Araújo Edilene Maria Queiroz, Coutinho-Lima Claubert Radamés Oliveira, Sousa André Silva de, Souza Lana Mércia Santiago de, Ramos Helton Estrela, Almeida-Pititto Bianca de, Canto Graziela De Luca, Trevisani Virginia Fernandes Moça
Postgraduate Program in Evidence Based Medicine, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, SP, Brazil.
Nutritional Genomics and Metabolic Dysfunctions Research and Extension Center (GENUT), Department of Life Sciences, State University of Bahia (UNEB), Salvador 41.150-000, BA, Brazil.
Nutrients. 2025 Oct 31;17(21):3437. doi: 10.3390/nu17213437.
: The gluten-free diet (GFD) may be anti-inflammatory in treating Hashimoto's thyroiditis (HT), but the studies are inconsistent. : To determine the effects of the GFD in non-celiac HT, we included randomized controlled trials from the following databases: Cochrane Central, Embase, Lilacs, Medline, Scopus, and Web of Science. The study was registered at Prospero (no. CRD42024566034). The outcomes assessed included free triiodothyronine (fT3), free tetraiodothyronine (fT4), thyroid stimulating hormone (TSH), Anti-thyroid Peroxidase (TPO), anti-thyroglobulin (Tg), C-reactive protein (CRP), body weight (BW), body mass index (BMI) and adverse effects. Sensitivity, subgroup, meta-regression, bias risk, and evidence analyses' certainty were also assessed. : Only three studies were meta-analyzed, comprising 110 participants. The pooled data revealed the evidence was very uncertain about the effect of GFD compared to the control group on mean differences (MD) of TSH (MD -0.63 uIU/mL; 95% CI -1.63 to 0.36; = 0.21), fT3 (MD -0.18 pg/mL; 95% CI -0.50 to 0.14; = 0.28), fT4 (MD -0.33 ng/dL; 95% CI -0.89 to 0.23; = 0.24), anti-Tg (MD -10.07 IU/mL; 95% CI -17.73 to -2.42; = 0.010), anti-TPO (MD 76.19 IU/mL; 95% CI 46.86 to 108.51; < 0.00001), CRP (MD -0.12 IU/mL; 95% CI -0.30 to 0.07), BW (MD -1.46 kg; 95% CI -6.70 to 3.77), and BMI (MD -1.80 kg/m2; 95% CI -3.30 to -0.31). The quality of evidence was rated as having serious methodological concerns to extremely serious imprecision. : The GFD decreased anti-Tg and increased the anti-TPO levels, both significantly. There were no significant results on fT3, fT4, and TSH.
无麸质饮食（GFD）在治疗桥本甲状腺炎（HT）时可能具有抗炎作用，但相关研究结果并不一致。为了确定无麸质饮食对非乳糜泻性桥本甲状腺炎的影响，我们纳入了来自以下数据库的随机对照试验：考克兰中央对照试验注册库、Embase、Lilacs、医学期刊数据库、Scopus和科学网。该研究已在国际前瞻性系统评价注册库（注册号：CRD42024566034）登记。评估的结果包括游离三碘甲状腺原氨酸（fT3）、游离甲状腺素（fT4）、促甲状腺激素（TSH）、抗甲状腺过氧化物酶（TPO）、抗甲状腺球蛋白（Tg）、C反应蛋白（CRP）、体重（BW）、体重指数（BMI）以及不良反应。还评估了敏感性、亚组分析、Meta回归分析以及偏倚风险和证据分析的确定性。仅对三项研究进行了Meta分析，共纳入110名参与者。汇总数据显示，与对照组相比，关于无麸质饮食对TSH平均差异（MD -0.63 uIU/mL；95%置信区间 -1.63至0.36；P = 0.21）、fT3（MD -0.18 pg/mL；95%置信区间 -0.50至0.14；P = 0.28）、fT4（MD -0.33 ng/dL；95%置信区间 -0.89至0.23；P = 0.24）、抗Tg（MD -10.07 IU/mL；95%置信区间 -17.73至 -2.42；P = 0.010）、抗TPO（MD 76.19 IU/mL；95%置信区间 46.86至108.51；P < 0.00001）、CRP（MD -0.12 IU/mL；95%置信区间 -0.30至0.07）、BW（MD -1.46 kg；95%置信区间 -6.70至3.77）和BMI（MD -1.80 kg/m²；95%置信区间 -3.30至 -0.31）影响的证据非常不确定。证据质量被评为存在严重的方法学问题到极其严重的不精确性。无麸质饮食显著降低了抗Tg水平并升高了抗TPO水平。在fT3、fT4和TSH方面未得出显著结果。
