The Microbiome-Thyroid Link: A Review of the Role of the Gut Microbiota in Thyroid Function and Disease


  • Venkateswarrao Adapa Department of Pharmacy Practice, Pydah College of Pharmacy, Patavala, Kakinada, Andhra Pradesh, India
  • Vijay Anand Kada Department of Pharmacy Practice, Pydah College of Pharmacy, Patavala, Kakinada, Andhra Pradesh, India
  • Jaya Santhoshi Gowri Nunna Department of Pharmacy Practice, Pydah College of Pharmacy, Patavala, Kakinada, Andhra Pradesh, India


Autoimmune thyroid diseases, Dysbiosis, Gut microbiota, Hashimoto's thyroiditis, Hypothyroidism, Thyroid hormones


The gut microbiota has emerged as a potential regulator of thyroid homeostasis and disease. Recent studies suggest that the composition and diversity of intestinal bacteria can impact thyroid stimulating hormone levels, thyroid hormone synthesis & metabolism and the risk of thyroid conditions like hypothyroidism and autoimmune thyroiditis. However, the mechanisms through which the gut microbiota influences the thyroid remain poorly understood. This review aims to summarize the current evidence on the role of the gut-thyroid microbiome axis in thyroid physiology and pathophysiology. Studies investigating the association of gut dysbiosis with altered thyroid function and disorders like Hashimoto’s thyroiditis were discussed. Potential mechanisms through which gut bacteria may influence thyroid hormone levels and autoimmunity, such as interference with autoantigen presentation, induction of inflammation, and production of metabolites were evaluated. The impact of dietary and probiotic interventions targeting the gut microbiota for managing thyroid disease is assessed. Future research directions focusing on delineating key bacteria influencing thyroid health, characterizing longitudinal microbiota changes in thyroid conditions, and identifying novel microbiota-based therapies are proposed. A deeper understanding of the gut-thyroid axis may lead to microbiota-targeted strategies for managing thyroid disorders.


Download data is not yet available.


Zhang J, Lazar MA. The mechanism of action of thyroid hormones. Annual review of physiology. 2000;62(1):439–66.

Virili C, Centanni M. Does microbiota composition affect thyroid homeostasis? Endocrine. 2015;49(3):583–7.

Lin B, Zhao F, Liu Y, Wu X, Feng J, Jin X, et al. Randomized Clinical Trial: Probiotics Alleviated Oral-Gut Microbiota Dysbiosis and Thyroid Hormone Withdrawal-Related Complications in Thyroid Cancer Patients Before Radioiodine Therapy Following Thyroidectomy. Frontiers in endocrinology. 2022;13:834674.

Virili C, Centanni M. “With a little help from my friends”-the role of microbiota in thyroid hormone metabolism and enterohepatic recycling. Molecular and cellular endocrinology. 2017;458:39–43.

Jiang W, Lu G, Gao D, Lv Z, Li D. The relationships between the gut microbiota and its metabolites with thyroid diseases. Frontiers in Endocrinology. 2022;13:943408.

Frohlich E, Wahl R. Microbiota and thyroid interaction in health and disease. Trends in Endocrinology & Metabolism. 2019;30(8):479–90.

Ejtahed HS, Angoorani P, Soroush AR, Siadat SD, Shirzad N, Hasani-Ranjbar S, et al. Our little friends with big roles: alterations of the gut microbiota in thyroid disorders. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders). 2020;20(3):344–50.

Knezevic J, Starchl C, Tmava Berisha A, Amrein K. Thyroid-gut-axis: how does the microbiota influence thyroid function? Nutrients. 2020;12(6):1769.

Fenneman AC, Bruinstroop E, Nieuwdorp M, van der Spek AH, Boelen A. A comprehensive review of thyroid hormone metabolism in the gut and its clinical implications. Thyroid. 2023;33(1):32–44.

Bargiel P, Szczuko M, Stachowska L, Prowans P, Czapla N, Markowska M, et al. Microbiome metabolites and thyroid dysfunction. Journal of Clinical Medicine. 2021;10(16):3609.

Fernández-García V, González-Ramos S, Martín-Sanz P, Laparra JM, Boscá L. Beyond classic concepts in thyroid homeostasis: Immune system and microbiota. Molecular and cellular endocrinology. 2021;533:111333.

Cayres LC de F, de Salis LVV, Rodrigues GSP, Lengert A van H, Biondi APC, Sargentini LDB, et al. Detection of alterations in the gut microbiota and intestinal permeability in patients with Hashimoto thyroiditis. Frontiers in immunology. 2021;12:579140.

Dong X, Yao S, Deng L, Li H, Zhang F, Xu J, et al. Alterations in the gut microbiota and its metabolic profile of PM2. 5 exposure-induced thyroid dysfunction rats. Science of The Total Environment. 2022;838:156402.

Feng J, Zhao F, Sun J, Lin B, Zhao L, Liu Y, et al. Alterations in the gut microbiota and metabolite profiles of thyroid carcinoma patients. International journal of cancer. 2019;144(11):2728–45.

Shin NR, Bose S, Wang JH, Nam YD, Song EJ, Lim DW, et al. Chemically or surgically induced thyroid dysfunction altered gut microbiota in rat models. Available at SSRN 3413587. 2019; 1-42.

Tong JY, Jiang W, Yu XQ, Wang R, Lu GH, Gao DW, et al. Effect of low-dose radiation on thyroid function and the gut microbiota. World Journal of Gastroenterology. 2022;28(38):5557.

Shen H, Han J, Li Y, Lu C, Zhou J, Li Y, et al. Different host-specific responses in thyroid function and gut microbiota modulation between diet-induced obese and normal mice given the same dose of iodine. Applied microbiology and biotechnology. 2019;103:3537–47.

Zhang J, Zhang F, Zhao C, Xu Q, Liang C, Yang Y, et al. Dysbiosis of the gut microbiome is associated with thyroid cancer and thyroid nodules and correlated with clinical index of thyroid function. Endocrine. 2019;64:564–74.

Du L, Qiu X, Zhu S, Liu J, Wang J, Wang Q, et al. Soybean oligosaccharides combined with probiotics reduce faecal odour compound content by improving intestinal microbiota in pigs. Journal of Animal Physiology and Animal Nutrition. 2023;107(3):839–49.

Huo D, Cen C, Chang H, Ou Q, Jiang S, Pan Y, et al. Probiotic Bifidobacterium longum supplied with methimazole improved the thyroid function of Graves’ disease patients through the gut-thyroid axis. Communications Biology. 2021;4(1):1046.

Talebi S, Karimifar M, Heidari Z, Mohammadi H, Askari G. The effects of synbiotic supplementation on thyroid function and inflammation in hypothyroid patients: A randomized, double-blind, placebo-controlled trial. Complementary therapies in medicine. 2020;48:102234.

Elbaz AM, Ibrahim NS, Shehata AM, Mohamed NG, Abdel-Moneim AME. Impact of multi-strain probiotic, citric acid, garlic powder or their combinations on performance, ileal histomorphometry, microbial enumeration and humoral immunity of broiler chickens. Tropical Animal Health and Production. 2021;53:1–10.

Khogali MK, Wen K, Jauregui D, Malik HE, Liu L, Zhao M, et al. Probiotics-induced changes in intestinal structure and gut microbiota are associated with reduced rate of pimpled eggs in the late laying period of hens. The Journal of Poultry Science. 2022;59(3):206–22.

Ramezani M, Hezaveh ZS. The effect of synbiotic supplementation on thyroid hormones, blood pressure, depression and quality of life in hypothyroid patients: A study protocol for a randomized double-blind placebo controlled clinical trial. Clinical Nutrition ESPEN. 2022;48:472–8.

Smith AP, Sutherland D, Hewlett P. An investigation of the acute effects of oligofructose-enriched inulin on subjective wellbeing, mood and cognitive performance. Nutrients. 2015;7(11):8887–96.

Lee SH, Cho DY, Lee SH, Han KS, Yang SW, Kim JH, et al. A Randomized Clinical Trial of Synbiotics in Irritable Bowel Syndrome: Dose-Dependent Effects on Gastrointestinal Symptoms and Fatigue. Korean J Fam Med. 2019 Jan;40(1):2–8.

Szajewska H, Berni Canani R, Domellöf M, Guarino A, Hojsak I, Indrio F, et al. Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications. Journal of Pediatric Gastroenterology & Nutrition. 2023 Feb;76(2):232–47.

Belvoncikova P, Maronek M, Gardlik R. Gut Dysbiosis and Fecal Microbiota Transplantation in Autoimmune Diseases. Int J Mol Sci. 2022 Sep 14;23(18):10729.

Gong B, Wang C, Meng F, Wang H, Song B, Yang Y, et al. Association Between Gut Microbiota and Autoimmune Thyroid Disease: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021 Nov 17;12:774362.

Hou J, Tang Y, Chen Y, Chen D. The Role of the Microbiota in Graves’ Disease and Graves’ Orbitopathy. Front Cell Infect Microbiol. 2021 Dec 22;11:739707.

Jiang W, Yu X, Kosik RO, Song Y, Qiao T, Tong J, et al. Gut microbiota may play a significant role in the pathogenesis of Graves’ disease. Thyroid. 2021;31(5):810–20.

Liu Q, Sun W, Zhang H. Interaction of Gut Microbiota with Endocrine Homeostasis and Thyroid Cancer. Cancers (Basel). 2022 May 27;14(11):2656.

Macvanin MT, Gluvic Z, Zafirovic S, Gao X, Essack M, Isenovic ER. The protective role of nutritional antioxidants against oxidative stress in thyroid disorders. Front Endocrinol (Lausanne). 2023 Jan 4;13:1092837.

Qi X, Yun C, Pang Y, Qiao J. The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes. 13(1):1894070.

Rahman MdM, Islam F, -Or-Rashid MdH, Mamun AA, Rahaman MdS, Islam MdM, et al. The Gut Microbiota (Microbiome) in Cardiovascular Disease and Its Therapeutic Regulation. Front Cell Infect Microbiol. 2022 Jun 20;12:903570.

Starchl C, Scherkl M, Amrein K. Celiac Disease and the Thyroid: Highlighting the Roles of Vitamin D and Iron. Nutrients. 2021 May 21;13(6):1755.

Zhao LY, Mei JX, Yu G, Lei L, Zhang WH, Liu K, et al. Role of the gut microbiota in anticancer therapy: from molecular mechanisms to clinical applications. Signal Transduct Target Ther. 2023 May 13;8:201.


57 Views | 166 Downloads

How to Cite

Venkateswarrao Adapa, Vijay Anand Kada, and Jaya Santhoshi Gowri Nunna. “The Microbiome-Thyroid Link: A Review of the Role of the Gut Microbiota in Thyroid Function and Disease”. Journal of Clinical and Pharmaceutical Research, vol. 3, no. 3, July 2023, pp. 4-10,



Review Articles