Evidence of Transient IgA Anti-Endomysial Antibody Positivity in a Patient with Graves’ Disease

Abstract

Background: Anti-endomysial antibodies (EmA) have been shown to have a high specificity and sensitivity in celiac disease (CD) diagnosis, and their use is considered effective in improving the diagnostic accuracy of CD screening. Aims: To report the clinical details of transient IgA EmA positivity in a patient with Graves’ disease. Methods: We screened 48 patients (7 males, age range 19–79, median 58.3 years) for CD. They were hospitalized for thyroid disorders (30 patients had autoimmune hypothyroidism and 18 had Graves’ disease with clinical hyperthyroidism associated with diffuse goitre). CD screening was carried out on all patients by assaying serum anti-gliadin antibodies (AGA) and EmA. Results: None of the 48 patients in our study were positive for IgA and/or IgG-class AGA and none showed IgA deficiency. Only 1 patient was positive for EmA; however, intestinal biopsy in this subject was normal both when thyroiditis was first diagnosed and subsequently after 2 and 3 years. Furthermore, EmA became negative after 2 years. New gastroenterological investigations performed 3 years after the diagnosis confirmed the normal intestinal histology and absorption capacity. Moreover, AGA, EmA and tissue transglutaminase antibodies were negative. Conclusions: This study underlines the possibility of transient EmA positivity without any signs of CD in patients with autoimmune thyroid disorders.