Celiac Disease And Endocrine Disorders

CD patients can exhibit some immune-mediated endocrine disorders alongside their clinical evolution, the most common being type 1 diabetes mellitus (T1DM) and thyroid disease. Each of these conditions affects 5%-10% of celiac disease patients throughout their lives.

The prevalence of celiac disease in the T1DM patients is substantially higher than expected in the general population. Approximately one half of subjects do not have gastrointestinal (GI) symptoms and the rest have only mild digestive disturbances. Indeed, many diabetic patients undergo endoscopy to investigate the frequent GI symptoms that affl ict those with T1DM.

It would require little extra effort or cost, to obtain duodenal biopsies, at least once to identify CD, and the biopsy result may explain the GI procedure has been done. It is not clear what impact that discovery has, if any, on diabetic control or complications, although GI symptoms seem to improve on a GFD. The gluten-free diet infl uence on the control or management of thyroid disease is limited at best, and additional studies are clearly needed to reach fi rm conclusions.

One interesting study performed in Italian children found a high incidence of autoimmune thyroid disease in 90 of 343 (26.2%) patients with celiac disease (62 on a GFD) and in 20 (10%) of the control subjects (P = 0.001). Fifty-four (15.7%) patients with celiac disease and autoimmune markers had normal thyroid function (euthyroidism) as did 12 (6.0%) of the control subjects.

Hypothyroidism was observed in 28 (8.1%) patients with celiac disease and in 7 (3.5%) of the control subjects. Hyperthyroidism was diagnosed in four patients with celiac disease and in none of the control subjects with autoimmune markers. An abnormal echographic pattern was seen in 37 patients with celiac disease (16.8%) and only in one (1.6%) of the control subjects (P = 0.002).

The high frequency of autoimmune thyroid disease found among patients with CD, even those on a GFD, may justify a thyroid status assessment at diagnosis and at follow-up evaluation of children and adults with CD.