Celiac/Thyroid Disorders

Posted by Elaine Moore Apr 15, 2006

In an article from France available through the Library of Medicine's Pub Med

search engine, researchers describe the case of a 68-year old female patient with hypothyroidism that was resistant to replacement hormone.

this patient also showed poor absorption of the vitamin D analogue alfacalcidol, which is used to increase calcium absorption and prevent bone loss.

Because this patient did not show the typical digestive symptoms of diarrhea, bloating, and nausea that are characteristic of celiac disease, her condition of celiac disease eluded diagnosis. However, when her resistance to replacement hormone appeared to be caused by malabsorption, celiac disease was suspected.

Malabsorption refers to a defective digestive process that causes poor absorption of nutrients, particularly oil-soluble substances. During the process of digestion, malabsorption causes nutrients to pass through the intestines quickly without beind absorbed. Typically, the stool fat content is increased in malabsorption causing stools to float to the top of the toilet bowl. Oil-soluble vitamins and hormones, including thyroid replacement hormone and the hormone vitamin-D, are also poorly absorbed in celiac disease.

In hyperthyroidism, malabsorption is a common symptom and often causes deficiencies of oil-soluble vitamins and related symptoms such as hair, skin, and nail changes, mood disorders and weight loss. This is caused by the fast transit of food molecules, particularly fatty molecules, through the intestines causing incomplete nutrient absorption.

In patients with either hypothyroidism or hyperthyroidism, the incidence of celiac disease, which is also known as gluten sensitivity, is increased. Celiac disease, which is an autoimmune disorder, often develops later in life and it is often not diagnosed when symptoms are vague.

In this case from France, malabsorption, specifically celiac disease, was eventually suspected when the patient failed to respond to high doses of thyroid replacement hormone. Although blood levels of thyroid hormone increased after loading doses of thyroid replacement hormone, oral replacement hormone was ineffective until the patient was put on a gluten-free diet.

The study's authors describe the value of testing for celiac disease in cases where patients with hypothyroidism fail to respond to adequate amounts of thyroid replacement hormone. In patients with autoimmune hyperthyroidism or

Graves' disease, untreated celiac disease can contribute to hyperthyroidism, symptoms related to malabsorption, and symptoms related to nutrient deficiencies. Previous studies have shown that patients with celiac disease who continue to ingest the gluten protein found in wheat, rye, and barley have increased levels of TSH receptor antibodies as well as increased levels of the gliadin and endomysial antibodies typically seen in celiac disease.

Resource: PubMed, Gluten-induced enteropathy (celiac disease) revealed by resistance to treatment with levothyroxine and alfacalcidol in a sixty-eight-year-old patient: a case report. Department of Endocrinology, Hospital Rangueil,

Toulouse, France.