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The thyroid, the eyes and the gut: a possible connection

There is a traditional shout in the House of Commons: The Ayes have it. In this case, the eyes may have it, but quite possibly the gut had it first.

I appreciate this sentence: The lack of knowledge in GD and GO pathogenesis implicates therapies that only limit damage but do not prevent disease onset.

All too true - we read lots of things which talk about therapy for Graves' (and Hashimoto's) which to the unitiated sound as if they really are cures. More, massively more, is needed to actually reach the obvious goal of preventing Graves'.

Also good to see Wales and Italy rather than the all-too-dominant USA and China.

J Endocrinol Invest. 2017 Jan 7. doi: 10.1007/s40618-016-0594-6. [Epub ahead of print]

The thyroid, the eyes and the gut: a possible connection.

Covelli D1, Ludgate M2.

Author information

1Graves' Orbitopathy Centre, Endocrinology, Department of Clinical Sciences and Community Health, Fondazione Ca'Granda IRCCS, University of Milan, via Sforza 35, 20122, Milan, Italy.

2Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK.



Graves' disease (GD) is an autoimmune disorder responsible for 60-90% of thyrotoxicosis, with an incidence of 1 to 2 cases per 1000 population per year in England. Graves' orbitopathy (GO) is the most frequent extrathyroidal manifestation, not provoked directly by abnormal thyroid hormone levels, but by the consequence of the underlying autoimmune process. The aetiology of autoimmune disorders is due to an interplay between susceptibility genes and environmental factors, such as infections and stress. What triggers the autoimmune reaction to a specific site of the body is not yet clearly understood. The lack of knowledge in GD and GO pathogenesis implicates therapies that only limit damage but do not prevent disease onset.


We performed on PubMed and the Cochrane Library a literature search for the articles published until July 2016 by using the search terms 'graves disease' and 'microbiome', 'orbitopathy' and 'autoimmune pathogenesis'. Reference lists of relevant studies were hand-searched for additional studies.


In this scenario, a Marie Sklodowska-Curie funded project INDIGO ( ) is investigating the role of the gut bacteria in GD and GO pathogenesis. The gut is the first and the widest area of bacteria access, with the highest concentration of T cells in the human body and trained to react to microorganisms. Interestingly, all the environmental factors involved in GD and GO pathogenesis can alter the balance within the microorganisms located in the gut, and influence the immune system, in particular the proportions of regulatory Treg and inflammatory TH17 cells. It is hoped that investigating GD and GO pathogenesis from this novel aspect will identify new targets for prevention and treatment.


Autoimmunity; Graves’ disease; Graves’ orbitopathy; Microbiota and dysbiosis

PMID: 28063079

DOI: 10.1007/s40618-016-0594-6

6 Replies

You've been busy today Helvella and all links are very interesting.


I recently read a book by Amy Myers called The Autoimmune Solution which explains that in her experience all autoimmune deceases - graves, hashimotos and non thyroid issues like MS and Parkinsons can all be reversed through radical changes to the diet. Basically eat REAL food, not processed, for 30 days and see the changes. She says the gut is vital to our health and a 30 day trial of her 'way' will help many of the folks on this forum who are struggling with all the various health issues.

Google her and the book - I hope it will help someone here. I wish I had known this before I had my thyroid 'killed' by radioactive iodine 20 years ago!


Hi clivevsmith I am new to this site. Having recently been diagnosed sjogrens syndrome following a horrendous battle with my deteriorating health over 18 months I am on a mission! I am hypothyroid 27 years managed very well worked brought up family etc.. Then, wham. 3 prolapse discs, sciatica, skin rashes, digestive/gut issues first time of my life. Entered role of patient! Every step of the way I have come to realise how harsh the life of a patient can be.

Suffice to say, I am doing everything I can for self help. I want to save myself and other sufferers the insidious difficulties that befall vulnerable patients. It appears to me, through experience, that breaking the body down into parts whereby we see this or that consultant, really is a flawed system. In addition, GP Jack of all trades, master of none, waiting times, lack of communication between professionals, ignoring or overiding patients concerns left me so debilitated and demoralised. From the beginning of what I call my health crises I repeatedly told professionals I have developed problems throughout my digestive, intestinal, elimination system. All ignored me. Time for action!

I have just finished reading Amy Myers, The Autoimmune Solution. Brilliant!! I have renewed hope! I have also joined sites like this one. Thank you everyone! Isolation and worry over my health was driving me to despair! Your sharing so much has helped me gain some of my lost confidence. I now insist on getting blood results from surgery! Also phoned hospital lab and got TSH over phone from 2015.

Interestingly, when my health deteriorated, I note my TSH was 0.02. (July 15). 0.18 September 15. 0.29 October 15. GP never told me or acted on those results until my dermatologist suggested meds needed review! Then she changed prescription from years on 125mcg day to 75mcg. By October 16 TSH was 0.39.

Came to this site read other experiences; requested TSH again, now 2.40. I am just learning much more than TSH needed! I will get onto this! I mean business! Lol.

So, back to Amy Myers. God sent, to me. I am almost gluten free. Long way to go but oh my, I am hopeful, and that is so refreshing after numerous trips to health professionals.

I wish you great improvements in your health and thank you for sharing.

Hellvella, there has to be something in all this about immunity the gut and disease. Thank you so much for leading us to the research.


Hi -

I just heard about Amy Myers and The Autoimmune Solution and will be getting the book.

Question for you - have you read her book, The Thyroid Connection? I'm just not sure if I should be getting that one too. (I am HypoT and have lupus (sle) and Sjogren's as well as antibodies for Hughes (Sticky Blood) Syndrome. I test negative for Hashi's but my endo says she knows autoimmune is playing a role with my HypoT since I have confirmed autoimmune diseases).

I've just started the process of eliminating gluten from our diet (my husband is a HUGE supporter and will do anything to help me be well). I test negative for celiac and don't have any issues with gluten in general but, I do know there are a myriad of health benefits from eliminating it. I've been baking my own GF soft bread and so far, so good.

I just don't know if there is any benefit to getting The Thyroid Connection on top of the Autoimmune Solution.



Hi tracy

I am sorry that you have overlapping autoimmune disease. I do believe your change to gluten free diet will help alleviate some of your symptoms. It helps me. It helps many people here overcome some thyroid symptoms.

Although I have suffered hypothyroidism for 27 yrs, the added diagnosis of sjogrens disease (and perhaps lupus, consultant not sure yet), I always maintain, the overlapping autoimmune disease, exacerbated thyroid symptoms. I think your endo sounds fantastic. I should be so lucky. My GP has totally refused referral to endo. I have never seen one and my GP adds insult to injury, because she says tsh fine. It is not fine. Has not been fine for at least 3 years. I came to HU I got the help and understanding I needed. I am now taking a lot of control over my health.

8 weeks ago I changed GP practice. I also got a lot of help and support from London sjogren centre as I put myself forward for volunteer into sjogrens effects on life. London consultant agreed check thyroid. Bingo!

So, anyway, I have recently seen my local rheumatologist (well a locum lol), he has agreed refer to endo! (I hope his decision doesn't get overridden).

Whatever I am doing to help myself is showing some encouraging signs. My RO reading was lower last rheumatologist appointment. I feel better taking some control. I am currently seeing Dr P about thyroid. He appears to be worth the financial investment.

So, no I haven't read The Thyroid Connection. I will do now! So, thank you for the tip. I also intend to get Stop the Thyroid Madness, and read that. I feel my GP has contributed to my body getting sicker. I wanted to work in partnership over my health. Sadly, she is too prescriptive. Lovely person. But I needed more than lovely. I needed a plan to manage my autoimmune the best way I can. With help from people willing to care and share, I am getting on with a better plan now.

The BSSA (British Sjogrens Syndrome Association), is a fantastic support for Sjogrens. Google them and join up if you want further knowledge and to meet others with sjogrens.

Your husband is a fantastic support. My GP did a good job convincing mine, that I was suffering anxiety. Yes, she probably right, when I was getting no support, plan, way forward, from her, I did get anxious. I think she would laugh knowing I've gone gluten free. She obviously doesn't research enough about the benefits, or respect patients become experts in their conditions.... we work very hard finding what we know will help.

Keep as well as you can, keep researching, keep caring and sharing. Together, we are all improving our health, a day at a time..

Best wishes

[ Edited by admin to include callout as reply was on Original Post.

milkwoman ]


Whoops! Sorry. My mistake. Thank you admin team.

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