Whether a Gluten-Free Diet Should Be Recommended in Chronic Autoimmune Thyroiditis or Not?-A 12-Month Follow-Up

Jakub Pobłocki, Tamara Pańka, Małgorzata Szczuko, Arkadiusz Telesiński, Anhelli Syrenicz, Jakub Pobłocki, Tamara Pańka, Małgorzata Szczuko, Arkadiusz Telesiński, Anhelli Syrenicz

Abstract

Elimination diets have recently become extremely popular among people with autoimmune diseases. A gluten-free diet is indicated in celiac disease (CD), but some studies show its effectiveness in cases of autoimmunity. The aim of this study was to assess whether the use of a gluten-free diet is also effective in patients with chronic autoimmune thyroid disease (cAITD), which is the most common thyroid autoimmune pathology associated with chronic inflammation, over-reactivity of the immune system, auto-destruction of thyrocytes and hypothyroidism. The final analysis of the study included 62 Caucasian women randomized into a control group (CG: n = 31) and an experimental group on a gluten-free diet (GFDG: n = 31), were subject to a 12-month follow-up, during which the concentrations of thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies were assessed at baseline and after 3, 6 and 12 months. During the 12-month follow-up between the CG and the GFDG, no differences were found in anti-TPO and anti-TG antibodies, fT3 or fT4 levels, except a significant reduction in TSH levels in the GFDG. Additionally, performed analysis between individual appointments presented no significant differences in changes in the median concentrations of anti-TPO, anti-TG or fT3, but confirmed a significant decrease in TSH and showed accessory an increase in fT4 after 12 months in GFDG. Statistical analyses performed separately for both groups indicated a constant reduction of anti-TG concentrations in the GFDG. In conclusion, a GFD may be administered in cAITD after ruling out celiac disease, but it is necessary to perform more studies to assess if cAITD patients achieve the benefits of following a GFD. Patients with cAITD should be offered proper nutrition education combined with a healthy lifestyle promotion.

Keywords: Hashimoto’s thyroiditis; antithyroid antibodies; cAITD; celiac disease; gluten free diet.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Wiersinga W.M. Endocrinology. Springer Science and Business Media LLC; Berlin, Germany: 2018. Hashimoto’s Thyroiditis; pp. 205–247.
    1. Ralli M., Angeletti D., Fiore M., D’Aguanno V., Lambiase A., Artico M., de Vincentiis M., Greco A. Hashimoto’s thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun. Rev. 2020;19:102649. doi: 10.1016/j.autrev.2020.102649.
    1. Luty J., Ruckemann-Dziurdzińska K., Witkowski J.M., Bryl E. Immunological aspects of autoimmune thyroid disease-Complex interplay between cells and cytokines. Cytokine. 2019;116:128–133. doi: 10.1016/j.cyto.2019.01.003.
    1. Brown R., Francis G.L. Autoimmune thyroid disorders. J. Thyroid Res. 2011;2011:432890. doi: 10.4061/2011/432890.
    1. Zaletel K., Gaberšček S. Hashimoto’s Thyroiditis: From Genes to the Disease. Curr. Genom. 2011;12:576–588. doi: 10.2174/138920211798120763.
    1. Fallahi P., Ferrari S.M., Ruffilli I., Elia G., Biricotti M., Vita R., Benvenga S., Antonelli A. The association of other autoimmune diseases in patients with autoimmune thyroiditis: Review of the literature and report of a large series of patients. Autoimmun. Rev. 2016;15:1125–1128. doi: 10.1016/j.autrev.2016.09.009.
    1. Mehrdad M., Mansour-Ghanaei F., Mohammadi F., Joukar F., Dodangeh S., Mansour-Ghanaei R. Frequency of celiac disease in patients with hypothyroidism. J. Thyroid Res. 2012;2012:201538. doi: 10.1155/2012/201538.
    1. Volta U., Caio G., Stanghellini V., De Giorgio R. The changing clinical profile of celiac disease: A 15-year experience (1998-2012) in an Italian referral center. BMC Gastroenterol. 2014;14:194. doi: 10.1186/s12876-014-0194-x.
    1. Salazar C. Understanding Celiac Disease from Genetics to the Future Diagnostic Strategies. Clin. Med. Insights Gastroenterol. 2017;10:1–13. doi: 10.1177/1179552217712249.
    1. Ludvigsson J.F., Bai J.C., Biagi F., Card T.R., Ciacci C., Ciclitira P.J., Green P.H., Hadjivassiliou M., Holdoway A., van Heel D.A., et al. Diagnosis and management of adult coeliac disease: Guidelines from the British Society of Gastroenterology. Gut. 2014;63:1210–1228. doi: 10.1136/gutjnl-2013-306578.
    1. Commission Implementing Regulation (EU) No 828/2014 of 30 July 2014 on the requirements for the provision of information to consumers on the absence or reduced presence of gluten in food Text with EEA relevance OJ L 228, 31.7.2014, p. 5–8. [(accessed on 15 January 2021)]; Available online: .
    1. Kahaly G.J., Frommer L., Schuppan D. Celiac disease and endocrine autoimmunity-the genetic link. Autoimmun. Rev. 2018;17:1169–1175. doi: 10.1016/j.autrev.2018.05.013.
    1. Husby S., Murray J.A., Katzka D.A. AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology. 2019;156:885–889. doi: 10.1053/j.gastro.2018.12.010.
    1. Husby S., Koletzko S., Korponay-Szabó I., Kurppa K., Mearin M.L., Ribes-Koninckx C., Shamir R., Troncone R., Auricchio R., Castillejo G., et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J. Pediatr. Gastroenterol. Nutr. 2020;70:141–156. doi: 10.1097/MPG.0000000000002497.
    1. Husby S., Koletzko S., Korponay-Szabó I.R., Mearin M.L., Phillips A., Shamir R. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J. Pediatr Gastroenterol. Nutr. 2012;54:136–160. doi: 10.1097/MPG.0b013e31821a23d0.
    1. Itzlinger A., Branchi F., Elli L., Schumann M. Gluten-Free Diet in Celiac Disease-Forever and for All? Nutrients. 2018;10:1796. doi: 10.3390/nu10111796.
    1. Elli L., Villalta D., Roncoroni L., Barisani D., Ferrero S., Pellegrini N., Bardella M.T., Valiante F., Tomba C., Carroccio A., et al. Nomenclature and diagnosis of gluten-related disorders: A position statement by the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) Dig. Liver Dis. 2017;49:138–146. doi: 10.1016/j.dld.2016.10.016.
    1. Tovoli F., Masi C., Guidetti E., Negrini G., Paterini P., Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World J. Clin. Cases. 2015;3:275–284. doi: 10.12998/wjcc.v3.i3.275.
    1. Sapone A., Bai J.C., Ciacci C., Dolinsek J., Green P.H.R., Hadjivassiliou M., Kaukinen K., Rostami K., Sanders D.S., Schumann M., et al. Spectrum of gluten-related disorders: Consensus on new nomenclature and classification. BMC Medicine. 2012;10:13. doi: 10.1186/1741-7015-10-13.
    1. Bruzzese V., Scolieri P., Pepe J. Efficacy of gluten-free diet in patients with rheumatoid arthritis. Reumatismo. 2021;72:213–217. doi: 10.4081/reumatismo.2020.1296.
    1. Haupt-Jorgensen M., Groule V., Reibel J., Buschard K., Pedersen A.M.L. Gluten-free diet modulates inflammation in salivary glands and pancreatic islets. Oral Dis. 2021 doi: 10.1111/odi.13775.
    1. Bruins M.J. The clinical response to gluten challenge: A review of the literature. Nutrients. 2013;5:4614–4641. doi: 10.3390/nu5114614.
    1. Caturegli P., De Remigis A., Rose N.R. Hashimoto thyroiditis: Clinical and diagnostic criteria. Autoimmun. Rev. 2014;13:391–397. doi: 10.1016/j.autrev.2014.01.007.
    1. Kowalska K., Brodowski J., Pokorska-Niewiada K., Szczuko M. The Change in the Content of Nutrients in Diets Eliminating Products of Animal Origin in Comparison to a Regular Diet from the Area of Middle-Eastern Europe. Nutrients. 2020;12:2986. doi: 10.3390/nu12102986.
    1. Leffler D.A., Dennis M., Edwards George J.B., Jamma S., Magge S., Cook E.F. A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin. Gastroenterol. Hepatol. 2009;7:530–536.e2. doi: 10.1016/j.cgh.2008.12.032.
    1. Valentino R., Savastano S., Tommaselli A.P., Dorato M., Scarpitta M.T., Gigante M., Micillo M., Paparo F., Petrone E., Lombardi G., et al. Prevalence of coeliac disease in patients with thyroid autoimmunity. Horm. Res. 1999;51:124–127. doi: 10.1159/000023344.
    1. Krysiak R., Szkróbka W., Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Exp. Clin. Endocrinol. Diabetes. 2018 doi: 10.1055/a-0653-7108.
    1. Ventura A., Neri E., Ughi C., Leopaldi A., Città A., Not T. Gluten-dependent diabetes-related and thyroid-related autoantibodies in patients with celiac disease. J. Pediatr. 2000;137:263–265. doi: 10.1067/mpd.2000.107160.
    1. Cosnes J., Cellier C., Viola S., Colombel J.F., Michaud L., Sarles J., Hugot J.P., Ginies J.L., Dabadie A., Mouterde O., et al. Incidence of autoimmune diseases in celiac disease: Protective effect of the gluten-free diet. Clin. Gastroenterol. Hepatol. 2008;6:753–758. doi: 10.1016/j.cgh.2007.12.022.
    1. Mainardi E., Montanelli A., Dotti M., Nano R., Moscato G. Thyroid-related autoantibodies and celiac disease: A role for a gluten-free diet? J. Clin. Gastroenterol. 2002;35:245–248. doi: 10.1097/00004836-200209000-00009.
    1. Meloni A., Mandas C., Jores R.D., Congia M. Prevalence of autoimmune thyroiditis in children with celiac disease and effect of gluten withdrawal. J. Pediatr. 2009;155:51–55.e1. doi: 10.1016/j.jpeds.2009.01.013.
    1. Ansaldi N., Palmas T., Corrias A., Barbato M., D’Altiglia M.R., Campanozzi A., Baldassarre M., Rea F., Pluvio R., Bonamico M., et al. Autoimmune thyroid disease and celiac disease in children. J. Pediatr. Gastroenterol. Nutr. 2003;37:63–66. doi: 10.1097/00005176-200307000-00010.
    1. Diamanti A., Ferretti F., Guglielmi R., Panetta F., Colistro F., Cappa M., Daniele A., Sole Basso M., Noto C., Crisogianni M., et al. Thyroid autoimmunity in children with coeliac disease: A prospective survey. Arch. Dis. Child. 2011;96:1038–1041. doi: 10.1136/archdischild-2011-300595.
    1. Cassio A., Ricci G., Baronio F., Miniaci A., Bal M., Bigucci B., Conti V., Cicognani A. Long-term clinical significance of thyroid autoimmunity in children with celiac disease. J. Pediatr. 2010;156:292–295. doi: 10.1016/j.jpeds.2009.08.047.
    1. Metso S., Hyytiä-Ilmonen H., Kaukinen K., Huhtala H., Jaatinen P., Salmi J., Taurio J., Collin P. Gluten-free diet and autoimmune thyroiditis in patients with celiac disease. A prospective controlled study. Scand. J. Gastroenterol. 2012;47:43–48. doi: 10.3109/00365521.2011.639084.
    1. Ma C., Li D., Yin Y., Wu J., Guo X., Zhang R., Hu Y., Zou Y., Li W., Wang D., et al. Establishing thresholds and effects of gender, age, and season for thyroglobulin and thyroid peroxidase antibodies by mining real-world big data. Clin. Biochem. 2019;74:36–41. doi: 10.1016/j.clinbiochem.2019.08.011.
    1. Passali M., Josefsen K., Frederiksen J.L., Antvorskov J.C. Current Evidence on the Efficacy of Gluten-Free Diets in Multiple Sclerosis, Psoriasis, Type 1 Diabetes and Autoimmune Thyroid Diseases. Nutrients. 2020;12:2316. doi: 10.3390/nu12082316.
    1. Hu Y., Feng W., Chen H., Shi H., Jiang L., Zheng X., Liu X., Zhang W., Ge Y., Liu Y., et al. Effect of selenium on thyroid autoimmunity and regulatory T cells in patients with thyroiditis: A randomized-controlled trial. Clin. Transl. Sci. 2021 doi: 10.1111/cts.12993.
    1. Winther K.H., Bonnema S.J., Hegedüs L. Is selenium supplementation in autoimmune thyroid diseases justified? Curr. Opin. Endocrinol. Diabetes Obes. 2017;24:348–355. doi: 10.1097/MED.0000000000000356.
    1. Wichman J., Winther K.H., Bonnema S.J., Hegedüs L. Selenium Supplementation Significantly Reduces Thyroid Autoantibody Levels in Patients with Chronic Autoimmune Thyroiditis: A Systematic Review and Meta-Analysis. Thyroid. 2016;26:1681–1692. doi: 10.1089/thy.2016.0256.
    1. Miranda J., Lasa A., Bustamante M.A., Churruca I., Simon E. Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods Hum. Nutr. 2014;69:182–187. doi: 10.1007/s11130-014-0410-4.
    1. Calvo-Lerma J., Crespo-Escobar P., Martínez-Barona S., Fornés-Ferrer V., Donat E., Ribes-Koninckx C. Differences in the macronutrient and dietary fibre profile of gluten-free products as compared to their gluten-containing counterparts. Eur J. Clin Nutr. 2019;73:930–936. doi: 10.1038/s41430-018-0385-6.
    1. Punshon T., Jackson B.P. Essential micronutrient and toxic trace element concentrations in gluten containing and gluten-free foods. Food Chem. 2018;252:258–264. doi: 10.1016/j.foodchem.2018.01.120.
    1. Dall’Asta C., Galaverna G., Mangia M., Sforza S., Dossena A., Marchelli R. Free and bound fumonisins in gluten-free food products. Mol. Nutr. Food Res. 2009;53:492–499. doi: 10.1002/mnfr.200800088.
    1. Marciniak M., Szymczak-Tomczak A., Mahadea D., Eder P., Dobrowolska A., Krela-Kaźmierczak I. Multidimensional Disadvantages of a Gluten-Free Diet in Celiac Disease: A Narrative Review. Nutrients. 2021;13:643. doi: 10.3390/nu13020643.
    1. Nistal E., Caminero A., Vivas S., Ruiz de Morales J.M., Saenz de Miera L.E., Rodriguez-Aparicio L.B., Casqueiro J. Differences in faecal bacteria populations and faecal bacteria metabolism in healthy adults and celiac disease patients. Biochimie. 2012;94:1724–1729. doi: 10.1016/j.biochi.2012.03.025.
    1. Lee H.S., Hwang J.S. The natural course of Hashimoto’s thyroiditis in children and adolescents. J. Pediatr. Endocrinol. Metab. 2014;27:807–812. doi: 10.1515/jpem-2013-0373.
    1. Schmidt M., Voell M., Rahlff I., Dietlein M., Kobe C., Faust M., Schicha H. Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) treated with levothyroxine. Thyroid. 2008;18:755–760. doi: 10.1089/thy.2008.0008.
    1. Costa A.F., Sugai E., Temprano M.D.L.P., Niveloni S.I., Vázquez H., Moreno M.L., Domínguez-Flores M.R., Muñoz-Suano A., Smecuol E., Stefanolo J.P., et al. Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients. World J. Gastroenterol. 2019;25:1409–1420. doi: 10.3748/wjg.v25.i11.1409.
    1. Di Sabatino A., Volta U., Salvatore C., Biancheri P., Caio G., De Giorgio R., Di Stefano M., Corazza G.R. Small Amounts of Gluten in Subjects With Suspected Nonceliac Gluten Sensitivity: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial. Clin. Gastroenterol. Hepatol. 2015;13:1604. doi: 10.1016/j.cgh.2015.01.029.
    1. Biesiekierski J.R., Iven J. Non-coeliac gluten sensitivity: Piecing the puzzle together. United Eur. Gastroenterol. J. 2015;3:160–165. doi: 10.1177/2050640615578388.

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