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Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study

American Journal of Gastroenterology volume 96, pages 751757 (2001) | Download Citation

Subjects

Abstract

OBJECTIVES:

Many afflictions have been associated with celiac disease, but chance associations may exists. The aim of this study was to establish, by means of a multicenter prospective study, the prevalence of thyroid impairment among adult patients with newly diagnosed celiac disease and to evaluate the effect of a 1-yr gluten withdrawal on thyroid function.

METHODS:

A total of 241 consecutive untreated patients and 212 controls were enrolled. In 128 subjects a thorough assessment, including intestinal biopsy, was repeated within 1 yr of dietary treatment. Thyroid function was assayed by measuring the levels of TSH, free T3, free T4, thyroperoxidase, and thyroid microsome antibodies.

RESULTS:

Thyroid disease was 3-fold higher in patients than in controls (p < 0.0005). Hypothyroidism, diagnosed in 31 patients (12.9%) and nine controls (4.2%), was subclinical in 29 patients and of nonautoimmune origin in 21. There was no difference regarding hyperthyroidism, whereas autoimmune thyroid disease with euthyroidism was present in 39 patients (16.2%) and eight controls (3.8%). In most patients who strictly followed a 1-yr gluten withdrawal (as confirmed by intestinal mucosa recovery), there was a normalization of subclinical hypothyroidism. Twenty-five percent of patients with euthyroid autoimmune disease shifted toward either a subclinical hyperthyroidism or subclinical hypothyroidism; in these subjects, dietary compliance was poor. In addition, 5.5% of patients whose thyroid function was normal while untreated developed some degree of thyroid dysfunction 1 yr later.

CONCLUSIONS:

The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may single-handedly reverse the abnormality.

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References

  1. 1.

    , Coeliac disease, and associated disorders. In: Coeliac disease. Cooke WT, Holmes GKT, eds. Churchill Livingstone: London, 1984: 225–248.

  2. 2.

    . Screening of coeliac disease. In: Maki M, Collin P, Visakorpi JK, eds. Coeliac disease. Proceedings of the 7th International Symposium on coeliac disease Coeliac Disease Study Group: Tampere, Finland, 1997: 23–34

  3. 3.

    , , . Coeliac disease, and autoimmune thyroid disease. Gut 1994;35: 844–846.

  4. 4.

    , , , et al. Autoimmune thyroid disease, and coeliac disease. Eur J Gastroenterol Hepatol 1998;10: 927–931.

  5. 5.

    , , , et al. Revised criteria for diagnosis of coeliac disease. Arch Dis Child 1990;65: 909–911.

  6. 6.

    , , . Clinical, and pathological spectrum of coeliac disease—Active, silent, latent, potential. Gut 1993;34: 150–151.

  7. 7.

    , , , et al. American Thyroid Association guideline for use of laboratory tests in thyroid disorders. JAMA 1990;263: 1529–1532.

  8. 8.

    . Morphology, and immunopathology of the jejunal lesion in gluten-sensitivity. Eur J Gastroenterol Hepatol 1991;3: 108–114.

  9. 9.

    , , , for the SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Duration of exposure to gluten, and risk for autoimmune disorders in patients with celiac disease. Gastroenterology 1999;117: 297–303.

  10. 10.

    , , , et al. Effect of severe, chronic illness on thyroid function. Lancet 1974;ii: 971–974.

  11. 11.

    , , , et al. Thyroid hormones and the regulation of thyroid function in men with coeliac disease. Clin Endocrinol 1982;16: 525–535.

  12. 12.

    , , , et al. Comparative screening for thyroid disorders in old age in areas of iodine deficiency, long term iodine prophylaxis, and abundant iodine intake. Clin Endocrinol 1997;47: 87–92.

  13. 13.

    Autoimmune endocrine disease. JAMA 1997;278: 1931–1937.

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Author information

Affiliations

  1. University of Torino, Torino, Italy

    • C Sategna-Guidetti
    • , A Carlino
    •  & C Brossa
  2. University of Bologna, Bologna, Italy

    • U Volta
    •  & L De Franceschi
  3. University of Napoli, Napoli, Italy

    • C Ciacci
    •  & A Camera
  4. University of Cagliari, Cagliari, Italy

    • P Usai
  5. University of Perugia, Perugia, Italy

    • A Pelli

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Corresponding author

Correspondence to C Sategna-Guidetti.

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DOI

https://doi.org/10.1111/j.1572-0241.2001.03617.x

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