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Title: Is screening test for celiac disease in children with autoimmune thyroid disease justified?

Zofia Grzenda-Adamek, Anna Kalicka-Kasperczyk, Jerzy Starzyk, Krzysztof Fyderek
Contemporary Pediatrics, Gastroenterology, Hepatology and Child Feeding
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celiac disease, autoimmune thyroid disease, screening test

Introduction: Celiac disease occurs in approximately 3-4% of patients with autoimmune thyroid disease (AITD). Aimof study: estimating whetherthe prevalenceof silentor previously not recognized celiac disease in children with AITD in Małopol­ska Districtjustifies the screeningfor celiac disease in these patients. Material and methods: 109 patients with AITD (89 girls and 20 boys) age 7-23 years (mean 14.86). We did not include in the study 6 children with AITD and celiac disease in which celiac disease occurred beforeAITD. AITD was recognized at mean age of 11.1 years (0.5-16.75). 50 children presented euthyroid goiter, 52 were diagnosed with clinical or subclinical hypothyroidism, and in 7 there was hyperthyroidism. All 109 children had elevated titers of thyroid peroxidaseantibodies (TPOAb). Endomysial antibodies (EMA) were examined by immunofluorescence method in IgA and IgG class. Atthe moment of EMA testing 108 children were euthyroid. 1 child was hypothyroid justafter substitutional therapy with thyroid hormones had been introduced. Heightand body mass index (BMI) expressed as standard deviation score (SD), alongwith hemoglobin (Hb) level were evaluated in all patients. Results: EMA was found in 1 patient. In histopathological examination of small bowel specimens total villous atrophy was found (Marsh 3c). Because the girl did not present any clinical symptoms (height +2.32 SD, BMI +0.92 SD, Hb=13.4 g/dl) a silent celiac disease was diagnosed. Gluten-free diet was introduced. The remaining children (mean height =-0.01 SD, BMI=0.16SD, Hb=13.5 g/dl) were EMA-negative. Prevalence of new cases of celiac disease in AITD was estimated for 1%. Conclusions: Newly diagnosed celiac disease was found in 1% of children with AITD. This prevalence does not justify screening for celiac disease in children with AITD. In majority of children with coexistence of both diseases, celiac disease was recognized before thyroid disease.