Prevalence of thyroid autoimmunity in first-degree relatives of patients with celiac disease

Soni, Shishir; Agarwal, Ashish; Singh, Alka; Gupta, Viney; Khadgawat, Rajesh; Chaturvedi, P. K.; Ahuja, Vineet; Makharia, Govind

doi:10.1007/s12664-019-00990-3

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…In an Indian case-control study, Soni et al identified that first-degree relatives of celiac disease patients have a threefold increased risk of developing AITD and associated thyroid dysfunction. The authors propose that first-degree relatives of CD patients be screened for both CD and AITD because most patients are asymptomatic [51]. However, we could not find any studies regarding screening relatives of AITD patients for CD.…”

Section: Need For Screeningmentioning

confidence: 84%

Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod

Ashok¹,

Patni²,

Fatima³

et al. 2022

Cureus

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Celiac disease (CD) is a small intestinal inflammatory disease commonly seen in the Western population. It has been observed that patients with monoglandular and polyglandular autoimmunity have a higher prevalence of celiac disease. Hashimoto's thyroiditis (HT) and Graves' disease (GD), which mainly constitute the autoimmune thyroid diseases (AITD), characterized by lymphocytic infiltration of the thyroid parenchyma, are noted to be frequently associated with celiac disease. The fundamental mechanism of this frequent coexistence is thought to be a shared genetic background. Due to the subclinical nature of the celiac disease, the diagnosis is often missed or made coincidentally during screening. The rising prevalence of the celiac disease among AITD patients has urged researchers to investigate the link between the two. We reviewed the most recent and relevant literature on the intriguing relationship between celiac disease and thyroid autoimmunity. The objectives of this article were to study the shared genetic background, the incidence of CD in AITD, the effect of a gluten-free diet on AITD, and the need for routine screening of CD in AITD patients.

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Section: Need For Screeningmentioning

confidence: 84%

Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod

Ashok¹,

Patni²,

Fatima³

et al. 2022

Cureus

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“…Moreover, in agreement with Ventura et al [ 155 ], disease duration was a significant predictor of additional autoimmune disorders, indicating that the increased risk of autoimmunity might be mainly linked to common genetic features in these subjects [ 124 ]. Of interest, first-degree relatives of patients with CeD had a three-fold higher prevalence of AITD (17.5% vs. 5.03%, p = 0.0013) and associated thyroid dysfunction (11.8% vs. 3.5%, p = 0.010) than healthy controls, although the lack of a baseline biochemical assessment to select healthy controls represents one of the major limitations of this research [ 159 ].…”

Section: The Bidirectional Relationship Between Autoimmune Thyroid Di...mentioning

confidence: 99%

“…The co-existence of CeD with other autoimmune disorders, including AITD, and vice versa, probably implies a potential role for gluten peptides, which are the known etiological agent of CeD but could also be involved, directly or indirectly, in the onset of AITD, whose etiopathogenesis is deemed multifactorial, albeit not fully clarified [ 159 ]. Some direct and indirect mechanisms have therefore been hypothesized to try to explain the concomitance of CeD with AITD ( Figure 2 ):…”

Section: The Bidirectional Relationship Between Autoimmune Thyroid Di...mentioning

confidence: 99%

Vitamin D: An Essential Nutrient in the Dual Relationship between Autoimmune Thyroid Diseases and Celiac Disease—A Comprehensive Review

Gorini,

Tonacci

2024

Nutrients

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Autoimmune thyroid diseases (AITD) are among the most frequent autoimmune disorders, with a multifactorial etiology in which both genetic and environmental determinants are probably involved. Celiac disease (CeD) also represents a public concern, given its increasing prevalence due to the recent improvement of screening programs, leading to the detection of silent subtypes. The two conditions may be closely associated due to common risk factors, including genetic setting, changes in the composition and diversity of the gut microbiota, and deficiency of nutrients like vitamin D. This comprehensive review discussed the current evidence on the pivotal role of vitamin D in modulating both gut microbiota dysbiosis and immune system dysfunction, shedding light on the possible relevance of an adequate intake of this nutrient in the primary prevention of AITD and CeD. While future technology-based strategies for proper vitamin D supplementation could be attractive in the context of personalized medicine, several issues remain to be defined, including standardized assays for vitamin D determination, timely recommendations on vitamin D intake for immune system functioning, and longitudinal studies and randomized controlled trials to definitely establish a causal relationship between serum vitamin D levels and the onset of AITD and CeD.

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“…For attribution the title, original author(s), the publication source -NIHR Journals Library, and the DOI of the publication must be cited. Summary 321 Kanungo et al 446 Kizilgul et al 451 Lampasona et al 448 Szepietowska et al 452 Zhao et al 431 276 Beser et al 349 Soni et al 346 Jansen et al 183 Abu-Zeid et al 277 Choung et al 347 Cintado et al 350 Fasano et al 348 Fasano et al 348 Kotze et al 351 Stahl et al 293 Nass et al 352 Utiyama et al 353 Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed.…”

Section: Referencementioning

confidence: 99%

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling

Elwenspoek

Thom

Sheppard

et al. 2022

Health Technol Assess

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Background Coeliac disease is an autoimmune disorder triggered by ingesting gluten. It affects approximately 1% of the UK population, but only one in three people is thought to have a diagnosis. Untreated coeliac disease may lead to malnutrition, anaemia, osteoporosis and lymphoma. Objectives The objectives were to define at-risk groups and determine the cost-effectiveness of active case-finding strategies in primary care. Design (1) Systematic review of the accuracy of potential diagnostic indicators for coeliac disease. (2) Routine data analysis to develop prediction models for identification of people who may benefit from testing for coeliac disease. (3) Systematic review of the accuracy of diagnostic tests for coeliac disease. (4) Systematic review of the accuracy of genetic tests for coeliac disease (literature search conducted in April 2021). (5) Online survey to identify diagnostic thresholds for testing, starting treatment and referral for biopsy. (6) Economic modelling to identify the cost-effectiveness of different active case-finding strategies, informed by the findings from previous objectives. Data sources For the first systematic review, the following databases were searched from 1997 to April 2021: MEDLINE® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), Cochrane Library, Web of Science™ (Clarivate™, Philadelphia, PA, USA), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and the National Institutes of Health Clinical Trials database. For the second systematic review, the following databases were searched from January 1990 to August 2020: MEDLINE, Embase, Cochrane Library, Web of Science, Kleijnen Systematic Reviews (KSR) Evidence, WHO ICTRP and the National Institutes of Health Clinical Trials database. For prediction model development, Clinical Practice Research Datalink GOLD, Clinical Practice Research Datalink Aurum and a subcohort of the Avon Longitudinal Study of Parents and Children were used; for estimates for the economic models, Clinical Practice Research Datalink Aurum was used. Review methods For review 1, cohort and case–control studies reporting on a diagnostic indicator in a population with and a population without coeliac disease were eligible. For review 2, diagnostic cohort studies including patients presenting with coeliac disease symptoms who were tested with serological tests for coeliac disease and underwent a duodenal biopsy as reference standard were eligible. In both reviews, risk of bias was assessed using the quality assessment of diagnostic accuracy studies 2 tool. Bivariate random-effects meta-analyses were fitted, in which binomial likelihoods for the numbers of true positives and true negatives were assumed. Results People with dermatitis herpetiformis, a family history of coeliac disease, migraine, anaemia, type 1 diabetes, osteoporosis or chronic liver disease are 1.5–2 times more likely than the general population to have coeliac disease; individual gastrointestinal symptoms were not useful for identifying coeliac disease. For children, women and men, prediction models included 24, 24 and 21 indicators of coeliac disease, respectively. The models showed good discrimination between patients with and patients without coeliac disease, but performed less well when externally validated. Serological tests were found to have good diagnostic accuracy for coeliac disease. Immunoglobulin A tissue transglutaminase had the highest sensitivity and endomysial antibody the highest specificity. There was little improvement when tests were used in combination. Survey respondents (n = 472) wanted to be 66% certain of the diagnosis from a blood test before starting a gluten-free diet if symptomatic, and 90% certain if asymptomatic. Cost-effectiveness analyses found that, among adults, and using serological testing alone, immunoglobulin A tissue transglutaminase was most cost-effective at a 1% pre-test probability (equivalent to population screening). Strategies using immunoglobulin A endomysial antibody plus human leucocyte antigen or human leucocyte antigen plus immunoglobulin A tissue transglutaminase with any pre-test probability had similar cost-effectiveness results, which were also similar to the cost-effectiveness results of immunoglobulin A tissue transglutaminase at a 1% pre-test probability. The most practical alternative for implementation within the NHS is likely to be a combination of human leucocyte antigen and immunoglobulin A tissue transglutaminase testing among those with a pre-test probability above 1.5%. Among children, the most cost-effective strategy was a 10% pre-test probability with human leucocyte antigen plus immunoglobulin A tissue transglutaminase, but there was uncertainty around the most cost-effective pre-test probability. There was substantial uncertainty in economic model results, which means that there would be great value in conducting further research. Limitations The interpretation of meta-analyses was limited by the substantial heterogeneity between the included studies, and most included studies were judged to be at high risk of bias. The main limitations of the prediction models were that we were restricted to diagnostic indicators that were recorded by general practitioners and that, because coeliac disease is underdiagnosed, it is also under-reported in health-care data. The cost-effectiveness model is a simplification of coeliac disease and modelled an average cohort rather than individuals. Evidence was weak on the probability of routine coeliac disease diagnosis, the accuracy of serological and genetic tests and the utility of a gluten-free diet. Conclusions Population screening with immunoglobulin A tissue transglutaminase (1% pre-test probability) and of immunoglobulin A endomysial antibody followed by human leucocyte antigen testing or human leucocyte antigen testing followed by immunoglobulin A tissue transglutaminase with any pre-test probability appear to have similar cost-effectiveness results. As decisions to implement population screening cannot be made based on our economic analysis alone, and given the practical challenges of identifying patients with higher pre-test probabilities, we recommend that human leucocyte antigen combined with immunoglobulin A tissue transglutaminase testing should be considered for adults with at least a 1.5% pre-test probability of coeliac disease, equivalent to having at least one predictor. A more targeted strategy of 10% pre-test probability is recommended for children (e.g. children with anaemia). Future work Future work should consider whether or not population-based screening for coeliac disease could meet the UK National Screening Committee criteria and whether or not it necessitates a long-term randomised controlled trial of screening strategies. Large prospective cohort studies in which all participants receive accurate tests for coeliac disease are needed. Study registration This study is registered as PROSPERO CRD42019115506 and CRD42020170766. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 44. See the NIHR Journals Library website for further project information.

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Prevalence of thyroid autoimmunity in first-degree relatives of patients with celiac disease

Cited by 9 publications

References 25 publications

Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod

Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod

Vitamin D: An Essential Nutrient in the Dual Relationship between Autoimmune Thyroid Diseases and Celiac Disease—A Comprehensive Review

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling

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