Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria.
Nutrients. 2020 Jun 12;12(6):1769. doi: 10.3390/nu12061769.
A healthy gut microbiota not only has beneficial effects on the activity of the immune system, but also on thyroid function. Thyroid and intestinal diseases prevalently coexist-Hashimoto's thyroiditis (HT) and Graves' disease (GD) are the most common autoimmune thyroid diseases (AITD) and often co-occur with Celiac Disease (CD) and Non-celiac wheat sensitivity (NCWS). This can be explained by the damaged intestinal barrier and the following increase of intestinal permeability, allowing antigens to pass more easily and activate the immune system or cross-react with extraintestinal tissues, respectively. Dysbiosis has not only been found in AITDs, but has also been reported in thyroid carcinoma, in which an increased number of carcinogenic and inflammatory bacterial strains were observed. Additionally, the composition of the gut microbiota has an influence on the availability of essential micronutrients for the thyroid gland. Iodine, iron, and copper are crucial for thyroid hormone synthesis, selenium and zinc are needed for converting T4 to T3, and vitamin D assists in regulating the immune response. Those micronutrients are often found to be deficient in AITDs, resulting in malfunctioning of the thyroid. Bariatric surgery can lead to an inadequate absorption of these nutrients and further implicates changes in thyroid stimulating hormone (TSH) and T3 levels. Supplementation of probiotics showed beneficial effects on thyroid hormones and thyroid function in general. A literature research was performed to examine the interplay between gut microbiota and thyroid disorders that should be considered when treating patients suffering from thyroid diseases. Multifactorial therapeutic and preventive management strategies could be established and more specifically adjusted to patients, depending on their gut bacteria composition. Future well-powered human studies are warranted to evaluate the impact of alterations in gut microbiota on thyroid function and diseases.
健康的肠道微生物群不仅对免疫系统的活性有有益影响，而且对甲状腺功能也有影响。甲状腺和肠道疾病普遍共存-桥本甲状腺炎（HT）和格雷夫斯病（GD）是最常见的自身免疫性甲状腺疾病（AITD），并且经常与乳糜泻（CD）和非乳糜泻小麦敏感（NCWS）同时发生。这可以通过受损的肠道屏障和随后增加的肠道通透性来解释，使抗原更容易通过并激活免疫系统或与肠外组织发生交叉反应。肠道菌群失调不仅在 AITD 中被发现，而且在甲状腺癌中也被报道，在甲状腺癌中观察到致癌和炎症性细菌菌株数量增加。此外，肠道微生物群的组成对甲状腺的必需微量营养素的可用性有影响。碘、铁和铜对甲状腺激素合成至关重要，硒和锌用于将 T4 转化为 T3，而维生素 D 有助于调节免疫反应。这些微量营养素经常在 AITD 中被发现不足，导致甲状腺功能障碍。减重手术可导致这些营养素吸收不足，进一步导致甲状腺刺激素（TSH）和 T3 水平的变化。益生菌的补充对甲状腺激素和甲状腺功能一般都有有益的影响。进行了文献研究，以检查肠道微生物群与甲状腺疾病之间的相互作用，在治疗患有甲状腺疾病的患者时应考虑这些相互作用。可以建立多因素治疗和预防管理策略，并根据患者的肠道细菌组成更具体地调整这些策略。未来需要进行更有力的人类研究，以评估肠道微生物群改变对甲状腺功能和疾病的影响。
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