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Celiac Disease with Thyroid Disease

By Elaine Moore on 9/16/2008

In 2006, French researchers described the case of a 68-year old female patient with hypothyroidism resistant to replacement hormone. In addition, the patient showed poor absorption of the vitamin D analogue alfacalcidol, a prescription drug used to increase calcium absorption and prevent bone loss.

The patient’s problem absorbing medications wasn’t at first connected to celiac disease because she didn’t have the typical symptoms of celiac disease (gluten sensitivity), which include diarrhea, bloating, and nausea. However, because she clearly wasn’t absorbing her medications, she was tested for celiac disease, a disorder causing malabsorption of medications and nutrients.

Understanding Malabsorption

Malabsorption refers to a defective digestive process that causes poor absorption of nutrients, particularly oil-soluble substances. During the process of digestion, malabsorption causes nutrients to pass through the intestines quickly without being absorbed. Oil-soluble vitamins and hormones, including thyroid replacement hormone and the hormone vitamin-D, are also poorly absorbed in celiac disease.

Celiac Disease in Autoimmune Thyroid Disease

In patients with either hypothyroidism or hyperthyroidism, the incidence of celiac disease is high. In patients with thyroid disease, celiac disease often develops later in life and frequently eludes diagnosis, especially when symptoms are vague.

In the case described, malabsorption, specifically celiac disease, was eventually suspected when the patient failed to respond to increasingly high doses of thyroid replacement hormone. Although blood levels of thyroid hormone increased after intravenous doses of thyroid replacement hormone, oral replacement hormone was ineffective until the patient was put on a gluten-free diet.

The study's authors describe the value of testing for celiac disease in cases where patients with hypothyroidism fail to respond to adequate amounts of thyroid replacement hormone.

Previous studies have shown that patients with celiac disease who continue to ingest the gluten protein found in wheat, rye, and barley have increased levels of TSH receptor antibodies as well as increased levels of the gliadin and endomysial antibodies typically seen in celiac disease. By raising TSI levels in patients with Graves’ disease, untreated celiac disease worsens hyperthyroidism,  malabsorption, and nutrient deficiencies.

Resource: PubMed, 2006 Gluten-induced enteropathy (celiac disease) revealed by resistance to treatment with levothyroxine and alfacalcidol in a sixty-eight-year-old patient: a case report. Department of Endocrinology, Hospital Rangueil, Toulouse, France.

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