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Association of autoimmune thyroid diseases, chronic atrophic gastritis and gastric carcinoid: experience from a single institution

The commonly reported low stomach acid in hypothyroidism tends to be regarded as minor, and something that will resolve with adequate thyroid hormone.

Sadly, for all too many, stomach issues continue, regardless of adequacy of thyroid hormones. Earlier today I was reminded that hypergastrinaemia is a far more significant issue than many think, and also very often totally missed. I ask, how many here have had their gastrin levels checked?

Worse still, the potential outcome of hypergastrinaemia is serious - as identified in this paper (abstract below):

J Endocrinol Invest. 2016 Jul;39(7):779-84. doi: 10.1007/s40618-016-0445-5. Epub 2016 Feb 29.

Association of autoimmune thyroid diseases, chronic atrophic gastritis and gastric carcinoid: experience from a single institution.

Castoro C1, Le Moli R1, Arpi ML2, Tavarelli M1, Sapuppo G1, Frittitta L1, Squatrito S1, Pellegriti G3.

Author information

1Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.

2Endocrinology, Garibaldi-Nesima Hospital, Via Palermo n. 636, 95126, Catania, Italy.

3Endocrinology, Garibaldi-Nesima Hospital, Via Palermo n. 636, 95126, Catania, Italy.



Autoimmune polyendocrine syndromes (APS) type III are characterized by the association of autoimmune thyroid disease (ATD) with other autoimmune diseases such as diabetes, alopecia, pernicious anemia, vitiligo and chronic atrophic gastritis. A strong association between ATD and atrophic gastritis (AG) has been demonstrated. Moreover 10 % of patients affected by AG have a predisposition to develop gastric carcinoid and adenocarcinoma as a result of chronic hypergastrinemia caused by achlorhydria and subsequent ELC cells neoplastic transformation.


The aim of the study is to evaluate, in a consecutive series of patients followed for ATD in our outpatients clinic, the prevalence of AG. In the period 2004-2014, 242 patients with ATD underwent a screening performing APCA, Vitamin B12, ferritin, iron, and hemoglobin and red cells count measurements with subsequent gastroscopy in case of APCA positivity.


We found 57/242 (23.5 %) patients with APCA positivity. Of these patients 33/57 (57.8 %), 31 F and 2 M, were affected by Graves disease; 24/57 (42.1 %) 21 F and 3 M by Hashimoto thyroiditis; 10/57 (17.5 %) presented with anemia, 14/57 (24.5 %) with vitamin B12 deficiency, 9/57 (15.7 %) with iron deficiency. In 2/57 a gastric carcinoid was found.


Our data confirm the high association rate of AG in ATD which frequently is not an isolated disease but configure the picture of APS type III and need to be followed accordingly. An early diagnosis may be useful for diagnosis of gastric carcinoids and to explain and treat a gastric related L-thyroxine malabsorption and presence of chronic unexplained anemia.


Autoimmune disease; Autoimmune gastritis; Carcinoid; Graves’ disease; Thyroid disease

PMID: 26928404

DOI: 10.1007/s40618-016-0445-5

12 Replies

Both of my endo's say there is no such thing, so that's helpful!

I take Betaine HCL and digestive enzymes, without both I would be in pain after eating.


Yes, I was like that Shambles. Things have improved with optimal thyroid hormone and time, but protein still proves a challenge to digest .... so I still sometimes take Betaine & digestive enzymes.

I think very long term undiagnosed hypothyroidism, even adequately replaced can make only substandard levels of recovery possible in some cases.


With little to no support from doctors it's all very tricky to monitor.

My concern is that once you start taking supplements, that it might be the case that your system becomes, well, lazy and stops doing what its supposed to do. But I have no evidence to support that.



There is thought that introducing gastric acid (Betaine HCL with Pepsin) will encourage own to start working. Mine has improved but who actually knows without measuring the impossible ? ? ...

Something so important to our gut health and digestion that is missing, obviously requires replacing, so whether it actually encourages secretion or not (I think) is irrelevant but a bonus should it happen.

I am pleased you are finding Betaine helpful as managing our symptoms is key to improvement.


Thanks for this very important topic Helvella. I have three of these autoimmune conditions and my Mother who had P.A. died of stomach cancer not helped by the fact that they stopped her B12 injections about three years previously and told her she didn't need them anymore!


Thanks for posting this Helvella - would be a good one for you to post on the PA site too?


thanks for posting this information Helvella. really good to know all this as I have just finished a month's worth of ferrous fumarate and will have blood test tomorrow to see if I have improved or not.


You should really only have iron or iron-related blood tests after being off supplements for at least 5 days. Otherwise there is a risk you are just measuring what was in your pills.

Also, iron tests should be done first thing in the morning, fasting (except for water).


humanbean It has been just over a week since I finished them, but unfortunately I do not have blood test until noon tomorrow. I will educate them for the next one. I did know about the five days and they did too. Will try and have early breakfast and hope it will be alright. Thanks for this information.

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The need for fasting is given here :

I disagree with the 24 hours they mention and prefer what STTM says which mentions 5 days, which you already know, but I'm giving the links for anyone else who doesn't. :)

b) For iron, we learned to be off for 5 days based on information from the Iron Institute, i.e. to see what we are “holding onto”.

Source :

I wish STTM would give the source from the Iron Institute they mention. I'd like to read it myself.

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humanbean many thanks for this information. it is good that it is NHS Choices as I shall be taking it to show surgery tomorrow. I guess if I have breakfast that does not include iron this might be good enough for tomorrow. I do not think it is the end of the ferrous fumarate by a long shot, so I am not putting too much importance on it. Can't find my blood tests and cannot remember what the level was. I know Intrinsic Value was 2 (0 - 24) but not what ferritin was. I'm not on the floor yet so will try to improve things supplement wise. I'm grateful for your input.

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For one thing, how are they determining that the patients is properly treated on thyroid meds? TSH and labs? There are alternative and old fashioned mainstream doctors, that say the resolution of symptoms, is the best way to know if treatment is optimal. I have not met one doctor, out of 50, who knew what Hypo looked like, all they know is labs and interpret them incorrectly as well. Also, when hypo or with hashi's low cortisol and Growth Hormone, play a huge roll in digestion too. They are also saying that this is autoimmune in nature..which according to functional medicine, most autoimmune disease can be reversed or put into permanent remission, through address a few things like diet and healing the immune system through healing the gut.

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