Ассоциация между кишечной микробиотой и дисфункцией щитовидной железы

Статья посвящена современным представлениям о потенциальной роли микробиоты в развитии патологии щитовидной железы. Кишечная микробиота играет одну из главных ролей как в формировании и поддержании здоровья человека, так и в патогенезе широкого спектра заболеваний. Имеются данные о взаимосвязи кишечной микробиоты и иммунной системы, риска развития ряда злокачественных и аутоиммунных заболеваний. В статье рассмотрены функции кишечной микробиоты, факторы, определяющие ее состав. Исследования показали наличие связи между кишечной микробиотой и щитовидной железой, что легло в основу формирования теории оси «кишечник – щитовидная железа». Показано, что кишечная микробиота принимает участие в метаболизме тиреоидных гормонов и обеспечивает их энтерогепатическую циркуляцию. Предполагается, что одним из связующих звеньев между щитовидной железой и микроорганизмами желудочно-кишечного тракта является иммунная система. Представлены результаты исследований, посвященных изучению таксономического состава кишечной микробиоты у пациентов с аутоиммунным тиреоидитом и болезнью Грейвса. Предполагается, что состав кишечной микробиоты может влиять на потребность в левотироксине натрия, особенно у пациентов с субклиническим гипотиреозом. При этом прием левотироксина при гипотиреозе и в меньшей степени непосредственно манифестный гипотиреоз в исходе аутоиммунного тиреоидита ассоциированы с синдромом избыточного бактериального роста, несмотря на достижение эутиреоза, и могут оказывать влияние на состав микробиоты. Несмотря на то что аутоиммунные заболевания щитовидной железы довольно распространены в общей популяции, работ, посвященной данной проблематике, проведено немного. Необходимы более надежные фундаментальные и клинические исследования для выявления конкретных взаимосвязей и механизмов развития патологии щитовидной железы в зависимости от изменения состава кишечной микробиоты, а также оценки потенциальной возможности ее использования с терапевтической целью.

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