Celiac, Hypothyroidism, and Adrenal dysfunction oh my!

I'm continuing my discussion on Gluten - see blog part 1 on diagnosis and symptoms. But I wanted to discuss the reason why this all ties into hormone function; in particular Cortisol and Thyroid. As many may know, Adrenal and Thyroid dysfunction and diseases are commonly linked to autoimmune diseases - Addisons, Hashimotos, & Graves for example. There is a strong association between having one autoimmune disease and having additional subsequent autoimmune diseases. Well, it does appear that we can count Celiac disease as a form of autoimmune disease. Many studies have looked at the representation of other autoimmune diseases if a patient has celiac disease; finding a higher rate than expected of thyroid, adrenal, and pancreatic dysfunction; for example - about 10-26% depending on the study and the autoimmune disease. More recent studies however, have reversed this search- looking instead for the presence of celiac disease in individuals who have thyroid or adrenal dysfunction. Not surprisingly, there has been an amazing frequency of celiac in these populations - about 3-5% for Autoimmune thyroid, 12% for Addisons, and 1/20 of patients with type 1 diabetes. So, a patient comes into the office and has multiple autoimmune diseases, think about adding a test for celiac as well and vice versa.

But what about the patient who comes in with hormonal problems, fatigue, headaches, and weight gain? Consider celiac as well. Untreated and undiagnosed celiac disease patients, which is about 90+% of celiac disease sufferers, have hormonal disruption that may not have yet been diagnosed OR as of yet, a disease. Celiac creates at number of inflammatory cytokines which may mimic multiple conditions. Cortisol levels may be high or low depending on the amount of adrenal autoimmunity, inflammatory cytokines, and overall stress of the individuals physiology due to eating gluten. As an example, individuals with profound skin itchiness due to celiacs, sleep maybe disrupted routinely due to discomfort. Plus, the changes to cortisol levels may also increase the inflammation when the adrenals are unable to produce enough cortisol to inhibit autoimmunity (TH1 and TH2 balance) and inflammation (relative adrenal insufficiency).

I routinely get asked what to do about individuals who have high levels of antibodies to their thyroid glands (TPOab and TGab) and going gluten-free is one of the tricks that you can try. I have seen that successfully lower antibody levels very quickly for some individuals. Remember however, that if you need to diagnose someone with celiac, you need to do that before they go gluten free.
The thyroid gland embryologically begins at the back of the tongue and migrates down into the neck by week 7 of fetal life. A process that to me epitomizes the magic of embryology. As a refugee of the GI tract however, thyroid tissue appears to share the same tendency to react to the same irritants as GI tissue does. Thus, we see many of the thyroid autoimmune diseases actually being GI infections; for example: H. pylori, giardia, and entamoeba histolytica.

I am constantly amazed at the many ways our body system interacts. It's truly amazing that any of us are able to be ok. But, if you haven't looked at Celiac disease as a contributor to endocrine disorders it's worth your time to consider it. Since most patients are undiagnosed, and family inheritance is high, you might cure and prevent a large amount of suffering and hormonal dysfunction.

Happy Holidays
Dr Alison McAllister