**4.1 Hashimoto's thyroiditis**

10 Autoimmune Disorders – Current Concepts and Advances from Bedside to Mechanistic Insights

Positivity for disease-related antibodies allows identification of patients with suspected celiac disease who must undergo intestinal biopsy. IgA-transglutaminase antibodies show the highest sensitivity and allow to identify around 98% of patients with celiac disease, while their specificity is lower, especially at a low titer (Salardi et al., 2008). IgA-antiendomysial antibodies show lower sensitivity (98%) but higher specificity. Fluctuating positivity for anti-endomysial antibodies at a low titer can be detected at time of diabetes clinical onset, and in absence of signs or symptoms related to celiac disease only periodical

Total IgA screening is mandatory before celiac disease-related antibodies detection. Patients with IgA deficiency benefit from IgG anti-transglutaminase antibody detection (Lenhardt et al., 2004) and, as recently reported, by IgG anti-deaminated gliadin peptides (Volta et al., 2010). IgA deficiency deserves attention, since this condition is more frequent in patients with celiac disease (1.7%) as compared to control population (0.25%)(Cataldo et al., 1997). As regards timing of screening, it has been reported that the serological screening of celiac disease allows diagnosing 1% of patients with celiac disease. The frequency of diagnoses increases to 5% when screening is performed in the next 5 years after diabetes diagnosis (Larsson et al., 2008). It has been reported that up to 85% of cases of celiac disease is diagnosed 2-5 years after type 1 diabetes clinical onset (Saukkonen et al., 1996). Markers of celiac disease can appear within 10 years, so it is recommended to perform screening yearly for the first 4 years after diabetes diagnosis, and every 2 years in the following 6 years

Fig. 1. Linear growth in a girl with type 1 diabetes and concomitant celiac disease, who

Diagnosis of celiac disease by intestinal biopsy requires a lifelong gluten-free diet. Major problems related to gluten-free diet include quality of life, impairment of social life, poor compliance especially in adolescents and in patients with silent celiac disease diagnosed

screening is recommended .

(Kordonouri et al., 2009).

developed autoimmune thyroiditis
