To Your Good Health: Hypothyroid, Diabetes Are Both Autoimmune Disorders
Dear Dr. Roach: My oldest grandson, 17, was diagnosed with hypothyroidism about three years ago and has been on levothyroxine daily, with good lab numbers since. He was diagnosed with Type 1 diabetes mellitus three months ago.
He is on insulin three times daily, and his sugars have come down really well. But recent lab work has shown that his thyroid levels are now inadequate. In addition, his testosterone and vitamin D levels are markedly low. He has been placed on medications to correct all of these deficiencies.
He is only about 5 feet, 6 inches tall, and I would be surprised if he weighs 120 pounds. He is pale, thin and truly does not look well at all. My concern is that he has some sort of an autoimmune disorder that is being missed. I would appreciate any input you may have. I am very concerned. — C.F.
Answer: I am sorry to hear what a hard time your grandson is going through. He almost certainly does have at least two autoimmune diseases: hypothyroidism and Type 1 diabetes both are caused by the body attacking itself, and it is not uncommon for the two of them to go together.
Likewise, vitamin D levels are low in many, many North Americans, especially those who live above the line from Atlanta to Los Angeles.
What I am concerned about is why his thyroid level, which was normal on treatment, is now not normal. Together with his relatively short height, it puts me in the mind of a serious condition, polyglandular autoimmune syndrome.
In this condition, many of the pituitary hormones are not released normally. Without stimulation from the pituitary, the target glands don’t function, which may cause hypothyroidism (no thyroid hormone), short stature (no growth hormone), abnormal sexual development (no sex hormones) and, most concerningly, Addison’s disease from having no cortisone.
His doctors can check this by measuring testosterone levels, or by a stimulation test of the pituitary, injecting CRH, a hormone that tells the pituitary to make ACTH, which, in turn, tells the adrenals to make cortisone.
There certainly are other causes for his condition. Type 1 diabetics can experience poor growth. Adolescents sometimes stop taking their medications, which might account for the thyroid change. But one last consideration is celiac disease, which commonly (at least 5 percent of the time) accompanies the diagnosis of Type 1 diabetes. Food malabsorption from celiac sprue causes poor growth or weight loss.
Dear Dr. Roach: Would you please address stem-cell treatment for a torn rotator cuff? My son is facing his second surgery for this problem and is considering stem-cell treatment instead. He had such terrible pain from surgery the first time. — L.P.
Answer: A torn rotator cuff is a common sports injury in athletes. Complete tears usually are repaired surgically. A new surgical technique is to inject the body’s own stem cells (obtained from the bone marrow) to help promote healing. It’s too new a technique for me to be able to compare it with standard surgical therapy, but the preliminary studies are very promising.
I often have said that only an individual’s surgeon can decide the right surgical procedure, based on far more information than we could include in this column. It’s really true that you never trust anyone quite the way you trust your surgeon. There are surgeons who are using the stem-cell technique, and it would be reasonable to get a consultation with one of them.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.