Ties between autoimmune disorders, tests, and what to ask the doc

June 6, 2018 10:40 AM

You are not my doctor, I have doctor appointments. I am looking for anecdotes, experiences, ways to approach an upcoming doctor appointment, and how to handle discussions with my current GP. RE: Hashimoto, hypothyroid, and a positive Celiac blood test.

Hi all. Thank you in advance for any advice you can give me. I appreciate you are not my doctors and I have upcoming appointments.

I understand that hypothyroid and Celiac can sometimes be comorbid. I understand that Celiac can sometimes be silent (as in, no gastrointestinal symptoms). The short question here is could a positive tTG, IgA be related to an elevated TSH.

I had a new GP take me off a long-standing dose of Armor Thyroid and put me on a much lower dose of levothyroxine. His reasoning was that Armor is not as controlled and rigorously manufactured, etc. I am not sure why he started me on such a low dose of levothyroxine, however.

I struggled and continue to struggle as he brings my TSH back down. While not astronomical by any stretch, it was a 30, where the lab used 0.5-4.0. range. That was in December, and we are just now halving that.

After he switched me, we waited a month and did a panel of tests that included the above TSH and the tTG, IgA. It came back a positive (17 on a 0-14.9 range). He now positively refers to me as having Celiac in all email correspondence. He referred me to a GI, who I will be seeing this coming week.

I would not have thought to even test for this, other than the idea that hypothyroid is somethimes paired with Celiac. I don't have any classic Celiac symptoms, and trust me, I would know. I am into the craft beer scene. So yes, I also have somewhat of a need to really figure this out, as I am socially and emotionally invested.

Before I go through the endoscopy/colonoscopy rodeo that is the definitive testing for Celiac, I would like to know if it is a reasonable thing to posit to the GI that I be retested and more thoroughly tested via the serology route after my TSH has leveled out. I keep hearing these things are related. Is it possible that they are related in that I got a positive because I was way out wack? Or is this line of thinking a non-starter?

posted by oflinkey to Health & Fitness (3 answers total)

Best answer: IANYD, I can't think of a plausible link between having an elevated TSH and a false positive tTG. When people say that Hashimoto's and Celiac are often linked or "paired," it's not because one causes or exacerbates the other, but because the same conditions tend to predispose patients to them (namely a lack of self tolerance, meaning the immune system attacking the body). The fact that you have Hashimoto's is what increases your likelihood of also having Celiac disease, not the degree to which your thyroid disease is managed or not.

Your tTG is certainly weakly positive and could easily be a false positive, but I do think you've earned an upper endoscopy for definitive testing via duodenal biopsy (a colonoscopy is not required for Celiac diagnosis). Untreated Celiac, even if you're not experiencing symptoms, can increase the risk for small bowel malignancies and nutrient deficiencies so it's worth looking into.
posted by telegraph at 11:07 AM on June 6, 2018 [6 favorites]

I agree with everything telegraph said. Am I reading it correctly that 17 refers to your TSH number?

re: getting your TSH retested by the GI--that won't matter per telegraph's explanation. Seconding that celiac diagnosis requires only an upper endocscopy. You just have to abstain from eating for a certain amount of time, much more pleasant than the prep required for a colonoscopy! Get the endoscopy done. That way you'll know for sure.
posted by purple_bird at 2:36 PM on June 6, 2018

I'm eager to hear how your upcoming appts and tests go, please update if you are so inclined. I'm also asymptomatic celiac and hypothyroid, though not Hashimoto's. Something to consider is that Armour provides both T3 (liothyronine) as well as T4 (levothyroxine), and some people need both. I personally didn't notice a difference when I tried to add T3, however.

I've seen it estimated that there are roughly 5 undiagnosed asymptomatic (silent) celiac sufferers for every one with classic symptoms. A couple of other conditions to watch out for are iron deficiency anemia and H pylori infection. I've gotten the impression that there's a LOT left unknown about celiac and thyroid conditions, and it can feel like that gap is ignored once you are told to go on a gluten free diet and T4 supplement.
posted by sapere aude at 1:37 PM on June 7, 2018