Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis
cross-sectional study
Keywords:
Celiac disease, Thyroiditis, autoimmune, Transglutaminases, Biopsy, Hashimoto diseaseAbstract
CONTEXT AND OBJECTIVE: Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients. DESIGN AND SETTING: Cross-sectional study in a public university hospital. METHODS: This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011. RESULTS: Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 ± 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic infiltrate and villous atrophy. CONCLUSION: The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence.
Downloads
References
Selimoğlu MA, Karabiber H. Celiac disease: prevention and treatment. J Clin Gastroenterol. 2010;44(1):4-8.
Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26(9):1217-25.
Oliveira RP, Sdepanian VL, Barreto JA, et al. High prevalence of celiac disease in Brazilian blood donor volunteers based on screening by IgA antitissue transglutaminase antibody. Eur J Gastroenterol Hepatol. 2007;19(1):43-9.
Pereira MA, Ortiz-Agostinho CL, Nishitokukado I, et al. Prevalence of celiac disease in an urban area of Brazil with predominantly European ancestry. World J Gastroenterol. 2006;12(40):6546-50.
Gandolfi L, Pratesi R, Cordoba JC, et al. Prevalence of celiac disease among blood donors in Brazil. Am J Gastroenterol. 2000;95(3):689-92.
Alencar ML, Ortiz-Agostinho CL, Nishitokukado L, et al. Prevalence of celiac disease among blood donors in São Paulo: the most populated city in Brazil. Clinics (Sao Paulo). 2012;67(9):1013-8.
Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology. 2006;131(6):1981-2002.
Delcò F, El-Serag HB, Sonnenberg A. Celiac sprue among US military veterans: associated disorders and clinical manifestations. Dig Dis Sci. 1999;44(5):966-72.
Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357(17):1731-43.
Rubio-Tapia A, Murray JA. Celiac disease. Curr Opin Gastroenterol. 2010;26(2):116-22.
Goh C, Banerjee K. Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus in a clinic based population. Postgrad Med J. 2007;83(976):132-6.
Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009;137(1):88-93.
Hill ID. What are the sensitivity and specificity of serologic tests for celiac disease? Do sensitivity and specificity vary in different populations? Gastroenterology. 2005;128(4 Suppl 1):S25-32.
Leffler DA, Kelly CP. Update on the evaluation and diagnosis of celiac disease. Curr Opin Allergy Clin Immunol. 2006;6(3):191-6.
Ch’ng CL, Jones MK, Kingham JG. Celiac disease and autoimmune thyroid disease. Clin Med Res. 2007;5(3):184-92.
Barker JM, Liu E. Celiac disease: pathophysiology, clinical manifestations, and associated autoimmune conditions. Adv Pediatr. 2008;55:349-65.
Counsell CE, Taha A, Ruddell WS. Coeliac disease and autoimmune thyroid disease. Gut. 1994;35(6):844-6.
Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Archives of Orofacial Sciences. 2006;1:9-
Available from: http://dental.usm.my/ver2/images/stories/AOS/ Vol_1/09_14_ayub.pdf. Accessed in 2013 (Nov 22).
Ravaglia G, Forti P, Maioli F, et al. Increased prevalence of coeliac disease in autoimmune thyroiditis is restricted to aged patients. Exp Gerontol. 2003;38(5):589-95.
Sari S, Yesilkaya E, Egritas O, Bideci A, Dalgic B. Prevalence of celiac disease in Turkish children with autoimmune thyroiditis. Dig Dis Sci. 2009;54(4):830-2.
Mehrdad M, Mansour-Ghanaei F, Mohammadi F, et al. Frequency of celiac disease in patients with hypothyroidism. J Thyroid Res. 2012;2012:201538.
Collin P. Should adults be screened for celiac disease? What are the benefits and harms of screening? Gastroenterology. 2005;128(4 Suppl 1):S104-8.
Dickey W, McMillan SA, Hughes DF. Sensitivity of serum tissue transglutaminase antibodies for endomysial antibody positive and negative coeliac disease. Scand J Gastroenterol. 2001;36(5):511-4.
Naiyer AJ, Hernandez L, Ciaccio EJ, et al. Comparison of commercially available serologic kits for the detection of celiac disease. J Clin Gastroenterol. 2009;43(3):225-32.
Lenhardt A, Plebani A, Marchetti F, et al. Role of human-tissue transglutaminase IgG and anti-gliadin IgG antibodies in the diagnosis of coeliac disease in patients with selective immunoglobulin A deficiency. Dig Liver Dis. 2004;36(11):730-4.
Middleton WR. Thyroid hormones and the gut. Gut. 1971;12(2):172-7.
Volta U, De Franceschi L, Molinaro N, Tetta C, Bianchi FB. Organ- specific autoantibodies in coeliac disease: do they represent an epiphenomenon or the expression of associated autoimmune disorders? Ital J Gastroenterol Hepatol. 1997;29(1):18-21.
Midhagen G, Järnerot G, Kraaz W. Adult coeliac disease within a defined geographic area in Sweden. A study of prevalence and associated diseases. Scand J Gastroenterol. 1988;23(8):1000-4.
Velluzzi F, Caradonna A, Boy MF, et al. Thyroid and celiac disease: clinical, serological, and echographic study. Am J Gastroenterol. 1998;93(6):976-9.
Elfström P, Montgomery SM, Kämpe O, Ekbom A, Ludvigsson JF. Risk of thyroid disease in individuals with celiac disease. J Clin Endocrinol Metab. 2008;93(10):3915-21.
da Silva Kotze LM, Nisihara RM, da Rosa Utiyama SR, Piovezan GC, Kotze LR. Thyroid disorders in Brazilian patients with celiac disease. J Clin Gastroenterol. 2006;40(1):33-6.
Meloni GF, Tomasi PA, Bertoncelli A, et al. Prevalence of silent celiac disease in patients with autoimmune thyroiditis from Northern Sardinia. J Endocrinol Invest. 2001;24(5):298-302.
Metso S, Hyytiä-Ilmonen H, Kaukinen K, et al. Gluten-free diet and autoimmune thyroiditis in patients with celiac disease. A prospective controlled study. Scand J Gastroenterol. 2012;47(1):43-8.
Collins D, Wilcox R, Nathan M, Zubarik R. Celiac disease and hypothyroidism. Am J Med. 2012;125(3):278-82.
Silva CM, Souza MV. Hipotiroidismo autoimune refratário a altas doses de levotiroxina e hipocalcemia grave [Autoimmune hypothyroidism nonresponsive to high doses of levothyroxine and severe hypocalcemia]. Arq Bras Endocrinol Metab. 2005;49(4):599-603.
Hadithi M, de Boer H, Meijer JW, et al. Coeliac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa. World J Gastroenterol. 2007;13(11):1715-22.
Collin P, Salmi J, Hällström O, Reunala T, Pasternack A. Autoimmune thyroid disorders and coeliac disease. Eur J Endocrinol. 1994;130(2):137-40.
Melo FM, Cavalcanti MS, Santos SB, Lopes AK, Oliveira FA. Associação entre marcadores sorológicos de doença celíaca e das doenças autoimunes da tireóide [Association between serum markers for celiac and thyroid autoimmune diseases]. Arq Bras Endocrinol Metab. 2005;49(4):542-7.
Iuorio R, Mercuri V, Barbarulo F, et al. Prevalence of celiac disease in patients with autoimmune thyroiditis. Minerva Endocrinol. 2007;32(4):239-43.
Cuoco L, Certo M, Jorizzo RA, et al. Prevalence and early diagnosis of coeliac disease in autoimmune thyroid disorders. Ital J Gastroenterol Hepatol. 1999;31(4):283-7.
Valentino R, Savastano S, Tommaselli AP, et al. Prevalence of coeliac disease in patients with thyroid autoimmunity. Horm Res. 1999;51(3):124-7.
Berti I, Trevisiol C, Tommasini A, et al. Usefulness of screening program for celiac disease in autoimmune thyroiditis. Dig Dis Sci. 2000;45(2):403-6.
Mainardi E, Montanelli A, Dotti M, Nano R, Moscato G. Thyroid-related autoantibodies and celiac disease: a role for a gluten-free diet? J Clin Gastroenterol. 2002;35(3):245-8.
Volta U, Ravaglia G, Granito A, et al. Coeliac disease in patients with autoimmune thyroiditis. Digestion. 2001;64(1):61-5.
Almeida LM, Castro LC, Uenishi RH, et al. Decreased prevalence of celiac disease among Brazilian elderly. World J Gastroenterol. 2013;19(12):1930-5.
da Silva Kotze LM, Nisihara RM, Kotze LR, da Rosa Utiyama SR. Celiac disease in older brazilians. J Am Geriatr Soc. 2011;59(8):1548-50.
Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006;101(10):2356-9.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894:i-xii, 1-253.
Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The epidemiology of obesity. Gastroenterology. 2007;132(6):2087-102.
Monteiro CA, Conde WL, Popkin BM. Income-specific trends in obesity in Brazil: 1975-2003. Am J Public Health. 2007;97(10):1808-12.
Terres NG, Pinheiro RT, Horta BL, Pinheiros KA, Horta LL. Prevalência e fatores associados ao sobrepeso e à obesidade em adolescentes [Prevalence and factors associated to overweight and obesity in adolescentes]. Rev Saude Publica. 2006;40(4):627-33.
Gigante DP, Dias-da-Costa JS, Olinto MT, Menezes AM, Silvia M. Obesidade da população adulta de Pelotas, Rio Grande do Sul, Brasil e associação com nível sócio-econômico [Adult obesity in Pelotas, Rio Grande do Sul, Brazil, and the association with socioeconomic status]. Cad Saude Publica. 2006;22(9):1873-9.
Peixoto Mdo R, Benício MH, Jardim PC. Relação entre índice de massa corporal e estilo de vida em uma população adulta do Brasil: um estudo transversal [The relationship between body mass index and lifestyle in a Brazilian adult population: a cross-sectional survey]. Cad Saude Publica. 2007;23(11):2694-740.
Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549-55.
Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010;44(4):267-71.
Finch CA, Bellotti V, Stray S, et al. Plasma ferritin determination as a diagnostic tool. West J Med. 1986;145(5):657-63.
Hagar W, Theil EC, Vichinsky EP. Diseases of iron metabolism. Pediatr Clin North Am. 2002;49(5):893-909.
