Prevalence of thyroid disorders in untreated adult celiac disease patientsand effect of gluten withdrawal: An Italian multicenter study

OBJECTIVES: Many afflictions have been associated with celiac disease, but chance associations may exists. The aim of this study was to establish, by means of a multicenter prospective study, the prevalence of thyroid impairm ent among adult patients with newly diagnosed celiac disease and to evaluat e the effect of a L-yr gluten withdrawal on thyroid function. METHODS: A total of 241 consecutive untreated patients and 212 controls wer e enrolled. In 128 subjects a thorough assessment, including intestinal bio psy, was repeated within 1 yr of dietary treatment. Thyroid function was as sayed by measuring the levels of TSH, free T3, free T4, thyroperoxidase, an d thyroid microsome antibodies. RESULTS: Thyroid disease was 3-fold higher in patients than in controls (p < 0.0005). Hypothyroidism, diagnosed in 31 patients (12.9%) and nine contro ls (4.2%), was subclinical in 29 patients and of nonautoimmune origin in 21 . There was no difference regarding hyperthyroidism, whereas autoimmune thy roid disease with euthyroidism was present in 39 patients (16.2%) and eight controls (3.8%). In most patients who strictly followed a I-yr gluten with drawal las confirmed by intestinal mucosa recovery), there was a normalizat ion of subclinical hypothyroidism. Twenty-five percent of patients with eut hyroid autoimmune disease shifted toward either a subclinical hyperthyroidi sm or subclinical hypothyroidism; in these subjects, dietary compliance was poor. In addition, 5.5% of patients whose thyroid function was normal whil e untreated developed some degree of thyroid dysfunction 1 yr later. CONCLUSIONS: The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, glut en withdrawal map single handedly reverse the abnormality. <(c)> 2001 by Am . Cell. of Gastroenterology.