Hyperthyroidism is a common condition worldwide. It occurs in 1-2 per cent of the population with greater incidence in iodine-deficient regions and is 10 times more common in women than men between the ages of 20 and 40 years.(1)
Hyperthyroidism is estimated to affect about 3 million people in the United States. The disease affects more women than men, breaking down to about 2% of women and .2% of men. As many as 15 percent of cases of hyperthyroidism occur in patients older than 60 years.(2)
Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can significantly accelerate your body’s metabolism, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability.(3)
Several treatment options are available if you have hyperthyroidism. Doctors use anti-thyroid medications and radioactive iodine to slow the production of thyroid hormones. Sometimes, treatment of hyperthyroidism involves surgery to remove part of your thyroid gland. Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated.(3)
Another medical condition that should be investigated in the presence of hyperthyroidism is celiac disease. An increased prevalence of celiac disease is found in people with hyperthyroidism and if celiac disease is the cause, a gluten-free diet can be used to successfully treat and resolve the problem. This information should be introduced to the doctor upon diagnosis of hyperthyroidism as the link has been made relatively recently and he or she probably would not have received this knowledge in medical school.
The Thyroid Gland
Your thyroid is a butterfly-shaped gland located at the base of your neck, just below your Adam’s apple. Although it weighs less than an ounce, the thyroid gland has an enormous impact on your health. Every aspect of your metabolism is regulated by thyroid hormones.
Your thyroid produces two main hormones, thyroxine and triiodothyronine, that influence every cell in your body. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate and help regulate the production of protein. Your thyroid also produces calcitonin, a hormone that helps regulate the amount of calcium in your blood.
How it all works
The rate at which thyroxine and triiodothyronine are released is controlled by your pituitary gland and your hypothalamus — an area at the base of your brain that acts as a thermostat for your whole system. Here’s how the process works:
The hypothalamus signals your pituitary gland to make a hormone called thyroid-stimulating hormone (TSH). Your pituitary gland then releases TSH — the amount depends on how much thyroxine and triiodothyronine are in your blood. If you don’t have enough thyroxine or triiodothyronine in your blood, your TSH blood level will be above normal; if you have too much, your TSH level will fall below normal. Finally, your thyroid gland regulates its production of hormones based on the amount of TSH it receives. (3)
Grave’s Disease, one form of hyperthyroidism, results from an autoimmune attack on the thyroid gland. Other types of hyperthyroidism are hyperfunctioning thyroid nodules that produce too much thyroxine for unknown reasons and thyroiditis, where the thyroid gland becomes inflamed for unknown reasons and produces too much thyroxine. (3)
Symptoms of Hyperthyroidism
Features of hyperthyroidism are diffuse non-tender goiter (enlarged thyroid gland), elevated blood levels of thyroxine hormone, suppressed blood levels of thyrotropin hormone (TSH), and the presence of thyroid receptor antibodies in the blood.(4)
Symptoms include various degrees of bulging eyeballs, staring, firm areas of edema or swellings of the lower legs in most patients, rapid pulse, increased blood pressure, palpitations, nervousness, depression, anxiety, heat intolerance, weight loss, thigh and upper arm weakness, brisk tendon reflexes, cardiac abnormalities and oligomenorrhea in females – infrequent or scanty menstruation.(4)
Hyperthyroidism, Gluten & Celiac Disease
According to a recent medical study of 111 people with hyperthyroidism, 4.5% had positive celiac disease antibodies, 14% had anti-gliadin antibodies and 3% had IgA deficiency.(4)
Anti-gliadin antibodies demonstrate a normal reaction to the abnormal presence of gluten in the blood. The high presence of anti-gliadin antibodies in thyroid disorders is likely related to gluten entering the bloodstream through the small intestine via “leaky gut.” Leaky gut can result from poorly digested gluten with or without celiac disease.
An immune-linked reason for the co-existence of hyperthyroidism and celiac disease revolves around the fact that both disorders (and several other diseases) share the immune system genetic markers HLA B-8 and HLA DR3. Individuals having these genetic markers can develop one or more of a certain cluster of diseases associated with these genes.(5)
The good news is that a strict gluten free diet can successfully treat hyperthyroidism in celiac disease.
Thyroid function should be assessed in all celiac disease patients at diagnosis and follow-up if clinically indicated. Screening of high-risk groups such as those with autoimmune thyroid disease is a reasonable strategy.(6)
If you have hyperthyroidism, be sure your doctor tests you for celiac disease and gluten sensitivity. Anti-gliadin antibody (AGA-IgA and AGA-IgG) tests for gluten sensitivity while EMA-IgA and EMA-IgG or tTG-IgA and tTG-IgG are specific tests for celiac disease. Testing that is based on IgA only would give a false negative result for individuals who are unable to produce IgA antibodies, that is, in IgA deficiency.
If your physician refuses or dismisses the idea of testing for celiac disease, please get a second opinion from a medical provider who is knowledgeable about celiac disease. The longer gluten is consumed, the greater will be its damaging effects on your body.
Celiac disease is a hereditary, auto-immune disorder estimated to affect 1% of the human population (3 million in the US). Less than 3 % are estimated to be medically diagnosed, but numbers are expected to rapidly increase as diagnosis improves. Celiac disease is caused by the ingestion of wheat, barley, rye and oats and treated by removing these items from the diet. Signs, symptoms, associated disorders and complications can affect any part of the body and removal of the offending foods can result in complete recovery.
1. Encyclopedia Britannica, http://www.britannica.com/bps/additionalcontent/18/39149704/Hyperthyroidism
2. American Academy of Family Physicians, http://www.aafp.org/afp/20050815/623.html
3. Mayo Clinic, http://www.mayoclinic.com/health/hyperthyroidism/DS00344
4. Cleo J. Libonati, RN, BSN. Recognizing Celiac Disease. Fort Washington, PA, USA: Gluten Free Works Publishing, 2007.
5. Grave’s Disease and Gluten Sensitivity Enteropathy (GSE). Elaine Moore. http://www.suite101.com/article.cfm/graves_disease/54749
6. Ch’ng CL, Keston Jones M, Kingham JGC. Celiac disease and autoimmune thyroid disease. Clinical Medicine & Research. May 2007; 5(3)184-192.
Author Information: John Libonati, Philadelphia, PA
President-elect, Celiac Sprue Association (CSA).
Editor & Publisher, Recognizing Celiac Disease.
John can be reached at firstname.lastname@example.org.