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.
Sattar
Nadia
N
Department of Pediatric Endocrinology, University Hospital at Stony Brook, Stony Brook, NY, USA.
Lazare
Farrah
F
Kacer
Martina
M
Aguayo-Figueroa
Lourdes
L
Desikan
Vardhini
V
Garcia
Mireya
M
Lane
Andrew
A
Chawla
Anupama
A
Wilson
Thomas
T
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