Highlights
- •The function of the thyroid and the gut are closely intertwined in both health and disease.
- •Thyroid dysfunction commonly causes various gastrointestinal symptoms.
- •Conversely, some gastrointestinal diseases can mimic thyroid disorders (non-thyroidal illness).
- •Thyroid function should be monitored in patients with gastrointestinal diseases and those on interferon therapies.
- •Medullary thyroid carcinoma should be considered in the differential diagnosis of unexplained, chronic diarrhoea.
Abstract
Thyroid disorders commonly impact on the gastrointestinal system and may even present
with gastrointestinal symptoms in isolation; for example, metastatic medullary thyroid
carcinoma typically presents with diarrhoea. Delays in identifying and treating the
underlying thyroid dysfunction may lead to unnecessary investigations and treatment,
with ongoing morbidity, and can potentially be life-threatening. Similarly, gastrointestinal
diseases can impact on thyroid function tests, and an awareness of the concept and
management of non-thyroidal illness is necessary to avoid giving unnecessary thyroid
therapies that could potentially exacerbate the underlying gastrointestinal disease.
Dual thyroid and gastrointestinal pathologies are also common, with presentations
occurring concurrently or sequentially, the latter after a variable time lag that
can even extend over decades. Such an association aetiologically relates to the autoimmune
background of many thyroid disorders (e.g. Graves' disease and Hashimoto's thyroiditis)
and gastrointestinal disorders (e.g. coeliac disease and inflammatory bowel disease);
such autoimmune conditions can sometimes occur in the context of autoimmune polyglandular
syndrome. Emphasis should also be given to the gastrointestinal side effects of some
of the medications used for thyroid disease (e.g. anti-thyroid drugs causing hepatotoxicity)
and vice versa (e.g. interferon therapy causing autoimmune thyroid dysfunction). In
this review, we discuss disorders of the thyroid-gut axis and identify the evidence
base behind the management of such disorders.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: August 07, 2015
Accepted:
July 18,
2015
Received in revised form:
July 17,
2015
Received:
July 4,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
