Unusual association of thyroiditis, Addison's disease, ovarian failure andceliac disease in a young woman

The coexistence of autoimmune endocrine diseases, particularly autoimmune t hyroid disease and celiac disease (CD), has recently been reported. We here present a 23-year-old woman with a diagnosis of hypothyroidism due to Hash imoto's thyroiditis, autoimmune Addison's disease, and kariotypically norma l spontaneous premature ovarian failure. Considering the close association between autoimmune diseases and CD, we decided to search for IgA anti-endom ysium antibodies (EmA) in the serum. The positivity of EmA and the presence of total villous atrophy at jejunal biopsy allowed the diagnosis of CD. On a gluten-free diet the patient showed a marked clinical improvement accomp anied, over a 3-month period, by a progressive decrease in the need for thy roid and adrenal replacement therapies. After 6 months, serum EmA became ne gative and after 12 months a new jejunal biopsy showed complete mucosal rec overy. After 18 months on gluten-free diet, the anti-thyroid antibodies tit re decreased significantly, and we could discontinue thyroid substitutive t herapy. This case emphasizes the association between autoimmune polyglandul ar disease and CD; the precocious identification of these cases is clinical ly relevant not only for the high risk of complications (e.g. lymphoma) inh erent to untreated CD, but also because CD is one of the causes for the fai lure of substitute hormonal therapy in patients with autoimmune thyroid dis ease. (C) 1999 Editrice Kurtis.