Celiac disease detection in hypothyroid patients requiring elevated thyroid supplementation: A prospective cohort study

Published:September 27, 2015DOI:https://doi.org/10.1016/j.ejim.2015.09.011

      Highlights

      • CD was more likely in hypothyroid patients requiring escalated levothyroxine.
      • CD prevalence increased directly with daily levothyroxine dose (range 1.8%–12.5%).
      • Patients requiring ≥125 mcg/day of levothyroxine had a CD prevalence of 5.6%.
      • A threshold levothyroxine dose of ≥125 mcg/day should stimulate CD testing.

      Abstract

      Background

      Celiac disease (CD) is associated with hypothyroidism, but the disease prevalence is not thought to be great enough to warrant testing all hypothyroid patients. We hypothesized that hypothyroid patients with concomitant CD would require elevated doses of levothyroxine, and there is a threshold daily dose, above which, hypothyroid patients should be tested for CD.

      Methods

      Hypothyroid patients presenting to the endoscopy or endocrinology clinics at the University of Vermont Medical Center were included. Patients were categorized by whether or not they required ≥125 mcg/day of levothyroxine. A serum tissue transglutaminase (tTG) was performed on enrolled patients. Patients with an elevated serum tTG underwent endoscopy with duodenal biopsies. Symptoms were assessed by the Gastrointestinal Symptom Rating Scale.

      Results

      Overall, 500 patients were enrolled and 29% (144 patients) required ≥125 mcg/day of levothyroxine. CD was detected in 9 patients. The prevalence of CD ranged from 1.8% in our entire cohort to 12.5% in patients requiring ≥200 mcg/day of levothyroxine. Eight patients with CD (89%) required ≥125 mcg/day of levothyroxine. Patients who required ≥125 mcg/day of levothyroxine had a significantly increased risk of CD (p < 0.001). CD was detected in 5.6% of patients requiring ≥125 mcg/day of levothyroxine.

      Conclusions

      Hypothyroid patients requiring elevated daily doses of levothyroxine are more likely to have CD. Hypothyroid patients requiring ≥125 mcg/day of levothyroxine should undergo serologic testing for CD.

      Keywords

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