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Gemma, a 30-year-old woman from Windsor, had been suffering with ill health for over a decade by the time she attended an appointment with her GP in July 2018.
Aged 14-17 years, Gemma had multiple presentations to primary care, due to abdominal cramping and stomach upset in connection with food intake. At this time, the GP advised her to ensure she ate a healthy and varied diet, including plenty of fibre.
At the age of 19 years, Gemma presented to her GP again, with difficulty eating, abdominal pain, mild diarrhoea, and general malaise/fatigue. Her full blood count and haematinics were normal, and she was referred for a colonoscopy which did not discover any abnormalities. The GP told Gemma that the most likely cause of her symptoms was irritable bowel syndrome (IBS), and no further investigations were performed.
Gastrointestinal symptoms alone cannot accurately differentiate celiac disease from IBS;1 organic diseases such as celiac disease should be ruled out before a diagnosis of IBS is made.2
Celiac disease has a prevalence of 1 percent in the general population,3 and up to 4.7 percent in patients who were diagnosed with IBS based on symptom criteria.4
Between the ages of 23 and 29 years, Gemma had three complicated pregnancies. With all three, she suffered with intense pruritis during the last two trimesters, with very high levels of serum bilirubin and alanine aminotransferase. Intrahepatic cholestasis of pregnancy was determined to be the cause, and the pruritis spontaneously resolved in the postnatal period. All three children were born prematurely.
Celiac disease is associated with high miscarriage rates, intrauterine growth retardation, low birth weight, and preterm birth.5
Gemma's endocrinologist ran further thyroid-function and antibody tests and found that she had subclinical Hashimoto's thyroiditis. This did not require treatment but was to be reviewed on a 3-monthly basis.
The prevalence of celiac disease in patients with autoimmune thyroid disease is 2-5 percent.9
By mid-2020, Gemma had completed 1 year of a strict gluten-free diet. Her bowel habits were much improved, but she still suffered with muscle pain, dry skin, malaise/fatigue, and depression.
Her tTG IgA levels were falling (43 U/mL, 4x ULN), but TSH was still elevated and FT4 had dropped below the lower limit of normal. She was subsequently diagnosed with hypothyroidism secondary to Hashimoto's thyroiditis, and began treatment with levothyroxine.
It is common practice for tTG IgA to be tested every 3 months, until normalised, and once a year as an indicator of diet adherence.6
These results together with this patient's case history and symptoms, help confirm the diagnosis.
Test | Type | <Patients Name> Results |
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