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Hi All--
   
  I apologize for taking so long to compose a summary - I know several people were interested in it and had deadlines. I have divided the summary into 2 parts - all of the information is excellent and I thank everyone from the bottom of my heart! There were a couple of responses not included here because I felt they were more personal. From my understanding of Hashimoto's thyroid disease now, I don't think there is any good reason for any doctor NOT to run the antibody test as the presence of antibodies can affect how you feel and the length of time it might take to get your thyroid levels under control. If you must insist your doc run it, then insist. My doc didn't include it on the lab slip and I requested that she add it....she agreed. I'll have the tests run on March 16.
   
  These were my questions:
  
Is Hashimoto's disease more common in people with celiac than the general population?
  
Would lab tests run for Hashimoto's disease while taking Synthroid be valid? Or do I have to be off of any thyroid meds?
  
If one has Hashimoto's disease, is it treated differently than the more common type of acquired hypothyroidism? (My doc doesn't see any reason to  test for Hashimoto's)

Is there an advantage to knowing if I have Hashimoto's thyroid disease if it's not 
treated differently than typical hypothyroidism?

I appreciate any and all responses, but I'm looking for hard, scientific, medical information if possible. I've done quite a lot of internet research on Hashimoto's, but I'm not finding the answers to these questions, specifically.
   
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    I have Hashi's  & take a personal interest in the subject due to family history.  Please note, I am not a gold-std. endo dx'd celiac, though I am gluten intolerant doing well on GFD, & have a DD w/severe gluten intolerance, +ve antibodies, & DQ2 celiac gene.  So ... my situation may not be identical to yours, but I believe we have overlapping interests.
   
  Here are a few things I've found that may be of interest.  I use Google Scholar;  perhaps you do as well & have read this stuff.  I'll send more in a second email.
   
  Is Hashimoto's disease more common in people with celiac than the general population? 
  Digestive Diseases and Sciences Volume 46, Number 12 December 2001 pg: 2631 - 2635 
  Clinical and Subclinical Autoimmune Thyroid Disease in Adult Celiac Disease   Mervi Hakanen, et al. Dept of Medicine, Tampere University Hospital, Medical School, Finland
  Investigated occurrence of clinical & subclinical autoimmune thyroid disease in 79 pts w/celiac disease as reflected in thyroid function, antibodies, & ultrasound; 184 nonceliac controls were also studied. Normal thyroid function combined w/positive antibodies & marked hypoechogenicity was considered subclinical disease. Autoimmune thyroid disease was observed in 13.9% of celiac pts & in 2.1% of controls (P = 0.0005); subclinical disease in 10.1% & 3.3%, respectively (P = 0.048). The mean thyroid gland volume was 8.3 ml in celiacs & 10.4 ml in controls (P = 0.007). Hypoechogenicity was found in 73% of celiac patients and in 42% of controls (P < 0.0001). Positive thyroid antibodies were assoc w/ hypoechogenicity in celiacs but not in controls. In conclusion, the occurrence of both clinical & subclinical autoimmune thyroid disease was increased in celiac disease; subclinical thyroid disease indicates regular surveillance."
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  European Journal of Gastroenterology & Hepatology. 17(1):A45-A46, January 2005.
Screening patients with Hashimoto's thyroiditis for celiac disease and vice versa. 
Hadithi, M, et al.
  Abstract not yet available online – may be avail.at a med. library or through a document delivery service.
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  www.postgradmed.com/issues/2000/01_00/fatourechi.htm+Hashimoto+celiac+autoimmune
  VOL 107 / NO 1 / JANUARY 2000 / POSTGRADUATE MEDICINE
  Demystifying autoimmune thyroid disease: Which disorders require treatment?  Vahab Fatourechi, MD
  An excellent overview;  part of the Continuing Medical Education credit program for M.D.s.

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    A few more comments on your questions:
  currently on Synthroid, replaced Armour... appear to be doing fairly well -another thyroid panel run in three weeks  Be sure to get free T3 & free T4 done as well as TSH. Too many docs ‘cheap out’ & make decisions based on TSH alone.  Many people feel best with frees in the top 1/3 of ref ranges,  & TSH around 1;  in some cases TSH becomes even more suppressed before the frees rise to opitimum levels. **********************************************************************************************************
  lab tests:  I believe you can have the antibody testing done while on T4.  Have heard that taking Selenium (mineral) can suppress antibodies;  might be wise to be off that for a week or so.  Minimally an anti-TPO antibody blood test would be done to rule out Hashi's. There are 2 other thyroid antibody blood tests, sometimes they're all done together. A thyroid ultrasound can be valuable. Commonly it is recommended to be repeated at interval to watch for changes. If ultrasound shows significant abnormalities, fine needle aspiration is the next step. However, many docs cowtow to insurance & refuse to go the distance w/diagnostic testing.   It's always advisable to get actual copies of lab test results.  My TPO antibodies were 50% elevated beyond range & the first doc said, "I don't usually dx Hashi's unless TPO Ab are 10x normal ... Yes, people with Hashi's can run antibodies in the thousands, the tens of thousands ... and antibody load does seem to affect symptoms.
   
  If one has Hashimoto's disease, is it treated differently than the more common type of acquired hypothyroidism? Methinks the question ought to be:  If you don't have a Hashi's dx, will you be treated differently than a patient w/a common acquired HypoT.
  The course of Hashi’s disease can include flares of hyperthyroidism.  Or mixed symptoms, due to antibodies.  In some Hashi's pts.,  all thyroid labs are normal except antibodies, but suffering can ensue due to antibody load alone.   Hashi’s requires closer med attention than simple acquired HypoT.  Some people w/Hashi's also show  Graves-type autoantibodies;  that certainly complicates things.  And rarely,  Hashi's patients can develop neurological antibodies (H. Encephalitis); quite serious & DOES definitely require something beyond a little T4.
  If antibody loads are high & a lot of weird stuff is going on, surgery (thyroidectomy) may become advisable.  Sounds drastic,  yet I’ve encountered a few people who’ve had total success & resolution of Hashi's symptoms (& loss of antibody load) going that route, after years of suffering & trying to get relief from meds.  Surgery is more common for Grave’s disease & in precancerous/cancerous thyroids; relatively uncommon at present for Hashi’s.
   
  (My doc doesn't see any reason to test for Hashimoto's). Are you sure this is the doc for you? On the one hand you’re doing well w/Synthroid … I assume that means that labs are looking OK?  Make sure your doc & lab are using the "new" 2002 Am. Acad of Endocrinologist’s TSH range (0.3 to 3.0 for normal). Most docs & labs around the country are still using the 0.5 to 5.0 range.   
  On the other hand I hear you complain about not feeling well, etc. … what does your doc say about this ???  Is he/she another one who ‘treats lab values,’ not the patient & her symptoms? If so, you can find a better doc.
  You can self-order thyroid antibody testing through LabOne/health check USA if you want.
  advantage to knowing if I have Hashimoto's thyroid disease if it's not treated differently than typical hypothyroidism? Treatment may be Synthroid in both cases.  Advantages to dx:  1) treatment decisions not based on assumptions.  2) heads up for any change in disease course, if it occurs  3) Hashi’s, like celiac, has a genetic component;  impt. info for your heirs.  4) you can keep on top of clinical developments & research ...  Lord knows, most of us can't count on our docs to do that ...  5) adds to rationale for testing for other endocrine autoantibodies. ***************************************************************************************************************
  Q J Med 2002; 95: 79-82
Coeliac disease and autoimmune Addison's disease: a clinical pitfall 
  C. O'leary, et al. Dept Med, National University of Ireland, Cork, Ireland, and affiliated teaching hospitals 
  … 12.2% of a sample of patients w/Addison’s disease were found to have celiac … a high correspondance, but does not necessarily apply in reverse. (i.e. How many celiacs have Addison’s? … can’t exactly say from this study)***********************************************************************************************************************************
  Since being dx'd with celiac six years ago and following a very strict GF diet, I don't believe I feel as well as I should. I still can't gain weight, I'm fatigued even on thyroid meds, I continue to build sensitivies to other foods. A number of the symptoms you’ve listed here sound like "adrenal malfunction" problems. Have you had adrenal testing? Cortisol rhythm, ACTH, adrenal challenge tests, adrenal autoantibodies. I would insist on it. 
  Even mildly compromised adrenal function affects/interacts with thyroid. You may have more success working with a naturopath or D.O. rather than standard M.D. on this issue. Most M.D.s will only test for Addison’s if there's  frank presentation of life-threatening adrenal crisis.  Another disease like celiac & gluten sensitivity … no consideration of the states "in between" normal & the gold standard.   E.g.  "normal" a.m.  cortisol is 3 - 22 units ... so a cortisol of 4 is deemed "low normal,"  but if it's 2, you're on the way to ICU ...
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    As always, these responses are not intended as medical advice for anyone. Please speak with your physician before altering your diet or medication in any way. 



		
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