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.