Commentary on the role of berberine in addition to methimazole compare to methimazole alone in the treatment of Graves’ Diseas

Abstract

Graves’ Disease (GD) is the most common form of hyperthyroidism. It affects 3% of female patients and 0.5% of male patients usually between the age of 30-60. It is the cause of 80% of hyperthyroid cases in the USA. The pathogenesis of the disease is complex and autoimmunity plays a key role. The antibodies stimulating the thyrotropin receptor (TRAb) lead to uncontrolled Thyroid-stimulating Hormone (TSH) overproduction of thyroid hormones from the overactive thyroid gland. The disease is frequently associated with Graves's ophthalmopathy, dermatopathy, and clubbing. It affects the whole body with deleterious effects on the Cardiovascular system, vision, bones, etc. The treatment of the disease is with anti-thyroid medications, Radioactive iodine, or thyroid surgery each one of which has its pluses and minuses. Other factors like Genetic, inflammatory, immune, environmental factors, etc. play critical roles in disease pathogenesis as well. In this article, we are discussing the newfound role of the gut-thyroid axis in the pathogenesis of GD. We are describing the role of the probiotic Berberine added to the anti-thyroid medication Methimazole in changing the gut microbiota by increasing the benefits and decreasing the deleterious bacteria in the gut. This can lead to the induction of anti-inflammatory cytokines and reduction of inflammatory ones which can regulate the immune system faster and better than with treatment with Methimazole alone. This treatment combination can eventually lead through the effect on the gut-thyroid axis to faster disappearance of the TRAb and remission and cure of GD.