Title Opravdanost nutritivnih intervencija u oboljelih od Hashimotovog tireoditisa Author Karmen Matković Melki Mentor Dubravka Vitali Čepo (mentor)Committee member Dubravka Vitali Čepo (predsjednik povjerenstva)Committee member Sanda Vladimir-Knežević (član povjerenstva)Committee member Ivana Kraljević (član povjerenstva) Granter University of Zagreb Defense date and country 2021-10-07, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Hashimotov tireoiditis (HT) je organ-specifična autoimuna bolest koju karakterizira kronična
upala štitne žlijezde s limfocitnom infiltracijom tkiva i pozitivnim nalazom tiroidnih antitijela. Za
optimalan rad štitnjače ključni su specifični mikronutrijenti; u prvom redu jod, selen, željezo i vitamin
D, zbog čega se sve više istražuje njihova uloga u etiologiji, prevenciji i podršci liječenju HT-a.
Istraživani su i učinci različitih obrazaca prehrane, iako još uvijek ne postoje službene smjernice za
nutritivnu podršku oboljelih od HT-a.
Cilj ovog rada je dati sustavni pregled rezultata istraživanja o mogućnostima nutritivne
intervencije u oboljelih od HT-a te ju vrednovati kao opravdanu komplementarnu strategiju u prevenciji
i liječenju hipotireoze uzrokovane HT-om, ali i samog HT-a.
Metode rada uključivale su pregled dostupne znanstvene literature na temu utjecaja mikronutricije i
prehrane na razvoj HT-a i komorbiditeta. Također su pregledani radovi koji su istraživali značajne
interakcije hrane i dodataka prehrani s levotiroksinom kao terapijom izbora kod hipotireoze uzrokovane
HT-om i radovi koji su analizirali sastav i utjecaj crijevne mikrobiote u oboljelih od HT-a na razvoj i
tijek bolesti.
Utvrđena je opravdanost individualne suplementacije u cilju korekcije dokazanih deficita
specifičnih vitamina i mineralnih tvari, kao i opravdanost primjene probiotika s ciljem prevencije ili
podrške liječenju disbioze crijeva u oboljelih od HT-a. Potvrđena je preporuka vremenski odvojenog
uzimanja levotiroksina i hrane/dodataka prehrani zbog prevencije klinički značajnih interakcija. Od
nutritivnih intervencija najperspektivnijom se pokazala opravdanost provođenja mediteranske prehrane
zbog visoke adherencije i koristi u prevenciji i podršci liječenju HT-a i komorbiditeta. Djelomično su
opravdane mogućnosti individualne primjene i ostalih nutritivnih intervencija poput
veganske/vegetarijanske prehrane te različitih eliminacijskih prehrana (bezglutenske, prehrane niskog
FODMAP-a, LCHF/ ketogene, Paleo prehrane, autoimunog protokola). Naglasak je na preporuci
provođenja navedenih prehrambenih modela isključivo nakon individualne procjene, pod strogom
kontrolom stručnjaka. Nutritivne intervencije u oboljelih od HT-a trebale bi biti pod nadzorom
multidisciplinarnog tima (liječnik, nutricionist, farmaceut, psiholog), a u kliničkoj praksi treba poticati
nutricionističko savjetovanje.
Zaključci rada potvrđuju postavljenu hipotezu da se primjenom specifičnih obrazaca prehrane i
ciljanom individualnom suplementacijom može doprinijeti prevenciji ili ublažavanju simptoma HT-a,
hipotireoze uzrokovane HT-om i simptoma najčešćih sekundarnih komorbiditeta.
Abstract (english) Hashimoto's thyroiditis (HT) is an organ-specific autoimmune disease characterized by chronic
inflammation of the thyroid gland with lymphocytic tissue infiltration and serum positive thyroid
autoantibodies. For optimal thyroid function, emphasis is set on specific micronutrients; iodine,
selenium, iron and vitamin D, with increasing number of studies regarding their role in etiology,
prevention and treatment of HT. Application of different dietary models has also been investigated,
although there are still no official guidelines for nutritional support in HT patients.
The aim of this literature review is to give a systematic overview of the latest research results
on possibilities of nutritional intervention in patients with HT and to evaluate them as a justified
complementary strategy for the prevention and treatment of hypothyroidism caused by HT and HT itself.
Methods included a review of the available scientific literature on the influence of
vitamin/mineral supplementation and nutrition on the development of HT and its comorbidities.
Occurrence of significant food/dietary supplements - levothyroxine interactions, and significance of the
intestinal microbiota on disease development and course were also investigated.
Tailored micronutrient supplementation for the correction of proven micronutritive deficiencies,
as well as probiotic supplementation for the prevention or treatment of intestinal dysbiosis in patients
with HT was justified. The recommendation of time-separate administration of levothyroxine and food
/ dietary supplements to prevent clinically significant interactions that reduce drug absorption and
effectiveness was confirmed. The most promising and justified nutritional intervention is Mediterranean
diet, due to high patient adherence and proven benefits in the prevention and support in treatment of HT
and its comorbidities. Application of other nutritional interventions such as vegan / vegetarian diet, and
various elimination diets (gluten-free, low FODMAP diet, LCHF / ketogenic, Paleo diet, autoimmune
protocol) was found to be only partially justified. When recommending elimination diet, emphasis
should be set on comprehensive individual counselling of HT patient, and conduction of therapy under
strict expert supervision. Nutritional interventions in HT patients should be implemented by a
multidisciplinary team (physician, dietitian, pharmacist, psychologist) and nutrition counselling should
be encouraged in clinical practice.
Hypothesis that the application of specific dietary patterns and targeted individual
supplementation can contribute to the prevention or alleviation of symptoms of HT, hypothyroidism
caused by HT and the symptoms of the most common secondary comorbidities was confirmed.
Keywords
štitnjača
autoimuna bolest
Hashimotov tireoiditis
hipotireoza
nutritivna intervencija
mikronutricija
mediteranska prehrana
Keywords (english)
thyroid
autoimmune disease
Hashimoto's thyroiditis
hypothyroidism
nutritional intervention
micronutrition
Mediterranean diet
Language croatian URN:NBN urn:nbn:hr:163:662832 Study programme Title: Phytopharmacy with dietotherapy Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-03-24 16:45:42
