Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
Nutrients. 2021 May 21;13(6):1755. doi: 10.3390/nu13061755.
Celiac disease (CD) and autoimmune thyroid diseases (AITD) like Hashimoto's thyroiditis (HT) and Graves' disease (GD) frequently coexist, entailing numerous potential impacts on diagnostic and therapeutic approaches. Possible correlations might exist through gut microbiota, regulating the immune system and inflammatory responses, promoting autoimmune diseases, as well as shared cytokines in pathogenesis pathways, cross-reacting antibodies or malabsorption of micronutrients that are essential for the thyroid like iron or vitamin D. Vitamin D deficiency is a common finding in patients with AITD, but might protect from autoimmunity by wielding immunoregulatory and tolerogenic impacts. Additionally, vitamin D is assumed to be involved in the onset and progression of CD, presumably plays a substantial protective role for intestinal mucosa and affects the thyroid via its immunomodulatory effects. Iron is an essential micronutrient for the thyroid gland needed for effective iodine utilization by the iron-dependent enzyme thyroid iodine peroxidase (TPO). Despite being crucial for thyroid hormone synthesis, iron deficiency (ID) is a common finding in patients with hypothyroidism like HT and is frequently found in patients with CD. A literature research was conducted to examine the interplay between CD, AITD, vitamin D and iron deficiency. This narrative review highlights the relevant correlation of the two disease entities CD and AITD, their reciprocal impact and possible therapeutic options that should be further explored by future studies.
乳糜泻（CD）和自身免疫性甲状腺疾病（AITD），如桥本甲状腺炎（HT）和格雷夫斯病（GD）经常同时存在，这对诊断和治疗方法有很多潜在的影响。可能存在通过肠道微生物群的相关性，调节免疫系统和炎症反应，促进自身免疫性疾病，以及发病机制途径中共同的细胞因子、交叉反应抗体或必需的微量元素如铁或维生素 D 的吸收不良。AITD 患者中维生素 D 缺乏是常见的，但可能通过发挥免疫调节和耐受作用来保护免受自身免疫。此外，维生素 D 被认为与 CD 的发病和进展有关，可能对肠黏膜发挥重要的保护作用，并通过其免疫调节作用影响甲状腺。铁是甲状腺所必需的微量元素，是铁依赖性酶甲状腺过氧化物酶（TPO）有效利用碘所必需的。尽管铁对甲状腺激素的合成至关重要，但铁缺乏（ID）在 HT 等甲状腺功能减退症患者中很常见，在 CD 患者中也经常发现。进行了文献研究，以检查 CD、AITD、维生素 D 和铁缺乏之间的相互作用。本综述强调了这两种疾病实体 CD 和 AITD 的相关性、它们的相互影响以及未来研究中应进一步探索的可能治疗选择。
