Associative relationships between vitamin D levels,immunological characteristics and thyroid volume in patients with hypothyroidism due to autoimmune thyroiditis

Main Article Content

O.A. Goncharova


Background. The leading factor of hypothyroidism in patients with autoimmune thyroiditis is destruction of the thyroid gland under the influence of the autoimmune process. Therefore, the essence of pathogenetic therapy for autoimmune thyroiditis is the prescription of immunomodulators. Understanding the features of autoimmune disorders in autoimmune thyroiditis will allow justifying the requirements for such drugs. Aim: to determine if there is an association between thyroid volume, vitamin D level, and immunological parameters in hypothyroidism due to autoimmune thyroiditis. Materials and methods. A comparative analysis of thyroid status in terms of thyroid-stimulating hormone and free thyroxine content, blood vitamin D levels and immune homeostasis indicators (CD3, CD4, CD8, CD16, CD22, thyroid pe­roxidase antibo­dies and thyroglobulin antibodies) was performed in 55 women with drug-compensated hypothyroidism due to autoimmune thyroiditis. The first group consisted of 29 women with autoimmune thyroi­ditis who for at least one year received indivi­dually selected thyroid replacement therapy, with thyroid volume of 11.05 ± 1.86 cm3, the second group — of 26 women, at least a year ago operated for benign thyroid nodules against the background of autoimmune thyroiditis, with thyroid volume of 4.26 ± 1.89 cm3 (p < 0.05 between groups). The control group included 12 women without autoimmune thyroiditis and hypothyroidism, thyroid volume was 8.7 ± 0.6 cm3. Results. While the thyroid status indicators in autoimmune thyroiditis patients were within the reference norms, the vitamin D level in the general group of women with autoimmune thyroidi­tis and hypothyroidism was significantly (p < 0.02) lower than in the control group, despite the fact that in the control group it corresponded to deficiency status (22.7 ng/ml), and against the background of autoimmune thyroiditis — to vitamin D deficiency (18.3 ng/ml). In patients with a smaller thyroid volume (group 2), the content of vitamin D was significantly (p < 0.05) lower than in group 1. Indicators of cellular immunity were within the re­ference standards, but the level of natural killers in group 2 was significantly (p < 0.05) lower. The levels of antithyroid antibo­dies in both groups were high, indicating the activity of the autoimmune process. Conclusions. In patients with hypothyroidism on the background of autoimmune thyroiditis in a state of drug compensation, smaller thyroid glands are associated with a more pronounced vitamin D deficiency. Thyroid volumes in patients with autoimmune thyroiditis are not associated with pronounced changes in cellular immunity, except for a decrease in the level of natural killers in smaller thyroid volume. The persistent activity of the autoimmune process in patients with hypothyroidism due to autoimmune thyroiditis against the background of prolonged and successful thyroid replacement therapy necessitates the addition of adequate immunomodulators to it, including vitamin D.

Article Details

How to Cite
Goncharova, O. “Associative Relationships Between Vitamin D levels,immunological Characteristics and Thyroid Volume in Patients With Hypothyroidism Due to Autoimmune Thyroiditis”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 16, no. 2, Mar. 2020, pp. 111-6, doi:10.22141/2224-0721.16.2.2020.201295.
Original Researches


Rydzewska M, Jaromin M, Pasierowska IE, Stożek K, Bossowski A. Role of the T and B lymphocytes in pathogenesis of autoimmune thyroid diseases. Thyroid Res. 2018;11:2. doi:10.1186/s13044-018-0046-9.

Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5(7):2502–2521. doi:10.3390/nu5072502.

Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol. 2010;10(4):482–496. doi:10.1016/j.coph.2010.04.001.

Kim D. The Role of Vitamin D in Thyroid Diseases. Int J Mol Sci. 2017;18(9):1949. doi:10.3390/ijms18091949.

D'Aurizio F, Villalta D, Metus P, Doretto P, Tozzoli R. Is vitamin D a player or not in the pathophysiology of autoimmune thyroid diseases?. Autoimmun Rev. 2015;14(5):363–369. doi:10.1016/j.autrev.2014.10.008.

Hewison M. An update on vitamin D and human immunity. Clin Endocrinol (Oxf). 2012;76(3):315–325. doi:10.1111/j.1365-2265.2011.04261.x.

Evliyaoğlu O, Acar M, Özcabı B, et al. Vitamin D Deficiency and Hashimoto's Thyroiditis in Children and Adolescents: a Critical Vitamin D Level for This Association?. J Clin Res Pediatr Endocrinol. 2015;7(2):128–133. doi:10.4274/jcrpe.2011.

Talaei A, Ghorbani F, Asemi Z. The Effects of Vitamin D Supplementation on Thyroid Function in Hypothyroid Patients: A Randomized, Double-blind, Placebo-controlled Trial. Indian J Endocrinol Metab. 2018;22(5):584–588. doi:10.4103/ijem.IJEM_603_17.

Kim D. Low vitamin D status is associated with hypothyroid Hashimoto's thyroiditis. Hormones (Athens). 2016;15(3):385–393. doi:10.14310/horm.2002.1681.

Pankiv V, Pankiv I. Association of vitamin D status with body mass index in adolescents in Ukraine. Romanian Journal of Diabetes Nutrition and Metabolic Diseases. 2018;25(4):377–381.

Ke W, Sun T, Zhang Y, et al. 25-Hydroxyvitamin D serum level in Hashimoto's thyroiditis, but not Graves' disease is relatively deficient. Endocr J. 2017;64(6):581–587. doi:10.1507/endocrj.EJ16-0547.

Bozkurt NC, Karbek B, Ucan B, et al. The association between severity of vitamin D deficiency and Hashimoto's thyroiditis. Endocr Pract. 2013;19(3):479–484. doi:10.4158/EP12376.OR.

Yasuda T, Okamoto Y, Hamada N, et al. Serum vitamin D levels are decreased and associated with thyroid volume in female patients with newly onset Graves' disease. Endocrine. 2012;42(3):739–741. doi:10.1007/s12020-012-9679-y.

Bizzaro G, Shoenfeld Y. Vitamin D and thyroid autoimmune diseases: the known and the obscure. Immunol Res. 2015;61(1-2):107–109. doi:10.1007/s12026-014-8591-3.

D'Aurizio F, Villalta D, Metus P, Doretto P, Tozzoli R. Is vitamin D a player or not in the pathophysiology of autoimmune thyroid diseases?. Autoimmun Rev. 2015;14(5):363–369. doi:10.1016/j.autrev.2014.10.008.

Holick MF. The D-batable Institute of Medicine report: a D-lightful perspective. Endocr Pract. 2011;17(1):143–149. doi:10.4158/ep.17.1.143.

Pankiv IV. The effect of vitamin D supplementation on insulin resistance and arterial stiffness in patients with hypothyroidism. Mìžnarodnij endokrinologìčnij žurnal. 2018;14(7):668–672. doi:10.22141/2224-0721.14.7.2018.148774.

Hosny SS, Aboromia MMM, Ibrahim NA, El Halim DKA. The relationship between vitamin D level and thyroid antibodies in primary hypothyroidism. The Egyptian Journal of Internal Medicine. 2019;31(2):164–170. doi:10.4103/ejim.ejim_104_18.

Mazokopakis EE, Kotsiris DA. Hashimoto's autoimmune thyroiditis and vitamin D deficiency. Current aspects. Hell J Nucl Med. 2014;17(1):37–40. doi:10.1967/s002449910120.

Effraimidis G, Badenhoop K, Tijssen JG, Wiersinga WM. Vitamin D deficiency is not associated with early stages of thyroid autoimmunity. Eur J Endocrinol. 2012;167(1):43–48. doi:10.1530/EJE-12-0048.

Yasmeh J, Farpour F, Rizzo V, Kheradnam S, Sachmechi I. Hashimoto thyroiditis not associated with vitamin D deficiency. Endocr Pract. 2016;22(7):809–813. doi:10.4158/EP15934.OR.

Goldsmith DJ. Pro: Should we correct vitamin D deficiency/insufficiency in chronic kidney disease patients with inactive forms of vitamin D or just treat them with active vitamin D forms?. Nephrol Dial Transplant. 2016;31(5):698–705. doi:10.1093/ndt/gfw082.

Bakr HG, Meawed TE. Relevance of 25 (OH) Vitamin D deficiency on Hashimoto's Thyroiditis. Egypt J Immunol. 2017;24(2):53–62.

Sassi F, Tamone C, D'Amelio P. Vitamin D: Nutrient, Hormone, and Immunomodulator. Nutrients. 2018;10(11):1656. doi:10.3390/nu10111656.

Mandal A, Viswanathan C. Natural killer cells: In health and disease. Hematol Oncol Stem Cell Ther. 2015;8(2):47–55. doi:10.1016/j.hemonc.2014.11.006.

Popko K, Górska E. The role of natural killer cells in pathogenesis of autoimmune diseases. Cent Eur J Immunol. 2015;40(4):470–476. doi:10.5114/ceji.2015.56971. 

Fogel LA, Yokoyama WM, French AR. Natural killer cells in human autoimmune disorders. Arthritis Res Ther. 2013;15(4):216. doi:10.1186/ar4232.

Lee EK, Sunwoo JB. Natural Killer Cells and Thyroid Diseases. Endocrinol Metab (Seoul). 2019;34(2):132–137. doi:10.3803/EnM.2019.34.2.132.

Most read articles by the same author(s)

1 2 > >>