Silva Cintia M dos Santos, Souza Marcus Vinicius L de
Serviço de Endocrinologia, Instituto Estadual de Diabetes e Endocrinologia Luis Capriglione, Rio de Janeiro, RJ.
Arq Bras Endocrinol Metabol. 2005 Aug;49(4):599-603. doi: 10.1590/s0004-27302005000400020. Epub 2005 Oct 19.
The factors that make difficult the normalization of TSH in hypothyroidism need special attention because some patients on thyroxine replacement do not maintain a normal TSH. We report a 50 year-old woman with autoimmune hypothyroidism of difficult compensation, associated with anemia, hypocalcemia with a previous episode of tetany, hypomagnesemia, psychologic alterations and important weight loss. After compensation of the hypothyroidism with doses of L-thyroxine as high as 325 microg/day, the hypothesis of a malabsorptive syndrome was raised. Celiac disease was confirmed by elevated serum antigliadin antibody. A gluten-free diet was instituted which improved the symptoms associated with malabsorption and reduced the L-thyroxine requirement to 125 microg/day. Because several studies have shown an association of both diseases, a routine screening for celiac disease has been widely proposed in patients with autoimmune thyroid disease.
