A Case of Type 1 Diabetes Mellitus with Negative Anti-GAD Antibodies and Positive Anti-IA-2 Antibodies Complicated with Progressive Chronic Thyroiditis at Onset

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  • 発症時に進行性の慢性甲状腺炎を合併した中年発症の抗GAD抗体陰性，抗IA-2抗体陽性1型糖尿病の1例
  • ショウレイ ホウコク ハッショウジ ニ シンコウセイ ノ マンセイ コウジョウセンエン オ ガッペイ シタ チュウネン ハッショウ ノ コウGAD コウタイ インセイ,コウIA-2 コウタイ ヨウセイ 1ガタ トウニョウビョウ ノ 1レイ

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Abstract

A 49-year-old man, seen for thirst and weight loss for a month, was hospitalized due to casual blood glucose of 482 mg/ml and HbA1c of 9.0 % (JDS; Diabetes 53: 450-467, 2010) with ketosis in March 2011. He had had shown normal fasting blood glucose at an annual physical check up in June 2010. On admission, Anti-GAD antibodies were negative, but anti-IA-2 antibodies were 3.7 U/ml, yielding a diagnosis of Type 1 diabetes. Urinary CPR of 4.0 μg/day and plasma CPR of 0.1 ng/ml 6 minutes after glucagon administration indicated decreased insulin secretion. Intensive insulin therapy was started. His condition was complicated with chronic thyroiditis involving TSH of 10.46 μIU/ml, FT3 of 3.25 pg/ml, FT4 of 0.80 ng/dl, and anti-thyroglobulin antibody of 4000 IU/ml. Hormone replacement was started due to progression of his hypothyroidism 4 weeks later. Our case was interesting because it dealt with an autoimmune thyroid disease complication at Type 1 diabetes onset with negative anti-GAD antibodies and positive anti-IA-2 antibodies.<br>

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