Confused with Celiac results - Graves disease diagnosed

[Lindsey K]

Hi all, a few months back my hubs was going through classic signs of hyperthyroidism and finally got a diagnosis of Graves Disease, which is an autoimmune disease.  I bought him a mail order lab test for celiac because I know autoimmune issues like to come in pairs.  Here are his results:

tTG IgA – 1.7 U/mL – normal

tTG IgG – 3.3 U/mL – normal

DGP IgA – 28.3 U/mL – Elevated (threshold 14.7)

DGP IgG – 6 U/mL – normal

From what I've read, the DPG IgA is 100% specific to celiac as it is an autoimmune response to only gliadin? We're getting him set up with a GI, but in the mean time, we're very confused.  He also has pretty significant and frequent gas, and what I thought was a cluster of acne on his lower back where his kidney is that has been consistently there for months, though it's a bit cleared up now.  I'm thinking this is actually from gluten and isn't actually acne.

Now my question is, could this be celiac or could this be due to his Graves?  I know about the molecular mimicry with gluten and thyroid hormones so I'm wondering if this elevated result isn't celiac but due to his graves.  I know either way we will need to clear the gluten out of the house...

Does anyone have any info they can share?

[trents]

Welcome to the forum, Lindsey!

I was not aware that DGP IGA is 100% specific for celiac disease. I do know that Endomysial IGA is specific for IGA but that is a more expensive test and less sensitive than some others. DH (Dermatitis Herpetiformis) is definitive for celiac disease.

NCGS (Non Celiac Gluten Sensitivity) is another possibility and shares many of the same symptoms with celiac disease. But there is no definitive test for it. celiac disease must first be ruled out. If further testing for celiac disease is planned, make sure your husband does not start the gluten-free diet as that would invalidate the testing. It would be great if he could get an endoscopy with biopsy to check for small bowel villi blunting which is the hallmark of celiac disease or a skin biopsy during an active outbreak of the rash.

Your question, "Could this be celiac or could this be due to his graves?" I cannot give a definitive answer but my hunch is either, though IGA tests tend to be more specific for celiac disease that do IGP tests.

Do you have a value for total IGA from the testing done? When total IGA is low, physicians will order IGG tests which are less specific for celiac disease.

 

 

[Scott Adams]

Welcome to the forum.

A single positive test for celiac disease definitely could mean that he has it, so it would be a good idea to follow up with an endoscopy, which is the normal next step after a positive blood test. One mistake we've seen some doctors make is that because only one of these tests is positive, and the others are negative, some doctors dismiss the positive test and call it "inconclusive" or "weak positive." 

Was he eating at least 2 slices of wheat bread worth of gluten in the 6-8 weeks leading up to the blood test? If not, this could also explain why some of the results were negative, or as @trents mentioned, it could also be due to NCGS. He should keep eating that much gluten until his endoscopy is done, if that is what the doctor recommends.

Many studies have linked untreated celiac disease to various thyroid issues, and in this category we've summarized many of them. If his thyroid issues are related he could see improvement, along with his other symptoms, on a gluten-free diet.

https://www.celiac.com/celiac-disease/celiac-disease-amp-related-diseases-and-disorders/thyroid-pancreatic-disorders-and-celiac-disease/ 

[Scott Adams]

Sorry if you got multiple replies here...the forum had some technical issues today which hopefully are resolved.

[Lindsey K]

Quote

I was not aware that DGP IGA is 100% specific for celiac disease.

I'm just digging into the testing research and whatnot, so this was something I saw when researching DGP, since it's specific for the gliadin protein.  There's so much info out there and some of it's conflicting, so I was basing that on some articles I read.

He definitely eats and drinks his gluten lol.  Unfortunately, the test he took wasn't specific with total IGA, so I hope the dr runs complete testing along with ordering an endoscopy.  Our GP is pretty pushy when it comes to testing (he's seen 3 specialists in various departments for his Graves) so I'm sure she will advocate for him.

We just want to get this all figured out so we can stop any further damage whether it be intestinal or thyroid.  Regardless of a diagnosis, we will be going gluten-free but are waiting until all the testing is done.  

 

[Scott Adams]

I think you are correct that DGP IGA is highly sensitive for celiac disease, so I would take the positive test seriously, not matter what anyone tells you, and try to either get more tests done, or try a gluten-free diet.

[Lindsey K]

Thanks, I appreciate the help.  There's a lot of info on Hashimoto's and gluten but not as much on Grave's and gluten and I want to learn all I can to help him.  Autoimmune thyroid issues and gluten don't go well together, and I know Celiac can come into play quite often too and I'd rather get issues sorted out sooner rather than later.