Celiac Disease and Treatment of Hypothyroidism: An Unappreciated Problem

The document presented a case of a 33-year-old female with Hashimoto's thyroiditis and undiagnosed celiac disease, highlighting the issue of levothyroxine malabsorption. Despite increasing her thyroxin dose from 25 μg to 250 μg, her TSH levels continued to rise, indicating poor absorption. A positive celiac panel and duodenal biopsy confirmed celiac disease, and a gluten-free diet led to significant improvement. Her hemoglobin levels increased, and her levothyroxine dose was reduced back to 25 μg, with stable TSH levels. The study emphasized the strong association between celiac disease and autoimmune thyroid disorders, suggesting that celiac disease should be considered in cases of increased T4 requirements due to malabsorption.