Gluten-induced Enteropathy (coeliac Disease) Revealed by Resistance to Treatment with Levothyroxine and Alfacalcidol in a Sixty-eight-year-old Patient: a Case Report

We report the case of a female patient in whom gluten-induced enteropathy was revealed at the age of 68 years by resistance to treatment with levothyroxine and alfacalcidol. This case report shows that malabsorption without major digestive symptoms led to reduction of absorption of levothyroxine (LT(4)) and alfacalcidol, although the patient had normal free thyroxine (T(4)) levels (which increased by 45.8% after a loading dose of 250 microg of levothyroxine), high thyrotropin (TSH) and slightly elevated 1.25 dihydroxy-vitamin D(3) levels, low free triiodothyronine (T(3)) and calcium levels were found. Malabsorption had additional effects by reducing T(3) and calcium levels. Because minor forms of gluten-induced enteropathy are not rare in patients with thyroid autoimmune diseases, the cost-effectiveness of using antigliadin antibodies as a first-line test (instead of an LT(4) loading test) in patients requiring daily doses of levothyroxine above 2 microg per kg of body weight, whatever their age may be, is discussed.