Coeliac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa

Abstract

AIM:To define the association between Hashimoto's thyroiditis and coeliac disease in Dutch patients. METHODS:A total of 104 consecutive patients with Hashimoto's thyroiditis underwent coeliac serological tests (antigliadins, transglutaminase and endomysium antibodies) and HLA-DQ typing. Small intestinal biopsy was performed when any of coeliac serological tests was positive. On the other hand, 184 patients with coeliac disease were subjected to thyroid biochemical (thyroid stimulating hormone and free thyroxine) and thyroid serological tests (thyroglobulin and thyroid peroxidase antibodies). RESULTS:Of 104 patients with Hashimoto's thyroiditis, sixteen (15%) were positive for coeliac serology and five patients with documented villous atrophy were diagnosed with coeliac disease (4.8%; 95% CI 0.7-8.9). HLA-DQ2 (and/or -DQ8) was present in all the five and 53 patients with Hashimoto's thyroiditis (50%; 95% CI 43-62). Of 184 patients with coeliac disease, 39 (21%) were positive for thyroid serology. Based on thyroid biochemistry, the 39 patients were subclassified into euthyroidism in ten (5%; 95% CI 2-9), subclinical hypothyroidism in seven (3.8%; 95% CI 1.8-7.6), and overt hypothyroidism (Hashimoto's thyroiditis) in 22 (12%; 95% CI 8-16). Moreover, four patients with coeliac disease had Graves' disease (2%; 95% CI 0.8-5) and one patient had post-partum thyroiditis. CONCLUSION:The data from a Dutch population confirm the association between Hashimoto's thyroiditis and coeliac disease. Screening patients with Hashimoto's thyroiditis for coeliac disease and vice versa is recommended.

Clustering of additional autoimmunity behaves differently in Hashimoto's patients compared with Graves' patients

“…This is somewhat lower than recent (smaller) studies which reported percentages between 2.7 and 4.8 (20)(21)(22)(23). We ruled out IgA-deficiency since Em and TTG test are an IgA-class test.…”

Celiac disease in children and adolescents with Hashimoto Thyroiditis

“…However, there are a limited number of studies examining the prevalence of CD in children and adolescents with autoimmune thyroid disease. In studies conducted with adults, the prevalence of CD has been reported to be 10.8-3.3% in subjects with autoimmune thyroid disease (28)(29)(30). In studies conducted with children, the prevalence of CD has been reported to be 0.3-1.2% in healthy children and 1,3-6,5% in children and adolescents with a diagnosis of autoimmune thyroiditis (31,32).…”

Celiac Disease: Pathophysiology, Clinical Manifestations, and Associated Autoimmune Conditions

“…In a series of 104 Dutch patients with Hashimoto's thyroiditis, 8 (7.6%) were positive for TG autoantibodies and 5 (4.8%) had biopsies consistent with celiac disease. In this same report, researchers screened 184 patients with celiac disease and diagnosed hypothyroidism in 22 (12%) with 21% positive for antibodies associated with thyroid disease (28). This some observations holds true for pediatrics, in a series of 90 children with autoimmune thyroid disease, 7 (7.8%) were diagnosed with celiac disease after identification of positive EMA and small intestinal biopsy (27).…”

“…Given the background prevalence of celiac disease of 1:100, there are populations that are at an increased risk for disease, including patients with type 1 diabetes (26), autoimmune thyroid disease (both hyper-and hypothyroidism) (27,28), relatives of patients with celiac disease (3) and type 1 diabetes and patients with Turner (29,30) and Down syndromes (31). Rates of celiac disease in these populations range from 5-10%.…”