Glutamic acid decarboxylase (anti-GAD) & tissue transglutaminase (anti-TTG) antibodies in patients with thyroid autoimmunity.

Background & objectives: Several autoimmune disorders have been reported to be associated with autoimmune thyroiditis and may coexist with other organ-specific autoantibodies. The aim of the present study was to evaluate the presence of tissue transglutaminase (anti-TTG) and glutamic acid decarboxylase (anti-GAD) antibodies in patients suffering from autoimmune thyroiditis as diagnosed by anti-thyroid peroxidase (anti-TPO) antibodies, which may indicate high risk for developing celiac disease or type 1 diabetes mellitus. Methods: Five thousand children and 2800 adults were screening as part of a general health examination done on a voluntary basis in four different parts of Delhi. A total of 577 subjects positive for anti-TPO antibody constituted the cases. Equal number of age and sex matched anti-TPO antibody negative controls were randomly selected from the same cohort to form paired case control study. The cases and controls were further divided into two groups as follows: group-1 (children and adolescent <18 yr), group-2 (adults >18 yr). Serum samples of cases and controls were analysed for thyroid function test (FT3, FT4, and TSH), anti-TTG and anti-GAD antibodies. Results: A total of 1154 subjects (577 cases and 577 controls) were included in this study. Hypothyroidism was present in 40.2 per cent (232) cases compared to only 4.7 per cent (27) in controls (P<0.001). Anti-TTG and anti-GAD antibodies were present in 6.9 and 12.5 per cent subjects among cases compared to 3.5 per cent (P=0.015) and 4.3 per cent (P=0.001) in controls, respectively. Only anti-GAD antibody were significantly positive in cases among children and adolescents (P =0.0044) and adult (P=0.001) compared to controls. Levels of anti-TTG and anti-GAD antibodies increased with increasing titre of anti-TPO antibody. Interpretation & conclusions: Our findings showed high positivity of anti-GAD and anti-TTG antibodies among subjects with thyroid autoimmunity. It is, therefore, important to have high clinical index of suspicion for celiac disease or type 1 diabetes mellitus in patients with autoimmune thyroiditis.

Nationwide reference data for height, weight and body mass index of Indian schoolchildren.

Background. The assessment of growth is crucial for child care and reference data are central to growth monitoring. We aimed to assess the height, weight and body mass index (BMI) of Indian schoolchildren in order to develop genderappropriate growth charts for children 5–18 years of age. Methods. Cross-sectional evaluation of anthropometric parameters (height, weight and BMI) was done in Indian schoolchildren (3–18 years) randomly selected from both fee-paying (upper socioeconomic strata) and non-fee paying (lower socioeconomic strata) schools from 4 regions (north, south, east and west) of India. A total of 106 843 children were evaluated, of which 42 214 children (19 303 boys, 22 911 girls) were from the lower socioeconomic strata and 64 629 children (34 411 boys, 30 218 girls) were from the upper socioeconomic strata. Normative charts, using the lambda–mu–sigma (LMS) method to smoothen the curves, were drawn from children belonging to the upper socioeconomic strata, in view of the gross discrepancy between the two socioeconomic strata. Results. Height, weight and BMI percentile (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th) data were calculated and charts generated. The height of boys and girls was consistently higher at all ages when compared with earlier India data, but the final height was 2–4 cm lower than that reported in the WHO multicentre study of 2007. Weight centiles showed a rising trend both in boys and girls compared not only to earlier Indian data published in 1992, but also to that reported by the WHO multicentre study. The median weight at all ages in both boys and girls was approximately 4 kg more than that reported in affluent Indian children two decades earlier. Conclusion. This large nationwide study indicates secular trends in height, weight and BMI in Indian children from the upper socioeconomic strata. We suggest that the height and weight percentiles reported by us may be used as reference standards for India.

Evaluation of the role of ultrasonography in diagnosis of autoimmune thyroiditis in goitrous children.

OBJECTIVES: To evaluate the role of thyroid ultrasound in children with autoimmune thyroiditis diagnosed either on cytopathology or by the presence of thyroid peroxidase antibodies. DESIGN AND SETTINGS: Children presenting for the first time to the Thyroid Clinic at the Institute of Nuclear Medicine and Allied Sciences for the complaint of goiter over a two year period (January 2005-December 2006) were studied. SUBJECTS: 695 school children (244 boys and 451 girls) aged 5-18 year were studied. METHODS: Children were subjected to thyroid ultrasound, cytopathology, thyroid peroxidase antibody and thyroid function tests. RESULTS: Overall, 16% of goitrous children had hypoechogenicity on ultrasound, 15.2% had cytopathological evidence of thyroiditis, 10.6% had positive thyroid peroxidase antibodies and 25.2% had abnormal thyroid function tests. Subjects with hypoechogenicity had higher percentage of thyroiditis on cytopathology (41.4% vs. 10.3%; P<0.01), thyroid peroxidase antibody positivity (30.6% vs. 6.8%; P<0.01) and thyroid dysfunction (46.8% vs. 21.2%; P<0.01) than those with normal echogenicity. CONCLUSION: Thyroid USG has a useful, though limited, role in excluding thyroid disease in children. The sensitivity of echogenicity for the diagnosis of autoimmune thyroiditis in children is less than that reported in adults.