A Case of Celiac Disease Presenting With Malabsorption of L-Thyroxine

摘要

A 26-year-old-female with a history of primary hypothy-roidism was referred to the endocrinology clinic for evaluation of persistent hypothyroidism despite a dose of 2.7mug/kg/d of L-thyroxine, After excluding issues with compliance and drag interactions, the possibility of malabsorption was considered; tissue transglutaminase antibody was elevated at 83 kU/L (positive >25), and the duodenal biopsy demonstrated complete villous atrophy. The diagnosis of celiac disease was established, and the patient was subsequently placed on a gluten-free diet. Malabsorption of L-thyroxine can be the only clue to the underlying diagnosis of celiac disease. As the prevalence of celiac disease is increased in patients with autoimmune thyroid disorders, the diagnosis of celiac disease should be considered in patients requiring high doses of L-thyroxine to achieve euthyroidism.