本报告突出了糖尿病患者的整体治疗和合并症的考虑。
BACKGROUND: Latent autoimmune diabetes in adults is an infrequent form of autoimmune diabetes mellitus, while Hashimoto\'s thyroiditis, the most common thyroid disease in adults, rarely manifests as thyrotoxicosis. The concurrent initial presentation of these two autoimmune disorders is extremely rare.
METHODS: A 29-year-old male of Albanian descent presented after being hospitalized owing to diabetic ketoacidosis. The diagnosis of type 1 diabetes mellitus was placed, and intensified insulin therapy was initiated. Medical history was not of significance except a 5 kg weight loss within 2 months. The patient presented with recurrent episodes of hypoglycemia, and the doses of preprandial and basal insulin were reduced. The differential diagnosis included type 1 diabetes mellitus \"honeymoon\" period or another type of diabetes mellitus. His serological tests only revealed positive autoantibodies against glutamic acid decarboxylase 65 and C-peptide. The diagnosis leaned toward latent autoimmune diabetes in adults, and the therapeutic approach involved cessation of preprandial insulin therapy, regulation, and subsequent discontinuation of basal insulin and introduction of metformin. Two years later, basal insulin was reintroduced along with a glucagon-like peptide-receptor agonist and metformin. Further physical examination during the initial visit disclosed upper limb tremor, lid lag, excessive sweating, increased sensitivity to heat, and tachycardia. Laboratory tests were indicative of
hashitoxicosis (suppressed level of thyroid-stimulating hormone, high levels of total and free thyroid hormones, positive anti-thyroglobulin and anti-thyroid peroxidase, and negative anti-thyroid-stimulating hormone receptor). Thyroid-stimulating hormone level was spontaneously restored, but an increase was observed during follow-up. Levothyroxine was administrated for 2 years until the patient had normal thyroid function.
CONCLUSIONS: The prevalence of thyroid autoantibodies in patients with latent autoimmune diabetes in adults ranges from 20% to 30%. This correlation can be attributed to genetic involvement as well as disorders of immune tolerance to autoantigens. Hence, this report gives prominence to the holistic approach and consideration of comorbidities in patients with diabetes mellitus.