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.
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. firstname.lastname@example.org.
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