The Association Between Severity of Vitamin D Deficiency and Hashimoto's Thyroiditis

doi:10.4158/EP12376.OR

Endocrine Practice

Volume 19, Issue 3, May–June 2013, Pages 479-484

https://doi.org/10.4158/EP12376.OR Get rights and content

ABSTRACT

Objective

The relation between vitamin D and autoimmune disorders has long been investigated regarding the important roles of this hormone in immune regulation. We evaluated 25-hydroxyvitamin D (25OHD) status in subjects with Hashimoto’s thyroiditis (HT) and healthy controls.

Methods

Group-1 included 180 euthyroid patients (123 females/57 males) with HT who were on a stable dose of L-thyroxine (LT). A total of 180 sex-, age-, and body mass index (BMI)-matched euthyroid subjects with newly diagnosed HT were considered as Group-2, and 180 healthy volunteers were enrolled as controls (Group-3). All 540 subjects underwent thyroid ultrasound and were evaluated for serum 25OHD, anti-thyroid peroxidase (anti- TPO), and anti-thyroglobulin (anti-TG) levels.

Results

Group-1 had the lowest 25OHD levels (11.4 ± 5.2 ng/mL) compared to newly diagnosed HT subjects (Group-2) (13.1 ± 5.9 ng/mL, P = .002) and to control subjects (15.4 ± 6.8 ng/mL, P<.001). Serum 25OHD levels directly correlated with thyroid volume (r = 0.145, P<.001) and inversely correlated with anti-TPO (r = -0.361, P<.001) and anti-TG levels (r = -0.335, P<.001). We determined that 48.3% of Group-1, 35% of Group-2, and 20.5% of controls had severe 25OHD deficiency (<10 ng/mL). Female chronic HT patients had the lowest serum 25OHD levels (10.3 ± 4.58 ng/mL), and male control subjects had the highest (19.3 ± 5.9 ng/mL, P<.001).

Conclusions

We demonstrated that serum 25OHD levels of HT patients were significantly lower than controls, and 25OHD deficiency severity correlated with duration of HT, thyroid volume, and antibody levels. These findings may suggest a potential role of 25OHD in development of HT and/or its progression to hypothyroidism. (Endocr Pract. 2013;19:479-484)

Section snippets

INTRODUCTION

Vitamin D is an important nutrient that exerts widespread effects on cellular proliferation, differentiation, apoptosis, and angiogenesis. Exploration into the roles of vitamin D receptor (VDR) on immune system cells, such as monocytes, macrophages, antigen-presenting cells, dendritic cells, and lymphoyctes, has recently increased interest into the immune modulator role of vitamin D (1). Results of epidemiological studies indicated a significant association between decreased levels of serum

Study Subjects

We included a total of 540 individuals in this crosssectional study. All participants were evaluated for thyroid function, thyroid autoimmunity, and ultrasonographic features before enrollment. Subjects who were (1) not euthyroidic; (2) who had diabetes, malignancy, chronic renal, and/or hepatic failure or autoimmune diseases; or (3) who were on oral contraceptive, anti-epileptic, or anti-osteoporotic medication were excluded. None of the subjects were taking vitamin and/or calcium supplements.

RESULTS

Each of the study groups consisted of 180 subjects (123 females, 57 males) who were similar in terms of mean age and BMI Table 1. Group-1 patients, who had chronic HT and took LT4 replacement, presented significantly lower 25OHD levels than the Group-2 subjects, who were not yet hypothyroid (11.4 ± 5.2 ng/mL versus 13.1 ± 5.9, P<.001) and control subjects (15.4 ± 6.8 ng/mL, P<.001). All subjects were euthyroid as mentioned in the selection criteria. Compared to the control population, all HT

DISCUSSION

Vitamin D deficiency is a prevalent health problem in Turkey. Erkal et al demonstrated that more than 78% of Turkish people had serum 25OHD levels <25 ng/mL independent of where they resided (9). In another study, Ergur and colleagues reported the frequency of severe vitamin D deficiency as 27% among reproductive age women (10). However, there is not enough data regarding vitamin D levels of patients with HT. The increased prevalence of vitamin D deficiency in our study population is likely

CONCLUSION

In conclusion, we showed that patients with HT exhibit lower vitamin D levels, and these values are inversely correlated to antibody levels and directly correlated to thyroid volume. Finally, our results suggest the existence of a casual relationship between vitamin D deficiency and development of HT. There may also be a relationship between vitamin D deficiency severity and thyroid damage progression. However, further studies are needed, especially regarding the effects of vitamin D

DISCLOSURE

The authors have no multiplicity of interest to disclose.

REFERENCES (20)

Van BelleT.L. et al.
Vitamin D in autoimmune, infectious and allergic diseases: a vital player?
Best Pract Res Clin Endocrinol Metab
(2011)
ArdizzoneS. et al.
Vitamin D and inflammatory bowel disease
Vitam Horm
(2011)
BaekeF. et al.
Human T lymphocytes are direct targets of 1,25-dihydroxyvitamin D3 in the immune system
J Steroid Biochem Mol Biol
(2010)
CantornaM.T. et al.
Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system
Am J Clin Nutr
(2004)
KongY.C. et al.
Autoimmune thyroiditis: a model uniquely suited to probe regulatory T cell function
J Autoimmun
(2009)
SamuelS. et al.
Vitamin D's role in cell proliferation and differentiation
Nutr Rev
(2008)
DelucaH.F. et al.
Vitamin D: its role and uses in immunology
Faseb J
(2001)
MaalejA. et al.
Lack of association of VDR gene polymorphisms with thyroid autoimmune disorders: familial and case/control studies
J Clin Immunol
(2008)
PearceE.N. et al.
Thyroiditis
N Engl J Med
(2003)
ChenW. et al.
Immune intervention effects on the induction of experimental autoimmune thyroiditis
J Huazhong Univ Sci Technolog Med Sci
(2002)

There are more references available in the full text version of this article.

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Original ArticleThe Association Between Severity of Vitamin D Deficiency and Hashimoto's Thyroiditis

ABSTRACT

Objective

Methods

Results

Conclusions

Section snippets

INTRODUCTION

Study Subjects

RESULTS

DISCUSSION

CONCLUSION

DISCLOSURE

Best Pract Res Clin Endocrinol Metab

Vitam Horm

J Steroid Biochem Mol Biol

Am J Clin Nutr

J Autoimmun

Vitamin D's role in cell proliferation and differentiation

Nutr Rev

Vitamin D: its role and uses in immunology

Faseb J

Lack of association of VDR gene polymorphisms with thyroid autoimmune disorders: familial and case/control studies

J Clin Immunol

Thyroiditis

N Engl J Med

Immune intervention effects on the induction of experimental autoimmune thyroiditis

J Huazhong Univ Sci Technolog Med Sci

Original Article
The Association Between Severity of Vitamin D Deficiency and Hashimoto's Thyroiditis