{"id":1727,"date":"2019-07-19T09:00:29","date_gmt":"2019-07-19T09:00:29","guid":{"rendered":"https:\/\/www.danielleal.pt\/?p=1727"},"modified":"2019-07-20T07:56:19","modified_gmt":"2019-07-20T07:56:19","slug":"helicobacter-pylori-infection-and-autoimmune-thyroid-diseases-is-there-an-association","status":"publish","type":"post","link":"https:\/\/danielleal.pt\/en\/helicobacter-pylori-infection-and-autoimmune-thyroid-diseases-is-there-an-association\/","title":{"rendered":"Helicobacter pylori Infection and Autoimmune Thyroid Diseases &#8211; is there an association?"},"content":{"rendered":"<p class=\"p1\"><span class=\"s1\">The thyroid is the most affected organ by autoimmune disease. Although thyroid autoimmunity\u2019s etiology is multifactorial, there is evidence that some infectious agents, including <i>Helicobacter pylori<\/i>, may contribute to its development.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><i>Helicobacter pylori <\/i>(Hp) is a gram-negative bacteria with the ability to colonize and infect the gastric mucosa. <b>This infection is quite common, being present in about half of the world\u2019s population.<\/b> The local consequences of Hp infection are gastritis, peptic ulcer, and gastric carcinoma. However, some extra digestive manifestations such as idiopathic thrombocytopenic purpura (a disease characterized by autoimmune destruction of platelets) and even atherosclerotic coronary disease have been associated with the presence of Hp, in the medical literature.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\" style=\"color: #35b5a3;\"><b>What are autoimmune thyroid diseases?<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Autoimmune thyroid diseases (ATDs) are very common, with an estimated prevalence of 5% in the population (women are more affected than men). <b>ATDs characterized by the presence of antibodies directed against the thyroid tissue, and lymphocytic infiltrates in the gland.<\/b> This immune reaction leads to the progressive destruction of the gland, which can then cause functional changes (hypo or hyperthyroidism). The two main ATDs are the following:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Hashimoto&#8217;s thyroiditis &#8211; antibodies against thyroglobulin (Anti-Tg) and thyroperoxidase (Anti-TPO) are generally present. Due to the gland\u2019s progressive destruction, hypothyroidism usually ensues after a few years.<\/span><\/li>\n<li class=\"p1\">Graves&#8217; disease &#8211; the presence of TSH receptor-specific antibodies (TRAb&#8217;s) promotes hyperstimulation of the gland, which causes hyperthyroidism.<\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\" style=\"color: #35b5a3;\"><b>What causes these diseases?<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">As with other autoimmune diseases, the cause is not known. A combination of genetic and environmental factors can trigger autoimmunity. <b>Exposure to certain drugs, iodine, smoking, and possibly stress, contributes to the development of ATD.<\/b> Certain viral and bacterial infections, such as <i>Hepatitis C, Coxsackie virus, Yersinia enterocolitica, Borrelia burgdorferi, <\/i>and<i> Helicobacter pylori,<\/i> have also been proposed as possible autoimmune triggers.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\" style=\"color: #35b5a3;\"><b>How can an infection promote autoimmunity?<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Infectious agents activate the immune system, which tries to control and eradicate them. This process is dynamic and more complicated than it may seem. <b>Microorganisms can &#8220;confuse&#8221; our immune system, causing it to react against molecules and tissues of the body itself. <\/b>Several mechanisms explain this phenomenon, such as molecular mimicry (similar molecules between the microorganism and the host), modification of host antigens due to interaction with the infectious agent, and excessive stimulation of immune cells.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\" style=\"color: #35b5a3;\"><b>Is there an association between <i>Helicobacter pylori<\/i> infection and ATDs?<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Over the past 20 years, multiple studies have tried to answer this question with different results.<b> A meta-analysis published in 2017 looked at 15 articles (a total of 3046 patients) and found a positive association between Hp infection and autoimmune thyroid disease<\/b> (OR-2.25, which means that an infected person has a risk 2.25-fold higher risk of developing ATD). <b>This association was more significant in Grave&#8217;s disease (OR-2.78) than in Hashimoto&#8217;s thyroiditis (OR-2.16).<\/b><\/span><\/p>\n<p><img loading=\"lazy\" class=\"alignnone size-full wp-image-1730\" src=\"https:\/\/www.danielleal.pt\/wp-content\/uploads\/2019\/07\/Fig1_Helicobacter_doenca_autoimune.jpg\" alt=\"\" width=\"800\" height=\"500\" \/><\/p>\n<h4 class=\"p1\" style=\"text-align: center;\"><span class=\"s1\" style=\"color: #5e5e5e;\">Fig. 1 &#8211; <i>Helicobacter pylori<\/i> is a Gram-negative bacteria that infects the mucosa of the stomach.<\/span><\/h4>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\" style=\"color: #35b5a3;\"><b>How does this likely association influence clinical practice?<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">In the case of autoimmune thyroid disease, the conventional treatment is to replace thyroid hormone levels when there is hypothyroidism (Hashimoto), or to suppress the endogenous production of the thyroid when there is hyperthyroidism (Graves&#8217; disease).<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>However, in parallel, it is important to identify and correct potential factors that may contribute to autoimmunity. <\/b>The association between Hp infection and ATDs is suggested in the literature, and there is, at least, one study reporting a significant decrease in anti-thyroid antibodies after Hp eradication. This was a small study with only 10 patients, but it raises an important question for the clinician: <b>Is eradication of Hp indicated in patients with ATD\u2019s?<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Autoimmune diseases are complex, and it is important to have a comprehensive view of the different factors that may have triggered their manifestation. Certain infections, such as <i>Helicobacter pylori,<\/i> fall in this category.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>References:<\/b><\/span><\/p>\n<p class=\"p3\"><span class=\"s2\">Hou Y, Sun W, Zhang C, et al. <\/span><span class=\"s1\" style=\"color: #35b5a3;\">Meta-analysis of the correlation between Helicobacter pylori infection and autoimmune thyroid diseases. <\/span><span class=\"s2\">Oncotarget. 2017;8(70):115691\u2013115700.<\/span><\/p>\n<p class=\"p5\"><span class=\"s1\">K\u00f6hling HL, Plummer SF, Marchesi JR, et al. <\/span><span class=\"s3\" style=\"color: #35b5a3;\">The microbiota and autoimmunity:Their role in thyroid autoimmune diseases. <\/span><span class=\"s1\">Clinical Immunology. 2017;183:63-74.<\/span><\/p>\n<p class=\"p3\"><span class=\"s2\">Shmuely H, Shimon I, Gitter LA.<\/span><span class=\"s1\" style=\"color: #35b5a3;\"> Helicobacter pylori infection in women with Hashimoto thyroiditis: A case-control study.<\/span><span class=\"s2\"> Medicine (Baltimore). 2016;95(29):e4074.<\/span><\/p>\n<p class=\"p7\"><span class=\"s1\">Bertalot G, Montresor G, Tampieri M, et al. <\/span><span class=\"s3\" style=\"color: #35b5a3;\">Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection.<\/span><span class=\"s1\"> Clinical Endocrinology (Oxf). 2004;61(5):650-652.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The thyroid is the most affected organ by autoimmune disease. Although thyroid autoimmunity\u2019s etiology is multifactorial, there is evidence that some infectious agents, including Helicobacter pylori, may contribute to its development. Helicobacter pylori (Hp) is a gram-negative bacteria with the ability to colonize and infect the gastric mucosa. This infection is quite common, being present&#8230;<\/p>\n","protected":false},"author":6,"featured_media":1735,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false},"categories":[19,38],"tags":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Helicobacter pylori Infection and Autoimmune Thyroid Diseases - is there an association? - Dr. Daniel Leal<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/danielleal.pt\/en\/helicobacter-pylori-infection-and-autoimmune-thyroid-diseases-is-there-an-association\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Helicobacter pylori Infection and Autoimmune Thyroid Diseases - is there an association? - Dr. Daniel Leal\" \/>\n<meta property=\"og:description\" content=\"The thyroid is the most affected organ by autoimmune disease. Although thyroid autoimmunity\u2019s etiology is multifactorial, there is evidence that some infectious agents, including Helicobacter pylori, may contribute to its development. Helicobacter pylori (Hp) is a gram-negative bacteria with the ability to colonize and infect the gastric mucosa. 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