To the Editor,
We read with interest the article by Kozlowska Alicja Anna et al. 1 entitled “Searching for LADA in patients with Hashimoto's thyroiditis: A tool for the prevention of LADA.” The authors highlight the important association between Hashimoto's thyroiditis (HT) and latent autoimmune diabetes in adults (LADA) and propose routine glutamic acid decarboxylase antibody (GADA) screening in patients with HT to facilitate early identification of autoimmune diabetes. Although this perspective raises an important clinical question, several aspects of the proposed screening strategy warrant further consideration.
However, we would like to caution the authors that the evidence presented is insufficient to support the implication that GADA screening in HT can prevent LADA. Although the article suggests that routine GADA testing may discover LADA early and frames it as a preventive strategy, it does not provide direct prospective evidence that screening HT patients changes the natural history of LADA. The teplizumab data cited by the authors were generated in carefully selected relatives at risk for type 1 diabetes, so they cannot be directly extrapolated to HT screening or used as proof that GADA testing prevents LADA in this population. 2
Furthermore, the evidence presented is insufficient to support the implication that GADA positivity in HT predicts progression to LADA. Although the article shows an association between HT and GADA, it does not provide longitudinal data demonstrating that GADA‐positive HT patients subsequently develop LADA, and isolated GADA positivity should not be interpreted as proof of inevitable autoimmune diabetes. Consistent with prior adult data showing that diabetes autoantibodies do not reliably predict progression to diabetes and with the view that LADA is likely to represent a mixed autoimmune and nonautoimmune phenotype, the prognostic significance of isolated GADA positivity in this setting remains uncertain. 3 , 4
Finally, the article does not provide prevalence, incidence, or predictive‐performance data for the actual HT screening population, so the positive predictive value and clinical utility of routine GADA screening remain difficult to assess. Although the paper includes approximate autoantibody frequencies in a summary table, those estimates are explicitly stated to vary by population and do not substitute for target‐population screening data. Without such data, it remains unclear whether routine GADA screening is beneficial in this population. 1
In conclusion, GADA positivity in HT should not be used as proof that LADA will develop in the future. To determine the prognostic significance and clinical utility of routine GADA screening in this cohort, more long‐term research is needed.
DISCLOSURE
The authors declare no conflicts of interest.
Approval of the research protocol: N/A.
Informed consent: N/A.
Registry and the registration no. of the study/trial: N/A.
Animal studies: N/A.
ACKNOWLEDGMENTS
The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors report no AI usage to facilitate this manuscript; however, they used Grammarly for the language clarity and flow of the manuscript and ChatGPT to recheck the suitability of the references. The authors take the responsibility of this usage in the manuscript.
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
REFERENCES
- 1. Anna KA, Vittoria MM, Paolo P. Searching for LADA in patients with Hashimoto's thyroiditis: A tool for the prevention of LADA. J Diabetes Investig 2026. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Herold KC, Bundy BN, Long SA, et al. An anti‐CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes. N Engl J Med 2019; 381: 603–613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Jones AG, McDonald TJ, Shields BM, et al. Latent autoimmune diabetes of adults (LADA) is likely to represent a mixed population of autoimmune (type 1) and nonautoimmune (type 2) diabetes. Diabetes Care 2021; 44: 1243–1251. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Dabelea D, Ma Y, Knowler WC, et al. Diabetes autoantibodies do not predict progression to diabetes in adults: The diabetes prevention program. Diabet Med 2014; 31: 1064–1068. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.