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CC BY-NC-ND 4.0 · Horm Metab Res 2019; 51(12): 792-797
DOI: 10.1055/a-1023-4181
Endocrine Care

Vitamin D Status and Thyroid Autoantibodies in Autoimmune Thyroiditis

Viktoria F. Koehler
1   Department of Endocrinology, Endokrinologikum Frankfurt, Frankfurt/Main, Germany
2   Department of Internal Medicine IV, University Hospital of Munich, LMU Munich, Munich, Germany
,
Natalie Filmann
3   Faculty of Medicine, Institute of Biostatistics and Mathematical Modeling, Goethe-University, Frankfurt/Main, Germany
,
W. Alexander Mann
1   Department of Endocrinology, Endokrinologikum Frankfurt, Frankfurt/Main, Germany
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Abstract

A lack of vitamin D seems to be related to autoimmune diseases including autoimmune thyroiditis (AIT). This study intends to determine the correlation between improvement of 25-hydroxyvitamin D [25(OH)D] levels and AIT in patients from an outpatient endocrine clinic in Frankfurt, Germany. This study included 933 patients with thyroid peroxidase antibodies (anti-TPO-Ab) ≥34 kIU/l, including most patients with clear AIT due to a concurrent sonographic evidence of reduced echogenicity. We performed clinical evaluation and laboratory analysis at five points in time within two years retrospectively. Due to a high dropout rate within the observation period, we excluded the last two time points from analysis. Data from 933 AIT patients revealed 89% having vitamin D deficiency or insufficiency [25(OH)D <75 nmol/l] with a median 25(OH)D level of 39.7 nmol/l. At baseline, a weak inverse correlation between 25(OH)D and anti-TPO-Ab was observed during winter (rs=–0.09, p=0.048*), but not during summer time (p>0.2). We discovered 58 patients having initially a 25(OH)D level < 75 nmol/l (median: 40.2 nmol/l), which improved over time to a 25(OH)D level ≥ 75 nmol/l (median: 83.2 nmol/l, p<0.0005***). Simultaneously, the median anti-TPO-Ab level showed a significant decrease of 25% from 245.8 to 181.3 kIU/l (p=0.036*). A significant reduction of the median anti-TPO-Ab level of 9% was also observed in the control group, which consisted of patients having constantly a 25(OH)D level <75 nmol/l. The result may suggest that in particular patients with 25(OH)D levels < 75 nmol/l benefit from an increase of 25(OH)D levels ≥ 75 nmol/l. Further prospective randomized controlled clinical trials are needed to finally evaluate if vitamin D has immunmodulatory effects in AIT.

Key words

autoimmune thyroid disease - vitamin D deficiency - 25(OH)D


Publikationsverlauf

Eingereicht: 26. Mai 2019

Angenommen: 04. Oktober 2019

Artikel online veröffentlicht:
25. November 2019

© 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Volzke H, Ludemann J, Robinson DM. et al. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003; 13: 803-810
    Google Scholar
  • 2 Voorby HA, Kabel PJ, de Haan M. et al. Dendritic cells and class II MHC expression on thyrocytes during the autoimmune thyroid disease of the BB rat. Clin Immunol Immunopathol 1990; 55: 9-22
    Google Scholar
  • 3 Mariotti S, Caturegli P, Piccolo P. et al. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990; 71: 661-669
    Google Scholar
  • 4 OʼConnell TD, Simpson RU. Immunochemical identification of the 1,25-dihydroxyvitamin D3 receptor protein in human heart. Cell Biol Int 1996; 20: 621-624
    Google Scholar
  • 5 Provvedini DM, Tsoukas CD, Deftos LJ. et al. 1,25-dihydroxyvitamin D3 receptors in human leukocytes. Science 1983; 221: 1181-1183
    Google Scholar
  • 6 Howitz J, Brodthagen H, Schwartz M. et al. Prevalence of vitiligo. Epidemiological survey on the Isle of Bornholm, Denmark. Arch Dermatol 1977; 113: 47-52
    Google Scholar
  • 7 Veldman CM, Cantorna MT, DeLuca HF. Expression of 1,25-dihydroxyvitamin D(3) receptor in the immune system. Arch Biochem Biophys 2000; 374: 334-338
    Google Scholar
  • 8 Mohr SB, Garland CF, Gorham ED. et al. The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide. Diabetologia 2008; 51: 1391-1398
    Google Scholar
  • 9 Simpson Jr. S, Blizzard L, Otahal P. et al. Latitude is significantly associated with the prevalence of multiple sclerosis: a meta-analysis. J Neurol Neurosurg Psychiatry 2011; 82: 1132-1141
    Google Scholar
  • 10 Vieira VM, Hart JE, Webster TF. et al. Association between residences in U.S. northern latitudes and rheumatoid arthritis: A spatial analysis of the Nursesʼ Health Study. Environ Health Perspect 2010; 118: 957-961
    Google Scholar
  • 11 Juzeniene A, Moan J. Beneficial effects of UV radiation other than via vitamin D production. Dermatoendocrinol 2012; 4: 109-117
    Google Scholar
  • 12 Bozkurt NC, Karbek B, Ucan B. et al. The association between severity of vitamin D deficiency and Hashimotoʼs thyroiditis. Endocr Pract 2013; 19: 479-484
    Google Scholar
  • 13 Mazokopakis EE, Papadomanolaki MG, Tsekouras KC. et al. Is vitamin D related to pathogenesis and treatment of Hashimotoʼs thyroiditis?. Hell J Nucl Med 2015; 18: 222-227
    Google Scholar
  • 14 Shin DY, Kim KJ, Kim D. et al. Low serum vitamin D is associated with anti-thyroid peroxidase antibody in autoimmune thyroiditis. Yonsei Med J 2014; 55: 476-481
    Google Scholar
  • 15 Mansournia N, Mansournia MA, Saeedi S. et al. The association between serum 25OHD levels and hypothyroid Hashimotoʼs thyroiditis. J Endocrinol Invest 2014; 37: 473-476
    Google Scholar
  • 16 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
    Google Scholar
  • 17 Yasmeh J, Farpour F, Rizzo V. et al. Hashimotoʼs Thyroiditis not associated with Vitamin-D Deficiency. Endocr Pract 2016; 22: 809-813
    Google Scholar
  • 18 Kivity S, Agmon-Levin N, Zisappl M. et al. Vitamin D and autoimmune thyroid diseases. Cell Mol Immunol 2011; 8: 243-247
    Google Scholar
  • 19 Tamer G, Arik S, Tamer I. et al. Relative vitamin D insufficiency in Hashimotoʼs thyroiditis. Thyroid 2011; 21: 891-896
    Google Scholar
  • 20 Camurdan OM, Doger E, Bideci A. et al. Vitamin D status in children with Hashimoto thyroiditis. J Pediatr Endocrinol Metab 2012; 25: 467-470
    Google Scholar
  • 21 Smyth PP, Wijeyaratne CN, Kaluarachi WN. et al. Sequential studies on thyroid antibodies during pregnancy. Thyroid 2005; 15: 474-477
    Google Scholar
  • 22 Kuijpens JL, Pop VJ, Vader HL. et al. Prediction of post partum thyroid dysfunction: can it be improved?. Eur J Endocrinol 1998; 139: 36-43
    Google Scholar
  • 23 Kampe O, Jansson R, Karlsson FA. Effects of L-thyroxine and iodide on the development of autoimmune postpartum thyroiditis. J Clin Endocrinol Metab 1990; 70: 1014-1018
    Google Scholar
  • 24 Holick MF, Binkley NC, Bischoff-Ferrari HA. et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911-1930
    Google Scholar
  • 25 Hothorn T, Hornik K, Zeileis A. Unbiased recursive partitioning: A conditional inference framework. J Comput Graph Statistics 2006; 15: 651-674
    Google Scholar
  • 26 Schmidt M, Voell M, Rahlff I. et al. Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimotoʼs thyroiditis) treated with levothyroxine. Thyroid 2008; 18: 755-760
    Google Scholar
  • 27 Padberg S, Heller K, Usadel KH. et al. One-year prophylactic treatment of euthyroid Hashimotoʼs thyroiditis patients with levothyroxine: Is there a benefit?. Thyroid 2001; 11: 249-255
    Google Scholar
  • 28 Romaldini JH, Biancalana MM, Figueiredo DI. et al. Effect of L-thyroxine administration on antithyroid antibody levels, lipid profile, and thyroid volume in patients with Hashimotoʼs thyroiditis. Thyroid 1996; 6: 183-188
    Google Scholar
  • 29 Chiovato L, Vitti P, Lombardi A. et al. Expression of the microsomal antigen on the surface of continuously cultured rat thyroid cells is modulated by thyrotropin. J Clin Endocrinol Metab 1985; 61: 12-16
    Google Scholar
  • 30 Rieu M, Richard A, Rosilio M. et al. Effects of thyroid status on thyroid autoimmunity expression in euthyroid and hypothyroid patients with Hashimotoʼs thyroiditis. Clin Endocrinol (Oxf) 1994; 40: 529-535
    Google Scholar
  • 31 Chaudhary S, Dutta D, Kumar M. et al. Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labeled randomized controlled trial. Indian J Endocrinol Metab 2016; 20: 391-398
    Google Scholar
  • 32 Krysiak R, Szkrobka W, Okopien B. The effect of vitamin D on thyroid autoimmunity in levothyroxine-treated women with hashimotoʼs thyroiditis and normal vitamin D status. Exp Clin Endocrinol Diabetes 2017; 125: 229-233
    Google Scholar
  • 33 Pani MA, Regulla K, Segni M. et al. Vitamin D 1alpha-hydroxylase (CYP1alpha) polymorphism in Gravesʼ disease, Hashimotoʼs thyroiditis and type 1 diabetes mellitus. Eur J Endocrinol 2002; 146: 777-781
    Google Scholar
  • 34 Kurylowicz A, Ramos-Lopez E, Bednarczuk T. et al. Vitamin D-binding protein (DBP) gene polymorphism is associated with Gravesʼ disease and the vitamin D status in a Polish population study. Exp Clin Endocrinol Diabetes 2006; 114: 329-335
    Google Scholar
  • 35 Yazici D, Yavuz D, Tarcin O. et al. Vitamin D receptor gene ApaI, TaqI, FokI and BsmI polymorphisms in a group of Turkish patients with Hashimotoʼs thyroiditis. Minerva Endocrinol 2013; 38: 195-201
    Google Scholar
  • 36 Mathieu C. Vitamin D and the immune system: Getting it right. IBMS BoneKEy 2011; 8: 178-186
    Google Scholar