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Very Interesting Study On Celiac And An Increased Risk Of Thyroid Cancer.


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#1 frenchiemama

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Posted 06 November 2006 - 02:45 PM

Increased Risk of Papillary Thyroid Cancer in Celiac Disease
Laura Kent · Russell McBride · Robert McConnell · Alfred I. Neugut · Govind Bhagat · Peter H. R. Green
Received: 20 December 2005 / Accepted: 30 January 2006
C Springer Science+Business Media, Inc. 2006

Abstract Patients with celiac disease have an increased rate
of malignancies that are not limited to lymphomas. Thyroid
carcinoma has not previously been associated with celiac
disease. However, among a cohort of patients with celiac disease,
we identified an increased risk of papillary carcinoma
of the thyroid, standard morbidity ratio of 22.52 (95% confi-
dence interval 14.90–34.04; P < .001), compared to United
States national surveillance data. These patients were on a
gluten-free diet. Only 1 had Hashimoto’s thyroiditis, suggesting
that mechanisms apart from autoimmune thyroiditis
contribute to the increased risk of carcinoma of the thyroid
in celiac disease.

Introduction
Compared to the general population, patients with celiac
disease carry an increased burden of disease [1]. In addition
to autoimmune diseases [2] and endocrine disorders [3], patients
diagnosed with celiac disease have an increased risk of
a variety of malignancies that include both T-cell and B-cell
non-Hodgkin lymphoma, squamous carcinoma of the esophagus
and oropharynx, and small intestinal adenocarcinoma
[4–6]. In this report, we document a significantly increased
risk of papillary carcinoma of the thyroid in patients with
celiac disease.
Methods
We have maintained a database of patients diagnosed with
celiac disease who were seen in our Celiac Disease Center
since 1981. Data, including age at diagnosis, mode of
presentation, adherence to the gluten-free diet, and other diagnoses,
was prospectively entered into the database that
was anonymized to protect privacy. Among these patients
we identified 606, seen between July 1981 and April 2004,
who had biopsy-proven celiac disease.
The prevalence of papillary thyroid cancer in our database
was compared to data in the Surveillance, Epidemiology
and End Point Results (SEER) program of the National
Cancer Institute, Washington, D.C. [7]. Information
was accessed using Surveillance Research Program,
National Cancer Institute SEER∗Stat software(available:
www.seer.cancer.gov/seerstat) version 6.1.
Patient-years at riskwere calculated from the date of diagnosis
of celiac disease to either the date of diagnosis of cancer
or the date of the most recent follow-up visit, whichever
came first. We calculated the standardized morbidity ratio

(SMR), ratio of observed to expected and 95% confidence
intervals (CI), assuming that the observed number of cancers
had a Poisson distribution. Histopathology of thyroid cancer
was reviewed. The study was approved by the Institutional
Review Board of Columbia University.
Results
The database consisted of 606 patients; 68% were female
and the age at diagnosis of celiac disease was 41.5 ± 17.6 years. The prevalence of thyroid disease was 18.4%.
The classical diarrhea-predominant presentation of celiac
disease was noted in 43%. Three of these patients had papillary
thyroid cancer, whereas only 0.133 patients were expected,
resulting in a SMR of 22.52 (95% CI 14.90–34.04;
P < .001; Table 1). The prevalence for papillary thyroid cancer
was 494 per 100,000 compared to 22 per 100,000 of the
general population.
Of the patients with papillary thyroid cancer (Table 2), 2
were female and 1 male; the age at diagnosis of cancer was
44.3 years (range, 38–48 years), and mean duration since
diagnosis of celiac disease 7.7 years (range, 1–19.4 years).
Each had originally presented with diarrhea-predominant,
symptomatic celiac disease and responded to a gluten-free
diet. Adherence to the diet was strict as confirmed by an examination
of the dietary history by an experienced dietician
and negative celiac serologies. None of the patients had a
family history of thyroid cancer or a history of exposure to
radiation. Each patient presented with a thyroid nodule or
mass and was euthyroid, although one had positive thyroid
antibodies.
Two patients underwent total thyroidectomy and one
hemithyroidectomy. One of the patients had a follicular vari-
ant of papillary thyroid carcinoma, 2 patients had multifocal
and bilateral tumors, and 2 patients had lymph node involvement.
Hashimoto’s thyroiditis (as defined histologically because
of the presence of diffuse lymphocytic and plasma cell
infiltration with formation of lymphoid follicles, damage to
the follicular basement membrane, and Hurthle cell change
of the thyroid follicular epithelium) was identified in the resected
nonmalignant thyroid tissue in only 1 patient, who
had the positive thyroid antibodies.
Discussion
We observed a significantly increased risk of papillary thyroid
cancer in our cohort of patients with celiac disease compared
to United States national SEER data. This occurred
despite adherence to a gluten-free diet that is considered
protective against the development of malignancies [4]. One
of the patients was on the diet for only 1 year.
Thyroid disease, especially Hashimoto’s thyroiditis, is
common in patients with celiac disease [3]. Papillary thyroid
cancer occurs frequently in the setting of Hashimoto’s
thyroiditis [8, 9]. Because clinically significant papillary thyroid
cancer is observed in fewer patients with Hashimoto’s
thyroiditis than those who harbor precursor lesions [9],
it is likely that additional mutagenic events or immune
mechanisms might play important roles in papillary thyroid
cancer development. Because only 1 of our patients
had Hashimoto’s thyroiditis, additional mechanisms apart
from autoimmune thyroiditis may be important for the development
of papillary thyroid cancer in patients with celiac
disease. Such mechanisms could include chronic genotoxic
stress owing to chronic inflammation mediated by the lymphocytic
infiltrates and/or alternatively an as-yet uncharacterized
immune deregulation could lead to ineffective tumor
surveillance and indirectly lead to an increased incidence of
malignancies [10].
Thyroid cancer has not previously been reported as an
associated malignancy in series of adult patients with celiac
disease [5, 6, 11–15]. However, there were thyroid cancers
among a European series of children with celiac disease and
malignancies [16]; Freeman [17] has reported a thyroid lymphoma
in a patient with celiac disease. Our patients were
seen in a specialist referral setting that may have biased the
results. In addition, we are not aware of any regional factor
that could have influenced the increased occurrence of thyroid
cancer in these patients. However, this study should alert
clinicians to be aware of an increased risk of papillary thyroid
cancer in patients with celiac disease. Examination of
the thyroid should be performed as part of the regular physical
examination, and thyroid nodules should be evaluated by
ultrasonography and biopsy, to exclude thyroid cancer.
  • 0

Carolyn


"When the going gets weird, the weird turn pro. "
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#2 georgie

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Posted 06 November 2006 - 04:59 PM

Scary stuff. All the more reason for me to keep taking my Iodine. I also have Pernicious Anaemia ( low B12) and that is autoimmune too, and also carries an extra risk of stomach cancer. It appears that having an autoimmune disease is bad news .... :(
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Diagnosed May 2006 - Hashimotos Thyroid after being diagnosed in 1977 and told it didn't matter.
Diagnosed June 2006 with adrenal insufficiency.
Diagnosed June 2006 as Gluten Intolerant after I failed the Challenge Diet. Negative blood test.No biopsy.
Diagnosed June 2006 as B12 low. Needed weekly injections for a year.Still have them every 2 weeks.
Trialled Dairy Free Diet and reacted positively to that challenge in January 07.
News Flash! Coeliac Genetic Testing done April 08 . DQ2 Positive !
Diagnosed July 2010 FODMAP. Limits on Fructose, lactose, polyols, fructans. NO ONION! But I can have hard cheese, butter and cream again!!!

#3 frenchiemama

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Posted 06 November 2006 - 06:15 PM

It appears that having an autoimmune disease is bad news .... :(


Too true, my friend. Too true. I actually have another one of these, showing that being a celiac carries an average 2x risk for ANY type of malignancy. Good reason for all of us to be careful with smoking, drinking, environmental exposure and eat a healthful diet.
  • 0

Carolyn


"When the going gets weird, the weird turn pro. "
- Hunter S. Thompson

#4 whereitscat

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Posted 05 July 2012 - 12:36 PM

Crazy. I had thyroid cancer 10 years ago, at age 21. Now I'm exploring celiac as a cause for IBS and constant headaches, and I just googled this on a whim. Makes me wonder if everything that's been wrong with me since I was young was related to celiac. I'm not diagnosed, but all the pieces are starting to fit together.
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