Celiac disease in children, adolescents, and young adults with autoimmune thyroid disease.
OBJECTIVE
To determine the prevalence of antibodies associated with celiac disease and biopsy-proven celiac disease in children with autoimmune thyroid disease.


METHODS
A total of 302 patients with positive anti-thyroid antibodies were prospectively studied. Total immunoglobulin A (IgA) and tissue transglutaminase-IgA (tTG-IgA) levels were obtained. Those with a positive tTG-IgA titer were offered biopsy for definitive diagnosis of celiac disease.


RESULTS
A total of 4.6% of subjects with autoimmune thyroid disease had positive tTG-IgA titers. The prevalence of biopsy-confirmed celiac disease was 2.3%. Our population was enriched with patients with type 1 diabetes mellitus (4.3%) and Down syndrome (3.4%). Excluding individuals with these co-morbidities, the prevalence of celiac disease in autoimmune thyroid disease is 1.3%, similar to that of the general population. The positive predictive value of biopsy-proven celiac disease in patients with autoimmune thyroid disease and positive tTG-IgA titer was 54%.


CONCLUSIONS
The increase in prevalence of celiac disease in autoimmune thyroid disease in our study was largely caused by enrichment with co-morbidities. Without comorbidities or symptoms, screening for celiac disease may not be justified in this population. The specificity of tTG-IgA titer for the diagnosis of celiac disease was decreased in patients with autoimmune thyroid disease compared with the general population.
Department of Pediatric Endocrinology, University Hospital at Stony Brook, Stony Brook, NY, USA.
Nadia
N
Sattar
Farrah
F
Lazare
Martina
M
Kacer
Lourdes
L
Aguayo-Figueroa
Vardhini
V
Desikan
Mireya
M
Garcia
Andrew
A
Lane
Anupama
A
Chawla
Thomas
T
Wilson
D000293:Adolescent; D017677:Age Distribution; D001707:Biopsy, Needle; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D050031:Hashimoto Disease / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007150:Immunohistochemistry; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013960:Thyroid Function Tests; D013967:Thyroiditis, Autoimmune / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D055815:Young Adult
D007070:Immunoglobulin A