From the Guidelines
There is an association between celiac disease and hypoparathyroidism, particularly in the context of autoimmune polyglandular syndrome type 1 (APS-1), where multiple autoimmune conditions affect different endocrine glands. Patients with celiac disease have a higher risk of developing hypoparathyroidism compared to the general population, and conversely, individuals with hypoparathyroidism should be screened for celiac disease 1. This association is believed to be due to shared autoimmune mechanisms, where the immune system mistakenly attacks both the small intestine (in celiac disease) and the parathyroid glands (in hypoparathyroidism) 1. For patients with either condition, screening for the other is important, typically through blood tests measuring calcium, phosphate, and parathyroid hormone levels for hypoparathyroidism, and celiac antibodies (anti-tissue transglutaminase and anti-endomysial antibodies) for celiac disease 1. Early detection of both conditions is crucial as untreated celiac disease can worsen calcium absorption problems already present in hypoparathyroidism, potentially leading to more severe hypocalcemia and its complications. Some key points to consider include:
- The importance of a gluten-free diet in managing celiac disease and its potential impact on bone health 1
- The need for monitoring and potentially supplementing vitamin D and calcium in patients with celiac disease or hypoparathyroidism 1
- The role of parathyroid hormone (PTH) levels in assessing bone health and the potential for secondary hyperparathyroidism in patients with celiac disease 1
From the Research
Association Between Celiac Disease and Hypoparathyroidism
- There is evidence to suggest an association between celiac disease and hypoparathyroidism, with several studies reporting cases of patients with both conditions 2, 3, 4, 5, 6.
- A study published in 2000 reported a case of a middle-aged woman with hypoparathyroidism associated with celiac disease, which did not respond to dietary measures 2.
- Another study published in 2016 found that 6.4% of patients with idiopathic hypoparathyroidism had coeliac disease, and that a gluten-free diet improved calcaemic control in these patients 3.
- A case report published in 1994 described a patient with idiopathic hypoparathyroidism and celiac disease, and found that the patient's parathyroid immunoreactivity decreased to undetectable levels after starting a gluten-free diet 4.
- A study published in 2004 reported a case of a 62-year-old woman with idiopathic hypoparathyroidism and co-existing celiac disease, and found that a gluten-free diet led to an improvement in nutritional parameters and a reduction in calcium and vitamin D requirements 5.
- An earlier study published in 1982 suggested that coexisting celiac sprue is one of the mechanisms responsible for the malabsorption associated with idiopathic hypoparathyroidism, and emphasized the importance of intestinal biopsy in evaluating malabsorption in patients with idiopathic hypoparathyroidism 6.
Clinical Implications
- The association between celiac disease and hypoparathyroidism has important clinical implications, as patients with hypoparathyroidism may require variable doses of calcium and vitamin D, and coexisting celiac disease may affect the absorption of these nutrients 3.
- A gluten-free diet may be beneficial for patients with hypoparathyroidism and coexisting celiac disease, as it can improve calcaemic control and reduce the risk of malabsorption 3, 4, 5.
- Healthcare providers should be aware of the potential association between celiac disease and hypoparathyroidism, and consider screening patients with hypoparathyroidism for celiac disease, particularly if they have symptoms of malabsorption or are not responding to treatment 2, 3, 4, 5, 6.