HLA DQ2 Haplotype,Early Onset of Graves Disease,and Positive Family History of Autoimmune Disorders are Risk Factors for Developing Celiac Disease in Patients with Graves Disease |
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| Institution: | 1. From the Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland;2. Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland;3. Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland;4. Department of Medical Genetics, Centre for Biostructure, Medical University of Warsaw, Warsaw, Poland.;1. From the UCLA David Geffen School of Medicine, Los Angeles, California.;2. Department of Biomathematics; UCLA David Geffen School of Medicine, Los Angeles, California.;3. Section of Endocrine Surgery; UCLA David Geffen School of Medicine, Los Angeles, California.;4. Division of Hematology/Oncology; UCLA David Geffen School of Medicine, Los Angeles, California.;5. Department of Pathology and Laboratory Medicine; UCLA David Geffen School of Medicine, Los Angeles, California.;6. Division of Endocrinology; VA Greater Los Angeles Healthcare System, Los Angeles, California.;7. Division of Endocrinology, Diabetes, and Hypertension; UCLA David Geffen School of Medicine, Los Angeles, California.;1. Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;2. Department of Chemical and Environmental Engineering, Masdar Institute of Science and Technology, Masdar City, United Arab Emirates |
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| Abstract: | Objective: The diagnosis of celiac disease (CD) in patients with different autoimmune diseases including Graves disease (GD) remains a challenge. The aims of our study were to: (1) assess the prevalence of CD in Polish patients with GD and (2) evaluate the prevalence of CD in the subgroups of patients with GD divided on the basis of clinical and human leukocyte antigen (HLA) typing criteria.Methods: The prospective study was conducted at an academic referral center. The study groups consisted of consecutive, euthyroid patients with GD (n = 232) and healthy volunteers without autoimmune thyroid diseases (n = 122). The diagnosis of CD was based on elevated immunoglobulin A autoantibodies to the enzyme tissue transglutaminase (IgA-TTG) and small intestine biopsy findings.Results: CD was diagnosed in 8 patients with GD (3.4%) and 1 healthy volunteer (0.8%). The development of CD in patients with GD was strongly associated with HLA-DQ2 haplotype (as predicted from linkage disequilibria, 14.6% vs. 1.5%, P = .009; odds ratio OR] = 11.3; 95% confidence interval CI] 1.3–252.7): 6 patients with CD carried HLA-DRB1*03, 1 carried an HLA-DRB1*04 allele, and 1 had an HLA-DRB1*07/*11 genotype. Multivariate analysis showed independent associations between CD and early GD onset (P = .014, OR = 9.6), autoimmunity in family (P = .029, OR = 6.3) and gastroenterologic symptoms (P = .031, OR = 8.1).Conclusions: The results of our study suggest that serologic screening for CD may be considered in GD patients (1) with the HLA alleles typical for CD, (2) with an early onset of GD, or (3) a family history of autoimmunity. Moreover, the diagnosis of CD should be explored in euthyroid GD patients with nonspecific gastrointestinal symptoms.Abbreviations: AITD = autoimmune thyroid disease APS = autoimmune polyglandular syndromes CD = celiac disease CI = confidence interval GD = Graves disease GFD = gluten-free diet HLA = human leukocyte antigen IgA-TTG = immunoglobulin A autoantibodies to the enzyme tissue transglutaminase OR = odds ratio T1D = type 1 diabetes mellitus TBII = TSH-binding inhibitory immunoglobulins TSH = thyroid-stimulating hormone |
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