title: Association of autoimmune thyroid diseases, chronic atrophic gastritis and gastric carcinoid: experience from a single institution.
abstract: OBJECTIVE
  Autoimmune polyendocrine syndromes (APS) type III are characterized by the association of autoimmune thyroid disease (ATD) with other autoimmune diseases such as diabetes, alopecia, pernicious anemia, vitiligo and chronic atrophic gastritis. A strong association between ATD and atrophic gastritis (AG) has been demonstrated. Moreover 10 % of patients affected by AG have a predisposition to develop gastric carcinoid and adenocarcinoma as a result of chronic hypergastrinemia caused by achlorhydria and subsequent ELC cells neoplastic transformation.
  
  
  METHODS
  The aim of the study is to evaluate, in a consecutive series of patients followed for ATD in our outpatients clinic, the prevalence of AG. In the period 2004-2014, 242 patients with ATD underwent a screening performing APCA, Vitamin B12, ferritin, iron, and hemoglobin and red cells count measurements with subsequent gastroscopy in case of APCA positivity.
  
  
  RESULTS
  We found 57/242 (23.5 %) patients with APCA positivity. Of these patients 33/57 (57.8 %), 31 F and 2 M, were affected by Graves disease; 24/57 (42.1 %) 21 F and 3 M by Hashimoto thyroiditis; 10/57 (17.5 %) presented with anemia, 14/57 (24.5 %) with vitamin B12 deficiency, 9/57 (15.7 %) with iron deficiency. In 2/57 a gastric carcinoid was found.
  
  
  CONCLUSIONS
  Our data confirm the high association rate of AG in ATD which frequently is not an isolated disease but configure the picture of APS type III and need to be followed accordingly. An early diagnosis may be useful for diagnosis of gastric carcinoids and to explain and treat a gastric related L-thyroxine malabsorption and presence of chronic unexplained anemia.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Castoro
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Le Moli
authors.affiliation: Endocrinology, Garibaldi-Nesima Hospital, Via Palermo n. 636, 95126, Catania, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Arpi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tavarelli
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sapuppo
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Frittitta
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Squatrito
authors.affiliation: Endocrinology, Garibaldi-Nesima Hospital, Via Palermo n. 636, 95126, Catania, Italy. g.pellegriti@unict.it.
authors.forename: G
authors.initials: G
authors.lastname: Pellegriti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications* / Q000473:pathology; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D002908:Chronic Disease; D005260:Female; D005757:Gastritis, Atrophic / Q000175:diagnosis / Q000209:etiology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000209:etiology*; D013959:Thyroid Diseases / Q000150:complications* / Q000473:pathology; D055815:Young Adult
keywords: Autoimmune disease; Autoimmune gastritis; Carcinoid; Graves’ disease; Thyroid disease