P-069 Severe Diarrhea Following Tirzepatide Therapy in a Woman With Celiac Disease

Abstract Introduction Tirzepatide, a dual GLP-1 and GIP receptor agonist, has shown substantial efficacy in type 2 diabetes and obesity but is frequently associated with gastrointestinal adverse events. Celiac disease is an immune-mediated disorder characterized by malabsorption and gastrointestinal symptoms, raising concerns about the tolerability of incretin-based therapies in this population. Reports on tirzepatide use in patients with celiac disease remain scarce. Clinical Case We describe a 40-year-old woman with a history of celiac disease, Hashimoto’s thyroiditis, and obesity, who was initiated on tirzepatide 2.5 mg weekly. On the first day of treatment, she developed profuse watery diarrhea, up to ten episodes daily, accompanied by dehydration and fatigue but without nausea or vomiting. Laboratory evaluation revealed mild electrolyte disturbances and transient elevation of liver enzymes. She required intravenous fluid replacement, and tirzepatide was discontinued on day six, resulting in prompt resolution of symptoms. She remains under clinical follow-up without recurrence. Conclusion This case highlights the risk of severe gastrointestinal intolerance to tirzepatide in patients with celiac disease, even at the lowest approved dose. Early recognition of adverse effects and timely treatment discontinuation are critical. To our knowledge, this is the first case of tirzepatide use in Celiac disease in the literature. Clinicians should exercise caution and implement close monitoring when prescribing GLP-1/GIP receptor agonists in individuals with underlying gastrointestinal disorders such as celiac disease.