Endocrine Abstracts

Introduction: Our current local management guidelines for Graves’ Disease (GD) in children and young people (CYP) do not include routine screening for coeliac disease (CD). However, ad hoc testing of patients in this cohort pointed to a high incidence of positive tissue transglutaminase (TTG) results.

Aims/Objectives: 1. To determine the incidence of CD in patients in our service diagnosed with GD. 2. To establish if a review of our GD management guideline was needed.

Methods: We reviewed the results of all patients aged 0-17 years in our service diagnosed with GD (TSH-receptor antibody positive, with biochemical thyrotoxicosis) between 01/01/2010-31/12/2022 - 13 years inclusive. We undertook a review of the literature in this field.

Results: n=41 patients fulfilled the inclusion criteria and had a full data set. 78% were female, and the age range was 3-17 years, with a mode and median of 12-15years (n=23). The peak incidence of GD diagnosis was 2020 and 2021 (7 per each year), which coincided with the COVID-19 pandemic.

Coeliac serology:: 54% of our patients with GD (n=22/41) had been tested for coeliac (TTG- analysis). Of these, 23% (n=5/22) were positive and diagnosed with CD.

Discussion: The general population incidence of CD is about 1%. A 2016 meta-analysis of the prevalence of CD in autoimmune thyroid disease (Hashimoto’s and Graves’) showed an overall incidence of 6.2% in CYP. In a further study looking specifically at coeliac disease in CYP with Graves’ disease, Larizza et al., found the incidence was 4.6% (n=1/22). A review of current guidelines in this field showed that the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines for the diagnosis of CD advocate screening in patients with GD; and an Italian paper by Beteerle et al. suggests screening at diagnosis and every 2-3 years if negative.

Conclusion: Based on the findings from our review, which confirm the high incidence of CD in CYP with GD, and in line with the ESPGHAN guidelines, we have now modified our management guidelines to include screening for CD in all CYP with GD, at diagnosis and ever 2-3 years thereafter.