A 16-year-old girl with type 1 diabetes presents with fatigue, weight gain, cold intolerance, and a firm, non-tender goiter. TSH is 18 mIU/L (elevated) and free T4 is low. Anti-thyroid peroxidase antibodies are strongly positive. What is the most likely diagnosis and associated condition that should be screened for?
- A Graves disease; screen for celiac disease
- B Hashimoto thyroiditis; screen for celiac disease ✓
- C Subacute thyroiditis; screen for Cushing syndrome
- D Iodine deficiency goiter; screen for phenylketonuria
Correct answer: B. Hashimoto thyroiditis; screen for celiac disease
Explanation
Elevated TSH, low free T4, goiter, and strongly positive anti-TPO antibodies confirm Hashimoto (autoimmune) thyroiditis. Type 1 diabetes is part of the autoimmune polyglandular syndrome type 2 association (with autoimmune thyroid disease and celiac disease). All patients with type 1 diabetes and thyroid autoimmunity should be screened for celiac disease (tissue transglutaminase IgA). Graves disease would show suppressed TSH. Subacute thyroiditis is painful and not associated with celiac screening. Iodine deficiency is uncommon in iodinated-salt regions and is not autoimmune.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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