Fulminating diabetes with lymphocytic thyroiditis.

Recorded observations suggest strongly but not conclusively that auto-immunity is a factor in the pathogenesis of at least some forms of juvenile diabetes mellitus. This view is based on the occasional association of juvenile diabetes with Hashimoto's disease, which is a well-known example of auto-immunity, the presence of thyroid antibodies in some cases of diabetes, and the pathohistological features of the lesions in juvenile diabetes. The problem of non-thyroid manifestations of auto-immunity in cases of Hashimoto's disease seems to be as yet unresolved. Blizzard, Chandler, Kyle, and Hung (1962) were so impressed by the frequency of associated endocrine involvement, e.g. of the adrenal, pituitary, and parathyroid, in cases of Hashimoto's disease, as to suggest that patients with one type of auto-immune endocrine disease are also liable to have another. On the other hand, though 11 of 74 cases of chronic thyroiditis in a post-mortem series surveyed by Masi, Hartmnann, Hahn, Abbey, and Shulman (1965) suffered from diabetes mellitus, the latter was also present in 8 patients of their corresponding control series without thyroiditis. That auto-immune disorders may often be associated with thyroiditis can be seen from the series of Becker, Titus, Woolner, and McConahey (1965) who found that 36 of 153 cases of thyroiditis also suffered from such disorders as rheumatoid arthritis, pernicious anaemia, myasthenia gravis, thrombocytopenic purpura, Addison's disease, and glomerulonephritis. The incidence of focal thyroiditis in post-mortem sections of 724 thyroids was studied by Williams and Doniach (1962). They confirmed the correlation of Addison's disease and of panhypopituitarism with a raised incidence of thyroid involvement. The incidence of such involvement in the diabetics in their series was, however, not significantly higher than in controls. The above studies were mostly on adults. The position seems to be more clear cut in children and adolescents. Thyroid antibodies were found in 13 of 58 diabetic children (22%) by Landing, Pettit,