Levothyroxine therapy and impaired clearance are the strongest contributors to small intestinal bacterial overgrowth: Results of a retrospective cohort study

Brechmann, Thorsten; Sperlbaum, Andre; Schmiegel, Wolff

doi:10.3748/wjg.v23.i5.842

Cited by 30 publications

(27 citation statements)

References 30 publications

(45 reference statements)

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“…Giloteaux et al demonstrated intestinal dysbiosis resulting from a more proinflammatory gut microbiome that may trigger the immune system ( 30 ). Recently, the relationship between the thyroid with gut microbiome and inflammation became apparent from the associations of both hypothyroidism and levothyroxine use with small intestinal bacterial overgrowth ( 31 ).…”

Section: Introductionmentioning

confidence: 99%

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

Ruiz-Núñez

Tarasse

Vogelaar³

et al. 2018

Front. Endocrinol.

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Chronic fatigue syndrome (CFS) is a heterogeneous disease with unknown cause(s). CFS symptoms resemble a hypothyroid state, possibly secondary to chronic (low-grade) (metabolic) inflammation. We studied 98 CFS patients (21–69 years, 21 males) and 99 age- and sex-matched controls (19–65 years, 23 males). We measured parameters of thyroid function, (metabolic) inflammation, gut wall integrity and nutrients influencing thyroid function and/or inflammation. Most remarkably, CFS patients exhibited similar thyrotropin, but lower free triiodothyronine (FT3) (difference of medians 0.1%), total thyroxine (TT4) (11.9%), total triiodothyronine (TT3) (12.5%), %TT3 (4.7%), sum activity of deiodinases (14.4%), secretory capacity of the thyroid gland (14.9%), 24-h urinary iodine (27.6%), and higher % reverse T3 (rT3) (13.3%). FT3 below the reference range, consistent with the “low T3 syndrome,” was found in 16/98 CFS patients vs. 7/99 controls (OR 2.56; 95% confidence interval = 1.00–6.54). Most observations persisted in two sensitivity analyses with more stringent cutoff values for body mass index, high-sensitive C-reactive protein (hsCRP), and WBC. We found possible evidence of (chronic) low-grade metabolic inflammation (ferritin and HDL-C). FT3, TT3, TT4, and rT3 correlated positively with hsCRP in CFS patients and all subjects. TT3 and TT4 were positively related to hsCRP in controls. Low circulating T3 and the apparent shift from T3 to rT3 may reflect more severely depressed tissue T3 levels. The present findings might be in line with recent metabolomic studies pointing at a hypometabolic state. They resemble a mild form of “non-thyroidal illness syndrome” and “low T3 syndrome” experienced by a subgroup of hypothyroid patients receiving T4 monotherapy. Our study needs confirmation and extension by others. If confirmed, trials with, e.g., T3 and iodide supplements might be indicated.

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Section: Introductionmentioning

confidence: 99%

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

Ruiz-Núñez

Tarasse

Vogelaar³

et al. 2018

Front. Endocrinol.

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“…Furthermore, most participants were women, limiting extrapolation of our findings to both sexes. As we followed the Dutch guidelines for DCT management [17,22], we could not include a control group of prolonged untreated hypothyroidism. However, plasma BCAA and alanine levels during hypothyroidism were compared with a large euthyroid reference group from the same region of The Netherlands.…”

Section: Discussionmentioning

confidence: 99%

Plasma branched chain amino acids are lower in short-term profound hypothyroidism and increase in response to thyroid hormone supplementation

Boom

Gruppen

Lefrandt

et al. 2020

Scandinavian Journal of Clinical and Laboratory Investigation

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Branched chain amino acids (BCAA) are implicated in the pathogenesis of cardiometabolic diseases conceivably by affecting insulin resistance and mitochondrial dysfunction. Circulating BCAA levels may predict (subclinical) atherosclerosis, diabetes and hypertension development but the factors involved in BCAA regulation are incompletely understood. Given the key role of thyroid hormones on many metabolic processes including protein metabolism, we aimed to determine effects of thyroid dysfunction on circulating BCAA. Effects of short-term profound hypothyroidism on plasma BCAA were determined in 17 patients who had undergone total thyroidectomy for differentiated thyroid carcinoma. Patients were studied during hypothyroidism, i.e. after thyroidectomy, and after thyroid hormone supplementation. Plasma BCAA (sum of valine, leucine and isoleucine) and alanine were measured by nuclear magnetic resonance spectroscopy. During hypothyroidism (median thyroid-stimulating hormone 81 (IQR 67-120.5) mU/L), plasma BCAA were lower (255 (IQR 222-289) mmol/L) compared to a euthyroid reference population (n ¼ 5579; 377 mmol/L (2.5th to 97.5th percentile 258-548), p < 0.001). After 20 weeks of thyroid hormone supplementation (thyroid-stimulating hormone 0.03 (IQR 0.01-0.14 mU/L) plasma BCAA had increased (328 (IQR 272-392) mmol/L, p ¼ .001), but plasma alanine concentrations were unaltered (p ¼ .50). Changes in body weight in response to thyroid hormone supplementation were correlated with changes in plasma BCAA (r ¼ 0.721 p ¼ .001, but not with changes in cholesterol or glucose (p > .80). In conclusion, plasma BCAA concentrations are lower during shortterm profound hypothyroidism in humans, and increase in response to thyroid hormone supplementation. Changes in BCAA and in body weight after reversal of the hypothyroid state appear to be interrelated.

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“…Decreased GIT vermicular movement is one of the factors in the development of SIBO. The study involving 1809 people demonstrated that the most important factors in the development of SIBO were immunosuppression, conditions after gastric/intestinal resection and HT [13]. Lauritano E.C.…”

Section: G M I N F L U E N C E O N T H Y R O I D F U N C T I O N F E a T U R E S O F G M C O M P O S I T I O N I N A I D S O F T H E T Hmentioning

confidence: 99%

Characteristics of Gut Microbiota in Autoimmune Diseases of the Thyroid Gland and the Methods of Its Correction

Стуров¹,

Попов²,

Kostenko³

et al. 2021

ArveMED

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Gut microbiota is considered as a pathogenetic factor of various diseases nowadays. The patients with autoimmune diseases are known to suffer from dysbiosis. There are studies in the modern literature that demonstrate changes in the composition of the gut microbiota in case of thyroid dysfunction. This review examines a contemporary view of the gut microbiota, its role in the development of autoimmune diseases. We investigated the interaction between the thyroid gland and the gut microbiota, its species composition in hypo- and hyperthyroidism. Possible methods of correction, including the use of pre- and probiotics and transplantation of fecal microbiota have been demonstrated.

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Levothyroxine therapy and impaired clearance are the strongest contributors to small intestinal bacterial overgrowth: Results of a retrospective cohort study

Cited by 30 publications

References 30 publications

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

Plasma branched chain amino acids are lower in short-term profound hypothyroidism and increase in response to thyroid hormone supplementation

Characteristics of Gut Microbiota in Autoimmune Diseases of the Thyroid Gland and the Methods of Its Correction

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