 Hi, this is Dr. Ruscio and let's discuss if SIBO or small intestinal bacterial overgrowth could actually cause thyroid autoimmunity. And just quickly, thyroid autoimmunity, also known as Hashimoto's, is the main cause of thyroid autoimmunity in westernized countries. So it's definitely an important underlying factor in hypothyroidism and in thyroid disease. We're learning more and more about the importance of the gut and how that connects to the immune system, most namely in this case how it connects to the thyroid. And there is some preliminary evidence, most notably in the treatment of AIDS pylori bacterial infections in the stomach being shown to have the ability to help improve thyroid autoimmunity. So there could definitely be a connection here. Now other studies have shown us that one of the strongest predictors of if someone will have SIBO is if they have hypothyroid or if they are on thyroid medication. So we definitely know that hypothyroidism and SIBO tend to have some overlap. The question is, could the SIBO actually be causing the thyroid autoimmunity? And while this is speculative, I think it's interesting in something that we could all benefit from understanding. Some evidence has shown that intestinal bacteria actually utilize selenium. And if these bacteria overgrow, there may be an increased demand for selenium in the gut by these bacteria as they're eating the selenium. That may cause a selenium deficiency in the host and the person who has the SIBO and selenium deficiencies have been documented to be one of the underlying factors that contributes to thyroid autoimmunity. This is why we see some trials showing that when people who have thyroid autoimmunity take supplemental selenium, we see an improvement in the thyroid autoimmunity. So again, the reason why we see SIBO and hypothyroid and thyroid autoimmunity go hand in hand may be because bacterial overgrowth are present. Those bacterial overgrowth utilize more of your selenium, creating a slight selenium deficiency, and that selenium deficiency may or that selenium deficiency had been shown to underlie thyroid autoimmunity. Now one question that comes up is, if intestinal bacteria can feed on selenium, would giving selenium cause or contribute to or exacerbate abacterial overgrowth? Most likely not because in the clinical trials where we give patient selenium, I have not seen any notable adverse reactions reported that would indicate that the SIBO is overgrowing, meaning gas, bloating, constipation, diarrhea, abdominal pain, what have you. So most likely if someone has SIBO and thyroid autoimmunity, a trial of selenium would be a safe bet for them. So kind of in recap. We know that thyroid autoimmunity is the main driver of hypothyroidism. We also know that thyroid autoimmunity and small intestinal bacteria overgrowth tend to go hand in hand in many cases. And what may happen and what may contribute to that in part is overgrowth of bacteria utilize your selenium, this utilization of selenium may create a subtle deficiency and that may contribute to thyroid autoimmunity. So what this means is that if you have thyroid autoimmunity, you should look to your gut health as an important part of the process for improving your immune system and improving the status of your thyroid autoimmunity. Also remember that many times the symptoms that we think are hypothyroid or coming from hypothyroid are actually coming from the gut. So the gut is a crucial part of the successful management of hypothyroidism and thyroid autoimmunity. This is Dr. Ruscio and I hope this information helps you get healthy and get back to your life. Thanks.