Schildklier en coeliakie
Geplaatst: 18 okt 2014, 12:17
Thyroid autoimmunity is prevalent in patients with celiac disease and their first degree relatives - prospective, controlled study, pagina 82, OP26
Detlef Schuppan, Martin Rosenthal, Mareike Roth, Jessica Willim, Elisa Kolbe1, Tanja Diana, George J. Kahaly
Objective
Autoimmune thyroid diseases (AITD) may cluster with several autoimmune disorders. We aimed to prospectively evaluate the close relationship between celiac disease (CD) and AITD.
Methods
In an academic referral center for autoimmune diseases with a joint thyroid-gastrointestinal outpatient clinic, demographic and clinical data were obtained from 101 consecutive patients with CD and their 132 first degree relatives. Serological and genetic investigations were performed and thyroid-related hormones and autoantibodies were measured in all 233 subjects. Also, three internationally validated psychometric tests were applied.
Results
Median age of the patients with CD (78 female) and their relatives (78/132 female or 59%) was 29 years (2 - 76 yrs.) and 33 yrs. (1 - 76 yrs.), respectively. AITD was present in 55/101 (54%) and 40/132 (30%) of CD patients and their relatives, respectively. Hashimoto's thyroiditis (HT) and Graves' disease (GD) were present in 41 and 14 CD pts., respectively. HT was also more prevalent in the relatives (33/132, 25%) than GD (7/132, 5%).
The following HLA-haplotypes (Xeligen RT, Eurospital) were noted in the CD pts.: DQ2.5 heterozygous (Cis+Trans) 39%, DQ2.5 homozygous 20%, DQ2.5/DQ2.2 17%, DQ2.5/DQ8 11%, DQ2.2 heterozygous 6%, heterozygous DQ8 3%, DQ2.2/DQ8 3%, and homozygous DQ8 1%. AITD was present in 80% and 57% in the DQ2.5/DQ8 and in the heterozygous DQ2.5 carriers, respectively. 83% of relatives with the DQ2.5/DQ8 had AITD.
Both the Short Form-36 Health Survey (all eight scales) and the Giessen Complaint List (GBB-24) showed markedly impaired scores in CD pts. with AITD vs. a large German healthy collective (P < 0.001), whereas pts. with combined CD+AITD had higher fatigue scores vs. CD alone (P < 0.044). The Hospital Anxiety and Depression Scales were not significantly impaired in CD.
Conclusions
This innovative prospective controlled study highlights the close relationship between CD and AITD and recommends immune genetic and thyroidal screening for pts. with CD and their relatives.
Detlef Schuppan, Martin Rosenthal, Mareike Roth, Jessica Willim, Elisa Kolbe1, Tanja Diana, George J. Kahaly
Objective
Autoimmune thyroid diseases (AITD) may cluster with several autoimmune disorders. We aimed to prospectively evaluate the close relationship between celiac disease (CD) and AITD.
Methods
In an academic referral center for autoimmune diseases with a joint thyroid-gastrointestinal outpatient clinic, demographic and clinical data were obtained from 101 consecutive patients with CD and their 132 first degree relatives. Serological and genetic investigations were performed and thyroid-related hormones and autoantibodies were measured in all 233 subjects. Also, three internationally validated psychometric tests were applied.
Results
Median age of the patients with CD (78 female) and their relatives (78/132 female or 59%) was 29 years (2 - 76 yrs.) and 33 yrs. (1 - 76 yrs.), respectively. AITD was present in 55/101 (54%) and 40/132 (30%) of CD patients and their relatives, respectively. Hashimoto's thyroiditis (HT) and Graves' disease (GD) were present in 41 and 14 CD pts., respectively. HT was also more prevalent in the relatives (33/132, 25%) than GD (7/132, 5%).
The following HLA-haplotypes (Xeligen RT, Eurospital) were noted in the CD pts.: DQ2.5 heterozygous (Cis+Trans) 39%, DQ2.5 homozygous 20%, DQ2.5/DQ2.2 17%, DQ2.5/DQ8 11%, DQ2.2 heterozygous 6%, heterozygous DQ8 3%, DQ2.2/DQ8 3%, and homozygous DQ8 1%. AITD was present in 80% and 57% in the DQ2.5/DQ8 and in the heterozygous DQ2.5 carriers, respectively. 83% of relatives with the DQ2.5/DQ8 had AITD.
Both the Short Form-36 Health Survey (all eight scales) and the Giessen Complaint List (GBB-24) showed markedly impaired scores in CD pts. with AITD vs. a large German healthy collective (P < 0.001), whereas pts. with combined CD+AITD had higher fatigue scores vs. CD alone (P < 0.044). The Hospital Anxiety and Depression Scales were not significantly impaired in CD.
Conclusions
This innovative prospective controlled study highlights the close relationship between CD and AITD and recommends immune genetic and thyroidal screening for pts. with CD and their relatives.