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Celiac Disease: An Important Comorbibity Associated With Type 1 Diabetes

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	PRESENTATION

 
A.M. is a 33-year-old white woman with a history of type 1 diabetes diagnosed at 19 years and complicated by microalbuminuria. She was treated with multiple insulin injections until 2003, when she started on insulin pump therapy. Her hemoglobin A_1c (A1C) levels have ranged between 7.0 and 7.5% during the past 3 years. She has history of anxiety disorder and tobacco use.

During a clinic visit, A.M. complained of a slow, steady weight loss of 20 lb during the past year. She admitted to rare postprandial bloating and some early satiety, but no diarrhea. She reported no significant changes in her diet or exercise and denied any changes in her bowel movements, nausea, fever, night sweating, skin hyperpigmentation, lightheadedness, or dizziness after standing.

Her physical examination revealed a thin, well-nourished young woman. She had no goiter, no ophthalmopathy, no hyperhidrosis, and no tremor. Laboratory tests, including hematocrit and hemoglobin, creatinine, potassium, and sodium measurement were all normal. She had no evidence of iron deficiency anemia and a normal complete blood count. Her liver function tests were normal, as were levels of vitamin B₁₂, folate, and calcium. Her thyroid function tests revealed a morning cortisol of 10.3 mg/dl, thyroid-stimulating hormone (TSH) level of < 0.01 mU/ml (normal range: 0.6-3.3), total triiodothyronine (TT3) level of 1.9 nmol/l (normal range: 1.0-1.7), and thyroxine (T4) level of 9.2 µg/dl (normal range: 5.5-11).

The patient was started on 50 mg propylthiouracil (PTU) three times daily. After 4 months of therapy, her TSH level was 0.32 mU/ml, TT3 was 1.6 nmol/l, and TT4 was 8.6 µg/dl. She has continued on PTU.

A.M. was still concerned about her difficulties gaining weight. She reported a good appetite. Because of her persistent weight loss despite improvement in thyroid function studies, immunoglobulin A (IgA) antiendomysial antibodies were checked, with . . . [Full Text of this Article]

	QUESTIONS

 

	COMMENTARY

 

	CLINICAL PEARLS

 

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