Levothyroxine and insulin requirement in autoimmune polyglandular type 3 syndrome: a real-life study

V Guarnotta,G Gambino,C Giordano,E Vigneri,G Pizzolanti,S Radellini,G Pillitteri

doi:10.1007/s40618-020-01421-3

V Guarnotta, G Gambino + Show 5 more

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https://doi.org/10.1007/s40618-020-01421-3

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Abstract

PurposeTo evaluate factors influencing the insulin and levothyroxine requirement in patients with autoimmune polyglandular syndrome type 3 (APS-3) vs. patients with type 1 diabetes mellitus (T1DM) and autoimmune hypothyroidism (AH) alone, respectively.MethodsFifty patients with APS-3, 60 patients with T1DM and 40 patients with AH were included. Anthropometric, clinical and biochemical parameters were evaluated in all patients. Insulin requirement was calculated in patients with APS-3 and T1DM, while levothyroxine requirement was calculated in APS-3 and AH.ResultsPatients with APS-3 showed higher age (p = 0.001), age of onset of diabetes (p = 0.006) and TSH (p = 0.004) and lower total insulin as U/day (p < 0.001) and U/Kg (p = 0.001), long-acting insulin as U/day (p = 0.030) and U/kg (p = 0.038) and irisin (p = 0.002) compared to T1DM. Patients with APS-3 had higher waist circumference (p = 0.008), duration of thyroid disease (p = 0.020), levothyroxine total daily dose (p = 0.025) and mcg/kg (p = 0.006), triglycerides (p = 0.007) and VAI (p = 0.010) and lower age of onset of thyroid disease (p = 0.007) than AH.At multivariate analysis, levothyroxine treatment and VAI were associated with insulin and levothyroxine requirement in APS-3, respectively. VAI was independently associated with insulin requirement in T1DM. Circulating irisin levels were independently associated with levothyroxine requirement in AH.ConclusionPatients with APS-3 show lower insulin requirement and higher levothyroxine requirement than T1DM and AH alone, respectively. Levothyroxine treatment and VAI affect insulin and levothyroxine requirement, respectively, in APS-3. In T1DM, adipose tissue dysfunction, indirectly expressed by high VAI, is associated with an increased insulin requirement, while circulating irisin levels influence the levothyroxine requirement in AH.

Highlights

Autoimmune polyglandular syndromes (APS) are characterized by the coexistence of at least two autoimmune-mediated endocrinopathies [1,2,3,4]
The diagnosis of type 1 diabetes mellitus (T1DM) was made according to the ADA guidelines [24], while the diagnosis of autoimmune hypothyroidism (AH) was made by the presence of antibodies against thyroid peroxidase (TPO antibodies)
Multivariate analysis was done based on the variables who were found to have a statistical significance at univariate analysis. It showed that levothyroxine replacement treatment was independently associated with insulin requirement (p = 0.044, β = – 0.005) (Table 2) and the visceral adiposity index (VAI) was independently associated with levothyroxine requirement (p = 0.035, β = 0.218) in autoimmune polyglandular syndrome type 3 (APS-3) (Table 3)

Summary

Introduction

Autoimmune polyglandular syndromes (APS) are characterized by the coexistence of at least two autoimmune-mediated endocrinopathies [1,2,3,4]. APS’s are generally characterized by the poor quality of life and increased morbidity and mortality, compared to the single disease and notably to T1DM [7]. The coexistence of T1DM and other autoimmune endocrinopathies impairs glucose metabolism, interferes with effective insulin therapy and deteriorates diabetes control [8]. Among the various factors involved, metabolic control appears to play an important role in the development of micro and macrovascular disease in T1DM, with a great impact on mortality [9, 10].

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