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             Thyroid Disease: Why Do Celiacs Have It?<2>
             -------------------------------------------
                         by Dr. Patricia Daly

(Dr. Daly is an endocrinologist at Harvard Medical School.  She gave
a presentation at the CSA annual conference held October 1998 at
Warwick, Rhode Island.  What follows are highlights of her talk, as
recorded by Janet Rinehart.)

There is a relationship between thyroid disease and celiac disease
(CD).  Thyroid disease and abnormal thyroid tests are more common in
people with CD than in the general population.  At the same time CD is
more common in individuals who have thyroid disease.  This association
appears to be based on the tendency for people with autoimmune
diseases to be predisposed to other autoimmune diseases.  The term
autoimmune refers to diseases in which the immune system of the body
makes antibodies (normally made to attack foreign substances like
viruses) against some part of the body.  Celiac disease is an
autoimmune condition; likewise a number of thyroid diseases are
autoimmune conditions:

   * Antibodies that stimulate the thyroid gland (causing an
     overactive thyroid condition, or Graves Disease)

   * Antibodies that block the effect of the thyroid (causing an
     underactive thyroid condition, or hypothyroidism)

   * Antibodies relating to autoimmune destruction of the thyroid, or
     Hashimoto's thyroid disease. (This condition can result in an
     underactive thyroid, and also can lead to enlargement of the
     thyroid or the formation of nodules in the thyroid gland.)

Research articles support evidence that there is a connection between
CD and thyroid disease:

  1. JCI 1972; *Lancet* 1976; Gut 1983:  Graves disease patients have
     a higher than usual proportion of HLA DR3 antigens.

  2. 1994, *European Journal of Endocrinology*:  5% of patients with
     autoimmune thyroid disease had sprue.

  3. 1995, *Endocrinology Practice*:  a case study report of increased
     dose requirements of thyroid hormone (because of malabsorption)
     leading to diagnosis of sprue.

  4. 1997, *British Journal of Dermatology*:  4.3% of UK and 6% of
     sprue patients had autoimmune thyroid disease.

Since we now know of the link between CD and thyroid disease, what can
you and your physician look for to determine if you might have thyroid
disease in addition to CD?

The thyroid gland, located at the base of your Adam's apple in your
throat, is important in regulating metabolism.  This gland affects
every system of the body including the brain, heart, liver, kidney,
pancreas, reproduction system, etc.  When you don't have enough
thyroid hormone, everything tends to slow down.  When you have an
overactive thyroid, things speed up.  The heart beats faster, you
breathe faster, you lose weight, bowels move faster, etc., but you
feel more tired because more energy is being expended.


Hypothyroidism
--------------
Hypothyroidism is 4-8 times more common in women.  It is more likely
when there is a family history of autoimmune disease.  It affects
10-20% of women over age 50 in the general population.  It is more
common in the elderly, and is often wrongly attributed to menopause
and aging.

Hypothyroidism affects all cells in the body and the symptoms tend to
worsen over time.  Symptoms include:

   Thyroid enlargement
   Constipation
   Weight gain
   Brittle nails
   Bradycardia (slowing of heart rate)
   Hypertension (increase in blood pressure)
   Psychiatric abnormalities, such as depression
   Cold intolerance
   Fatigue
   Coarse hair
   Dry, scaly skin
   Menstrual irregularities
   Infertility
   Elevated cholesterol

Thyroid disease can contribute to menstrual disorders, particularly
heavier periods.  Infertility is common in untreated hypothyroidism,
and pregnancy management is an important issue if one has thyroid
disease

Treatment of hypothyroidism consists of replacement therapy.
Treatment choices include desiccated thyroid or Levothyroxine.
Desiccated Thyroid is made from desiccated (dried and pulverized) pig
thyroids.  The amount of thyroid hormone can vary greatly from batch
to batch.  Levothyroxine (Synthroid, Levoxyl, Levothroid, and other
brands ) is synthesized in the laboratory.  It contains a fixed amount
of Levothyroxine (T4).  This is one of the hormones your thyroid gland
makes.  Using Levothyroxine tends to be more accurate than with
dessicated thyroid.

Side effects of over-treatment (getting too much thyroid hormone)
include an increased risk of osteoporosis and an increased risk of an
irregular heart rhythm, known as atrial fibrillation.

For best absorption, Levothyroxine should best be taken on an empty
stomach, one-half to one hour before eating, or 2 hours afterwards.
Don't take iron supplements (or vitamins containing iron) at the same
time.

Because absorption can vary, once you start on one brand, it is best
to stay with it.  Or if you switch, blood tests can be taken to see if
levels are still in range (6-8 weeks after change).

Hyperthyroidism
---------------
Graves Disease is a condition in which the body makes antibodies that
"trick" the thyroid into thinking it needs to continue making
excessive amounts of thyroid hormone.  Graves Disease can sometimes
result in hypothyroidism due to thyroid destructive therapies or the
natural history of the disease itself..

Common symptoms of Graves Disease include:

   Weight loss, but with increased appetite
   Hyperpigmentation (darkening of the skin)
   Pretibial myxedemia (rare)
   Enlarged thyroid (goiter)
   Emotional instability--irritability and moodiness
   Shortness of breath with exertion
   Contributes to congestive heart failure
   Increased frequency of bowel movements
   Osteoporosis--thinning of the bones
   Myopathy--weakness of proximal muscles (near shoulders and thighs)
   Heat intolerance, sweaty
   Warm, smooth skin
   Plummer's nails
   Hives
   Eye signs - deteriorations
   Racing heart beat
   Changes in periods, fewer, lighter
   Tremors
   Insomnia

The best laboratory test to diagnose an overactive thyroid is the TSH
(thyroid stimulation hormone).  The normal range is usually 0.5 to 5.
A low value would suggest you need more tests to confirm that your
thyroid is underactive.

Hyperthyroidism can be treated in several ways, including antithyroid
agents, radioactive iodine, surgery, and iodine (temporary measure
only).

If you are diagnosed with hyperthyroidism, ask your doctor to refer
you to a board-certified endocrinologist to help you determine which
treatment is best for you.

Implication between the Association of CD and Thyroid Disease
-------------------------------------------------------------
You and your doctor should have a lower threshold for testing for
thyroid disease in people with CD.  If you have CD and an underactive
thyroid, you need to be concerned about thyroid hormone absorption.
If your CD is not adequately treated (resulting in malabsorption), you
will not absorb all of your thyroid hormone and your thyroid condition
will worsen.

With regard to an overactive thyroid, the symptoms may be confusing
and may mimic CD (particularly with increased bowel movements and
weight loss).