title: Thyroid disorders and gastrointestinal and liver dysfunction: A state of the art review.
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.
authors.affiliation: Endocrinology and Diabetes, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK. Electronic address: angelos5@doctors.org.uk.
authors.forename: Angelos
authors.initials: A
authors.lastname: Kyriacou
authors.affiliation: Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, the University of Manchester, Manchester, UK; Gastroenterology, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK.
authors.forename: John
authors.initials: J
authors.lastname: McLaughlin
authors.affiliation: Endocrinology and Diabetes, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK; Manchester Medical School, Faculty of Medical and Human Sciences, the University of Manchester, Manchester, UK.
authors.forename: Akheel A
authors.initials: AA
authors.lastname: Syed
mesh_terms: D018278:Carcinoma, Neuroendocrine / Q000150:complications / Q000175:diagnosis; D003967:Diarrhea / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D008107:Liver Diseases / Q000209:etiology*; D013959:Thyroid Diseases / Q000150:complications* / Q000175:diagnosis; D013960:Thyroid Function Tests; D013964:Thyroid Neoplasms / Q000150:complications / Q000175:diagnosis
keywords: Gastrointestinal dysfunction; Hypothyroidism; Liver disease; Obesity; Thyroid disease; Thyrotoxicosis