Hipotireoidismo e doença celíaca: correlações e implicações terapêuticas
DOI:
https://doi.org/10.11606/issn.1679-9836.v101i4e-176008Palavras-chave:
Hipotireoidismo, Doença Celíaca, Doenças AutoimunesResumo
O hipotireoidismo é definido como uma hipofunção da tireoide, tendo como principal causa, atualmente, as doenças autoimunes da glândula, caracterizadas por uma resposta imune local e redução da produção dos hormônios tireoidianos. A doença celíaca (DC), por sua vez, é definida como uma enteropatia autoimune permanente desencadeada pelo glúten, na qual há produção de diversos autoanticorpos. Uma parcela significativa de pacientes com hipotireoidismo requer doses maiores de T4 para alcançar os níveis ideais de TSH, incluindo os pacientes celíacos. Ademais, dentre as causas que diversificam a apresentação clínica da DC destaca-se o hipotireoidismo. Com o objetivo de estabelecer associações entre ambas as doenças foi realizada uma revisão embasada nos bancos de dados MEDLINE e SciELO. Os resultados mostram que as doenças autoimunes comumente se associam e representam fatores de risco entre si. Porém, o rastreamento indiscriminado dessas ainda é inviável e pouco benéfico. Por isso, saber quando suspeitar clinicamente e como investigar o hipotireoidismo e/ou a DC é de extrema importância.
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Referências
Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550-.62. doi: https://doi.org/10.1016/s0140-6736(17)30703-1
Silano M, Volta U, Mecchia AM, Dessi M, Benedetto RD, Vincenzi MD. Delayed diagnosis of coeliac disease increases cancer risk. BMC Gastroenterol. 2007;8(7):1-5. doi: https://doi.org/10.1186/1471-230x-7-8
Mehrdad M, Mansour-Ghanaei F, Mohammadi F, Joukar F, Dodangeh S, Mansour-Ghanaei R. Frequency of celiac disease in patients with hypothyroidism. Thyroid Res. 2012;2012:1-6. doi: https://doi.org/10.1155/2012/201538
Nijhawan S, Katiyar P, Nagaich N, Saradava V, Nijhawan M, Gupta G, Mathur A, Sharma R, Nepalia S. Prevalence of associated disorders in indian patientes with celiac disease. Indian J Gastroenterol. 2013;32(5):330-4. doi: https://doi.org/10.1007/s12664-013-0345-y
Kahaly GJ, Schuppan D. Celiac disease and endocrine autoimmunity. Dig Dis. 2015; 33(2):155-61. doi: https://doi.org/10.1159/000369535
Lundin KE, Wijmenga C. Coeliac disease and autoimmune disease-genetic overlap and screening. Nat Rev Gastroenterol Hepatol. 2015;12(9):507-15. doi: https://doi.org/10.1038/nrgastro.2015.136
Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement.Thyroid. 2014;24(12):1670-751. doi: https://doi.org/10.1089/thy.2014.0028
Eligar V, Taylor PN, Okosieme OE, Leese GP, Dayan CM. Thyroxine replacement: a clinical endocrinologist’s viewpoint. Ann Clin Biochem. 2016;53(4):421-33. doi: https://doi.org/10.1177/0004563216642255
Cellini M, Santaguida MG, Gatto I, Virili C, Duca SCD, Brusca N, Capriello S, Gargano L, Centanni M. Systematic appraisal of lactose intolerance as a cause of increased need for oral thyroxine. J Clin Endocrinol Metab. 2014;99(8):1454-8. doi: https://doi.org/10.1210/jc.2014-1217
Garber JR, Cobin RH, Gharib H, Pessah-Pollack R, Singer PA, Woeber KA. American association of clinical endocrinologists and american thyroid association taskforce on hypothyroidism in adults: clinical practice guidelines for hypothyroidism in adults. Endocr Pract. 2012:18(6). doi: https://doi.org/10.4158/ep12280.gl
Lips DJ, Reisen MTV, Voigt V, Venekamp W. Diagnosis and treatment of levothyroxine pseudomalabsortion. Neth J Med. 2004;62(4):114-8. PMID: 15255080
Deiana L, Marini S, Mariotti S. Ingest of large amounts of papaya fruit and impaired effectiveness of levothyroxine therapy. Endoc Pract. 2012;18(1):98-100. doi: https://doi.org/10.4158/ep11233.co
Centanni M, Centanni M, Gargano L, Canettieri G, Viceconti N. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med. 2006;354(17):1787-95. doi: https://doi.org/10.1056/nejmoa043903
Virili C, Antonelli A, Santaguida MG, Benvenga S, Centanni M. Gastrointestinal malabsortion of thyroxine. Endocr Rev. 2018;40(1):118-36.
Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med. 2004;351(3):241-9. doi: https://doi.org/10.1056/nejmoa040079
Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Recent advances in thyroid hormone regulation: toward a new paradigm for optimal diagnosis and treatment. Front Endocrinol (Lausanne). 2017;8(364):1-8. doi: https://doi.org/10.3389/fendo.2017.00364
Venneman K, Huybrechts I, Gunter MJ, Vandendaele L, Herrero R, Herck KV. The epidemiology of Helicobacter pylori infection in Europe and the impact of lifestyle in its natural evolution toward stomach cancer after infection: a systematic review. Helicobacter. 2018;23(3):1-16. doi: https://doi.org/10.1111/hel.12483
Neumann WL, Cross E, Rugge M, Genta RM. Autoimmune atrophic gastritis – pathogenesis, pathology and management. Nat Rev Gastroenterol Hepatol. 2013;10(9):529-41. doi: https://doi.org/10.1038/nrgastro.2013.101
Lobasso A, Nappi L, Barbieri L, Peirce C, Ippolito S, Arpaia D, Rossi FW, de Paulis A, Biondi B. Severe hypothyroidism due to the loss of therapeutic eficacy of L-thyroxine in a patient with esophageal complication associated with systemic sclerosis. Front Endocrinol (Lausanne). 2017;20(8):1-4. doi: https://doi.org/10.3389/fendo.2017.00241
Zubarik R, Ganguly E, Nathan M, Vecchio J. Celiac disease detection in hypothyroid patients requiring elevated thyroid supplementation: a prospective cohort study. Eur J Intern Med. 2015;26(10):825-9. doi: https://doi.org/10.1016/j.ejim.2015.09.011
Emilsson L, Wijmenga C, Murray JA, Ludvigsson JF. Autoimmune disease in first-degree relatives and spouses of individuals with celiac disease. Clin Gastroenterol Hepatol. 2015;13(7):1271-77. doi: https://doi.org/10.1016/j.cgh.2015.01.026
Sollid LM, Jabri B. Triggers and drivers of autoimmunity: lessons from coeliac disease. Nat Rev Immunol. 2013;13(4):294-302. doi: https://doi.org/10.1038/nri3407
Abadie V, Sollid LM, Barreiro LB, Jabri B. Integration of genetic and imunological insights into a model of celiac disease pathogenesis. Annu Rev Immunol. 2011;29(1):493-525. doi: https://doi.org/10.1146/annurev-immunol-040210-092915
Lionetti E, Catassi C. The role of enviromental factors in the development of celiac disease: what is new. Diseases. 2015;3(4):282-93. doi: https://doi.org/10.3390/diseases3040282
Passos MCF, Moraes-Filho JP. Intestinal microbiota in digestive diseases. Arq Gastroenterol. 2017;54(3):255-262. doi: https://doi.org/10.1590/s0004-2803.201700000-31
Liu SM, Resende PVG, Bahia M, Penna FJ, Ferreira AR, Liu PMF, Neto ASA, Santos LRA, Eliazar GC, Júnior MAFA. Doença celíaca. Rev Med Minas Gerais. 2014;24(2):38-45. doi: http://dx.doi.org/10.5935/2238-3182.20140037
Silva PC, Almeida PDV, Azevedo LR, Grégio AMT, Machado, MAN, Lima, AAS. Doença celíaca: revisão. Rev Clín Pesq Odontol. 2006;2(5):401-406. doi: http://dx.doi.org/10.7213/aor.v2i5/6.23032
Hill ID, Dirks MH, Liptak GS, Colleti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005;40(1):1-19. doi: https://doi.org/10.1097/00005176-200501000-00001
Freeman H. Adult celiac disease and its malignant complications. Gut Liver. 2009;3(4):237-46. doi: https://doi.org/10.5009/gnl.2009.3.4.237
Sdepanian VL, Morais MB, Fagundes-Neto U. Doença celíaca: características clínicas e métodos utilizados no diagnóstico de pacientes cadastrados na Associação dos Celíacos do Brasil. J Pediatr. 2001;77(2):131-8. doi: https://doi.org/10.1590/S0021-75572001000200014
Freeman H. Endocrine manifestations in celiac disease. World J Gastroenterol. 2016; 22(38):8472-79. doi: https://doi.org/10.3748/wjg.v22.i38.8472
Volta U, Ravaglia G, Granito A, Forti P, Maioli F, Petrolini N, Zoli M, Bianchi FB. Coeliac disease in patients with autoimune thyroiditis. Digestion. 2001;64(1):61-5. doi: https://doi.org/10.1159/000048840
Ludvigsson JF., Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, Green PHR, Hadjivassiliou M, Holdoway A, Heel DAV, Kaukinen K, Leffler DA, Leonard JN, Lundin KEA, McGough N, Davidson M, Murray JA, Swift GL, Walker MM, Zingone F, Sanders DS. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63(8):1210-28. doi: http://dx.doi.org/10.1136/gutjnl-2013-306578
Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 1.149 de 11 de novembro de 2015. Aprova o protocolo clínico e diretrizes terapêuticas da doença celíaca. Diário Oficial da União. 11 nov 2015;Seção 3:2.
Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Philips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Maki M, Ribes-Koninckx C, Ventura A, Zimmer KP. ESPGHAN guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54(1):136-60. doi: https://doi.org/10.1097/mpg.0b013e31821a23d0
Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PHR, Guandalini S, Hill ID, Pietzak MP, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163(3):286-92. doi: https://doi.org/10.1001/archinte.163.3.286
Tursi A, Giorgetti GM, Brandimarte G, Elisei W. Crohn’s disease and celiac disease: association or epiphenomenon? Eur Rev Med Pharmacol Sci. 2006;10(6):120-30. PMID: 16875046
Nejad MR, Rostami K, Zali MR. Hepatitis B vaccination reliability in celiac disease. Hepat Mon. 2011;11(8):597-8. doi: https://doi.org/10.5812/kowsar.1735143x.761
Lohdi MU, Stamman T, Kuzel AR, Syed IA, Ishtiaq R, Rahim M. Celiac disease and concomitant conditions: a case-based review. Cureus. 2018;10(2):1-12. doi: https://doi.org/10.7759/cureus.2143
Neuhausen SL, Steele L, Ryan S, Mousavi M, Pinto M, Osann KE, Flodman P, Zone JJ. Co-occurrence of celiac disease and other autoimmune diseases in celiacs and their first-degree relatives. J Autoimmun. 2008;31(2):160-5. doi: https://doi.org/10.1016/j.jaut.2008.06.001
Zhao Z, Zou J, Zhao L, Cheng Y, Hanqing C, Li M, Liu E, Yu L, Liu Y. Celiac disease autoimmunity in patients with autoimmune diabetes and thyroid disease among chinese population. Plos one. 2016;11(7):1-8. doi: https://doi.org/10.1371/journal.pone.0157510
Collin P, Kaukinen K, Valimaki M, Salmi J. Endocrinological disorders and celiac disease. Endoc Rev. 2002;23(4):464-83. doi: https://doi.org/10.1210/er.2001-0035
Kahaly GJ, Frommer L, Schuppan D. Celiac disease and autoimmunity – the genetic link. Autoimmun Rev. 2018;17(12):1169-75. doi: https://doi.org/10.1016/j.autrev.2018.05.013
Harpreet S, Deepak J, Kiran B. Multiple autoimune syndrome with celiac disease. Reumatologia. 2016;54(6):326-9. doi: https://doi.org/10.5114/reum.2016.64911
Jiskra J, Limanova Z, Vanickova Z, Kocna P. IgA and IgG antigliadin, IgA anti-tissue transglutaminase and antiendomysial antibodies in patients with autoimune thyroid diseases and their relationship to thyroidal replacement therapy. Physiol Res. 2003;52(1):79-88. Available from: http://www.biomed.cas.cz/physiolres/pdf/52/52_79.pdf
Liwanpo L, Hershman JM. Conditions and drugs interfering with thyroxine absorption. Best Pract Res Clin Endocrinol Metab. 2009;23(6):781-92. doi: https://doi.org/10.1016/j.beem.2009.06.006
Bayless TM, Brown E, Paige DM. Lactase non-persistence and lactose intolerance. Curr Gastroenterol Rep. 2017;19(5):1-11. doi: https://doi.org/10.1007/s11894-017-0558-9
Ward LS. The difficult patient: drug interaction and the influence of concomitante diseases on the treatment of hypothyroidism. Arch Endocrin Metab. 2010;54(5):435-42. doi: http://dx.doi.org/10.1590/S0004-27302010000500002
Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet. 2018;391(10115):70-81. doi: https://doi.org/10.1016/s0140-6736(17)31796-8
Ch’ng CL, Jones MK, Kingham JG. Celiac disease and autoimune thyroid disease. Clin Med Res. 2007;5(3):184-92. doi: https://doi.org/10.3121/cmr.2007.738
Hadith M, Boer HD, Meijer JWR, Willekens F, Kerckhaert JA, Heijmans R, Peña AS, Stehouwer CDA, Mulder CJJ. Colieac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa. World J Gastroenterol. 2007;13(11):1715-22. doi: https://doi.org/10.3748/wjg.v13.i11.1715
Collins D, Wilcox R, Nathan M, Zubarik R. Celiac disease and hyphothyroidism. Am J Med. 2012;125:278-82. doi: https://doi.org/10.1016/j.amjmed.2011.09.003
Virili C, Bassotti G, Santaguida MG, Iuorio R, Duca SCD, Mercuri V, Picarelli A, Gargiulo P, Gargano L, Centanni M. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. J Clin Endocrinol Metab. 2012;97(3):419-22. doi: https://doi.org/10.1210/jc.2011-1851
Williamson D, Marsh MN. Celiac disease. Mol Biotechnol. 2002;22(3):293-9. doi: https://doi.org/10.1385/mb:22:3:293
Goddard CJR, Gillett HR. Complications of coeliac disease: are all patients at risk? J Postgrad Med. 2006;82(973):705-12. doi: https://doi.org/10.1136/pgmj.2006.048876
Nenna R, Tiberti C, Petrarca L, Lucantoni F, Mennini M, Luparia RPL, Panimolle F, Mastrogiorgio G, Pietropaoli N, Magliocca FM, Bonamico M. The celiac iceberg: characterization of the disease in primary schoolchildren. J Pediatr Gastroenterol Nutr. 2013;56(4):416-21. doi: https://doi.org/10.1097/mpg.0b013e31827b7f64
Sategna-Guidetti C, Volta U, Ciacci C, Usai P. Prevalence of thyroid disorder in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. Am J Gastroenterol. 2001;96(3):751-7. doi: https://doi.org/10.1111/j.1572-0241.2001.03617.x
Metso S, Hyytia-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(1):43-8. doi: https://doi.org/10.3109/00365521.2011.639084
Hakanen M, Luotola K, Salmi J, Laippala P, Kaukinen K, Collin P. Clinical and subclinical autoimmune thyroid disease in adult celiac disease. Dig Dis Sci. 2001;46(12):2631-5. doi: https://doi.org/10.1023/a:1012754824553
Rua EC, Villar MTG, Wright RA, Gomez CL. Associated or concomitante diseases influence significantly the health-sickness concept in celiacs. Open J Epidemiol. 2017;7(2):139-58. doi: https://doi.org/10.4236/ojepi.2017.72013
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