REVIEW PAPER
Are probiotics, prebiotics, and synbiotics beneficial in primary thyroid diseases? A systematic review with meta-analysis
1
Students’ Scientific Research Group of Systematic Reviews, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
2
Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
3
Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
4
Department of Computer Engineering, Faculty of Engineering, University of Arak, Arak, Iran
5
Chair and Department of Endocrinology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
Corresponding author
Małgorzata M. Bała
Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
Ann Agric Environ Med. 2023;30(2):217-223
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
A number of studies indicate the presence of a thyroid-gut axis and the important influence of the gut microbiota on thyroid function. As prebiotics, probiotics and synbiotics show therapeutic potential in the treatment of intestinal dysbiosis, the aim of this review is to evaluate the efficacy of their supplementation in primary thyroid diseases.
Review methods:
Electronic databases (Ovid MEDLINE, Embase, CENTRAL), registers of clinical trials, and grey literature up to 6 October 2022 were searched for randomised controlled trials (RCTs) meeting pre-specified inclusion criteria. The protocol was registered in PROSPERO (CRD42021235054).
Brief description of the state of knowledge:
After screening 1,721 references, two RCTs were identified, which included 136 hypothyroid participants in total. Meta-analysis of the results after eight weeks of supplementation with predominantly Lactobacillus and Bifidobacterium strains indicated a clinically and statistically nonsignificant decrease in TSH (MD –0.19 mIU/L; 95% CI –0.43 to 0.06; I2= 0%), and no effect on fT3 levels (MD 0.01 pg/mL; 95% CI–0.16 to 0.18; I2= 0%). Data from single studies indicated no significant change in the levels of fT4, thyroid auto-antibodies, BMI, levothyroxine doses, and severity of symptoms measured with validated scales. Only constipation scores showed significant improvement (MD –8.71 points in the Faecal Incontinence Questionnaire; 95% CI –15.85 to –1.57; I2= 0%).
Summary:
Low-certainty evidence from two randomised trials, suggests that routine administration of probiotics, prebiotics or synbiotics may result in little to no benefit in patients with primary hypothyroidism.
A number of studies indicate the presence of a thyroid-gut axis and the important influence of the gut microbiota on thyroid function. As prebiotics, probiotics and synbiotics show therapeutic potential in the treatment of intestinal dysbiosis, the aim of this review is to evaluate the efficacy of their supplementation in primary thyroid diseases.
Review methods:
Electronic databases (Ovid MEDLINE, Embase, CENTRAL), registers of clinical trials, and grey literature up to 6 October 2022 were searched for randomised controlled trials (RCTs) meeting pre-specified inclusion criteria. The protocol was registered in PROSPERO (CRD42021235054).
Brief description of the state of knowledge:
After screening 1,721 references, two RCTs were identified, which included 136 hypothyroid participants in total. Meta-analysis of the results after eight weeks of supplementation with predominantly Lactobacillus and Bifidobacterium strains indicated a clinically and statistically nonsignificant decrease in TSH (MD –0.19 mIU/L; 95% CI –0.43 to 0.06; I2= 0%), and no effect on fT3 levels (MD 0.01 pg/mL; 95% CI–0.16 to 0.18; I2= 0%). Data from single studies indicated no significant change in the levels of fT4, thyroid auto-antibodies, BMI, levothyroxine doses, and severity of symptoms measured with validated scales. Only constipation scores showed significant improvement (MD –8.71 points in the Faecal Incontinence Questionnaire; 95% CI –15.85 to –1.57; I2= 0%).
Summary:
Low-certainty evidence from two randomised trials, suggests that routine administration of probiotics, prebiotics or synbiotics may result in little to no benefit in patients with primary hypothyroidism.
ACKNOWLEDGEMENTS
The authors express their thanks Dr. Giorgia Spaggiari and Prof. Daniele Santi from the Department of Biomedical, Metabolic and Neural Sciences at the University of Modena and Reggio Emilia, Modena; Prof. Gholamreza Askari and Ms. Sepide Talebi from the Food Security Research Centre and Department of Community Nutrition, School of Nutrition and Food Science, University of Medical Sciences, Isfahan, as well as Dr. Mario Salvi from the Graves’ Orbitopathy Centre, Endocrinology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, for providing additional information concerning their studies.
REFERENCES (38)
1.
Chaker L, Bianco AC, Jonklaas J, et al. Hypothyroidism. Lancet. 2017;390:1550–1562. https://doi.org/10.1016/S0140-....
2.
de Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016;388:906–918. https://doi.org/10.1016/S0140-....
3.
Jordan B, Uer O, Buchholz T, et al. Physical fatigability and muscle pain in patients with Hashimoto thyroiditis. J Neurol. 2021;268:2441–2449. https://doi.org/10.1007/s00415....
4.
Knezevic J, Starchl C, Berisha AT, et al. Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function? Nutrients. 2020;12:1–16, https://doi.org/10.3390/nu1206....
5.
Köhling HL, Plummer SF, Marchesi JR, et al. The microbiota and autoimmunity: Their role in thyroid autoimmune diseases. Clin Immunol. 2017;183:63–74, https://doi.org/10.1016/j.clim....
6.
Virili C, Fallahi P, Antonelli A, et al. Gut microbiota and Hashimoto’s thyroiditis. Rev Endocr Metab Disord. 2018;19:293–300. https://doi.org/10.1007/s11154....
7.
de Oliveira GLV, Leite AZ, Higuchi BS, et al. Intestinal dysbiosis and probiotic applications in autoimmune diseases. Immunology. 2017;152:1–12. https://doi.org/10.1111/imm.12....
8.
Hemarajata P, Versalovic J. Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Therap Adv Gastroenterol. 2013;6:39–51. https://doi.org/10.1177/175628....
9.
Wang S, Xiao Y, Tian F, et al. Rational use of prebiotics for gut microbiota alterations: Specific bacterial phylotypes and related mechanisms. J Funct Foods. 2020;66:103838. https://doi.org/10.1016/j.jff.....
10.
Sergeev IN, Aljutaily T, Walton G, et al. Effects of Synbiotic Supplement on Human Gut Microbiota, Body Composition and Weight Loss in Obesity. Nutrients. 2020;12:222. https://doi.org/10.3390/nu1201....
11.
Hill C, Guarner F, Reid G, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11:506–514. https://doi.org/10.1038/nrgast....
12.
Swanson KS, Gibson GR, Hutkins R, et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics. Nat Rev Gastroenterol Hepatol. 2020;17:687–701. https://doi.org/10.1038/s41575....
13.
Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014;24:1670–1751. https://doi.org/10.1089/thy.20....
14.
Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26:1343–1421, https://doi.org/10.1089/thy.20....
15.
Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022) [Internet]. Cochrane 2022.
16.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89. https://doi.org/10.1186/s13643....
17.
Gibson GR, Hutkins R, Sanders ME, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14:491–502. https://doi.org/10.1038/nrgast....
18.
Talebi S, Karimifar M, Heidari Z, et al. The effect of synbiotic supplementation on anthropometric indices, appetite, and constipation in people with hypothyroidism: A randomized, double-blind, placebo-controlled trial. Phytother Res. 2020;34:2712–2720. https://doi.org/10.1002/ptr.67....
19.
Talebi S, Karimifar M, Heidari Z, et al. The effects of synbiotic supplementation on thyroid function and inflammation in hypothyroid patients: A randomized, double-blind, placebo-controlled trial. Complement Ther Med. 2020;48:102234. https://doi.org/10.1016/j.ctim....
20.
Talebi S, Karimifar M, Heidari Z, et al. The effects of synbiotic supplementation on fatigue management and mental health status in levothyroxine-treated patients with hypothyroidism: A randomized, double-blind, placebo-controlled clinical trial study. J Isfahan Med Sch 2016;38:74–84. https://doi.org/10.22122/JIMS.....
21.
Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5....
22.
Sterne JAC, Sutton AJ, Ioannidis JPA, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002. https://doi.org/10.1136/bmj.d4....
23.
der Simonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188. https://doi.org/10.1016/0197-2....
24.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. https://doi.org/10.1136/bmj.39....
25.
Spaggiari G, Brigante G, De Vincentis S, et al. Probiotics Ingestion Does Not Directly Affect Thyroid Hormonal Parameters in Hypothyroid Patients on Levothyroxine Treatment. Front Endocrinol (Lausanne). 2017;8:316. https://doi.org/10.3389/fendo.....
26.
Krupp LB, Larocca NG, Muir Nash J, et al. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46:1121–1123. https://doi.org/10.1001/archne....
27.
Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44:227–239. https://doi.org/10.1348/014466....
28.
Flint A, Raben A, Blundell JE, et al. Reproducibility, power and validity of visual analogue scales in assessment of appetite sensations in single test meal studies. Int J Obes Relat Metab Disord. 2000;24:38–48. https://doi.org/10.1038/sj.ijo....
29.
Andersen S, Bruun NH, Pedersen KM, et al. Biologic variation is important for interpretation of thyroid function tests. Thyroid. 2003;13:1069–1078. https://doi.org/10.1089/105072....
30.
Zhao F, Feng J, Li J, et al. Alterations of the Gut Microbiota in Hashimoto’s Thyroiditis Patients. Thyroid. 2018;28:175–186. https://doi.org/10.1089/thy.20....
31.
Ishaq HM, Mohammad IS, Guo H, et al. Molecular estimation of alteration in intestinal microbial composition in Hashimoto’s thyroiditis patients. Biomed Pharmacother. 2017;95:865–874. https://doi.org/10.1016/j.biop....
32.
Cayres LC de F, de Salis LVV, Rodrigues GSP, et al. Detection of Alterations in the Gut Microbiota and Intestinal Permeability in Patients With Hashimoto Thyroiditis. Front Immunol. 2021;12:579140. https://doi.org/10.3389/fimmu.....
33.
Fröhlich E, Wahl R. Microbiota and Thyroid Interaction in Health and Disease. Trends Endocrinol Metab. 2019;30:479–490. https://doi.org/10.1016/j.tem.....
34.
David LA, Maurice CF, Carmody RN, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505:559–563. https://doi.org/10.1038/nature....
35.
Kaminski M, Skonieczna-Zydecka K, Loniewski I, et al. Are probiotics useful in the treatment of chronic idiopathic constipation in adults? A review of existing systematic reviews, meta-analyses, and recommendations. Prz Gastroenterol. 2020;15:103–118. https://doi.org/10.5114/pg.201....
36.
Zhang C, Jiang J, Tian F, et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020;39:2960–2969, https://doi.org/10.1016/j.clnu....
37.
Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines 6. Rating the quality of evidence-imprecision. J Clin Epidemiol. 2011;64:1283–1293. https://doi.org/10.1016/j.jcli....
38.
Dong YH, Fu DG. Autoimmune thyroid disease: mechanism, genetics and current knowledge. Eur Rev Med Pharmacol Sci. 2014;18:3611–3618.
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