Celiac Disease and Treatment of Hypothyroidism: An Unappreciated Problem

The document discussed a case of a 33-year-old female with Hashimoto's thyroiditis and undiagnosed celiac disease, highlighting the issue of levothyroxine malabsorption due to celiac disease. Despite increasing her levothyroxine dose from 25 μg to 250 μg, her TSH levels continued to rise, peaking at 400 μIU/l. Upon diagnosis of celiac disease through positive IgA anti-tissue transglutaminase antibodies and duodenal biopsy, she was advised to follow a gluten-free diet. This dietary change led to improved anemia, reduced levothyroxine requirements, and stabilized TSH levels. The study emphasized the importance of considering celiac disease in patients with autoimmune thyroid dysfunction and increased levothyroxine needs, as malabsorption may be an early indicator of silent celiac disease.