Recommendations were made to check antiparietal cell and anti-intrinsic factor antibody titers, serum gastrin levels, and to perform a Schilling test. Supplementation with parenteral vitamin B12 was started with resolution of her anemia. Her type A atrophic gastritis with pernicious anemia is a predisposing factor for development of gastric adenocarcinoma and gastric carcinoid tumors. Furthermore, because of her gastroparesis with IDDM, long-term follow-up with a gastroenterologist was recommended. It is routine teaching in pediatrics to consider one disease process as a unifying cause of multiple problems. In appropriate circumstances, multiple system problems and diseases must be sought and cared for. This case displays a wide spectrum of autoimmune manifestations, including IDDM, thyrotoxicosis, and pernicious anemia with gastric atrophy and response to vitamin B12 supplementation.