Occurrence of overt celiac disease in the elderly following total thyroidectomy
Abstract
We report the case of a female patient in whom gluten-induced entheropathy was revealed at the age of 71 yr by resistance to treatment with levothyroxine (L-T4), calcium carbonate and alfacalcidol. Hypothyroidism and hypoparathyroidism were the consequence of a total thyroidectomy performed at the age of 65 yr for a large multinodular goiter. Six months after thyroid ablation the patient started to complain of abdominal pain, diarrhea and weight loss. Following, anemia and osteopenia were documented. A progressive increase of replacement therapy for hypothyroidism and hypoparathyroidism was necessary. The clinical presentation suggested a malabsorption syndrome: celiac disease (CD) was diagnosed by serological markers and duodenal biopsy. Following gluten-free diet a normalization of clinical and serological findings was observed, bone mass density improved and a reduction of L-T4, calcium and vitamin D requirements was observed.
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There are case reports of increased LT4 requirements in individuals with celiac disease, lactose intolerance, and intestinal giardiasis, with reduction in LT4 requirement after institution of gluten-free or lactose-restricted diet and treatment of infection.
“There are also case reports of increased LT4 requirements in individuals with celiac disease (158,159), lactose intolerance (160), and intestinal giardiasis (161) with reduction in the LT4 requirement occurring after institution of a gluten-free or lactose-restricted diet and treatment of the infection, respectively.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [158]
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- Authors
- Caputo, M., Brizzolara, R., Schiavo, M., Salmaso, C., Pesce, G., & Bagnasco, M.
- Affiliations
- University of Genoa (IT)
- Corresponding author
- Bagnasco, M.
- Venue
- Journal of Endocrinological Investigation
- Published
- 2006-10
- Volume
- 29
- Issue
- 9
- Pages
- 831-833
- ISSN
- 0391-4097 (ISSN-L)
- 1720-8386
- OpenAlex
- W2076412206
- Cited by
- 17
- References
- 16
- Citations by year
- 2022: 1 · 2017: 2 · 2016: 1 · 2015: 2 · 2014: 2 · 2012: 5
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Endocrinological Investigation (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- celiac disease, older adults, total thyroidectomy, gluten-induced enteropathy, hypothyroidism, hypoparathyroidism, multinodular goiter, malabsorption, osteopenia, anemia, gluten-free diet, bone mineral density
- MeSH terms
- Aged, Calcium, Celiac Disease, Dose-Response Relationship, Drug, Drug Resistance, Female, Humans, Hydroxycholecalciferols, Hypoparathyroidism, Hypothyroidism, Intestinal Absorption, Thyroidectomy, Thyroxine, Hormone Replacement Therapy
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