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Tissue Transglutaminase Antibodies May Contribute to Thyroid Dysfunction in Celiac Disease Patients 12/08/2008 - Celiac disease is a life-long autoimmune enteropathy that results in damage to the small intestinal mucosa. When people with celiac disease eat the gluten proteins found in wheat, rye and barley, they damage the cells that line the small intestine, which interferes with normal digestion and absorption of nutrients. Recent studies have shown that most people present with a silent, non-diarrheal form of the disease, and show no obvious symptoms. People with celiac disease face rates of autoimmune disease that are10 times higher than the general population.

People with untreated celiac disease have higher rates of thyroid problems, which generally improve with the adoption of a gluten-free diet. A connection between the span of gluten consumption and autoimmune diseases has been observed in people with celiac disease. Tissue transglutaminase (TGase) is a ubiquitous enzyme and manifests in all tissues, with both intra- and extracellular localization.

A team of researchers recently set out determine if tissue transglutaminase-2 IgA antibodies (anti-TGase II) present in blood samples from celiac disease patients react with thyroid tissue and possibly contribute to thyroid disease.

The research team made up of doctors Afzal J. Naiyer, Jayesh Shah, Lincoln Hernandez, Soo-Youl Kim, Edward J. Ciaccio, Jianfeng Cheng, Sanil Manavalan, Govind Bhagat, and Peter H.R.Green. The team took blood samples from 40 people with active celiac disease, but not following a gluten free diet, samples from 46 celiac patients on a gluten-free diet (CD), 40 normal controls (NC), and 25 with Crohn’s disease.

They screened all samples for anti-thyroperoxidase antibodies (TPO-AB) and thyroglobulin antibodies (TG-AB), and conducted indirect immunofluorescence on primate thyroid tissue sections using TPO-AB– and TG-AB–negative blood samples.

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The team performed indirect immunofluorescence on thyroid seronegative, anti-TGase II–positive CD+ blood samples (n1/423) and observed staining patterns on thyroid follicular cells and extracellular matrices that was identical with monoclonal anti-human TGase II antibody.

Signs of TGase II as the antigen in thyroid tissue were reinforced by elimination of the IIF pattern when sera were depleted of anti-TGase II by pretreatment with human recombinant TGase II. The team saw no such staining of thyroid tissue in blood samples from celiac disease patients who were negative for TGase II antibodies, or samples from the non-celiac control group.

Thyroid antibodies were found in 43% of CD+ patients, substantially higher than NC and CROHN patients ( p < 0.0001). Moreover, a positive correlation was observed between anti-TGase II and TPO-AB titers (p1/40.0001; r1/40.63).

The results show that anti-TGase II antibodies bind to TGase II in thyroid follicles and extracellular matrix, and that titers correlate with TPO antibody titers. This indicates that anti-TGase II antibodies might contribute to the development of thyroid disease in people with celiac disease.

Thyroid Volume 18, Number 11, 2008 welcomes your comments below (registration is NOT required).

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11 Responses:

Sharon A. Long
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said this on
09 Dec 2008 6:35:06 AM PDT
I am a celiac person and in general, I think the article is very good. But, it is too technical for a non-medically trained person.

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said this on
10 Dec 2008 2:42:32 PM PDT
I was diagnosed 11 years ago with celiac and only this year treated for type 2 hypothyroidism. I am finally starting to feel better. Everyone should insist on a free t3 and t4 blood test to find out!!!! TSH is not going to tell you if you hypothyroid. It took me 8 years to find a doctor who would do the t3 and t4 blood test. It will make a difference!!

Anita Lesniak
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said this on
11 Dec 2008 11:52:13 AM PDT
I am one that has thyroid &amp; celiac disease also, and I would like to know more about it but it is to technical for me to understand all of it .

Jan Bennett
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said this on
19 Dec 2008 9:27:57 AM PDT
Thank you for the article. A non technical conclusion would be much appreciated.

Ricardo Ferreira
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said this on
08 Jan 2009 12:12:27 PM PDT
I live in Portugal and I am amazed when I see that so many people are undiagnosed for so many years.

In August 2007 I saw a gastroenterologist complaining of stomach problems.
On the same week I was doing a blood test and an endoscopy which led to a biopsy.

When the blood tests arrived my T3, T4 and TSH levels were sky high so I was referred to a endocrinologist who diagnosed me immediately with hypothyoidism.

So it took just 2 weeks for my 2 diseases to be diagnosed and I payed about 30€ for the entire process (I have medical insurance - 12€/month).

I really cannot understand how these situations happen... people suffering years and years when it can all be avoided with simple blood tests.

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said this on
10 Mar 2010 11:13:43 PM PDT
I was diagnosed in 1997 with celiac and only in 2008 did I find a doctor who would test free t3 and t4 and began treatment. It took about two years to get to the correct level and I feel great!! The fibromyalsia, lethargy, hypersensitivity, hair falling out, ingrown toenails, etc are all gone!!!! You really need to do your own homework and learn about type 2 hypothyroidism and insist on a doctor or nurse practitioner who is your advocate and will do the tests and treat you. Arm yourself with these kinds of articles on why you need the treatment you do. Be your own best friend, be strong, learn as much as you can, consider this a journey forever unfolding until you reach that point where you start to really feel better. It is all up to you.

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said this on
23 Oct 2012 4:31:21 AM PDT
Agreeing that articles like this need to be broken down into layman's terms.

I'm one who was also dx'ed hypothyroid long after celiac disease, and the hypo symptoms were there beforehand - I just wasn't aware of what they were. I'd like to see more awareness among doctors about the connection, and about celiac and thyroid issues in general. I've had a terrible time with doctors, who don't tend to like it when their patient comes in knowing more about things than they do.

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said this on
12 Apr 2013 11:44:21 AM PDT
I have not been diagnosed at all, but I know that I am hypothyroid and recently discovered (on my own) that I am gluten sensitive (maybe celiac). Every woman in my immediate family is hypothyroid and subclinical. The doctors don't listen!! Despite regular exercise (running 10+ miles per week) and following a diet of 18 WW points a day (900 calories), I GAIN weight. I know there is a connection between the thyroid problems that I know are there and the gluten sensitivity that I have only recently discovered (October 2012). I tried a gluten-free diet because of my concerns over GMOs in our food and found that my unrealized gartric issues DISAPPEARED. I had no idea that these issues were a "problem"!! I am thankful for this info.


said this on
13 May 2013 8:48:53 AM PDT
The same thing happened to me after going gluten-free with my acid reflux. It completely disappeared! The one thing that I would recommend to you is you should be on a minimum of 1200 calories or your body goes into starvation mode and stores fat. By increasing your calories above the 1200 calories and eating every 3 hours small meals, you will see the pounds start to fall off. But don't be discouraged by plateaus because they will happen, just keep going! I believe the best thing to do is stay away from processed foods as well. I share your thankfulness since going gluten-free!

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said this on
15 Dec 2013 3:11:48 PM PDT
I was like you. I have CD and hypothyroid. I do better on the non-synthetic thyroid. The one I take is Armor. Had to talk the doctor into it. Over a one year period she weaned me from the synthetic to the desiccated porcine (literally ground up, dried pork thyroid) which has been around for like 100 years. I shouldn't eat gluten - it makes me miserable with loads of symptoms - both in my guts and all the way to nervous function. My own immune system is attacking me. All I have to do is eat right.

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said this on
08 Nov 2016 12:01:36 AM PDT
I am having hypo-thyroidism for last 4 years but was diagnosed with celiac last year. rnrnPrior to diagnosis for celiac, I had to make to make my Thyronorm table dose as much as twice to keep my TSH levels at normal level due to Mal-absorption. However, now my Thyroid absorption is much improved since I have adopted gluten-free diet.rn

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you're lucky you dont catch colds. im the opposite i catch everything very easily and get alot sicker than whoever i caught it from and take much longer to get better.

Even one positive can be diagnostic. This is one: Gliadin deamidated peptide IgG 33.9. If unsure, a biopsy of the small intestine will provide definite confirmation. There is a control test to validate the other ones, but I don't see it there. What is does is validate the others by checking on the overall antibody levels. But it is to detect possible false negatives. A positive is a positive. I think your daughter has joined our club.

My daughter, almost 7 years old, recently had a lot of blood work done, her Dr is out of the office, but another Dr in the practice said everything looked normal. I'm waiting for her Dr to come back and see what she thinks. I'm concerned because there is one abnormal result and I can't find info to tell me if just that one test being abnormal means anything. The reason for the blood work is mainly because of her poor growth, though she does have some other symptoms. IgA 133 mg/dl Reference range 33-200 CRP <2.9 same as reference range Gliadin Deamidated Peptide IgA .4 Reference range <=14.9 Gliadin deamidated peptide IgG 33.9 Reference range <=14.9 TTG IgA .5 Reference range <=14.9 TTG IgG <.8 Reference range <=14.9

Just watch out. I just went to the expo in Schaumburg, IL, and ended up getting glutened. I realized afterward that I ate all these samples thinking they were gluten free, and they weren't. One company was advertising some sugar, and had made some cake, but then I realized.... How do I know if this contains any other ingredients that might have gluten? Did they make it with a blender or utensils that had gluten contamination? Makes me realize the only safe things would be packaged giveaways with gluten free labeling. My fault for not thinking things through. It was just too exciting thinking i could try it all and enjoy without worry.

No fasting required for a celiac blood test unless they were checking your blood glucose levels during the same blood draw.