{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T20:01:04Z","timestamp":1784059264094,"version":"3.55.0"},"reference-count":48,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>There is an association between hypothyroidism and small intestinal bacterial overgrowth (SIBO), but the exact mechanistic link between these 2 conditions is not fully elucidated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We evaluate the incidence and risks of subsequently developing SIBO, and changes in small bowel microbial populations, in subjects with hypothyroidism or autoimmune thyroiditis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Outcome Measures<\/jats:title>\n                    <jats:p>Duodenal aspirates from REIMAGINE study subjects with a history of hypothyroidism (hypothyroid group, N = 49) and controls (N = 323) underwent 16S rRNA sequencing (MiSeq, Illumina); a subset also underwent metagenomic sequencing (NovaSeq6000, Illumina). Separately, the TriNetX Analytics platform was used to evaluate 10-year cumulative incidences and relative risk (RR) of developing SIBO in subjects with hypothyroidism (unspecified etiology [HUE]), and a subset with autoimmune thyroiditis, vs propensity score matched control groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among REIMAGINE subjects, SIBO prevalence was higher in the hypothyroid group (32.65%) vs controls (15.17%). In the TriNetX analysis, 10-year cumulative incidences of SIBO were higher in HUE (RR = 2.20) and autoimmune thyroiditis (RR = 2.40) subjects vs matched controls. However, these risks appeared to be mitigated both in HUE (RR = 0.33) and autoimmune thyroiditis (RR = 0.78) subjects taking levothyroxine. Analyzing the duodenal microbiome, genus Neisseria was part of the core microbiome in the hypothyroid group (Hypo+\/SIBO\u2212, Hypo+\/SIBO+) but not in nonhypothyroid subjects (Hypo\u2212\/SIBO\u2212, Hypo\u2212\/SIBO+). Increased prevalence of Gram-negative coliforms occurred in both SIBO+ groups, but Escherichia\/Shigella formed part of the core in nonhypothyroid subjects (Hypo\u2212\/SIBO+), whereas Klebsiella species were prevalent in hypothyroid group subjects with SIBO (Hypo+\/SIBO+).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest there is an increased risk for development of SIBO in individuals with a history of hypothyroidism that may be ameliorated by treatment, and may involve specific Gram-negative coliforms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf495","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T11:53:42Z","timestamp":1756986822000},"page":"707-720","source":"Crossref","is-referenced-by-count":4,"title":["Relationship Between Hypothyroidism, Risk of Small Intestinal Bacterial 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