Effects of probiotics and synbiotics oral supplementation on thyroid function in adults: a grade-assessed systematic review and meta-analysis.

Background and aim: Evidence suggests that the gut microbiota may have a potential impact on thyroid function, given the gut-thyroid axis and the microbiome's involvement in nutrient absorption, immune modulation, and hormone metabolism. Emerging research highlighted that probiotics and synbiotics may influence thyroid hormone regulation, although findings in original studies are inconsistent. Therefore, this meta-analysis aims to evaluate the effects of probiotics and synbiotics oral supplementation on thyroid hormones in adults.

Methods: A systematic search was conducted across major online databases until April 2025. Studies were selected, relevant data extracted, and statistically analyzed using standard mean differences (SMD) and 95% confidence intervals (CI).

Results: The pooled analysis of nine clinical trials showed that probiotics and synbiotics oral supplementation led to a significant reduction in thyroid-stimulating hormone (TSH) (SMD: -1.10, 95%CI: [-1.96, -0.23], p = 0.013), and significantly increase free triiodothyronine (T3) (SMD: 0.98, 95% CI: [0.10, 1.85], p = 0.029) and free thyroxine (T4) (SMD: 1.04, 95%CI: [0.04, 2.05], p = 0.042). Subgroup analyses indicated that supplementation lasting ≤ 8 weeks showed a stronger effect. Additionally, patients with thyroid disorders show higher responsiveness.

Conclusion: Probiotics and synbiotics supplementation may beneficially modulate thyroid function, demonstrated by a significant reduction in TSH levels and increases in free T3 and free T4, particularly among individuals with thyroid disorders. These findings support the potential role of microbiome-targeted interventions as adjunctive strategies in managing thyroid dysfunction. However, further large-scale, long-term RCTs are needed to confirm their clinical efficacy and to establish standardized protocols for their use in routine care.