Dr. Ron’s Research Review – June 30, 2010

This week’s research review focuses on celiac disease with several recent articles:

Risk of thyroid disease in individuals with celiac disease (Elfstrom, Montgomery et al. 2008)

Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients (Toscano, Conti et al. 2000)

We also have a case study:

An obese patient with Hashimoto’s thyroiditis was investigated for hypochromic microcytic anaemia that is unresponsive to iron replacement therapy (Arslan, Esen et al. 2009)

In the News:

The National Report on Human Exposure to Environmental Chemicals

Dr. Ron


The National Report on Human Exposure to Environmental Chemicals

http://www.cdc.gov/exposurereport/index.html        

Some highlights of the report indicating widespread exposure include:

·      Fire retardant (polybrominated diphenyl ethers or PBDEs) was found in the serum of nearly all of the participants

·      Bisphenol A (BPA) was found in more than 90% of samples. Bisphenol A (BPA), a component of epoxy resins and polycarbonates, may have potential reproductive toxicity.

·      PFOA (perflurooctanoic acid) or non-stick coating like Teflon was found in most participants. PFOA is a carcinogen. Studies have associated it with infertility, higher cholesterol, and thyroid disease.

·      Perchlorate was found in ALL participants. The chemical perchlorate is both naturally occurring and manmade and is used to manufacture fireworks, explosives, flares, and rocket propellant. For decades, scientists have known that large medical doses of perchlorate affect thyroid function.

·      Triclosan was found in 75% of participants. Triclosan is an antibacterial and antifungal agent used in many consumer products. In August 2009, the Canadian Medical Association asked the Canadian government to ban triclosan use in household products under concerns of creating bacterial resistance and producing dangerous side products (chloroform). A comprehensive analysis from the University of Michigan School of Public Health indicated that plain soaps are just as effective as consumer-grade antibacterial soaps with triclosan in preventing illness and removing bacteria from the hands.


Articles

Risk of thyroid disease in individuals with celiac disease

            (Elfstrom, Montgomery et al. 2008) Download

BACKGROUND: It has been suggested that celiac disease is associated with thyroid disease. Earlier studies, however, have been predominately cross-sectional and have often lacked controls. There is hence a need for further research. In this study, we estimated the risk of thyroid disease in individuals with celiac disease from a general population cohort. METHODS: A total of 14,021 individuals with celiac disease (1964-2003) and a matched reference population of 68,068 individuals were identified through the Swedish national registers. Cox regression estimated the risk of thyroid disease in subjects with celiac disease. Analyses were restricted to individuals with a follow-up of more than 1 yr and with no thyroid disease before study entry or within 1 yr after study entry. Conditional logistic regression estimated the odds ratio for subsequent celiac disease in individuals with thyroid disease. RESULTS: Celiac disease was positively associated with hypothyroidism [hazard ratio (HR) = 4.4; 95% confidence interval (CI) = 3.4-5.6; P < 0.001], thyroiditis (HR = 3.6; 95% CI =1.9-6.7; P < 0.001) and hyperthyroidism (HR = 2.9; 95% CI = 2.0-4.2; P < 0.001). The highest risk estimates were found in children (hypothyroidism, HR = 6.0 and 95% CI = 3.4-10.6; thyroiditis, HR = 4.7 and 95% CI = 2.1-10.5; hyperthyroidism, HR = 4.8 and 95% CI = 2.5-9.4). In post hoc analyses, where the reference population was restricted to inpatients, the adjusted HR was 3.4 for hypothyroidism (95% CI = 2.7-4.4; P < 0.001), 3.3 for thyroiditis (95% CI = 1.5-7.7; P < 0.001), and 3.1 for hyperthyroidism (95% CI = 2.0-4.8; P < 0.001). CONCLUSION: Celiac disease is associated with thyroid disease, and these associations were seen regardless of temporal sequence. This indicates shared etiology and that these individuals are more susceptible to autoimmune disease.

Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients

            (Toscano, Conti et al. 2000) Download

OBJECTIVE: It is well known that a high number of celiac patients may develop autoantibodies against endocrine glands, but it has not yet been clarified if this increased autoimmune response and the impaired organ function that can develop may be related to the presence or absence of gluten in the diet. The aim of the present study was to evaluate the effect of gluten on the autoimmunity and function of the endocrine glands in adolescent celiac patients. METHODS: To clarify this aspect we investigated 44 patients (28 females), aged 11-20 yr (15.21+/-2.7 yr): 25 (mean age, 15.1+/-2.2 yr) on a gluten-free diet (treated patients) and 19 (mean age 15.4+/-2.9 yr) with a diet containing gluten (untreated patients). Forty adolescent subjects, aged 14-19 yr (mean age, 14.9+/-2.7 yr), of whom 20 were females, were studied as controls. Antibodies against the thyroid, adrenal, and pancreas were evaluated. Thyroid-stimulating hormone FT3, FT4, T3, T4, dehydroepiandrosterone sulphate, 17-OH progesterone, and cortisol, analyzed basally and 60 min after intravenous ACTH stimulation, were assayed to evaluate thyroid and adrenal function. The fasting glycemia level was used to evaluate the endocrine pancreas function. An ultrasonogram of the thyroid gland was performed on all patients. HLA class II typing for DR3 and DQB1 was performed in 32 of 44 patients. RESULTS: Seven of 44 (15.9%) patients were positive for antibodies against peroxidase. Six of 44 (13.6%) were positive for antibodies against thyreoglobulin and four of them also showed positive antibodies against peroxidase. Therefore, in nine of 44 at least one antibody directed against thyroid tissue was positive. Seven of 44 (15.9%) were positive for antibodies against islet cell, one of 44 (2.3%) positive for antibodies against glutamic acid decarboxilase, one of 44 (2.3%) positive for antibodies against insulin, and none for antibodies against islet cell- 512bdc. In 15 of 44 (34%) at least one antibody against an endocrine tissue was positive. The genotype DR3 was found in 21 of 32 (65.6%) celiac patients (10 in the untreated and 11 in the treated group, respectively) and the genotype DQB1*02 (DQ2) was found in 30 of 32 (93.8%) patients (16 in the treated and 14 in the untreated group, respectively). DHA-S values were significantly lower in the untreated (30.5+/-28.5 microg/dl) than in the treated group (61.3+/-59.4 microg/dl, p < 0.05), and both showing significantly (p < 0.01) lower levels with respect to the controls (161+/-52 microg/dl). One patient showed diabetes, another one clinical hypothyroidism (thyroid-stimulating hormone > 6), and two patients showed preclinical hypothyroidism. Interestingly, at least one antibody was positive in 10 of 19 untreated patients (52.6%) but only in five of 25 treated patients (20%), with a significantly different distribution (p < 0.001) between the two groups and without differences in the HLA genotype. The ultrasonographic evaluation of the thyroid resulted in a pathological score in six patients of the 44 examined (13.6%), suggesting the presence of thyropathy. CONCLUSIONS: The main results of this study are the high incidence of thyroid and pancreatic antibodies, and the possible role of gluten in the induction of the antibodies as well as, in few cases, the consequent organ dysfunction.

The changing face of celiac disease: a girl with obesity and celiac disease

            (Arslan, Esen et al. 2009) Download

In this paper, we present an obese patient with Hashimoto’s thyroiditis who was investigated for hypochromic microcytic anaemia that is unresponsive to iron replacement therapy and finally had the diag- nosis of celiac disease.

References

Arslan, N., I. Esen, et al. (2009). "The changing face of celiac disease: a girl with obesity and celiac disease." J Paediatr Child Health 45(5): 317-8.

Elfstrom, P., S. M. Montgomery, et al. (2008). "Risk of thyroid disease in individuals with celiac disease." J Clin Endocrinol Metab 93(10): 3915-21.

Toscano, V., F. G. Conti, et al. (2000). "Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients." Am J Gastroenterol 95(7): 1742-8.