Long-term Clinical Significance of Thyroid Autoimmunity in Children with Celiac Disease
Received 26 February 2009; received in revised form 6 July 2009; accepted 28 August 2009. published online 21 October 2009.
Objective
To evaluate the long-term outcome of thyroid function and autoimmunity in a large series of children with celiac disease.
Study design
This longitudinal, retrospective study (duration of follow-up, 8.9 ± 4.0 years) was conducted at the Pediatric Department, University of Bologna, Italy. One hundred thirty-five consecutive patients diagnosed between June 1990 and December 2004 and followed on a gluten-free diet were examined. Inclusion criteria were good dietary compliance and duration of follow-up for at least 3 years.
Results
Of 101 patients who never showed positive antithyroid titers during the follow-up, 86 remained euthyroid; 15 showed high thyroid-stimulating hormone values at diagnosis that normalized in 11 cases after 12 to 18 months of gluten withdrawal. Of 31 patients with persistently positive antibody titers, 23 (74%) remained consistently euthyroid during the follow-up and 8 (26%) had a subclinical hypothyroidism. The prevalence of cases with positive antibodies was similar in children with growth retardation or gastroenterological symptoms at diagnosis and different durations of gluten exposure.
Conclusions
The presence of antithyroid antibodies in children with celiac disease has a low predictive value for the development of thyroid hypofunction during the indicated surveillance period. Longer follow-up is needed.
ABSTRACT