title: Occurrence of overt celiac disease in the elderly following total thyroidectomy.
abstract: We report the case of a female patient in whom gluten-induced entheropathy was revealed at the age of 71 yr by resistance to treatment with levothyroxine (L-T4), calcium carbonate and alfacalcidol. Hypothyroidism and hypoparathyroidism were the consequence of a total thyroidectomy performed at the age of 65 yr for a large multinodular goiter. Six months after thyroid ablation the patient started to complain of abdominal pain, diarrhea and weight loss. Following, anemia and osteopenia were documented. A progressive increase of replacement therapy for hypothyroidism and hypoparathyroidism was necessary. The clinical presentation suggested a malabsorption syndrome: celiac disease (CD) was diagnosed by serological markers and duodenal biopsy. Following gluten-free diet a normalization of clinical and serological findings was observed, bone mass density improved and a reduction of L-T4, calcium and vitamin D requirements was observed.
authors.affiliation: Medical and Radiometabolic Therapy Unit, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Caputo
authors.forename: R
authors.initials: R
authors.lastname: Brizzolara
authors.forename: M
authors.initials: M
authors.lastname: Schiavo
authors.forename: C
authors.initials: C
authors.lastname: Salmaso
authors.forename: G
authors.initials: G
authors.lastname: Pesce
authors.forename: M
authors.initials: M
authors.lastname: Bagnasco
mesh_terms: D000368:Aged; D002118:Calcium / Q000008:administration & dosage; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis*; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance / Q000502:physiology*; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage; D007011:Hypoparathyroidism / Q000188:drug therapy / Q000209:etiology; D007037:Hypothyroidism / Q000188:drug therapy / Q000209:etiology; D007408:Intestinal Absorption; D013965:Thyroidectomy / Q000009:adverse effects*; D013974:Thyroxine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D006887:Hydroxycholecalciferols; D013974:Thyroxine; D002118:Calcium; C008088:alfacalcidol