“Birds of a Feather Flock Together”: Type 1A Diabetes and Other Autoimmune Disease States

W.E.W. is a 54-year-old white man who has type 1A diabetes, the most common form of type 1 diabetes. Type 1A diabetes is a cellular-mediated autoimmune disease characterized by the production of autoantibodies causing β-cell destruction and subsequent insulin deficiency.1At age 12 years, he was diagnosed with vitiligo. This autoimmune dermatological process involved mainly his neck, arms, and hands. After repeated medical consultations, he and his family received reassurance, but no treatment was recommended.At age 14 years, W.E.W. was diagnosed with type 1 diabetes after the onset of polyuria, polydipsia, and weight loss. Because an older brother had been previously diagnosed at age 12 years with type 1 diabetes, his mother diagnosed his diabetes via home urine testing in 1964. Type 1 diabetes was subsequently confirmed via venous blood testing, W.E.W. was hospitalized, and insulin therapy was initiated.In 1984, W.E.W. was diagnosed with Hashimoto's thyroiditis after experiencing fatigue, poor exercise tolerance, and weight gain. Thyroid peroxidase antibodies were positive, and he was begun on levothyroxine replacement therapy. His presenting symptoms resolved with this treatment. At age 34 years, W.E.W. now had three coexisting autoimmune diseases.Pertinent family history includes:1. mother with Hashimoto's thyroiditis2. brother with type 1 diabetes3. paternal grandfather with Graves' disease4. suspicion of type 1 diabetes in a paternal great uncle. (This relative died without a definitive diagnosis at age 18 years in 1917, after a 2-month history of weight loss and frequent urination.)1. How common are other autoimmune diseases in patients with type 1A diabetes?2. In which patients should health care providers be more vigilant in testing for these other disease states?3. What symptoms offer clues to other autoimmune disease entities?This case demonstrates the importance of both the patient's medical history and family history. Many …