The Thyroid-Gut Connection

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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

Hippocrates said: “All disease begins in the gut.” 2,500 years later we’re just beginning to understand how right he was. And, as I’ll explain in this article, hypothyroidism is no exception. Poor gut health can suppress thyroid function and trigger Hashimoto’s disease, and low thyroid function can lead to an inflamed and leaky gut – as illustrated in the following diagram:

thyroidgut

The gut-thyroid-immune connection

Have you ever considered the fact that the contents of the gut are outside the body? The gut is a hollow tube that passes from the mouth to the anus. Anything that goes in the mouth and isn’t digested will pass right out the other end. This is, in fact, one of the most important functions of the gut: to prevent foreign substances from entering the body.

Another important function of the gut is to host 70% of the immune tissue in the body. This portion of the immune system is collectively referred to as GALT, or gut-associated lymphoid tissue. The GALT comprises several types of lymphoid tissues that store immune cells, such as T & B lymphocytes, that carry out attacks and produce antibodies against antigens, molecules recognized by the immune system as potential threats.

Problems occur when either of these protective functions of the gut are compromised. When the intestinal barrier becomes permeable (i.e. “leaky gut syndrome”), large protein molecules escape into the bloodstream. Since these proteins don’t belong outside of the gut, the body mounts an immune response and attacks them. Studies show that these attacks play a role in the development of autoimmune diseases like Hashimoto’s.

We also know that thyroid hormones strongly influence the tight junctions in the stomach and small intestine. These tight junctions are closely associated areas of two cells whose membranes join together to form the impermeable barrier of the gut. T3 and T4 have been shown to protect gut mucosal lining from stress induced ulcer formation. In another study, endoscopic examination of gastric ulcers found low T3, low T4 and abnormal levels of reverse T3.

Likewise, thyrotropin releasing hormone (TRH) and thyroid stimulating hormone (TSH) both influence the development of the GALT. T4 prevents over-expression of intestinal intraepithelial lymphocytes (IEL), which in turn causes inflammation in the gut.

The gut-bacteria-thyroid connection

One little known role of the gut bacteria is to assist in converting inactive T4 into the active form of thyroid hormone, T3. About 20 percent of T4 is converted to T3 in the GI tract, in the forms of T3 sulfate (T3S) and triidothyroacetic acid (T3AC). The conversion of T3S and T3AC into active T3 requires an enzyme called intestinal sulfatase.

Where does intestinal sulfatase come from? You guessed it: healthy gut bacteria. Intestinal dysbiosis, an imbalance between pathogenic and beneficial bacteria in the gut, significantly reduces the conversion of T3S and T3AC to T3. This is one reason why people with poor gut function may have thyroid symptoms but normal lab results.

Inflammation in the gut also reduces T3 by raising cortisol. Cortisol decreases active T3 levels while increasing levels of inactive T3. 1

Studies have also shown that cell walls of intestinal bacteria, called lipopolysaccharides (LPS), negatively effect thyroid metabolism in several ways. LPS:

  • reduce thyroid hormone levels;
  • dull thyroid hormone receptor sites;
  • increase amounts of inactive T3;
  • decrease TSH; and
  • promote autoimmune thyroid disease (AITD).

Other gut-thyroid connections

Hypochlorhydria, or low stomach acid, increases intestinal permeability, inflammation and infection (for more on this, see my series on acid reflux & GERD). Studies have shown a strong association between atrophic body gastritis, a condition related to hypochlorhydria, and autoimmune thyroid disease.

Constipation can impair hormone clearance and cause elevations in estrogen, which in turn raises thyroid-binding globulin (TBG) levels and decreases the amount of free thyroid hormones available to the body. On the other hand, low thyroid function slows transit time, causing constipation and increasing inflammation, infections and malabsorption.

Finally, a sluggish gall bladder interferes with proper liver detoxification and prevents hormones from being cleared from the body, and hypothyroidism impairs GB function by reducing bile flow.

Healing the gut-thyroid axis

All of these connections make it clear that you can’t have a healthy gut without a healthy thyroid, and you can’t have a healthy thyroid without a healthy gut. To restore proper function of the gut-thyroid axis, both must be addressed simultaneously.

Healing the gut is a huge topic that can’t be covered adequately in a few short sentences. But I will say this: the first step is always to figure out what’s causing the gut dysfunction. As we’ve reviewed in this article, low thyroid is one possible cause, but often hypochlorhydria, infections, dysbiosis, food intolerances (especially gluten), stress and other factors play an even more significant role. The second step is to address these factors and remove any potential triggers. The third step is to restore the integrity of the gut barrier. My preferred approach for this last step is the GAPS diet.

The influence of thyroid hormones on the gut is one of many reasons why I recommend that people with persistently high TSH and low T4 and T3 take replacement hormones. Low thyroid hormones make it difficult to heal the gut, and an inflamed and leaky gut contributes to just about every disease there is, including hypothyroidism. Fixing the gut is often the first – and most important – step I take with my patients.

  1. Stockigt, JR and Baverman LE. Update on the Sick Euthyroid Syndrome. Diseases of the Thyroid. Humana Press, Totowa, NJ, 1997, pp.49-68

138 Comments

Join the conversation

  1. I am having a flare of diverticulitis and on flagyl and cipro. I had my thyroid removed and take both T4 and T3 because I don’t convert right. Question is while on the antibiotics my eyes are swelling which happen before I got my thyroid numbers stable. Could the medication or change in my diet (liquid for 3 days) or medication mess with my thyroid numbers?

  2. Have there been any studies in the effects of thyroid absorbtion in a person who has had their large intestine removed (due to colitis that was unresponsive to treatment) ? Is there a connection between the two? After the surgery my son has developed severe hypothyroid symptoms but normal TSH, T3 levels.

  3. Are the thyroid supplements, such as synthroid and levothroid, acidic or alkaline on their own?

            • Some foods and such are listed on a spectrum with some being more acidic or alkaline. The best overall general diet is in the middle. It then can sometimes be helpful to know where on the spectrum such things are. The body, relatively healthy ones, work to maintain a balance.

          • You replied to me so your comment is located right under mine and slightly off to the side. That is why I thought you were trying to answer my question. If you make a general reply then it will be aligned with all the other original ones. It’s about a type of grouping.

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<div class='gf_browser_unknown gform_wrapper qc_box_container_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' ><form method='post' enctype='multipart/form-data' id='gform_9' class='qc_box_container gform_legacy_markup' action='/the-thyroid-gut-connection/comment-page-4/' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_1" class="gfield field gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_1' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_1' id='input_9_1' type='email' value='' class='large' placeholder='Your Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_2" class="gfield health-concern field field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_2' >I want to improve my...</label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_9_2' class='large gfield_select' aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>I want to improve my...</option><option value='Weight' >Weight</option><option value='Energy' >Energy</option><option value='Digestion' >Digestion</option><option value='Brain' >Brain</option><option value='Overall Health' >Overall Health</option><option value='All of the Above' >All of the Above</option></select></div></li><li id="field_9_4" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_4' id='input_9_4' type='hidden' class='gform_hidden' aria-invalid="false" value='870' /></div></li><li id="field_9_5" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" ><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='hidden' class='gform_hidden' aria-invalid="false" value='Heartburn/GERD' /></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Download eBook' onclick='if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} if( !jQuery("#gform_9")[0].checkValidity || jQuery("#gform_9")[0].checkValidity()){window["gf_submitting_9"]=true;} jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsIjVkYTAyNjYxOTg4ZDNhZGQwOTU0Yzc4NDcyNDk5YmM4Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='popup_name=Heartburn%2FGERD' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js" name="ak_js" value="74"/><script>document.getElementById( "ak_js" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>
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