Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil

Abstract

Objective: The objective of this study was to determine the prevalence of celiac disease (CD) in adults with autoimmune thyroid disease (ATD) from the endocrinology outpatient setting in a university hospital in Southern Brazil. Subjects and methods: From the years 2007 to 2011, 254 patients with ATD were enrolled consecutively, Grave's disease was diagnosed in 143 (56.3%) and Hashimoto's thyroiditis in 111 (43.7%) of them. All patients answered a questionnaire related to symptoms that could be associated with CD and serum samples to screen for IgA anti-endomysial (EmA-IgA) were collected. EmA-IgA-positive patients were offered upper gastrointestinal endoscopy and biopsy of duodenum. Results: A total of 254 patients were included; 222 (87.4%) female, mean age 45.4 ± 13.43 years (18 to 79 years). EmA-IgA was positive in seven patients (2.7%) and five done endoscopy with biopsy. Of these, three diagnosis of CD was confirmed (1.2%). All the three patients with CD had higher EmA-IgA titration, were female and had Hashimoto's thyroiditis. Like other patients with ATD, CD patients had nonspecific gastrointestinal symptoms, such as heartburn and gastric distention. In our study, one in each 85 patients confirmed the diagnosis of CD. Conclusion: We found a prevalence of 1.2% (1:85) of confirmed CD among Brazilian patients with ATD. Although some IgA-EmA positive patients had Graves' disease and one was male, all three patients with confirmed CD were female and had Hashimoto's thyroiditis.

Prevalence of Celiac Disease in Patients with Autoimmune Thyroid Disease: A Meta-Analysis

“…Thirty-seven papers were read in detail, and 11 were excluded for the following reasons: two studies were duplicates and reported the same data as separate publications (10,11); three studies were not primarily aimed at assessing the association between CD and ATD (12)(13)(14); two studies focused on patients with non-ATD, including thyroid agenesis/ hemiagenesis, or positive antithyroid antibodies of unclear clinical significance (15,16); one study focused on patients with a ''risk'' of CD based on antibodies without any further diagnostic evaluation (17); in two studies, diagnosed CD was based only on patient reports/surveys rather than on serologic or histologic criteria (18,19); and one study was excluded because it was based on a sample with high suspicion for selection bias (20). After an initial peer review, one more relevant paper was identified and included (21). In the end, 27 studies were hence entered into the meta-analysis (Table 1) (8,9,11,.…”

“…Biopsy data and Marsh III. Fifteen studies required Marsh III for the CD diagnosis (11,21,23,(25)(26)(27)(28)(29)(30)33,36,38,39,41,42). The prevalence of CD in these studies was 1.4% [CI 1.0-1.8%].…”

“…3F) and presence of CD in ATD. Finally, the study examined if the prevalence of CD differed between studies with available full-text (11,19,21,(23)(24)(25)(26)(27)(28)(29)(30)(31)33,35,36,(39)(40)(41)(42)(43) or not (8,9,20,22,32,34,38,44). No difference in prevalence was seen (data not shown).…”

“…and in mixed populations (1.7% [CI 1.2-2.2]) (8,9,20-24,26-28, 31-34,37,38,40,43) than among individuals with hypothyroidism (1.4% [CI 1.0-1.9]) (11,19,25,29,30,35,36,41,44). The prevalence was higher in children with ATD (6.2% [CI 4.0-8.4%]) (9,11,37,38,41) than in adults (2.7% [CI 2.1-3.4])(19,21,22,24,27,29,(34)(35)(36)40,42,44) or in studies examining both adults and children (1.0% [CI 0.6-1.4])…”

MANAGEMENT OF ENDOCRINE DISEASE: Pitfalls on the replacement therapy for primary and central hypothyroidism in adults

“…Inflammation, hyperplasia of crypts and villous atrophy are some of the histological findings, which may regress or disappear with the removal of gluten from the diet (42). The prevalence of CD in the population is approximately 1%, and the prevalence of CD in patients with thyroid autoimmune disease is increased -approximately 1.5-5% (43,44).…”