Clinical and Laboratory Observations
Gluten-dependent diabetes-related and thyroid-related autoantibodies in patients with celiac disease

https://doi.org/10.1067/mpd.2000.107160Get rights and content

Abstract

Patients with celiac disease are at high risk of having autoimmune disorders. Moreover, untreated patients with celiac disease have been found to have a higher than expected prevalence of organ-specific autoantibodies. In a prospective study of 90 patients with celiac disease, we found that the prevalence of diabetes and thyroid-related serum antibodies was 11.1% and 14.4%, respectively. Like antiendomysium autoantibodies, these organ-specific antibodies seem to be gluten-dependent and tend to disappear during a gluten-free diet. (J Pediatr 2000;137:263-5)

Section snippets

Patients and methods

Patients with biopsy-confirmed CD (n = 90, 61 female, mean age at diagnosis 10.1 years) diagnosed according to European Society for Paediatric Gastroenterology, Hepatology and Nutrition revised criteria5 were tested for serum levels of EMA, islet cell antibodies, glutamic acid decarboxylase antibodies, anti-insulin antibodies, and anti-thyreoperoxidase at diagnosis and after 6, 12, and 24 months of a gluten-free diet. Healthy university students (n = 90, 60 female, mean age 20.5 years) were

Results

All subjects tested positive for serum EMA at diagnosis, and by the end of the 2-year follow-up period on GFD, all tested negative. Six (6.6%) tested positive at diagnosis for serum ICA, 3 (3.3%) for GAD, and 2 (2.2%) for IAA, and therefore at least 1 IDDM-related autoantibody was present in 11 (11.1%) of 90 subjects at diagnosis. At the 6-month follow-up on GFD, GAD and IAA were negative in all 5 cases, but ICA persisted in 5 of 6 cases. At 12- and 24-month follow-up, all 11 patients tested

Discussion

In patients affected by CD or by dermatitis herpetiformis, several serum autoantibodies such as thyroid-related autoantibodies, diabetes-related autoantibodies, and rheumatoid immunoglobulin A factor may be present in addition to EMA.3, 8 The presence of serum organ-specific autoantibodies in patients with CD seems related to the presence of a second autoimmune disease and does not appear to be gluten-dependent.9 However, there is some evidence that a large series of gluten-dependent

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    Citation Excerpt :

    The literature on the role of GFD and thyroid disease is mixed. A prospective study by Ventura et al. (Ventura et al., 2000) found higher titers of TPO antibody at the diagnosis of celiac disease, which decreased with GFD, with no abnormality in TSH or thyroid hormone levels. Sategna-Guidetti et al., (Sategna-Guidetti et al., 2001) also demonstrated in a multicenter, prospective study that subclinical hypothyroidism normalized after 1 year of GFD.

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Reprint requests: Alessandro Ventura, MD, Istituto di Clinica Pediatrica, Università di Trieste, IRCCS “Burlo Garofolo”, Via dell'Istria 65/1, 34100 Trieste, Italy.

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