Title: Autoimmune Hypothyroidism and Vitamin D Levels
Authors: Dr Ritu Priya, Dr Pramila Kalra, Dr Vasudha K C
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.57
Abstract
Objectives: Hypothyroidism is one of the commonest endocrine disorders. Autoimmunity has an important role in its etiology. The immunomodulatory role of vitamin D is emphasized in recent years. Vitamin D insufficiency/deficiency is seen to be associated with many autoimmune diseases like multiple sclerosis, SLE, Type 1 DM etc. This study was aimed to see the relation between serum vitamin D levels and serum TPO Ab levels in hypothyroid disease.
Materials and Methods: Serum vitamin D (25-OH) levels were measured in 25 patients with autoimmune positive hypothyroidism and 27 healthy subjects, utilizing the ELISA method (Calbiotech diagnostics, USA). Vitamin D deficiency was designated at levels lower than 20 ng/ml. Antithyroid peroxidase antibodies were assayed by ELISA. TSH, T3, T4 levels were evaluated in all patients.
Results: Serum 25(OH)D was significantly lower in hypothyroid patients [median value with interquartile range-14.3(12.65-17.90)] than in controls [median value with interquartile range- 26(21-32.8)]. Serum 25(OH)D values has shown weak inverse correlation with TPOAbtitres.
Conclusion: The results of this study showed vitamin D deficiency in autoimmune hypothyroidism. The weak correlation between vitamin D and TPO Ab indicates the association but to prove it more extensive studies are required.
Keywords: Vitamin D; Hypothyroidism; TPO Ab; Thyroid autoantibodies, Autoimmune hypothyroidism.
References
1. Hollick MF, Chen TC. Vitamin D deficiency a worldwide problem with health consequences. Am J ClinNutr. 2008; 87:10805–68.
2. Naeem Z. Vitamin D Deficiency- An Ignored Epidemic. Int J Health Sci (Qassim).2010; 4(1): 5–6.
3. Goswami R, Mishra SK &Kochupillai N. Prevalence & potential significance of vitamin D deficiency in Asian Indians. Indian J Med Res 2008; 127, 229 – 238.
4. Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001; 358: 1500–1503.
5. Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 2004; 50: 72–77.
6. Huisman AM, White KP, Algra A, Harth M, Vieth R, Jacobs JW et al. Vitamin D levels in women with systemic lupus erythematosus and fibromyalgia. J Rheumatol 2001; 28: 2535–2539.
7. Baeke F, Takiishi T, Korf H, Gysemans C and Mathieu C. Vitamin D: modulator of the immune system. Curr. Opin. Pharmacol. 2010; 10 (4):482–96.
8. Shoenfeld N, Amital H, Shoenfeld Y. The effect of melanism and vitamin D synthesis on the incidence of autoimmune disease. Nat ClinPractRheumatol 2009; 5: 99–105.
9. Arnson Y, Amital H &Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis 2007; 66, 1137– 1142.
10. vanEtten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid BiochemMolBiol 2005; 97: 93–101.
11. Kochupillai N. Clinical endcrinology in India. CurrSci 2000; 79, 1061 –1067.
12. Goswami R, Marwaha RK, Gupta N et al. Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. Br J Nutr. 2009; 102: 382-386.
13. Kivity S, Agmon-Levin N, Zisappl M et al. Vitamin D and autoimmune thyroid diseases. Cell MolImmunol. 2011; 8: 243-247.
14. Zhang Q, Wang Z, Sun M, Cao M, Zhu Z, Fu Q et al. Association of high Vitamin D status with low circulating thyroid-stimulating hormone independent of thyroid hormone levels in middle-aged and elderly males. Int J Endocrinol. 2014; 63:18-22.
15. Garber JR, Cobin RH, Gharib H, Hennessey JV, Mechanik JI et al. American Association of Clinical Endricologists and American Thyroid Association Taskforce on Hypothyroidism in Adults.Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. EndocrPract. 2012 Nov-Dec; 18 (6): 988-1028.
16. Shoenfeld Y, Zandman-Goddard G, Stojanovich L, Cutolo M, Amital H, Levy Y et al. The mosaic of autoimmunity: hormonal and environmental factors involved in autoimmune diseases—2008. Isr Med Assoc J 2008; 10: 8–12.
17. Penna G, Adorini L. 1 Alpha,25-dihydroxyvitamin D3 inhibits differentiation, maturation, activation, and survival of dendritic cells leading to impaired alloreactive T cell activation. J Immunol 2000; 164: 2405–2411.
18. Boonstra A, Barrat FJ, Crain C, Heath VL, Savelkoul HF, O’Garra A. 1alpha,25- Dihydroxyvitamin d3 has a direct effect on naive CD4+T cells to enhance the development of Th2 cells. J Immunol 2001; 167: 4974–4980.
19. Naderi N, Farnood A, Habibi M, Derakhshan F, Balaii H , Motahari Z, Agah M R et al . Association of vitamin D receptor gene polymorphisms in Iranian patients with inflammatory bowel disease. J. Gastroenterol. Hepatol.2008; 23(12):1816–22.
20. Effraimidis G, Badenhoop K, Tijssen JG and Wiersinga WM. Vitamin D deficiency is not associated with early stages of thyroid autoimmunity. Eur J Endocrinol. 2012 Jul; 167(1):43-8.
21. Tamer G, Arik S, Tamer I and Coksert D. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid .2011; 21(8):891–96.