Autoimmune thyroid disease and celiac disease in children.
BACKGROUND
Celiac disease (CD) may be associated with other immunologic disorders in adults and children. Previous studies linking CD and autoimmune thyroid disease in children have included very few patients with limited biochemical and immunologic screening tests. The aim of this multicenter study was to establish the prevalence of autoimmune thyroid involvement in a large series of pediatric patients with CD.


METHODS
Five hundred seventy-three consecutive pediatric patients were enrolled from clinics in Torino, Bologna, Foggia, Rome (two clinics), Naples, and Bari. Three hundred forty-three patients with CD were studied, 230 girls and 113 boys (median age, 8.5 years). Two hundred fifty-six of the patients with CD (median age, 9 years) had been following a gluten-free diet for 3 months to 16 years; 87 patients were untreated (median age, 6.2 years). The diagnosis of CD was made using the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. A control group of 230 subjects (median age, 8.3 years) was enrolled. Serum free triiodothyronine, free thyroxine, and thyroid-stimulating hormone (TSH), antithyroperoxidase, antithyroglobulin, anti-TSH receptor antibodies, and thyroid echographic pattern were considered.


RESULTS
Autoimmune thyroid disease was found in 90 of 343 (26.2%) patients with CD (62 on a gluten-free diet) and in 20 (10%) of the control subjects (P = 0.001). Fifty-four (15.7%) patients with CD and autoimmune markers had normal thyroid function (euthyroidism) as did 12 (6.0%) of the control subjects; hypothyroidism was observed in 28 (8.1%) patients with CD and in 7 (3.5%) of the control subjects. Hyperthyroidism was diagnosed in four patients with CD and in none of the control subjects with autoimmune markers. An abnormal echographic pattern was seen in 37 patients with CD (16.8%) and only in 1 (1.6%) of the control subjects (P = 0.002).


CONCLUSIONS
The high frequency of autoimmune thyroid disease found among patients with CD, even those on a gluten-free diet, may justify a thyroid status assessment at diagnosis and at follow-up evaluation of children with CD.
Ansaldi
Nicoletta
N
Azienda Ospedaliera O.I.R.M.-S.ANNA, III Divisione Universitaria di Pediatria, Servizio di Gastroenterologia, Università di Torino, Italy. nicolettaansaldi@tiscalinet.it
Palmas
Tiziana
T
Corrias
Andrea
A
Barbato
Maria
M
D'Altiglia
Mario Rocco
MR
Campanozzi
Angelo
A
Baldassarre
Mariella
M
Rea
Francesco
F
Pluvio
Rosanna
R
Bonamico
Margherita
M
Lazzari
Rosanna
R
Corrao
Giovanni
G
D000293:Adolescent; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D002446:Celiac Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D013959:Thyroid Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D014463:Ultrasonography