Atypical Celiac Disease as Cause of Increased Need for Thyroxine: A Systematic Study

Virili, Camilla; Bassotti, G; Santaguida, Maria Giulia; Iuorio, R; Duca, Susanna Carlotta Del; Mercuri, Valeria; Picarelli, Antonio; Gargiulo, Patrizia; Gargano, Lucilla; Centanni, Marco

doi:10.1210/jc.2011-1851

Cited by 99 publications

(85 citation statements)

References 20 publications

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“…In the present study, patients with ATD and concomitant CD did not have typical symptoms, which include chronic diarrhea, loss of weight, or anemia, and this can occur in a high percentage of cases (22). Our patients had most commonly gastric distention and heartburn that represent gastrointestinal symptoms seen in the general population.…”

Section: Discussionmentioning

confidence: 44%

“…This fact can be explained by mucosal damage or presence of undigested food and a net increase of water in the intestinal lumen. Partial recovery of mucosal structure may be sufficient to improve T4 absorption (21,22). In this context, one patient of our study with confirmed diagnosis of CD, which has been treated by the gastroenterology service of our hospital, had a reduction in the dosage of levothyroxine from 175 to 125 mcg, with a better control of the hypothyroidism, approximately one year after the initiation of a GFD.…”

Section: Discussionmentioning

confidence: 94%

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

Teixeira

Nisihara

Utiyama

et al. 2014

Arq Bras Endocrinol Metab

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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.

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 94%

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

Teixeira

Nisihara

Utiyama

et al. 2014

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

show abstract

“…Exclusion criteria were: i) a history of hyperthyroidism or toxic nodular goitre as well as the presence of autonomously functioning areas in the thyroid scan; ii) the recent use (!6 months) of drugs known to interfere with thyroid homeostasis (20); iii) the presence of concomitant gastrointestinal disorders (gastritis related to Helicobacter pylori infection, atrophic gastritis, coeliac disease, lactose intolerance, etc.) known to increase L-T 4 requirement (21,22,23); iv) being pregnant.…”

Section: Methodsmentioning

confidence: 99%

“…All patients with NTMG were treated with an individually tailored dose of T 4 , as previously described (21,22,23,24) and in semi-suppressive mode (target serum TSHZ0.1-0.5 mU/l) (2). The individually tailored dose is the dose of T 4 which is administered following a standardized assumption procedure and titrated on the basis of patient's age, weight, BMI, the amount of residual thyroid tissue and the ability to absorb the hormone (12,14,15,21,22,23,24).…”

Section: Methodsmentioning

confidence: 99%

“…The individually tailored dose is the dose of T 4 which is administered following a standardized assumption procedure and titrated on the basis of patient's age, weight, BMI, the amount of residual thyroid tissue and the ability to absorb the hormone (12,14,15,21,22,23,24). All patients were treated with the same brand of oral and agreed to take T 4 under fasting conditions, abstaining from eating or drinking anything other than water for at least 1 h after treatment.…”

Section: Methodsmentioning

confidence: 99%

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Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

Duca

Santaguida

Brusca

et al. 2015

European Journal of Endocrinology

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Objective: Thyroxine (T 4 ) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T 4 requirement in the same patients and treatment settings, before and after total thyroidectomy. Design, patients and methods: This was a longitudinal study including 23 goitrous patients treated with T 4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSHZ0.28 mU/l) at a stable T 4 dose for at least 1 year before surgery (median T 4 doseZ1.50 mg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T 4 . Results: Three months after surgery,using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P!0.0001) and so the T 4 dose had to be increased (median T 4 doseZ1.95 mg/kg per day; C30%; P!0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSHZ4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 mg/kg per day (C25 and C21%) respectively. Conclusions: Following the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T 4 dose than before surgery. Despite this increase, the dose of T 4 needed in our patients remains significantly lower than that previously described in athyreotic patients.

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Atypical Celiac Disease as Cause of Increased Need for Thyroxine: A Systematic Study

Abstract: Atypical CD increases the need for T4. The effect was reversed by GFD or by increasing T4 dose. Malabsorption of T4 may provide the opportunity to detect CD that was overlooked until the patients were put under T4 therapy.

Cited by 99 publications

References 20 publications

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

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

Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

Levothyroxine sodium oral solution to control thyroid function in a patient with hypothyroidism and celiac disease

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