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Cited by 114Celiac Disease Research and ManagementThyroid Disorders and TreatmentsThyroid and Parathyroid Surgery

Atypical celiac disease as cause of increased need for thyroxine: a systematic study

Virili, Camilla, Bassotti, Giulia, Santaguida, Maria Giulia, Iuorio, Raffaella, Del Duca, Susanna Carlotta, Mercuri, Valeria, Picarelli, Antonio, Gargiulo, Patrizia +2 more·2012·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2011-1851
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Abstract

OBJECTIVE: Replacement T4 dose in hypothyroid patients bearing both chronic autoimmune thyroiditis and atypical celiac disease (CD) has been analyzed. DESIGN: Replacement T4 dose has been analyzed in 35 hypothyroid patients with Hashimoto's thyroiditis (HT) and atypical CD, as defined by the American Gastroenterological Association. We have evaluated the ability of the same dose of T4 to reach target TSH in 21 patients before and during gluten-free diet (GFD). In the remaining 14 patients, noncompliant with GFD, we analyzed replacement T4 dose and compared it with that in a similar group consisting of 68 patients with hypothyroid HT but no evidence of celiac sprue or other conditions interfering with T4 absorption. RESULTS: In patients with isolated HT, the desired serum TSH (median=1.02 mU/liter) was reached in all patients after 5±2 months of treatment at a median T4 dose of 1.31 μg/kg·d. After a similar period and dose of T4, higher levels of TSH (median=4.20 mU/liter) were observed in patients with HT and CD. In 21 CD patients, target TSH (median TSH=1.25 mU/liter) has been attained after 11±3 months of GFD without increasing T4 dose (1.32 μg/kg·d). In the remaining 14 patients, who were noncompliant with GFD, target TSH has also been achieved but at a higher T4 dose (median=1.96 μg/kg·d; +49%; P=0.0002) than in hypothyroid patients without CD. CONCLUSIONS: Atypical CD increases the need for T4. The effect was reversed by GFD or by increasing T4 dose. Malabsorption of T4 may provide the opportunity to detect CD that was overlooked until the patients were put under T4 therapy.

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  • Celiac disease may lead to a reduced absorptive surface due to intestinal villi damage and increased mouth-to-cecum transit time, and variations in intestinal juice pH.

    “Celiac disease, one of the most common autoimmune disorders in patients with thyroid autoimmunity, may lead to a reduced absorptive surface due to intestinal villi damage and the increased mouth-to-cecum transit time, and the variations in intestinal juice pH, as well (110).”

    From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [110]

  • In patients with atypical celiac disease, an increase of 49% in LT4 requirement was described that was fully reversed by adherence to a gluten-free diet.

    “In patients with atypical celiac disease, the more frequent form of this disease, an increase of 49% in LT4 requirement, was described that was fully reversed by adherence to a gluten-free diet (110).”

    From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [110]

  • In individuals with atypical celiac disease, a gluten-free diet reduces the required dose of levothyroxine.

    “Similarly, individuals suffering from atypical celiac disease required lesser dose of levothyroxine when provided with a gluten-free diet (Virili et al., 2012).”

    From Thyroid disorders and gastrointestinal dysmotility: an old association (2024) · cites this paper as Virili et al., 2012

  • Primary hypothyroidism is refractory to oral thyroxine when there is biochemical or clinical evidence of hypothyroidism (TSH above the upper target level, usually 4.5 mU/L after a 6-week interval after the last dose increase) and/or unresolved hypothyroid symptoms, despite increasing levothyroxine dosages beyond 1.9 μg/kg daily.

    “Primary hypothyroidism is considered to be refractory to oral thyroxine when there is biochemical or clinical evidence of hypothyroidism [serum level of thyroid-stimulating hormone (TSH) above the upper target level, usually 4.5 mU/L following a 6-week interval after the dosage was last increased] and/or unresolved hypothyroid symptoms, despite increasing dosages of levothyroxine beyond 1.9 μg/kg”

    From Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report (2017) · cites this paper as [2]

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Authors
Virili, C., Bassotti, G., Santaguida, M. G., Iuorio, R., Del Duca, S. C., Mercuri, V., Picarelli, A., Gargiulo, P., Gargano, L., & Centanni, M.
Affiliations
  • Endocrinology Section, Department of Medico-Surgical Sciences and Biotechnologies (C.V., M.G.S., S.C.D.D., M.C.), 00161 Rome, Italy
  • Department of Experimental Medicine (G.B., R.I., V.M., P.G.), 00161 Rome, Italy
  • Sapienza University of Rome (IT)
  • Endocrinology Unit (L.G., M.C.), Azienda Unità Sanitaria Locale di Latina, 04100 Latina, Italy
Corresponding author
Centanni, Marco
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2012-03-01
Volume
97
Issue
3
Pages
E419-E422
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2011-1851
OpenAlex
W2067997413
Cited by
114
References
23
Citations by year
2025: 6 · 2024: 11 · 2023: 3 · 2022: 13 · 2021: 15 · 2020: 5 · 2019: 9 · 2018: 9 · 2017: 10 · 2016: 7 · 2015: 7 · 2014: 9 · 2013: 4 · 2012: 4
FWCI
7.45
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (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
atypical celiac disease, Hashimoto's thyroiditis, hypothyroidism, levothyroxine dose, thyroid-stimulating hormone, gluten-free diet, autoimmune thyroiditis
MeSH terms
Adult, Celiac Disease, Female, Humans, Hypothyroidism, Male, Middle Aged, Thyrotropin, Thyroxine, Cohort Studies, Hashimoto Disease, Diet, Gluten-Free

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