June 19, 2001
By NATALIE ANGIER
Only recently have doctors and researchers begun thinking of autoimmune syndromes as a kind of boxed set, rather than as a series of distinct disorders. And in some families, it seems, a predisposition to autoimmunity is a box packed by Pandora.
Sarah Ciambrone, 47, a manager of a medical clinic for the homeless in Boston, is hard-working, fit, spirited and renowned among local immunologists for the extent of her family hex. Ms. Ciambrone's mother had Graves' thyroiditis in her late 20's — an autoimmune disorder in which the thyroid gland becomes wildly overactive. One of Sarah's older brothers also came down with Graves' disease in his late 20's, and Sarah soon followed, turning hyperthyroid at the age of 23. Recently, she learned that one of her young maternal cousins had to be treated for Graves'. A maternal uncle has vitiligo, an autoimmune condition that destroys patches of pigment cells in the skin.
Another older brother came down with Type 1, or juvenile, diabetes in his early 30's, and had to start insulin injections. Then, six years ago, in addition to her thyroid condition, Sarah Ciambrone was afflicted with juvenile diabetes.
"It came on as a ton of bricks," she said. "I suddenly developed all the symptoms of full-blown diabetes, the extreme thirst, constant urination, fatigue, sudden and profound weight loss. One day I complained to the company nurse that I was feeling really lousy. She took my blood sugar, and it was so high that she called an ambulance.
"I thought Graves' disease was a bad thing," she added, "but it's nothing compared to diabetes."
Her family history is so extreme, she said, "that the one brother I have without any autoimmune disease brags about it whenever he can."
So far, she said, her two teenage children likewise seem in the clear, but given her background, the one thing Ms. Ciambrone is not immune to is worry.