Date: Wed, 24 Jul 1996 01:05:15 -0700 (MST) From: Ron Hoggan Subject: Re: low thyroid dietary recommendations May I suggest that you consider getting a blood test for antibodies associated with gluten intolerance? The association between thyroid disease and gluten intolerance is quite well documented in the medical literature. Such testing, in addition with helping with your thyroid problem, might well improve your general health. In support of the above statement regarding the association between the two diseases, I offer the following list of such articles as just a sample of the *many* that are out there. 1. Counsell et. al. "Coeliac disease and autoimmune thyroid disease" _Gut_ 1994; 35: 844-846 2. Collin, et. al. "Autoimmune thyroid disorders and coeliac disease" _European Journal of Endocrinology_ 1994; 130: 137-140. 3. Freeman H, "Celiac-associated autoimmune thyroid disease: A study of 16 patients with overt hypothyroidism" 1995; July/Aug 1995, 9(5): 242-246. In Freeman it says: "Greater small intestinal permeability in celiac disease patients may permit excessive amounts of antigen to enter the circulation and crossreact with other tissues, including the thyroid gland." I hope this is helpful. Best Wishes, Ron Hoggan ================= Here are the abstracts on the first two articles that Ron cited: Coeliac disease and autoimmune thyroid disease, Gut, 1994, June, Vol 35, Pg. 844-6. Counsell, et al. A well defined cohort of coeliac patients was studied prospectively to assess the prevalence of coexisting thyroid disease and positive thyroid autoantibodies. Comparison with epidemiological data on the prevalence of coeliac disease in a neighboring area suggested that few adult coeliac patients had been missed. Overall, 14% of the coeliac patients had thyroid disease: 10.3% were hypothyroid and 3.7% hyperthyroid, both significantly more than expected. There were significantly more coeliac disease patients with thyroid autoantibodies than expected--11% had thyroglobulin antibodies and 15% had thyroid microsomal antibodies. This association is clinically important. Three patients are described in whom the coexistence of coeliac disease and hypothyroidism led to diagnostic difficulties and delay of treatment. Autoimmune thyroid disorders and coeliac disease, Eur J Endocrinol, 130: 2, 1994 Feb, 137-40, Collin P; Salmi J; Hällström O; Reunala T; Pasternack A Eighty-three patients with autoimmune thyroid disorders were screened for coeliac disease. The screening was performed with IgA-class reticulin and endomysium antibody, IgA- and IgG-class gliadin antibody tests, and various biochemical tests for malabsorption. None of the tested subjects had selective IgA deficiency, which excludes the possibility of not detecting positives by an IgA-class test. Of the 83 patients, three asymptomatic coeliac patients were found, and one patient with coeliac disease previously diagnosed, an overall frequency of 4.8%. In addition, 25 patients with a solitary nodule of the thyroid gland were examined and one of them (4%) was found to have coeliac disease. By contrast, one (0.4%) out of 249 age- and sex-matched blood donors was found to have coeliac disease. All newly detected coeliac patients had IgA-class gliadin, reticulin and endomysium antibodies, but none of the patients had any gastrointestinal symptoms or abnormal biochemical findings suggesting coeliac disease. Treatment of thyroid disorders and coeliac disease was successful in these patients. The present results confirm that the frequency of subclinical coeliac disease is increased among patients with autoimmune thyroid disorders. IgA-class reticulin, endomysium or gliadin antibody tests are suitable screening methods for detecting these patients, as far as selective IgA-deficiency is excluded. ======================================== A graduate student at Rutgers once looked up the Counsell article above. This is her analysis: From: Lynda Callicotte
Date: 16 Nov 95 Autoimmune hypothyroidism is more common in coeliac patients than Graves disease is. Around 10% of coeliacs had hypothyroidism and there was a high incidence of anti-thyroid antibodies. Anti-thyroid antibodies, unlike Graves antibodies, target the thyroid hormone itself and cause it to be destroyed or to be ineffective. The doctors didn't know why coeliacs should be predisposed to hypothyroidism, but they speculated that maybe the excessive gut permeability results in greater than normal exposure to foreign antigens that resemble thyroid hormone and can trigger an immune response to it. Most coeliacs who had hypothyroidism were elderly and probably had untreated coeliac disease for a long time. The reason why hypothyroidism and coeliac result in diagnosic complications is that some of the symptoms are the same. When one of the two diseases is treated, but the symptoms don't all go away, the doctors are confused. Hypothyroidism can also mask some symptoms of coeliac disease. For instance, coeliacs often have diarrhea, but hypothyroidism can cause constipation.