Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study

Abstract

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. RESUMO CONTEXTO E OBJETIVO:A doença celíaca é uma doença autoimune, com prevalência média de 1% na Europa e nos Estados Unidos. Em função da forte ascendência europeia no sul do Brasil, este estudo objetiva relatar a soroprevalência de doença celíaca em indivíduos com tireoidite autoimune. TIPO DE ESTUDO E LOCAL: Estudo transversal em um hospital público universitário. MÉTODOS: Este estudo transversal de prevalência incluiu pacientes com tireoidite autoimune que foram submetidos a testes de anticorpos antiendomísio e antitransglutaminase entre agosto de 2010 e julho de 2011. RESULTADOS: Foram incluídos 53 pacientes com tireoidite autoimune, 92,5% mulheres, com idade média de 49,0 ± 13,5 anos. Cinco (9,3%) pacientes apresentaram sorologia positiva para doença celíaca, sendo três (5,6%) com anticorpo antiendomísio positivo e dois (3,7%) com antitransglutaminase positivo. Nenhum paciente apresentou anemia e um apresentou diarreia. Apenas dois pacientes realizaram endoscopia: um com histologia normal e outro apresentou infiltrado linfocitário e atrofia vilositária. CONCLUSÕES: A prevalência de doença celíaca entre pacientes com doença autoimune da tireoide foi de 9,3%; um paciente queixou-se de diarreia e ninguém apresentou anemia. Em populações de risco, como é o caso de pacientes com tireoidite autoimune, a presença de diarreia ou anemia não devem ser utilizados como critério para indicar investigação de doença celíaca, que deve ser feita em todos os indivíduos com tireoidite autoimune devido a sua alta prevalência.

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

“…Twenty-seven relevant studies were identified, including 6024 individuals with ATD. Six of these studies had screened <100 patients with ATD (9,11,23,24,32,37). The prevalence of CD ranged between 0% and 10% ( Table 1).…”

“…Type of ATD. The prevalence of CD was slightly higher in hyperthyroidism (2.6% [CI 0.7-4.4]) (11,39,42) (8,23,25,26,28,30,31,33,39,43). The highest pooled prevalence was, however, seen in one study where the age of participants was unclear (9.0% [CI 5.3-12.8%]) (32).…”

“…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).…”

Screening of patients with juvenile idiopathic arthritis and those with rheumatoid arthritis for celiac disease in southwestern Iran

“…Vigorous CD4 + T-helper 1 cell activation has been implicated in patients with CD (3,4). The association of CD with autoimmune rheumatologic diseases such as juvenile idiopathic arthritis (JIA), rheumatoid arthritis (RA), and primary Sjögren syndrome has been reported (5)(6)(7).…”