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Exp Clin Endocrinol Diabetes 2019; 127(07): 417-422
DOI: 10.1055/a-0653-7108
Article
© Georg Thieme Verlag KG Stuttgart · New York

The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study

Robert Krysiak
1   Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
,
Witold Szkróbka
1   Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
,
Bogusław Okopień
1   Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
› Author Affiliations
Further Information

Publication History

received 05 June 2018
revised 26 June 2018

accepted 04 July 2018

Publication Date:
30 July 2018 (online)

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Abstract

Background Autoimmune thyroid disease is often accompanied by celiac disease.

Objective The purpose of this study was to investigate whether a gluten-free diet affects thyroid autoimmunity, hypothalamic-pituitary-thyroid axis activity and thyroid function tests in women with Hashimoto’s thyroiditis and incidentally found positive anti-tissue transglutaminase antibodies.

Methods The study included 34 women with autoimmune thyroiditis divided into two group. The patients belonging to the first one (group A, n=16) complied with the gluten-free diet for 6 months, while the remaining patients (group B, n=18) remained without any dietary treatment. Serum titers of thyroid peroxidase and thyroglobulin antibodies, as well as serum levels of thyrotropin, free thyroid hormones and 25-hydroxyvitamin D were measured at the beginning of the study and 6 months later. Based on thyrotropin and free thyroid hormone levels, Jostel’s thyrotropin index, the SPINA-GT index and the SPINA-GD index were calculated.

Results All patients completed the study protocol. In group B, serum thyrotropin and free thyroid hormones levels, serum 25-hydroxyvitamin D levels as well as the calculated indices remained at the similar levels. The gluten-free diet reduced thyroid antibody titers, as well as slightly increased 25-hydroxyvitamin D levels and the SPINA-GT index. In group A, the impact on TPOAb and TgAb titers correlated with the changes in the SPINA-GT index, whereas the impact on TPOAb with the changes in 25-hydroxyvitamin D levels.

Conclusions The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease.

Key words

celiac disease - hypothalamic-pituitary-thyroid axis - thyroid function tests - thyroiditis
 

  • References

  • 1 Lorini R, Gastaldi R, Traggiai C. et al. Hashimoto’s thyroiditis. Pediatr Endocrinol Rev 2003; 1 (Suppl. 02) 205-211
    Search in Google Scholar
  • 2 Caturegli P, Kimura H, Rocchi R. et al. Autoimmune thyroid diseases. Curr Opin Rheumatol 2007; 19: 44-48
    CrossrefPubMedSearch in Google Scholar
  • 3 Hiromatsu Y, Satoh H, Amino N. Hashimoto’s thyroiditis: history and future outlook. Hormones (Athens) 2013; 12: 12-18
    CrossrefPubMedSearch in Google Scholar
  • 4 Brown RS. Autoimmune thyroid disease: unlocking a complex puzzle. Curr Opin Pediatr 2009; 21: 523-528
    CrossrefPubMedSearch in Google Scholar
  • 5 Tuhan H, Işık S, Abacı A. et al. Celiac disease in children and adolescents with Hashimoto thyroiditis. Turk Pediatri Ars 2016; 51: 100-105
    CrossrefPubMedSearch in Google Scholar
  • 6 Hadithi M, de Boer H, Meijer JW. et al Coeliac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa. World J Gastroenterol 2007; 13: 1715-1722
    CrossrefPubMedSearch in Google Scholar
  • 7 Ruggeri RM, Trimarchi F, Giuffrida G. et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. Eur J Endocrinol 2017; 176: 133-141
    CrossrefPubMedSearch in Google Scholar
  • 8 Fallahi P, Ferrari SM, Ruffilli I. et al. The association of other autoimmune diseases in patients with autoimmune thyroiditis: review of the literature and report of a large series of patients. Autoimmun Rev 2016; 15: 1125-1128
    CrossrefPubMedSearch in Google Scholar
  • 9 Demirezer Bolat A, Akin FE, Tahtaci M. et al. Risk factors for polyautoimmunity among patients with celiac disease: a cross-sectional survey. Digestion 2015; 92: 185-189
    CrossrefPubMedSearch in Google Scholar
  • 10 Roy A, Laszkowska M, Sundström J. et al. Prevalence of celiac disease in patients with autoimmune thyroid disease: a meta-analysis. Thyroid 2016; 26: 880-890
    CrossrefPubMedSearch in Google Scholar
  • 11 Stazi AV, Trinti B. Selenium status and over-expression of interleukin-15 in celiac disease and autoimmune thyroid disease. Ann Ist Super Sanita 2010; 46: 389-399
    PubMedSearch in Google Scholar
  • 12 Fisher AH, Lomasky SJ, Fisher MJ. et al. Celiac disease and the endocrinologist: a diagnostic opportunity. Endocr Pract 2008; 14: 381-388
    CrossrefPubMedSearch in Google Scholar
  • 13 Naiyer AJ, Shah J, Hernandez L. et al. Tissue transglutaminase antibodies in individuals with celiac disease bind to thyroid follicles and extracellular matrix and may contribute to thyroid dysfunction. Thyroid 2008; 18: 1171-1178
    CrossrefPubMedSearch in Google Scholar
  • 14 Kahaly GJ, Frommer L. Polyglandular autoimmune syndromes. J Endocrinol Invest 2018; 41: 91-98
    CrossrefPubMedSearch in Google Scholar
  • 15 Mansournia N, Mansournia MA, Saeedi S. et al. The association between serum 25-OHD levels and hypothyroid Hashimoto's thyroiditis. J Endocrinol Invest 2014; 37: 473-476
    CrossrefPubMedSearch in Google Scholar
  • 16 Krysiak R, Okopień B. The effect of levothyroxine and selenomethionine on lymphocyte and monocyte cytokine release in women with Hashimoto’s thyroiditis. J Clin Endocrinol Metab 2011; 96: 2206-2215
    CrossrefPubMedSearch in Google Scholar
  • 17 Jostel A, Ryder WD, Shalet SM. The use of thyroid function tests in the diagnosis of hypopituitarism: definition and evaluation of the TSH index. Clin Endocrinol 2009; 71: 529-534
    CrossrefPubMedSearch in Google Scholar
  • 18 Dietrich JW, Müller P, Schiedat F. et al. Nonthyroidal illness syndrome in cardiac illness involves elevated concentrations of 3,5-diiodothyronine and correlates with atrial remodeling. Eur Thyroid J 2015; 4: 129-137
    CrossrefPubMedSearch in Google Scholar
  • 19 Dietrich JW, Landgrafe-Mende G, Wiora E. et al. Calculated parameters of thyroid homeostasis: emerging tools for differential diagnosis and clinical research. Front Endocrinol (Lausanne) 2016; 7: 57
    CrossrefPubMedSearch in Google Scholar
  • 20 Lips P. Vitamin D physiology. Prog Biophys Mol Biol 2006; 92: 4-8
    CrossrefPubMedSearch in Google Scholar
  • 21 Krysiak R, Kowalcze K, Okopień B. The effect of vitamin D on thyroid autoimmunity in non-lactating women with postpartum thyroiditis. Eur J Clin Nutr 2016; 70: 637-639
    CrossrefPubMedSearch in Google Scholar
  • 22 Muller AF, Drexhage HA, Berghout A. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocr Rev 2001; 22: 605-630
    CrossrefPubMedSearch in Google Scholar
  • 23 Kłapcińska B, Poprzecki S, Danch A. et al. Selenium levels in blood of Upper Silesian population: evidence of suboptimal selenium status in a significant percentage of the population. Biol Trace Elem Res 2005; 108: 1-15
    CrossrefPubMedSearch in Google Scholar
  • 24 Hinks LJ, Inwards KD, Lloyd B. et al. Body content of selenium in coeliac disease. Br Med J (Clin Res Ed) 1984; 288: 1862-1863
    CrossrefPubMedSearch in Google Scholar
  • 25 Kalita B, Nowak P, Slimok M. et al. Selenium plasma concentrations in children with celiac disease in different stages of diagnosis. Pol Merkur Lekarski 2002; 12: 43-44
    PubMedSearch in Google Scholar
  • 26 Hurst R, Collings R, Harvey LJ. et al. EURRECA-estimating selenium requirements for deriving dietary reference values. Crit Rev Food Sci Nutr 2013; 53: 1077-1096
    CrossrefPubMedSearch in Google Scholar
  • 27 Antvorskov JC, Fundova P, Buschard K. et al. Dietary gluten alters the balance of pro-inflammatory and anti-inflammatory cytokinws in T cells of BALB/c mice. Immunology 2013; 13: 23-34
    CrossrefPubMedSearch in Google Scholar
  • 28 Street ME, Volta C, Ziveri MA. et al. Changes and relationships of IGFS and IGFBPS and cytokines in coeliac disease at diagnosis and on gluten-free diet. Clin Endocrinol (Oxf) 2008; 68: 22-28
    CrossrefPubMedSearch in Google Scholar
  • 29 Chaker L, Bianco AC, Jonklaas J. et al. Hypothyroidism. Lancet 2017; 390: 1550-1562
    CrossrefPubMedSearch in Google Scholar
  • 30 Arrigo T, Wasniewska M, Crisafulli G. et al. Subclinical hypothyroidism: the state of the art. J Endocrinol Invest 2008; 31: 79-84
    CrossrefPubMedSearch in Google Scholar
  • 31 Szybiński Z. Polish council for control of iodine deficiency disorders. Work of the Polish council for control of iodine deficiency disorders, and the model of iodine prophylaxis in Poland. Endokrynol Polska 2012; 63: 156-160
    PubMedSearch in Google Scholar