Thyroid disorders and gastrointestinal and liver dysfunction: A state of the art review

Angelos Kyriacou, John Mclaughlin, Akheel Syed

    Research output: Contribution to journalReview articlepeer-review


    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.
    Original languageEnglish
    Pages (from-to)563-571
    Number of pages9
    JournalEuropean Journal of Internal Medicine
    Issue number8
    Early online date8 Aug 2015
    Publication statusPublished - Oct 2015


    • Thyroid disease
    • Thyrotoxicosis
    • Hypothyroidism
    • Gastrointestinal dysfunction
    • Liver disease
    • Obesity
    • Bariatric surgery
    • Coeliac disease


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