Screening for celiac disease in Tunisian patients with Graves’ disease using anti-endomysium and anti-tissue transglutaminase antibodies

Summary Objective — Celiac disease (CD) can be associated with autoimmune thyroid diseases. The aim of this study was to screen for CD in patients with Graves’ disease in Tunisia. Patients and methods — Sera from 161 patients with Graves’ disease were tested for IgA class anti-endomysium antibodies (AEA) using indirect immunofluorescence on cryostat sections of human umbilical cord and for IgA class anti-human tissue transglutaminase antibodies (AtTG) by ELISA. Results — AEA were positive in 6 out of 161 (3.7%) patients with Graves’ disease and all 6 patients were also positive for AtTG. Four of these 6 patients with positive serological markers of CD underwent duodenal biopsy; three had marked villous atrophy, one has normal histological picture and two did not agree to undergo biopsy. The prevalence of biopsy confirmed CD in patients with Graves’ disease was 1.86% (3/161). Conclusion — Patients with Graves’ disease are at substantial risk of CD and therefore antibody screening for CD may be included in the work-up of these patients. Either AEA or AtTG may be used.