Associated Conditions: What Else to Watch For

Celiac disease is an autoimmune condition. And autoimmune conditions tend to cluster. If you have one, you’re at higher risk for others.

Here’s what to watch for and why regular monitoring matters.

The Autoimmune Connection

Your immune system has mistargeted gluten. Unfortunately, immune systems that make one mistake sometimes make others.

Celiac disease is associated with increased risk of several other autoimmune conditions. “Associated” doesn’t mean you’ll get them, just that your risk is higher than average.

Thyroid Disease

The most common association. Celiacs have 3-4x higher risk of thyroid autoimmunity.

Two main types:

Hashimoto’s thyroiditis (hypothyroid):

• Your immune system attacks your thyroid
• Results in low thyroid function
• Symptoms: fatigue, weight gain, cold intolerance, constipation, dry skin

Graves’ disease (hyperthyroid):

• Less common than Hashimoto’s
• Results in overactive thyroid
• Symptoms: weight loss, rapid heartbeat, anxiety, heat intolerance

What to do: Get thyroid function tested (TSH, and possibly free T4 and antibodies) at diagnosis and periodically. Many doctors recommend annual screening for celiacs.

Type 1 Diabetes

Type 1 diabetes and celiac share genetic risk factors. Both are autoimmune; both involve the HLA genes.

The connection:

• About 8% of people with Type 1 diabetes also have celiac
• About 3-5% of celiacs have or will develop Type 1 diabetes
• If you have both, managing diet is extra complicated

Symptoms to watch: Excessive thirst, frequent urination, unexplained weight loss, fatigue.

What to do: If you have risk factors (family history of Type 1), screening may be appropriate. Discuss with your doctor.

Other Autoimmune Conditions

Celiac is also associated with:

Autoimmune hepatitis: Inflammation of the liver without viral cause.

Primary biliary cholangitis: Autoimmune disease affecting bile ducts.

Sjögren’s syndrome: Dry eyes and mouth from immune attack on moisture-producing glands.

Addison’s disease: Autoimmune adrenal insufficiency (rare but serious).

Lupus and rheumatoid arthritis: Slightly elevated risk compared to general population.

Psoriasis and eczema: Skin-related autoimmune conditions, sometimes improve on GF diet.

Dermatitis Herpetiformis

DH is essentially “celiac of the skin.” It’s intensely itchy, blistering rash typically on elbows, knees, buttocks, back.

Key points:

• If you have DH, you have celiac (intestinal involvement may be minimal)
• GF diet treats DH, but skin takes longer to clear than GI symptoms
• Medication (dapsone) can help while waiting for diet to work

What to do: If you develop an itchy, blistering rash, see a dermatologist who can biopsy for DH.

Osteoporosis

Not autoimmune, but common in celiac due to malabsorption.

The problem: Celiac damage impairs calcium and vitamin D absorption. Bone density suffers.

Who’s at risk: Especially those diagnosed later in life, with more years of damage.

What to do:

• Get a bone density scan (DEXA) at diagnosis if you’re an adult
• Ensure adequate calcium and vitamin D intake
• Repeat testing based on results and doctor’s advice

Neurological Conditions

Celiac is associated with:

Peripheral neuropathy: Numbness, tingling, pain in hands and feet.

Gluten ataxia: Balance and coordination problems from immune attack on the cerebellum.

Migraines: Elevated rates in celiacs; sometimes improve on GF diet.

“Brain fog”: Not a medical diagnosis, but cognitive issues are common and often improve with GF diet.

What to do: If you have persistent neurological symptoms, mention celiac to your neurologist. Some neurological complications improve on GF diet; others require additional treatment.

Reproductive Issues

Untreated celiac is associated with:

• Infertility (in both men and women)
• Recurrent miscarriage
• Complications during pregnancy

The good news: These often resolve with strict GF diet.

What to do: If you’re having fertility issues, make sure your celiac is well-controlled.

Screening Recommendations

Based on these associations, here’s what many celiac experts recommend:

At diagnosis:

• Thyroid function (TSH)
• Bone density scan (adults)
• Liver function tests
• Complete blood count (anemia screening)
• Vitamin and mineral levels (iron, B12, D, folate)

Ongoing (annually or as indicated):

• Thyroid function
• Follow-up on any abnormalities
• Celiac antibody levels
• General wellness labs

If new symptoms appear:

• Don’t assume everything is celiac-related
• Investigate new symptoms with appropriate testing
• Consider autoimmune screening if symptoms suggest another condition

The Good News

Not everyone with celiac develops associated conditions. Many celiacs live their lives with just celiac to manage.

But knowing your risks lets you monitor appropriately. Early detection of thyroid disease, osteoporosis, or other conditions means earlier treatment and better outcomes.

Self-Advocacy

Some doctors aren’t aware of all celiac associations. You may need to ask:

• “Can I get my thyroid checked?”
• “Should I have a bone density scan?”
• “Could my symptoms be related to celiac or an associated condition?”

Bring this article or a list of associations if helpful. Advocate for appropriate screening.

Living with Awareness

Monitoring for associated conditions isn’t about living in fear. It’s about informed awareness.

Most celiacs won’t develop most of these conditions. But if one starts, catching it early makes all the difference.

Get your baselines. Do your periodic check-ups. And then go live your life.