Shared etiology of type 1 diabetes and Hashimoto's thyroiditis: a population-based twin study

Hashimoto's Encephalopathy: Clinical Features, Therapeutic Strategies, and Rehabilitation Approaches

Hashimoto's encephalopathy (HE), also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is an autoimmune disorder with heterogeneous presentation that poses diagnostic challenges. This review synthesizes the current literature to clarify the clinical, laboratory, and radiological features of SREAT/HE, including the diagnostic utility of thyroid peroxidase (TPO) antibodies, cerebrospinal fluid (CSF) abnormalities, and neuroimaging findings. Cognitive impairment and behavioral changes are common in HE, but specific manifestations vary widely, which can lead to misdiagnosis. While elevated TPO antibodies are frequently observed, a direct causal relationship with HE is unlikely, and their presence may indicate a general state of autoimmunity. Corticosteroids remain the cornerstone of treatment, although responses vary, and alternative immunosuppressive agents or intravenous immunoglobulin may be needed in some cases. Evidence regarding rehabilitation for people affected by HE is limited, but neurorehabilitation strategies adapted from other neurological conditions, including cognitive re-education (CR), physical therapy, and psychosocial support, may be beneficial. Further research is needed to elucidate the underlying mechanisms of SREAT, refine the diagnostic criteria, and develop more targeted and effective therapies, including rehabilitation strategies, for this debilitating neurological disorder.

Increased purchases of prescription medicines in offspring of women with type 1 diabetes: a Finnish register-based cohort study between 1995 and 2018

OBJECTIVE

This study aimed to assess whether in utero exposure to hyperglycemia influences prescription medicine purchases in the offspring of women with type 1 diabetes (exposed offspring).

PATIENTS/MATERIALS AND METHODS

We identified all singleton exposed offspring born in the hospital district of Helsinki and Uusimaa, Finland, between 1988 and 2011 from the Finnish Medical Birth Register, maintained by the Finnish Institute for Health and Welfare. For each exposed offspring, we obtained five age- and province-matched offspring of women without diabetes (reference offspring), from the Finnish Medical Birth Register. By combining data from three national registers, this longitudinal cohort study assessed prescription medicine purchases in exposed offspring (n = 1,725) and reference offspring (n = 8,755) from seven to thirty years of age. Prescription medicine purchases were grouped according to the Anatomical Therapeutic Chemical (ATC) classification system.

RESULTS

Between 1995 and 2018, a total of 211,490 prescription medicines were purchased. After a median follow-up of 10.9 (interquartile range 4.9,17.6) years, we observed higher incidence risk ratios (IRR) of prescription medicine purchases for several ATC main groups in exposed offspring compared to reference offspring, with the highest IRR of 4.06 (95% CI: 2.78 to 5.94) for medicines affecting metabolism (e.g. diabetes medicines).

CONCLUSION

Our findings suggest that exposed offspring purchase more reimbursable prescription medicines than reference offspring from age seven to thirty years. More research is needed to examine the effects of intrauterine exposure to hyperglycemia on long-term health in offspring.

The Prevalence of Autoimmune Diseases Among Children With Type I Diabetes Mellitus

Background Type I diabetes mellitus (T1DM) is a prevalent chronic illness that typically manifests in childhood. In patients who are genetically predisposed to diabetes, complex interactions between environmental and genetic factors play a role in the development of type 1 diabetes. There is proof that the onset of type 1 diabetes raises the possibility of developing additional autoimmune conditions. This has to do with the hereditary predisposition to these illnesses. As the autoimmune process in pancreatic beta cells advances, it may also impact other organs, leading to the emergence of autoimmune diseases that are either organ-specific or organ-nonspecific. Purpose The purpose of this study is to determine the prevalence of autoimmune disorders among children who are diagnosed with T1DM in Al-Ahsa, Saudi Arabia, and assess the potential impact of these conditions on other comorbidities. Methods Over the course of three years, from 2020 to 2023, children with T1DM were the subjects of this descriptive retrospective cross-sectional study conducted in the Endocrinology and Diabetes Unit of the Maternity and Children's Hospital in Al-Ahsa, Saudi Arabia. There were 281 participants in total. Clinical and laboratory research was conducted on autoimmune T1DM. Results A total of 281 T1DM children were investigated, with 59.9% being female and 43.1% being male. The mean age was 12.8 ± 3.3 years, and the mean disease duration at the end of follow-up was 6.6 ± 2.9 years. Among these participants, 5.3% were diagnosed with at least one autoimmune disease (AID). Celiac disease is the most commonly reported AID, accounting for 56.3%, followed by hypothyroidism (31.3%). An increased risk of developing AIDs was linked to significant associations between older age (>10 years old) and longer duration of DM (p<0.05). Conclusion The data show a high prevalence of autoimmune comorbidities among pediatric T1DM patients treated at our department. The findings highlight the importance of regular screenings in facilitating timely diagnosis and intervention, which is critical in promoting the well-being and normative development of pediatric patients.

National trends in thyroid disease and COVID-19 pandemic-related factors, 1998-2021: A nationwide representative study in South Korea

Objective

Although thyroid disease is a common condition, there is limited research examining the prevalence of thyroid disease over a long period of time, including both before and during the COVID-19 pandemic. Therefore, we aimed to investigate sociodemographic aspects that might be associated with thyroid disease and how its prevalence has varied during the pandemic.

Methods

We assessed the prevalence of thyroid disease among Korean adults by using data from the Korea National Health and Nutrition Examination Survey from 1998 to 2021. We evaluated weighted prevalence and β-coefficients with 95 % CI for factors such as age, sex, residential area, education level, household income, perceived stress level, weight change, occupation category, and body mass index groups.

Results

From 1998 to 2021, the prevalence of thyroid disease among 159,896 Korean adults (88,120 females [55.1 %]) aged 20 years and older exhibited an overall increasing trend. The weighted prevalence in the general population rose from 1.52 % (95 % CI, 1.41-1.64) in 1998-2005 to 3.84 % (3.30-4.39) in 2021, with a higher likelihood of thyroid disease exposure as age increased. In addition, females, individuals with lower education levels, those with high levels of perceived stress, those who gained weight, and those classified as overweight or obese emerged as vulnerable groups for thyroid disease. For the majority of subgroups, the change amid the effect of the pandemic on prevalence was minimal. However, the aged ≥60 years group showed a greater increase in prevalence during the pandemic than before the pandemic (βdiff: 0.52 [95 % CI, 0.37-0.68]).

Conclusions

A nationwide representative study in South Korea revealed an increasing trend in the prevalence of thyroid disease over 24 years, particularly among the older population. Despite the minimal variation during the pandemic, our findings emphasize the need for targeted thyroid disease policies and further research, especially for specific subgroups such as the older population.

Association of HLA Haplotypes with Autoimmune Pathogenesis in Newly Diagnosed Type 1 Romanian Diabetic Children: A Pilot, Single-Center Cross-Sectional Study

BACKGROUND

The increasing incidence of autoimmune diseases in type 1 diabetes mellitus (T1DM) patients highlights the influence of human leukocyte antigen (HLA) haplotypes on their development. This study aims to determine genetic predisposition to autoimmune diseases in T1DM patients, including thyroid disease and celiac diseases, and explore its correlation with vitamin D deficiency.

METHODS

A cross-sectional study involving thirty-six T1DM children was conducted. Typing was performed for the HLA A, B, C, DP, DR, and DQ loci. Regression analysis linked DR-DQ haplotypes to T1DM and the associated conditions.

RESULTS

The most frequent predisposing alleles and haplotypes were HLA-DR3 (70.27%), DQ2 (70.27%), DR3-DQ2 (70.27%), DQB1*02:01 (70.27%), A02 (54.05%), whereas the most prevalent protecting allele was DPB1*04:01 (52.63%). Positive correlations were observed between positive anti-thyroid peroxidase antibodies and the absence of protective alleles (DPB1*04:02, p = 0.036; DPB1*04:01, p = 0.002). Associations were found between the absence of DPB1*04:01 and anti-thyroglobulin antibodies (p = 0.03). HLA allele DPB1*03:01 was linked with vitamin D deficiency (p = 0.021). Positive anti-transglutaminase antibodies correlated with C03:03 (p = 0.026) and DRB1*04:01-DQA1*03-DQB1*03:01 (p < 0.0001) and the lack of DQA1*01:03-DQB1*06:03-DRB1*13:01 (p < 0.0001).

CONCLUSIONS

The predisposing T1DM haplotypes were associated with the presence of anti-transglutaminase and anti-thyroid antibodies, indicating a genetic predisposition to autoimmune diseases.

Familial aggregation and heritability of childhood-onset and adult-onset type 1 diabetes: a Swedish register-based cohort study

BACKGROUND

Type 1 diabetes in children is known to be highly heritable, but much less is known about the heritability of adult-onset type 1 diabetes. Thus, our objective was to compare the familial aggregation and heritability of type 1 diabetes in adults and children.

METHODS

This Swedish nationwide register-based cohort study included individuals born from Jan 1, 1982, to Dec 31, 2010, identified through the Medical Birth Register who were linked to their parents, full siblings, half siblings, and cousins through the Multi-Generation Register (MGR). We excluded multiple births, deaths within the first month of life, individuals who could not be linked to MGR, or individuals with contradictory information on sex. Information on diagnoses of type 1 diabetes was retrieved by linkages to the National Diabetes Register and National Patient Register (1982-2020). Individuals with inconsistent records of diabetes type were excluded. We estimated the cumulative incidence and hazard ratios (HRs) of type 1 diabetes in adults (aged 19-30 years) and children (aged 0-18 years) by family history of type 1 diabetes and the heritability of adult-onset and childhood-onset type 1 diabetes based on tetrachoric correlations, using sibling pairs.

FINDINGS

2 943 832 individuals were born in Sweden during the study period, 2 832 755 individuals were included in the analysis of childhood-onset type 1 diabetes and 1 805 826 individuals were included in the analysis of adult-onset type 1 diabetes. 3240 cases of adult-onset type 1 diabetes (median onset age 23·4 years [IQR 21·1-26·2]; 1936 [59·7%] male and 1304 [40·2%] female) and 17 914 cases of childhood-onset type 1 diabetes (median onset age 9·8 years [6·2-13·3]; 9819 [54·8%] male and 8095 [45·2%] female) developed during follow-up. Having a first-degree relative with type 1 diabetes conferred an HR of 7·21 (95% CI 6·28-8·28) for adult-onset type 1 diabetes and 9·92 (9·38-10·50) for childhood-onset type 1 diabetes. The HR of developing type 1 diabetes before the age 30 years was smaller if a first-degree relative developed type 1 diabetes during adulthood (6·68 [6·04-7·39]) rather than during childhood (10·54 [9·92-11·19]). Similar findings were observed for type 1 diabetes in other relatives. Heritability was lower for adult-onset type 1 diabetes (0·56 [0·45-0·66]) than childhood-onset type 1 diabetes (0·81 [0·77-0·85]).

INTERPRETATION

Adult-onset type 1 diabetes seems to have weaker familial aggregation and lower heritability than childhood-onset type 1 diabetes. This finding suggests a larger contribution of environmental factors to the development of type 1 diabetes in adults than in children and highlights the need to identify and intervene on such factors.

FUNDING

Swedish Research Council, the Swedish Research Council for Health, Working Life and Welfare, Swedish Diabetes Foundation, and the China Scholarship Council.

Mapping the path towards novel treatment strategies: a bibliometric analysis of Hashimoto's thyroiditis research from 1990 to 2023

Background

Hashimoto's thyroiditis (HT), a common form of thyroid autoimmunity, is strongly associated with deteriorating clinical status and impaired quality of life. The escalating global prevalence, coupled with the complexity of disease mechanisms, necessitates a comprehensive, bibliometric analysis to elucidate the trajectory, hotspots, and future trends in HT research.

Objective

This study aims to illuminate the development, hotspots, and future directions in HT research through systematic analysis of publications, institutions, authors, journals, references, and keywords. Particular emphasis is placed on novel treatment strategies for HT and its complications, highlighting the potential role of genetic profiling and immunomodulatory therapies.

Methods

We retrieved 8,726 relevant documents from the Web of Science Core Collection database spanning from 1 January 1990 to 7 March 2023. Following the selection of document type, 7,624 articles were included for bibliometric analysis using CiteSpace, VOSviewer, and R software.

Results

The temporal evolution of HT research is categorized into three distinct phases: exploration (1990-1999), rapid development (1999-2000), and steady growth (2000-present). Notably, the United States, China, Italy, and Japan collectively contributed over half (54.77%) of global publications. Among the top 10 research institutions, four were from Italy (4/10), followed by China (2/10) and the United States (2/10). Recent hotspots, such as the roles of gut microbiota, genetic profiling, and nutritional factors in HT management, the diagnostic dilemmas between HT and Grave's disease, as well as the challenges in managing HT complicated by papillary thyroid carcinoma and type 1 diabetes mellitus, are discussed.

Conclusion

Although North America and Europe have a considerable academic impact, institutions from emerging countries like China are demonstrating promising potential in HT research. Future studies are anticipated to delve deeper into the differential diagnosis of HT and Grave's disease, the intricate relationship between gut microbiota and HT pathogenesis, clinical management of HT with papillary thyroid carcinoma or type 1 diabetes, and the beneficial effects of dietary modifications and micronutrients supplementation in HT. Furthermore, the advent of genetic profiling and advanced immunotherapies for managing HT offers promising avenues for future research.