Original Article
Prevalence of Autoimmune Thyroiditis in Children with Celiac Disease and Effect of Gluten Withdrawal

https://doi.org/10.1016/j.jpeds.2009.01.013Get rights and content

Objective

To study the prevalence of autoimmune thyroiditis (AT) in Sardinian children with celiac disease (CD) and the effects of a gluten-free diet (GFD) on thyroid function.

Study design

Children with biopsy-proven CD (n = 324; female:male 2:1; mean age, 6.6 years) followed from 1 to 15 years, were retrospectively evaluated for AT at onset of CD and during GFD. Serum thyroid peroxidase and thyroglobulin antibodies (AbTPO, AbTG), thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and thyroid ultrasonography were considered. Age-matched Sardinian schoolchildren (n = 8040), previously evaluated for antithyroid antibodies and thyroid function, were used as controls.

Results

Thirty-four patients with CD (10.5%) developed AT (female:male 4,5:1; mean age, 10.5 years), 11 at onset of CD and 23 during GFD, with a higher prevalence than controls (P = 2.9−13). Twenty-eight patients were euthyroid and 6 hypothyroid. AbTPO and/or AbTG persisted elevated for 2 to 9 years despite the GFD in 9 of 11 patients with AT at onset of CD.

Conclusions

AT is strongly associated with CD in Sardinian children, has an age of onset of 10.5 years, and appears to be gluten-independent. In children with CD with AT, the female:male bias reported in adult AT is present before puberty.

Section snippets

Patients

Children with biopsy-proven CD (n = 324) from Sardinia (223 girls; mean age at diagnosis, 6.6 years; range, 10 months to 18 years), followed between 1992 and 2007 (mean follow-up period, 8 years) at the Pediatric Gastroenterological Unit in Cagliari, Italy, were included in the study. Clinical data were collected retrospectively; affected family members of probands, patients with preexisting autoimmune conditions (type 1 diabetes, autoimmune thyroid disorders, Addison's disease), and patients

Results

Clinical data of patients with CD with AT are summarized in Table II (available at www.jpeds.com).

Overall AT was found in 34 (28 girls, 6 boys) of 324 patients with CD; 23 were on GFD when AT was diagnosed (Table III). Considered as a whole, a high prevalence of AT among children with CD (10.5%), compared with the Sardinian pediatric background population (2.92%), was found (P = 2.9−13). This prevalence is similar to or even lower than that reported in other studies conducted in adults and

Discussion

Our study documents the association between AT and CD in Sardinian children. Because it includes a large number of subjects, it provides the actual prevalence of AT in our pediatric population with CD. Previous studies on the prevalence of AT in Sardinian patients with CD, or vice versa on the occurrence of CD in AT, have been conducted only in adults.9, 28

We found that the prevalence of AT in CD is about 4 times greater than that found in the age matched Sardinian schoolchildren background

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    Supported by a grant from Fritz-Thyssen-Stiftung, Germany (R.-D.J.). The authors declare no potential conflicts of interest, real or perceived.

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