The prevalence of newly diagnosed autoimmune diseases among patients with Graves’ disease and autoimmune polyglandular syndrome of adults

Graves’s disease is a common part of Autoimmune polyglandular syndrome (APS) and among thyroid autoimmune disorders is usually preceded the onset of the syndrome.

Aim. The aim of this study was to determine the frequency of occurrence of APS type 2, 3 among patients with Graves’ disease.

Materials and methods. Sera of 94 patients with Graves’s disease, 116 patients with APS 2–4 types and 80 healthy subjects were screened for 21-OH Ab, insulin-Ab (IAA), Islet Cell-Ab (ICA), glutamic acid decarboxylase-Ab (GADA), protein tyrosine phosphatase-Ab (IA2), Zinc Transporter 8-Ab (ZnT8), Anti-gliadin-Ab (IgA+IgG) (AGA), Anti-transglutaminase-Ab (IgA+IgG) (Anti-tTG), Anti-parietal cell-Ab (APCA), Intrinsic Factor-Ab (IF), Rheumatoid factor (RF), Anti Ovarian Antibodies (AOA). Serum cortisol, fasting plasma glucose levels were measured.

Results. The presence of Addison’s disease and the onset of Type 1 DM was not determined among Graves’ disease patients. None of the patients with Graves’ disease and in the healthy control group had 21-OH-antibodies detected. The frequency of 21-OH-Ab was 4.2% in APS type 3 (p=0.07) and 91.6% in APS type 2, 4 (p<0.001). The prevalence of diabetes-associated autoantibodies was 20.2% among Graves’s disease patients against 8.75% in healthy subjects control group (p<0.05); OR 2.64; 95% CI 1.05–6.66 and 30.2% in APS of adults (DM 1 negative group) (p=0.18). The prevalence of APCA-markers of autoimmune gastritis – was 31.9% in Graves’s disease, 48.3% in APS 2–4 types (p=0.01); OR 1.99; 95% CI 1.18–3.51, and 12.5% in control group (p<0.01); OR 3.28; 95% CI 1.49–7.24. There were no significant differences in the frequency of occurrence of IF-Ab and RF-Ab in the groups. The frequency of AGA and ATA was 28.7% in Graves’ disease, 36.2% in APS types 2–4 (p=0.3), 10% – in the control group ((р<0.01); OR 3.63; 95% CI 1.54–8.54. Graves’ disease patients with risk of developing APS type 3 (positive diabetes-associated and other autoantibodies) had relatives with autoimmune diseases in 57.5% of cases (p=0.05); OR 2.18; 95% CI 1.03–4.63.

Conclusion. Graves’ disease patients are at high risk for future development of APS 3 type, especially those with inheritance for autoimmune diseases. Screening for the immunological markers, pathognomonic for coexisting autoimmune diseases in such patients with Graves’ disease, as well as in patients with APS type 3, should be done regularly.