Endocrine Abstracts

Introduction: Chronic autoimmune thyroid disease (ATD) or Hashimoto thyroiditis (HT) is one of the main thyroid diseases in pediatric age. HT characterized by the production of anti-thyroid antibodies, by an infiltration of autoreactive B and T lymphocytes into the thyroid parenchyma and by alterations in thyroid function. Coeliac disease (CD) is a systemic autoimmune disease caused by gluten ingestion in genetically predisposed subjects. At presents with a pathognomonic enteropathy, a variety of clinical manifestations, positivity for specific antibodies, positivity for typical haplotypes HLA DQ2/DQ8. The close relationship between celiac disease and glandular autoimmunity can be largely explained by sharing of a common genetic background. Haplotypes HLA B8 and DR3 occur with increased frequency in adults and children with CD, as well as in ATD. Modern international recommendations recommend screening for CD in children with already diagnosed ATD.

The aim: of this study was to investigate the incidence of celiac disease in children with ATD.

Methods: 65 children with ATD aged 7-17 years (57 girls, 8 boys) were examined. We studied the level of TSH, free T4, antibodies to thyroperoxidase (Anti-TPO), antibodies to thyroglobulin (Anti-TG) gliadin immunoglobulin G (Anti-IgG Gl), anti-tissue transglutaminase (Anti-IgG TGT), ultrasound of the thyroid gland (US ThG). Diagnosis of autoimmune thyroiditis was made if Anti-TPO >35 IU/ml or Anti-TG >20 IU/ml. Diagnosis of CD was made according recommendation from the European Society for the Study of Coeliac Disease (ESsCD) (2019).

Results: Among the children with ATD 32.3% (n=21) were diagnosed with hypothyroidism, the patients received levothyroxine replacement therapy and were in a state of medical euthyroidism at the time of inclusion in the study. CD was detected in 10.8% (n=7, all girls) of the patients. The mean age (12.5± 1.6 yrs) at the diagnosis of HT was significantly lower in patients with higher levels Anti-TPO (432.2 ± 23.8 IU/ml) and Anti-TG (86.6 ± 12.5 IU/ml). After prescribing a gluten-free diet for 6 months to children with a positive level of Anti-IgG TGT, patients showed a statistically significant decrease in the level of  Anti-TPO and in 3 patients (280.4 ± 18.2 IU/ml) and decrease the dose of levothyroxine by an average of 30%.

Conclusion: Frequency of СD in children with ATD was 10.8%. Gluten-free diet for 6 months has some effect on improving and maintaining euthyroid status of CD patients and decreased anti-thyroid antibodies.

Keywords: Autoimmune thyroid disease; Coeliac disease; Gluten-Free Diet.