Autoimmune thyroiditis and multiple nutritional factors

Main Article Content

Chandanvir Saini

Abstract

Autoimmune thyroiditis (AT) is considered to be the most common autoimmune disease. It is currently accepted that genetic susceptibility, environmental factors, and immune disorders contribute to its development. With regard to nutritional factors, evidence implicates high iodine intake and deficiencies of selenium and iron with a potential relevance of vitamin D status. To elucidate the role of nutritional factors in the risk, pathogenesis, and treatment of AT, PubMed and the Cochrane Library were searched for publications on iodine, iron, selenium, and vitamin D and risk/treatment of AT. Chronic exposure to excess iodine intake induces autoimmune thyroiditis, partly because highly iodinated thyroglobulin (Tg) is more immunogenic. Selenoproteins are essential to thyroid action. There is evidence from observational studies and randomized controlled trials that selenium/selenoproteins can reduce thyroid peroxidase (TPO)-antibody titers, hypothyroidism, and postpartum thyroiditis. AT patients are frequently iron deficient, since autoimmune gastritis, which impairs iron absorption, is a common co-morbidity. In recent years, evidence has emerged pointing to various roles for vitamin D, including, proliferation and differentiation of normal and cancer cells, cardiovascular function, and immunomodulation. Vitamin D deficiency has been especially demonstrated in AT patients. Lower vitamin D status has been found in AT patients than in controls, and inverse relationships of serum vitamin D with TPO/Tg antibodies have been reported. Adequate selenium intake is vital in areas of iodine deficiency/excess, and in regions of low selenium intake a supplement of 50–100 μg/day of selenium may be appropriate. Myo-inositol and selenium are able to restore the euthyroid state as well as improve the wellbeing of AT with subclinical hypothyroidism. Bearing in mind also the safety of these two molecules’ usage, accentuated by the absence of side effects, the Myo-Ins-Se combination can be considered a very efficacious and safe therapy for AT treatment.

Article Details

How to Cite
Saini, C. “Autoimmune Thyroiditis and Multiple Nutritional Factors”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 16, no. 8, Aug. 2021, pp. 648-53, doi:10.22141/2224-0721.16.8.2020.222885.
Section
Literature Review

References

Flores-Rebollar A, Moreno-Castañeda L, Vega-Servín NS, López-Carrasco G, Ruiz-Juvera A. Prevalence Of Autoimmune Thyroiditis And Thyroid Dysfunction In Healthy Adult Mexicans With A Slightly Excessive Iodine Intake. Nutr Hosp. 2015 Aug 1;32(2):918-24. doi:10.3305/nh.2015.32.2.9246.

Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. Thyroid. 2017 May;27(5):597-610. doi:10.1089/thy.2016.0635.

Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc. 2019 Feb;78(1):34-44. doi:10.1017/S0029665118001192.

Harris Rosenzweig P, Volpe SL. Effect of iron supplementation on thyroid hormone levels and resting metabolic rate in two college female athletes: a case study. Int J Sport Nutr Exerc Metab. 2000 Dec;10(4):434-43. doi:10.1123/ijsnem.10.4.434.

Zupo R, Castellana F, Panza F, et al. Adherence to a Mediterranean Diet and Thyroid Function in Obesity: A Cross-Sectional Apulian Survey. Nutrients. 2020 Oct 16;12(10):3173. doi:10.3390/nu12103173.

Chahardoli R, Saboor-Yaraghi AA, Amouzegar A, Khalili D, Vakili AZ, Azizi F. Can Supplementation with Vitamin D Modify Thyroid Autoantibodies (Anti-TPO Ab, Anti-Tg Ab) and Thyroid Profile (T3, T4, TSH) in Hashimoto's Thyroiditis? A Double Blind, Randomized Clinical Trial. Horm Metab Res. 2019 May;51(5):296-301. doi:10.1055/a-0856-1044.

Vieira IH, Rodrigues D, Paiva I. Vitamin D and Autoimmune Thyroid Disease-Cause, Consequence, or a Vicious Cycle? Nutrients. 2020 Sep 11;12(9):2791. doi:10.3390/nu12092791.

Kmieć P, Sworczak K. Vitamin D in thyroid disorders. Exp Clin Endocrinol Diabetes. 2015 Jul;123(7):386-93. doi:10.1055/s-0035-1554714.

Kim D. The Role of Vitamin D in Thyroid Diseases. Int J Mol Sci. 2017 Sep 12;18(9):1949. doi:10.3390/ijms18091949.

Barchetta I, Baroni MG, Leonetti F, et al. TSH levels are associated with vitamin D status and seasonality in an adult population of euthyroid adults. Clin Exp Med. 2015 Aug;15(3):389-96. doi:10.1007/s10238-014-0290-9.

Muscogiuri G, Tirabassi G, Bizzaro G, et al. Vitamin D and thyroid disease: to D or not to D? Eur J Clin Nutr. 2015 Mar;69(3):291-6. doi:10.1038/ejcn.2014.265.

Thvilum M, Brandt F, Brix TH, Hegedüs L. Month of birth is associated with the subsequent diagnosis of autoimmune hypothyroidism. A nationwide Danish register-based study. Clin Endocrinol (Oxf). 2017 Dec;87(6):832-837. doi:10.1111/cen.13425.

Sivalingam S, Thvilum M, Brix TH, Hegedüs L, Brandt F. No link between season of birth and subsequent development of Graves' disease or toxic nodular goitre: a nationwide Danish register-based study. Endocr Connect. 2018 Aug 23;7(10):1090–5. doi:10.1530/EC-18-0185.

Kyrgios I, Giza S, Tsinopoulou VR, Maggana I, Haidich AB, Galli-Tsinopoulou A. Seasonality of month of birth in children and adolescents with autoimmune thyroiditis: a continuing conundrum. J Pediatr Endocrinol Metab. 2018 Oct 25;31(10):1123-1131. doi:10.1515/jpem-2018-0051.

Kim M, Song E, Oh HS, et al. Vitamin D deficiency affects thyroid autoimmunity and dysfunction in iodine-replete area: Korea national health and nutrition examination survey. Endocrine. 2017 Nov;58(2):332-339. doi:10.1007/s12020-017-1425-z.

Vondra K, Bílek R, Matucha P, et al. Vitamin D supplementation changed relationships, not levels of metabolic-hormonal parameters in autoimmune thyroiditis. Physiol Res. 2017 Sep 26;66(Suppl 3):S409-S417. doi:10.33549/physiolres.933727.

Kivity S, Agmon-Levin N, Zisappl M, et al. Vitamin D and autoimmune thyroid diseases. Cell Mol Immunol. 2011 May;8(3):243-7. doi:10.1038/cmi.2010.73.

Unal AD, Tarcin O, Parildar H, Cigerli O, Eroglu H, Demirag NG. Vitamin D deficiency is related to thyroid antibodies in autoimmune thyroiditis. Cent Eur J Immunol. 2014;39(4):493-7. doi:10.5114/ceji.2014.47735.

Wang J, Lv S, Chen G, et al. Meta-analysis of the association between vitamin D and autoimmune thyroid disease. Nutrients. 2015 Apr 3;7(4):2485-98. doi:10.3390/nu7042485.

Tamer G, Arik S, Tamer I, Coksert D. Relative vitamin D insufficiency in Hashimoto's thyroiditis. Thyroid. 2011 Aug;21(8):891-6. doi:10.1089/thy.2009.0200.

Muscogiuri G, Mari D, Prolo S, et al. 25 Hydroxyvitamin D Deficiency and Its Relationship to Autoimmune Thyroid Disease in the Elderly. Int J Environ Res Public Health. 2016 Aug 26;13(9):850. doi:10.3390/ijerph13090850.

Metwalley KA, Farghaly HS, Sherief T, Hussein A. Vitamin D status in children and adolescents with autoimmune thyroiditis. J Endocrinol Invest. 2016 Jul;39(7):793-7. doi:10.1007/s40618-016-0432-x.

Demir K, Keskin M, Kör Y, Karaoğlan M, Bülbül ÖG. Autoimmune thyroiditis in children and adolescents with type 1 diabetes mellitus is associated with elevated IgG4 but not with low vitamin D. Hormones (Athens). 2014 Jul-Sep;13(3):361-8. doi:10.14310/horm.2002.1481.

Wang S, Wu Y, Zuo Z, Zhao Y, Wang K. The effect of vitamin D supplementation on thyroid autoantibody levels in the treatment of autoimmune thyroiditis: a systematic review and a meta-analysis. Endocrine. 2018 Mar;59(3):499-505. doi:10.1007/s12020-018-1532-5.

Koehler VF, Filmann N, Mann WA. Vitamin D Status and Thyroid Autoantibodies in Autoimmune Thyroiditis. Horm Metab Res. 2019 Dec;51(12):792-797. doi:10.1055/a-1023-4181.

Krysiak R, Kowalcze K, Okopień B. Selenomethionine potentiates the impact of vitamin D on thyroid autoimmunity in euthyroid women with Hashimoto's thyroiditis and low vitamin D status. Pharmacol Rep. 2019 Apr;71(2):367-373. doi:10.1016/j.pharep.2018.12.006.

Mirhosseini N, Brunel L, Muscogiuri G, Kimball S. Physiological serum 25-hydroxyvitamin D concentrations are associated with improved thyroid function-observations from a community-based program. Endocrine. 2017 Dec;58(3):563-573. doi:10.1007/s12020-017-1450-y.

Kutateladze TG. Translation of the phosphoinositide code by PI effectors. Nat Chem Biol. 2010 Jul;6(7):507-13. doi:10.1038/nchembio.390.

Ohye H, Sugawara M. Dual oxidase, hydrogen peroxide and thyroid diseases. Exp Biol Med (Maywood). 2010 Apr;235(4):424-33. doi:10.1258/ebm.2009.009241.

Nordio M, Pajalich R. Combined treatment with Myo-inositol and selenium ensures euthyroidism in subclinical hypothyroidism patients with autoimmune thyroiditis. J Thyroid Res. 2013;2013:424163. doi:10.1155/2013/424163.

Ferrari SM, Fallahi P, Di Bari F, Vita R, Benvenga S, Antonelli A. Myo-inositol and selenium reduce the risk of developing overt hypothyroidism in patients with autoimmune thyroiditis. Eur Rev Med Pharmacol Sci. 2017 Jun;21(2 Suppl):36-42.