Relevance, pathogenesis and clinical implications of thyroid disorders in children with celiac disease

Abstract

Celiac disease is a frequent chronic inflammatory small bowel disease which may present itself with associated autoimmune comorbidities. Among these comorbidities, thyroid disorders show a significant prevalence; even in the pediatric population. However, the exact epidemiology and clinical significance of such alterations are yet to be fully elucidated. The most updated guidelines do not currently offer any specific support. Focusing on the pediatric population, we will review the recent available literature that we believe might be helpful in advancing the clinician’s knowledge-base regarding this issue. We also discuss which, to our knowledge, are the key pathophysiologic concepts behind the association between these two entities. Finally, we offer our own clinical perspective, recommending routine laboratory thyroid screening, possibly followed by an echographic thyroid evaluation as we believe such an approach to be appropriate when caring for children with celiac disease.

Keywords:

• autoimmune thyroiditis
• autoimmunity
• celiac disease
• children
• thyroid

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Celiac disease (CD) is a chronic autoimmune enteropathy triggered by the exposure of genetically susceptible subjects to dietary gluten.

• It is a frequent disease, with an estimated prevalence of 1% in the USA.

• The usual presentation of childhood CD consists of symptoms of malabsorption and failure to thrive.

• It is well known that thyroid diseases occur in celiac patients with an increased frequency.

• The term ‘thyroid disorders’ includes (I) autoimmune thyroiditis (i.e., positivity to thyroid peroxidase antibody, thyroglobulin antibody or TSH-receptor antibodies) and (II) altered thyroid function exams (i.e., hypo-/hyperthyroidism).

• The pathogenesis of both CD and autoimmune thyroiditis share a common pathway, particularly at the human leukocyte antigen (HLA) locus, with haplotypes HLA-DQ2 and DQ8 shown to be present in both conditions.

• It also possible that some degree of cross-reaction between activated T-cells and autoantigens mimicking gliadin or trans-glutaminase occurs in CD patients.

• We believe the implementation of a gluten-free diet, despite being the mainstay of CD therapy, does not significantly impact the incidence thyroid complications.

• We suggest in celiac children, routine annual laboratory thyroid screening, possibly followed, if necessary, by an echographic thyroid evaluation.