Aggressiveness of autoimmunity in celiac disease

Celiac disease is an autoimmune disease that occurs most frequently in individuals with positive HLA DQ2 or HLA DQ8 histocompatibility antigens, which demonstrate underlying autoimmunity. The autoimmune conditions most frequently associated with these HLA DQ2 or HLA DQ8 histocompatibility antigens are type 1 diabetes and thyroid conditions.

It should be borne in mind that following a gluten-free diet in this type of patient cannot prevent the development of diabetes or thyroid disorders. For this reason, special emphasis should be placed on monitoring these patients to detect early if they develop these conditions.

On the one hand, type 1 diabetes is usually preceded by polyuria, i.e. urinating more and more frequently than usual, as well as drinking more water and weight loss. In cases of weight loss, patients often mistakenly consider that they are not following the gluten-free diet properly. When these symptoms appear, a fasting glycemia study, determination of glycosylated hemoglobin and glycemia curve should be performed.

On the other hand, in Hashimoto’s thyroiditis, the symptoms are more varied: weight loss, lack of appetite, insomnia or irritability, among others. From the biochemical point of view, it is advisable to perform TSH, T3, T4 and the determination of anti-thyroid antibodies. The latter is the best indicator of anti-thyroid autoimmunity. Antibodies can be positive in cases of both hypo- and hyperthyroidism.

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