Background and Hypothesis: Autoimmune thyroid disorders (AITD), including Hashimotos Thyroiditis (HT) and Graves disease (GD), are known to cluster with other autoimmune disorders (AID). There seem to exist both a pathophysiological basis of immunomodulator genes and epidemiological indications of a higher prevalence of AID including Celiac disease (CeD) in patients with AITD, compared to that in the healthy pediatric population. CeD is asymptomatic in a large proportion (ranging from 33% to 67%) of patients at the time of diagnosis. The hazard of complications, such as malignancy, which worsen the quality of life and increase mortality, is lower when diagnosis is made at a younger age, due to longer adherence to a gluten-free diet. Taking all the above into account, we should consider if screening children with AITD for CeD on a regular basis should be recommended.
Objective: To determine the prevalence of CeD among asymptomatic pediatric patients with AITD and no other co-morbidities as to justify CeD screening in this population.
Methods: Children and adolescents with AITD and no other co-morbidities followed at our Pediatric Endocrinology Outpatient Clinic were serologically tested for CeD with Immunoglobulin A (IgA) tissue Transglutaminase antibodies (IgA-tTg), as well as for their IgA serum levels, in order to exclude IgA deficiency. Intestinal biopsy for a definite diagnosis of CeD was offered to those with a confirmed positive IgA-tTg titer.
Results: Eighty-eight patients (62 girls and 26 boys), 80 of which had HT and 8 had GD, with a mean age of 11.80±3.14 years were included in the analysis. Three of them (3.41%), all of which were female diagnosed with HT, were found positive for IgA anti tTg in two samples and had the diagnosis of CeD confirmed by an intestinal biopsy. The proportions of CeD diagnosis in HT patients or female HT patients alone were even higher (3.75% and 5.36%, retrospectively). Finally, another 2 female patients with HT were found to have transient seropositivity for IgA anti-tTg, with borderline positive results in the first test and negative in the repeating one. No differences regarding age, age at diagnosis, years since diagnosis, anti-thyroid antibodies titers or anthropometric parameters were observed between those diagnosed with CeD and the rest of the studied population.
Conclusions: The relatively high prevalence of CeD in patients with AITD in this study justifies the screening for CeD in this specific pediatric population and especially in girls with HT.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology