Çetinkaya Altuntaş Seher
Endocrinology and Diabetes, Bursa Yuksek Ihtisas Education and Training Hospital, University of Health Sciences, Bursa, TUR.
Cureus. 2025 Apr 7;17(4):e81814. doi: 10.7759/cureus.81814. eCollection 2025 Apr.
Background Hashimoto's thyroiditis (HT) is an organ-specific autoimmune disorder. While eating disorders have been associated with other autoimmune diseases, no studies have explored this relationship in patients with HT to date. This study aimed to evaluate eating behaviors in euthyroid patients with HT. Materials and methods This case-control, cross-sectional study included a total of 107 patients diagnosed with HT, aged 18-45 years, as well as 54 healthy volunteers. Thyroid function tests, anti-thyroid peroxidase (TPO), and anti-antithyroglobulin (Tg) antibodies were measured in all participants. The Three-Factor Eating Questionnaire (TFEQ), the Night Eating Questionnaire (NEQ), and the International Physical Activity Questionnaire (IPAQ) were used to assess eating disorders and physical activity levels. Results Compared to the healthy control group, patients with HT, especially those receiving levothyroxine (LT4), had significantly higher scores on the TFEQ and NEQ. A positive correlation was detected between TFEQ and NEQ scores and anti-TPO and anti-Tg levels, LT4 treatment duration, and LT4 dose. However, there were no significant differences between the groups in terms of the IPAQ scores. A negative correlation was found between TFEQ scores and serum triiodothyronine (sT3). In patients with HT, thyroid-stimulating hormone (TSH) levels were within the higher-normal range, while sT3 levels were lower-normal compared to controls. Conclusion There is a spectrum of eating disorders among patients with HT. The underlying cause of these disorders remains unclear and may be associated with thyroid antibodies and/or hormonal status. In LT4 replacement therapy, efforts should be made to mimic true physiology as closely as possible. In the follow-up of patients with HT, while TSH is within lower-normal limits, sT3 levels may be observed to be in a higher-normal range. In selected cases, a combination of T4/T3 therapy or T3 extract may be recommended. Close monitoring of patients with HT is essential, particularly for potential eating disorder-related complications, such as obesity.
背景 桥本甲状腺炎（HT）是一种器官特异性自身免疫性疾病。虽然饮食失调与其他自身免疫性疾病有关，但迄今为止尚无研究探讨HT患者中的这种关系。本研究旨在评估甲状腺功能正常的HT患者的饮食行为。
材料与方法 本病例对照横断面研究共纳入107例年龄在18至45岁之间诊断为HT的患者以及54名健康志愿者。对所有参与者进行甲状腺功能测试、抗甲状腺过氧化物酶（TPO）和抗甲状腺球蛋白（Tg）抗体检测。使用三因素饮食问卷（TFEQ）、夜间饮食问卷（NEQ）和国际体力活动问卷（IPAQ）评估饮食失调和体力活动水平。
结果 与健康对照组相比，HT患者，尤其是接受左甲状腺素（LT4）治疗的患者，在TFEQ和NEQ上的得分显著更高。TFEQ和NEQ得分与抗TPO和抗Tg水平、LT4治疗持续时间和LT4剂量之间存在正相关。然而，两组在IPAQ得分方面无显著差异。TFEQ得分与血清三碘甲状腺原氨酸（sT3）之间存在负相关。在HT患者中，促甲状腺激素（TSH）水平处于较高正常范围，而与对照组相比，sT3水平处于较低正常范围。
结论 HT患者中存在一系列饮食失调情况。这些失调的潜在原因尚不清楚，可能与甲状腺抗体和/或激素状态有关。在LT4替代治疗中，应尽可能努力模拟真实生理状态。在HT患者的随访中，当TSH处于较低正常范围时，可能会观察到sT3水平处于较高正常范围。在某些特定情况下，可能推荐T4/T3联合治疗或T3提取物。对HT患者进行密切监测至关重要，特别是对于潜在的与饮食失调相关的并发症，如肥胖。
