The Impact of Thyroid Autoimmunity on Thyroid Function in 12-year-old Children With Celiac Disease

ABSTRACTObjectives:Celiac disease (CD) is associated with thyroid autoimmunity and other autoimmune diseases. However, data are lacking regarding the relationship between thyroid autoimmunity and thyroid function, especially in regard to CD. Our aim was to investigate the impact of thyroid autoimmunity on thyroid function in 12-year-old children with CD compared to their healthy peers.Methods:A case-referent study was conducted as part of a CD screening of 12-year-olds. Our study included 335 children with CD and 1,695 randomly selected referents. Thyroid autoimmunity was assessed with antibodies against thyroid peroxidase (TPOAb). Thyroid function was assessed with thyroid stimulating hormone and free thyroxine.Results:TPOAb positivity significantly increased the risk of developing hypothyroidism in all children. The odds ratios (with 95% confidence intervals) were: 5.3 (2.7–11) in healthy 12-year-olds, 10 (3.2–32) in screening-detected CD cases, 19 (2.6–135) in previously diagnosed CD cases, and 12 (4.4–32) in all CD cases together. Among children with TPOAb positivity, hypothyroidism was significantly more common (odds ratio 3.1; 95% CI 1.03–9.6) in children with CD (10/19) than in children without CD (12/46).Conclusions:The risk of thyroid dysfunction due to thyroid autoimmunity is larger for those with CD than their healthy peers. Our study indicate that a gluten-free diet does not reduce the risk of thyroid dysfunction. Further studies are required for improved understanding of the role of the gluten-free diet for the risk of autoimmune diseases in children with CD. Objectives: Celiac disease (CD) is associated with thyroid autoimmunity and other autoimmune diseases. However, data are lacking regarding the relationship between thyroid autoimmunity and thyroid function, especially in regard to CD. Our aim was to investigate the impact of thyroid autoimmunity on thyroid function in 12-year-old children with CD compared to their healthy peers. Methods: A case-referent study was conducted as part of a CD screening of 12-year-olds. Our study included 335 children with CD and 1,695 randomly selected referents. Thyroid autoimmunity was assessed with antibodies against thyroid peroxidase (TPOAb). Thyroid function was assessed with thyroid stimulating hormone and free thyroxine. Results: TPOAb positivity significantly increased the risk of developing hypothyroidism in all children. The odds ratios (with 95% confidence intervals) were: 5.3 (2.7–11) in healthy 12-year-olds, 10 (3.2–32) in screening-detected CD cases, 19 (2.6–135) in previously diagnosed CD cases, and 12 (4.4–32) in all CD cases together. Among children with TPOAb positivity, hypothyroidism was significantly more common (odds ratio 3.1; 95% CI 1.03–9.6) in children with CD (10/19) than in children without CD (12/46). Conclusions: The risk of thyroid dysfunction due to thyroid autoimmunity is larger for those with CD than their healthy peers. Our study indicate that a gluten-free diet does not reduce the risk of thyroid dysfunction. Further studies are required for improved understanding of the role of the gluten-free diet for the risk of autoimmune diseases in children with CD. Address correspondence and reprint requests to Fredrik Norström, PhD, Department of Public Health and Clinical Medicine Epidemiology and Global Health Umeå University SE-901 87 Umeå (e-mail: fredrik.norstrom@umu.se). Received 23 September, 2017 Accepted 11 January, 2018 Sources of support: The study was funded by the Swedish Research Council (grants 521-2004-7093 and 521-2007-2953), the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (grants 222-2004-1918 and 222-2007-1394), and the Swedish Council for Working Life and Social Research (grants 2005-0802). In addition, a contribution was made by Skåne County Council. The study was part of the European Union-supported project FP6-2005-FOOD-4B-36383-PREVENTCD. Phadia (Freiburg, Germany) and Eurospital SpA (Trieste, Italy) contributed analyses of coded serum samples. Conflicts of interest: The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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