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“Hyperthyroidism, Iron-deficiency Anemia, and
Celiac Disease”: An Important Case Report by
Dr. Cindy Huang, Dr. Amy Toscano-Zukor, and
Dr. Xiangbing Wang

March 16, 2009

We at Thyroid Science are please to publish today a special case report. It is special for two reasons that I want to bring to the attention of our readers.

In their report, Drs. Huang, Toscano-Zukor, and Wang explain that they first diagnosed their patient as having hyperthyroidism and iron-deficiency anemia. Further testing then showed that the patient had celiac disease. Their report is the first in the research literature to describe a single patient with Graves’ disease, iron-deficiency anemia, and celiac disease.

The outcome of these physicians’ care of the patient is noteworthy. They explain that through the appropriate treatment for celiac disease—that is, withdrawal of gluten-containing foods from the patient’s diet—she was no longer anemic and her hyperthyroidism markedly improved. Two months after withdrawing from gluten, she was clinically euthyroid. The outcome of the patient’s diagnosis and treatment has important implications for clinical practice.

As Drs. Huang, Toscano-Zukor, and Wang note, celiac disease is on the rise in Western countries.[1,p.1] Italian researchers have also reported a recent increase of a milder, subclinical, or “silent” celiac disorder.[2] Patients with this milder form of celiac may not have symptoms that prompt their clinicians to test for the disorder. As a result, the patient’s mild celiac condition may progress and intensify before it is diagnosed. Consequently, the patients’ prolonged exposure to dietary gluten may lead to other autoimmune diseases. The is indicated by a study that showed that longer exposure to dietary gluten was associated with a higher incidence of autoimmune diseases among celiac patients.[3] Such study results highlight the importance of diagnosing celiac disease, even the silent form, as expeditiously as possible.

As Drs. Huang, Toscano-Zukor, and Wang state in their report, identifying and treating celiac disease by the withdrawal of gluten can improve the patient’s quality of life. Moreover, this simple treatment may protect the patient from further sickness. As the authors note, if a patient is not effectively treated for celiac disease, he or she can develop benign and even malignant complications. Such complications can usually be avoided simply by gluten withdrawal—possibly without the patient having to use  medications, as in the case reported by the physicians.

We thank Dr. Cindy Huang, Dr. Amy Toscano-Zukor, and Dr. Xiangbing Wang for their case report. It is remarkable in that it is a first in the medical research literature. In addition, their description of this case provides other clinicians with practical clinical information. Clinicians can use that information to better serve their patients whose autoimmune thyroid disease and iron-deficiency may be improved by identifying and treating underlying celiac disease.

Reference

1. Huang, C., Toscano-Zukor, A., Wang, X.: Case Report: Hyperthyroidism, Iron-deficiency Anemia, and Celiac Disease. Thyroid Science, 4(3):CR1-3, 2009.

2. Brandimarte, G., Tursi, A., and Giorgetti, G.M.: Changing trends in clinical form of celiac disease. Which is now the main form of celiac disease in clinical practice? Minerva Gastroenterol. Dietol., 48(2):121-130, 2002.

3. Ventura, A., Magazzù, G., and Greco, L.: Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. Gastroenterology, 117(2):297-303, 1999.

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