الفهرس 
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Abstract
SUMMARY
H
ashimoto thyroiditis (HT) is the most common autoimmune disease worldwide, characterized by chronic inflammation and circulating autoantibodies against thyroid peroxidase and thyroglobulin. There is a lot of evidence that the intestinal dysbiosis, bacterial overgrowth, and increased intestinal permeability favor the HT development, and a thyroid–gut axis has been proposed, which seems to impact our entire body metabolism.
The aim of this study was to study zonulin and gut microbiota (lactobacillus acidophilus) as markers of leaky gut syndrome in patients with Hashimoto’s thyroiditis.
This was a case control study that was conducted on 80 Egyptian subjects at Ain Shams University hospitals inpatient and outpatient Endocrinology Clinic, Cairo, Egypt. Subjects with matched age (20 – 60 years old) & sex were divided into two groups:
*group 1: 60 naïve patients with autoimmune thyroid disease Hashimoto’s thyroiditis, newly diagnosed with cut off value of Anti TPO more than 34IU/ml (AnnemiekeRoos et al., 2010) that were further subdivided into three groups:
group 1a: 20 euthyroid patients with Hashimoto’s thyroiditis who are antibodies positive (TSH from 0.5 - 5.2 mIU/ml) FT4 within normal range.
group 2b: 20 patients with Hashimoto’s thyroiditis and sub-clinical hypothyroidism (TSH more than 5.2mIU/ml & less than 10mIU/ml) FT4 within normal range (0.9 to 2.3 ng/dl) (AnnemiekeRoos et al., 2010).
group 1c: 20 patients with Hashimoto’s thyroiditis and overt primary hypothyroidism (TSH more than 10mIU/ml) FT4 normal or low (0.9 to 2.3 ng/dl).
*group 2: 20 subjects with negative anti-thyroid antibodies and no history of autoimmune thyroid disease was recruited as healthy control
All subjects were subjected to: Detailed history, full clinical examination, thyroid antibodies (Anti-TPO), thyroid profile (TSH, FT4, FT3) assay, stool culture for lactobacillus acidophilus in stool and zonulin level in serum (markers for leaky gut).
RESULTS:
There was no statistical significant difference regards age and sex between Hashimoto’s thyroiditis patient group and control group as well as BMI.
There was high significant statistical increase in zonulin level in Hashimoto’s thyroiditis patient group compared to control group, (P-Value 0.000). serum zonulin was higher in hypothyroid (group1c) subgroup .
There was high significant statistical decrease in FT4 and increase in TSH in Hashimoto’s thyroiditis group compared to control group (P-Value <0.001). However, there was no significant statistical difference found between two groups regarding FT3 (P- value >0.05).
Patients with Hashimoto’s thyroiditis patient group showed higher Anti TPO levels and increase in Lactobacillus acidophilus stool culture growth compared to control (P-Value <0.001). In the Hashimoto’s thyroiditis patients group there was significant statistical difference between positive and negative lactobacilius acidophilus growth groups regarding TSH and zonulin being significantly higher in the positive lactobacilius group (P-Value < 0.05)
Patients with Hashimoto’s thyroiditis showed significant higher statistical relation between anti-TPO titre and lactobacilius acidophilus stool culture growth positivity group (P-Value <0.001).
In Hashimoto’s thyroiditis patients group, there was significant positive correlation between serum zonulin level, anti TPO and significant negative correlation with TSH level
Also thee was high significant statistical relation between zonulin level and lactobacillus acidophilus stool culture growth in Hashimoto’s thyroiditis patient group
Our study showed statistically significant increase in serum zonulin level and correlated to TPO level in Hashimoto’s thyroiditis patients implicating a possible presence of leaky gut syndrome as it was also associated with lactobacillus acidophilus stool culture positivity which reflect a bacterial dysbiosis. This data may reflect the interaction between the gut microbiota and possible leaky gut syndrome and an association with Hashimoto’s thyroiditis. However, whether this data is a result from Hashimoto’s’ disease or a cause, this need a further evaluation.