This study was designed to test for the presence of celiac disease among children with autoimmune thyroid disease (ATD).  Ninety patients (78 females) ages 1.8 to 17.3 years with ATD were studied; 20 of them had Graves disease, and 16 had other associated conditions i.e. alopecia (4), vitiligo (2), juvenile rheumatoid arthritis (2), autoimmune hepatitis (2),  Down's syndrome (1) and other miscellaneous autoimmune alterations (5).  Screening for IgA antiendomysium antibodies (EMA) and HLA typing for Class I and II DQA1 and DQA2 heterodimers were done.  There were 7 patients with positive EMA; an intestinal biopsy in these patients revealed intestinal villi alterations, with partial or total atrophy, crypt hyperplasia and intraepithelial lymphocytes.  Clinically, one of the celiac disease patients had iron deficiency, one had diarrhea, and one had short stature, while the others were asymptomatic.  A significant positive correlation was present for celiac-susceptible heterodimers in the patients with celiac disease. The authors concluded that screening for celiac disease should be done on all patients with ATD.

Editor’s Comments: This report is one more in the recent literature documenting the presence of celiac disease among patients with endocrinopathies.  The prevalence of celiac disease in patients with ATD was 7.7% which is higher than that observed in other studies of adults with ATD, and of course much higher than the 1% reported in normal populations.^1-3  In Vol 17 No 2 of Growth Genetics & Hormones, I abstracted and commented upon the article describing the presence of celiac disease in 4.6% of children with type I diabetes.⁴  Celiac disease was a significant factor in the development of hypoglycemia complicating the course of the diabetic illness.  The presence of celiac disease in the patients in this study, as well as those in other reports, was without clinical evidence of malabsorption and the patients were largely asymptomatic.  Nonetheless, it has been suggested that the presence of unidentified celiac disease could play a role in the development of autoimmune disorders, and the prompt diagnosis and treatment of this disease could prevent the onset of other alterations.⁵  The availability of an accurate, sensitive and specific test (IgA antiendomysium antibodies) to screen for celiac disease should not be overlooked by Pediatric Endocrinologists who in my opinion should test all patients with autoimmune endocrine disorders regularly for antibodies reflecting the presence of celiac disease.

Fima Lifshitz, MD

References

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	Mohn A, et al. J Pediatr Gastroenterol Nutr 2001; 32:37-40.
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