graph LR
Achlorhydria["Achlorhydria"]
CD4+_T_Cell_Mediated_Autoimmune_Response_Against_the_Gastric_Proton_Pump["CD4+ T Cell-Mediated Autoimmune Response Against the Gastric Proton Pump"]
Peripheral_Neuropathy["Peripheral Neuropathy"]
Somatostatin_Analog_Therapy["Somatostatin Analog Therapy"]
Parietal_Cell_Destruction_and_Oxyntic_Atrophy["Parietal Cell Destruction and Oxyntic Atrophy"]
Intrinsic_Factor_Deficiency_and_B12_Malabsorption["Intrinsic Factor Deficiency and B12 Malabsorption"]
Hypergastrinemia_and_ECL_Cell_Hyperplasia["Hypergastrinemia and ECL Cell Hyperplasia"]
Hypergastrinemia["Hypergastrinemia"]
Netazepide_Gastrin_CCK2_Receptor_Antagonist["Netazepide (Gastrin/CCK2 Receptor Antagonist)"]
Glossitis["Glossitis"]
Atrophic_Gastritis["Atrophic Gastritis"]
Endoscopic_Resection_of_Gastric_Neuroendocrine_Tumors["Endoscopic Resection of Gastric Neuroendocrine Tumors"]
Iron_Deficiency_Anemia["Iron Deficiency Anemia"]
Gastric_Adenocarcinoma["Gastric Adenocarcinoma"]
Pernicious_Anemia["Pernicious Anemia"]
Gastric_Neuroendocrine_Tumor["Gastric Neuroendocrine Tumor"]
CD4+_T_Cell_Mediated_Autoimmune_Response_Against_the_Gastric_Proton_Pump --> Parietal_Cell_Destruction_and_Oxyntic_Atrophy
Parietal_Cell_Destruction_and_Oxyntic_Atrophy --> Atrophic_Gastritis
Parietal_Cell_Destruction_and_Oxyntic_Atrophy --> Achlorhydria
Parietal_Cell_Destruction_and_Oxyntic_Atrophy --> Iron_Deficiency_Anemia
Parietal_Cell_Destruction_and_Oxyntic_Atrophy --> Intrinsic_Factor_Deficiency_and_B12_Malabsorption
Parietal_Cell_Destruction_and_Oxyntic_Atrophy --> Hypergastrinemia_and_ECL_Cell_Hyperplasia
Parietal_Cell_Destruction_and_Oxyntic_Atrophy --> Gastric_Adenocarcinoma
Intrinsic_Factor_Deficiency_and_B12_Malabsorption --> Pernicious_Anemia
Intrinsic_Factor_Deficiency_and_B12_Malabsorption --> Peripheral_Neuropathy
Intrinsic_Factor_Deficiency_and_B12_Malabsorption --> Glossitis
Hypergastrinemia_and_ECL_Cell_Hyperplasia --> Hypergastrinemia
Hypergastrinemia_and_ECL_Cell_Hyperplasia --> Gastric_Neuroendocrine_Tumor
Netazepide_Gastrin_CCK2_Receptor_Antagonist --> Gastric_Neuroendocrine_Tumor
Endoscopic_Resection_of_Gastric_Neuroendocrine_Tumors --> Gastric_Neuroendocrine_Tumor
Somatostatin_Analog_Therapy --> Gastric_Neuroendocrine_Tumor
style Achlorhydria fill:#fef3c7
style CD4+_T_Cell_Mediated_Autoimmune_Response_Against_the_Gastric_Proton_Pump fill:#dbeafe
style Peripheral_Neuropathy fill:#fef3c7
style Somatostatin_Analog_Therapy fill:#fce7f3
style Parietal_Cell_Destruction_and_Oxyntic_Atrophy fill:#dbeafe
style Intrinsic_Factor_Deficiency_and_B12_Malabsorption fill:#dbeafe
style Hypergastrinemia_and_ECL_Cell_Hyperplasia fill:#dbeafe
style Hypergastrinemia fill:#fef3c7
style Netazepide_Gastrin_CCK2_Receptor_Antagonist fill:#fce7f3
style Glossitis fill:#fef3c7
style Atrophic_Gastritis fill:#fef3c7
style Endoscopic_Resection_of_Gastric_Neuroendocrine_Tumors fill:#fce7f3
style Iron_Deficiency_Anemia fill:#fef3c7
style Gastric_Adenocarcinoma fill:#fef3c7
style Pernicious_Anemia fill:#fef3c7
style Gastric_Neuroendocrine_Tumor fill:#fef3c7
graph LR
Selenium_Deficiency["Selenium Deficiency"]
CTLA4["CTLA4"]
Iodine_Excess["Iodine Excess"]
Free_T4["Free T4"]
Autoimmune_Thyroid_Destruction["Autoimmune Thyroid Destruction"]
Thyroglobulin_Hyperiodination_and_Neoantigen_Formation["Thyroglobulin Hyperiodination and Neoantigen Formation"]
LAG3["LAG3"]
Hepatitis_C_Virus_Infection["Hepatitis C Virus Infection"]
Depression["Depression"]
Vitamin_D_Deficiency["Vitamin D Deficiency"]
Loss_of_Immune_Tolerance_to_Thyroid_Antigens["Loss of Immune Tolerance to Thyroid Antigens"]
Dry_Skin["Dry Skin"]
Impaired_Vitamin_D_Dependent_Immune_Tolerance["Impaired Vitamin D-Dependent Immune Tolerance"]
Low_Vitamin_D_Intake_and_Cutaneous_Synthesis["Low Vitamin D Intake and Cutaneous Synthesis"]
Thyroid_Hormone_Deficiency["Thyroid Hormone Deficiency"]
Constipation["Constipation"]
Vitamin_D_Supplementation["Vitamin D Supplementation"]
NF_κB_IL_6_Signaling_Pathway_Activation["NF-κB-IL-6 Signaling Pathway Activation"]
Hypothyroidism["Hypothyroidism"]
Goiter["Goiter"]
Hepatitis_C_Virus_Associated_Thyroid_Immune_Activation["Hepatitis C Virus-Associated Thyroid Immune Activation"]
Cold_Intolerance["Cold Intolerance"]
Weight_Gain["Weight Gain"]
Thyrocyte_Antigen_Presentation["Thyrocyte Antigen Presentation"]
Hashitoxicosis["Hashitoxicosis"]
Anti_Thyroglobulin_Antibodies["Anti-Thyroglobulin Antibodies"]
Selenium_Supplementation["Selenium Supplementation"]
TSH["TSH"]
Levothyroxine["Levothyroxine"]
PTPN22["PTPN22"]
Low_Dietary_Selenium_Intake["Low Dietary Selenium Intake"]
Lymphocytic_Infiltration["Lymphocytic Infiltration"]
Anti_TPO_Antibodies["Anti-TPO Antibodies"]
Thyroidal_Oxidative_Stress_from_Selenoprotein_Insufficiency["Thyroidal Oxidative Stress from Selenoprotein Insufficiency"]
Fatigue["Fatigue"]
Thyroglobulin_Hyperiodination_and_Neoantigen_Formation --> Loss_of_Immune_Tolerance_to_Thyroid_Antigens
Thyroidal_Oxidative_Stress_from_Selenoprotein_Insufficiency --> Loss_of_Immune_Tolerance_to_Thyroid_Antigens
Impaired_Vitamin_D_Dependent_Immune_Tolerance --> Loss_of_Immune_Tolerance_to_Thyroid_Antigens
Hepatitis_C_Virus_Associated_Thyroid_Immune_Activation --> Loss_of_Immune_Tolerance_to_Thyroid_Antigens
Loss_of_Immune_Tolerance_to_Thyroid_Antigens --> Thyrocyte_Antigen_Presentation
Loss_of_Immune_Tolerance_to_Thyroid_Antigens --> Lymphocytic_Infiltration
Thyrocyte_Antigen_Presentation --> Lymphocytic_Infiltration
Autoimmune_Thyroid_Destruction --> Thyroid_Hormone_Deficiency
Autoimmune_Thyroid_Destruction --> Hashitoxicosis
Lymphocytic_Infiltration --> Autoimmune_Thyroid_Destruction
Lymphocytic_Infiltration --> Goiter
NF_κB_IL_6_Signaling_Pathway_Activation --> Lymphocytic_Infiltration
Thyroid_Hormone_Deficiency --> Hypothyroidism
Vitamin_D_Deficiency --> Impaired_Vitamin_D_Dependent_Immune_Tolerance
Selenium_Deficiency --> Thyroidal_Oxidative_Stress_from_Selenoprotein_Insufficiency
Hypothyroidism --> Fatigue
Hypothyroidism --> Weight_Gain
Hypothyroidism --> Cold_Intolerance
Hypothyroidism --> Dry_Skin
Hypothyroidism --> Constipation
Hypothyroidism --> Depression
Iodine_Excess --> Thyroglobulin_Hyperiodination_and_Neoantigen_Formation
Low_Dietary_Selenium_Intake --> Selenium_Deficiency
Hepatitis_C_Virus_Infection --> Hepatitis_C_Virus_Associated_Thyroid_Immune_Activation
Low_Vitamin_D_Intake_and_Cutaneous_Synthesis --> Vitamin_D_Deficiency
Levothyroxine --> Thyroid_Hormone_Deficiency
Selenium_Supplementation --> Autoimmune_Thyroid_Destruction
Vitamin_D_Supplementation --> Autoimmune_Thyroid_Destruction
Thyroid_Hormone_Deficiency -.-> TSH
Thyroid_Hormone_Deficiency -.-> Free_T4
Autoimmune_Thyroid_Destruction -.-> Anti_TPO_Antibodies
Autoimmune_Thyroid_Destruction -.-> Anti_Thyroglobulin_Antibodies
CTLA4 --> Loss_of_Immune_Tolerance_to_Thyroid_Antigens
PTPN22 --> Loss_of_Immune_Tolerance_to_Thyroid_Antigens
LAG3 --> Loss_of_Immune_Tolerance_to_Thyroid_Antigens
style Selenium_Deficiency fill:#fef3c7
style CTLA4 fill:#f3e8ff
style Iodine_Excess fill:#dcfce7
style Free_T4 fill:#e0e7ff
style Autoimmune_Thyroid_Destruction fill:#dbeafe
style Thyroglobulin_Hyperiodination_and_Neoantigen_Formation fill:#dbeafe
style LAG3 fill:#f3e8ff
style Hepatitis_C_Virus_Infection fill:#dcfce7
style Depression fill:#fef3c7
style Vitamin_D_Deficiency fill:#fef3c7
style Loss_of_Immune_Tolerance_to_Thyroid_Antigens fill:#dbeafe
style Dry_Skin fill:#fef3c7
style Impaired_Vitamin_D_Dependent_Immune_Tolerance fill:#dbeafe
style Low_Vitamin_D_Intake_and_Cutaneous_Synthesis fill:#dcfce7
style Thyroid_Hormone_Deficiency fill:#dbeafe
style Constipation fill:#fef3c7
style Vitamin_D_Supplementation fill:#fce7f3
style NF_κB_IL_6_Signaling_Pathway_Activation fill:#dbeafe
style Hypothyroidism fill:#fef3c7
style Goiter fill:#fef3c7
style Hepatitis_C_Virus_Associated_Thyroid_Immune_Activation fill:#dbeafe
style Cold_Intolerance fill:#fef3c7
style Weight_Gain fill:#fef3c7
style Thyrocyte_Antigen_Presentation fill:#dbeafe
style Hashitoxicosis fill:#fef3c7
style Anti_Thyroglobulin_Antibodies fill:#e0e7ff
style Selenium_Supplementation fill:#fce7f3
style TSH fill:#e0e7ff
style Levothyroxine fill:#fce7f3
style PTPN22 fill:#f3e8ff
style Low_Dietary_Selenium_Intake fill:#dcfce7
style Lymphocytic_Infiltration fill:#dbeafe
style Anti_TPO_Antibodies fill:#e0e7ff
style Thyroidal_Oxidative_Stress_from_Selenoprotein_Insufficiency fill:#dbeafe
style Fatigue fill:#fef3c7
name: com_Autoimmune_Gastritis__Hashimotos_Thyroiditis
creation_date: '2026-07-01T00:00:00Z'
curation_status: CANDIDATE
notes: >-
Thyrogastric syndrome: the frequent co-occurrence of autoimmune (atrophic)
gastritis and autoimmune thyroid disease (Hashimoto thyroiditis) is the most
characteristic polyautoimmune pairing for autoimmune gastritis, reflecting a
shared organ-specific autoimmune susceptibility. Autoimmune gastritis also
clusters with type 1 diabetes mellitus and vitiligo; those pairings could be
captured as additional comorbidity entries.
disease_a:
slug: Autoimmune_Gastritis
preferred_term: Autoimmune Gastritis
term:
id: MONDO:0031014
label: autoimmune gastritis
disease_b:
slug: Hashimotos_Thyroiditis
preferred_term: Hashimoto thyroiditis
term:
id: MONDO:0007699
label: Hashimoto thyroiditis
directionality: BIDIRECTIONAL
literature_evidence:
- reference: PMID:31864909
reference_title: "Thyro-entero-gastric autoimmunity: Pathophysiology and implications for patient management."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "autoimmune thyroid disorders, in particular Hashimoto's thyroiditis, may be frequently associated with other organ-specific, immune-mediated disorders, such as autoimmune atrophic gastritis or celiac disease."
explanation: Establishes the frequent association of Hashimoto thyroiditis with autoimmune atrophic gastritis - the thyrogastric syndrome.
- reference: PMID:28102858
reference_title: "Luminescent Immunoprecipitation System (LIPS) for Detection of Autoantibodies Against ATP4A and ATP4B Subunits of Gastric Proton Pump H+,K+-ATPase in Atrophic Body Gastritis Patients."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "prevalence of ~2% in the general population and up to 10% in patients with other autoimmune diseases, such as type I diabetes or autoimmune thyroid disease."
explanation: Autoimmune gastritis prevalence rises to ~10% among patients with other autoimmune diseases, including autoimmune thyroid disease.
hypotheses:
- description: >-
Shared organ-specific autoimmune susceptibility - HLA class II haplotypes plus
non-HLA loci such as PTPN22 - predisposes to both autoimmune gastritis and
autoimmune thyroid disease, manifesting as thyrogastric polyautoimmunity rather
than one condition causing the other.
evidence:
- reference: PMID:34145262
reference_title: "Genome-wide association study identifies five risk loci for pernicious anemia."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "We conduct a genome-wide association study meta-analysis in 2166 cases and 659,516 European controls from population-based biobanks and identify genome-wide significant signals in or near the PTPN22"
explanation: The PTPN22/HLA susceptibility architecture of pernicious anemia / autoimmune gastritis is shared with other organ-specific autoimmune diseases including autoimmune thyroid disease.