Vitamin D deficiency and autoimmune thyroid disease: relationship and correction (literature review and clinical cases)

Authors

  • V.I. Pankiv Ukrainian Research and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine http://orcid.org/0000-0002-9205-9530

DOI:

https://doi.org/10.22141/2224-0721.16.7.2020.219010

Keywords:

Graves’ disease, autoimmune thyroiditis, vitamin D deficiency, cholecalciferol

Abstract

Numerous studies by various authors indicate an association between vitamin D and autoimmune thyroid diseases. Most authors point to a correlation between lower vitamin D levels and an increased risk of developing the disease and/or higher antibody titers. After the onset of autoimmune thyroid disease, the existing vitamin D deficiency creates a vicious circle, exacerbating the deficiency. In real clinical practice, it is important to correct vitamin D deficiency/insufficiency in persons with autoimmune thyroid diseases. The approach is to achieve a level of 25(OH)D within the reference ranges proposed by international guidelines. Vitamin D deficiency is an integral part of the pathogenesis of autoimmune thyroid diseases. Because vitamin D administration reduces antithyroid antibody titers in patients with autoimmune thyroid disea­ses, vitamin D supplements are recommended for the treatment of these diseases, especially in vitamin D deficiency. Both in Graves’ disease and autoimmune thyroiditis with subclinical hypothyroi­dism, the initial dose of cholecalciferol is 4,000 IU per day for three months, followed by control of the content of 25(OH)D in the serum. When the level of vitamin D reaches 30–50 ng/ml, it is recommended to continue taking cholecalciferol in a daily dose of 2,000 IU for three months. It is desirable to conduct such courses at least twice a year. As the positive effect of the optimal level of 25(OH)D in the serum of both children and adults has been proven to date, it is advisable to maintain it for a healthy population in the range of 30–50 ng/ml in accordance with the guidelines for Central European countries. There are two cases from real clinical practice, in which a positive effect was achieved after additional administration of cholecalciferol to patients with autoimmune thyroid diseases.

Downloads

Download data is not yet available.

References

Roth DE, Abrams SA, Aloia J, et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci. 2018;1430(1):44-79. doi: 10.1111/nyas.13968.

Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013 Jul 5;5(7):2502-21. doi: 10.3390/nu5072502.

Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab. 2009 Jan;94(1):26-34. doi: 10.1210/jc.2008-1454.

Muscogiuri G, Mitri J, Mathieu C, et al. Mechanisms in endocrinology: vitamin D as a potential contributor in endocrine health and disease. Eur J Endocrinol. 2014 Sep;171(3):R101-10. doi: 10.1530/EJE-14-0158.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007 Jul 19;357(3):266-81. doi: 10.1056/NEJMra070553.

Mele C, Caputo M, Bisceglia A, et al. Immunomodulatory Effects of Vitamin D in Thyroid Diseases. Nutrients. 2020 May 16;12(5):1444. doi: 10.3390/nu12051444.

Nettore IC, Albano L, Ungaro P, Colao A, Macchia PE. Sunshine vitamin and thyroid. Rev Endocr Metab Disord. 2017 Sep;18(3):347-354. doi: 10.1007/s11154-017-9406-3.

Kim D. The Role of Vitamin D in Thyroid Diseases. Int J Mol Sci. 2017 Sep 12;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 May;14(5):363-9. doi: 10.1016/j.autrev.2014.10.008.

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.

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.

Štefanić M, Tokić S. Serum 25-hydoxyvitamin D concentrations in relation to Hashimoto's thyroiditis: a systematic review, meta-analysis and meta-regression of observational studies. Eur J Nutr. 2020 Apr;59(3):859-872. doi: 10.1007/s00394-019-01991-w.

Gallo D, Mortara L, Gariboldi MB, et al. Immunomodulatory effect of vitamin D and its potential role in the prevention and treatment of thyroid autoimmunity: a narrative review. J Endocrinol Invest. 2020 Apr;43(4):413-429. doi: 10.1007/s40618-019-01123-5.

Goncharova OA, Arkhipkina TL, Bondarenko VO, Lyubimova LP. Vitamin D status and features of the immune status in women with autoimmune thyroiditis in the postmenopausal period. Clinical Endocrinology and Endocrine Surgery. 2020;1(69):51-56. doi: 10.30978/CEES-2020-1-51. (in Russian).

Pankiv IV. Prevalence of autoimmune thyroiditis in women with vitamin D deficiency. Mìžnarodnij endokrinologìčnij žurnal. 2017;13(5):336-9. doi: 10.22141/2224-0721.13.5.2017.110023. (in Ukrainian).

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.

McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012 Oct;42(2):252-65. doi: 10.1007/s12020-012-9703-2.

Klecha AJ, Barreiro Arcos ML, Frick L, Genaro AM, Cremaschi G. Immune-endocrine interactions in autoimmune thyroid diseases. Neuroimmunomodulation. 2008;15(1):68-75. doi: 10.1159/000135626.

González-Amaro R, Marazuela M. T regulatory (Treg) and T helper 17 (Th17) lymphocytes in thyroid autoimmunity. Endocrine. 2016 Apr;52(1):30-8. doi: 10.1007/s12020-015-0759-7.

Płudowski P, Karczmarewicz E, Bayer M, et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013;64(4):319-27. doi: 10.5603/ep.2013.0012.

Pankiv VI, Yuzvenko TYu, Pankiv IV. Type 2 diabetes mellitus and subclinical hypothyroidism: focusing on the role of cholecalciferol. Problems of Endocrine Pathology. 2019;2:46-51. doi: 10.21856/j-PEP.2019.2.07.

Antonelli A, Ferrari SM, Corrado A, Di Domenicantonio A, Fallahi P. Autoimmune thyroid disorders. Autoimmun Rev. 2015 Feb;14(2):174-80. doi: 10.1016/j.autrev.2014.10.016.

Gallo D, Mortara L, Gariboldi MB, et al. Immunomodulatory effect of vitamin D and its potential role in the prevention and treatment of thyroid autoimmunity: a narrative review. J Endocrinol Invest. 2020 Apr;43(4):413-429. doi: 10.1007/s40618-019-01123-5.

Wang J, Lv S, Chen G, Gao C, He J, Zhong H, Xu Y. 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.

Mackawy AM, Al-Ayed BM, Al-Rashidi BM. Vitamin d deficiency and its association with thyroid disease. Int J Health Sci (Qassim). 2013 Nov;7(3):267-75. doi: 10.12816/0006054.

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.

Ke W, Sun T, Zhang Y, He L, Wu Q, Liu J, Zha B. 25-Hydroxyvitamin D serum level in Hashimoto's thyroiditis, but not Graves' disease is relatively deficient. Endocr J. 2017 Jun 29;64(6):581-587. doi: 10.1507/endocrj.EJ16-0547.

Shin DY, Kim KJ, Kim D, Hwang S, Lee EJ. Low serum vitamin D is associated with anti-thyroid peroxidase antibody in autoimmune thyroiditis. Yonsei Med J. 2014 Mar;55(2):476-81. doi: 10.3349/ymj.2014.55.2.476.

Wang X, Zynat J, Guo Y, et al. Low Serum Vitamin D Is Associated with Anti-Thyroid-Globulin Antibody in Female Individuals. Int J Endocrinol. 2015;2015:285290. doi: 10.1155/2015/285290.

ElRawi HA, Ghanem NS, ElSayed NM, Ali HM, Rashed LA, Mansour MM. Study of Vitamin D Level and Vitamin D Receptor Polymorphism in Hypothyroid Egyptian Patients. J Thyroid Res. 2019 Aug 26;2019:3583250. doi: 10.1155/2019/3583250.

Kim CY, Lee YJ, Choi JH, Lee SY, Lee HY, Jeong DH, Choi YJ. The Association between Low Vitamin D Status and Autoimmune Thyroid Disease in Korean Premenopausal Women: The 6th Korea National Health and Nutrition Examination Survey, 2013-2014. Korean J Fam Med. 2019 Sep;40(5):323-328. doi: 10.4082/kjfm.18.0075.

Kaminskyi OV, Pankiv VI, Pankiv IV, Afanasyev DE. Vitamin D Content In Population Of Radiologically Contaminated Areas In Chernivtsi Oblast (pilot project). Probl Radiac Med Radiobiol. 2018 Dec;23:442-451. doi: 10.33145/2304-8336-2018-23-442-451.

Choi YM, Kim WG, Kim TY, et al. Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid. 2014 Apr;24(4):655-61. doi: 10.1089/thy.2013.0460.

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

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.

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.

Krysiak R, Szkróbka W, Okopień B. The Effect of Vitamin D on Thyroid Autoimmunity in Levothyroxine-Treated Women with Hashimoto's Thyroiditis and Normal Vitamin D Status. Exp Clin Endocrinol Diabetes. 2017 Apr;125(4):229-233. doi: 10.1055/s-0042-123038.

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.

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.

Yasmeh J, Farpour F, Rizzo V, Kheradnam S, Sachmechi I. Hashimoto thyroiditis not associated with vitamin D deficiency. Endocr Pract. 2016 Jul;22(7):809-13. doi: 10.4158/EP15934.OR.

Gao XR, Yu YG. Meta-Analysis of the Association between Vitamin D Receptor Polymorphisms and the Risk of Autoimmune Thyroid Disease. Int J Endocrinol. 2018 Mar 22;2018:2846943. doi: 10.1155/2018/2846943.

Wang X, Cheng W, Ma Y, Zhu J. Vitamin D receptor gene FokI but not TaqI, ApaI, BsmI polymorphism is associated with Hashimoto's thyroiditis: a meta-analysis. Sci Rep. 2017 Jan 30;7:41540. doi: 10.1038/srep41540.

Wiersinga WM. Clinical Relevance of Environmental Factors in the Pathogenesis of Autoimmune Thyroid Disease. Endocrinol Metab (Seoul). 2016 Jun;31(2):213-22. doi: 10.3803/EnM.2016.31.2.213.

Yasuda T, Okamoto Y, Hamada N, et al. Serum vitamin D levels are decreased in patients without remission of Graves' disease. Endocrine. 2013 Feb;43(1):230-2. doi: 10.1007/s12020-012-9789-6.

Planck T, Shahida B, Malm J, Manjer J. Vitamin D in Graves Disease: Levels, Correlation with Laboratory and Clinical Parameters, and Genetics. Eur Thyroid J. 2018 Jan;7(1):27-33. doi: 10.1159/000484521.

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.

Lenormand Y, Rautureau M, Mary JY, Rambaud JC. Intestinal absorption of vitamin D, linoleic acid and cholesterol from micellar solutions: study in normal humans by the "in situ" perfusion method. Biol Gastroenterol (Paris). 1975 Jul-Aug;8(3):207-21. (in French).

Norrdin RW, de Barros CS, Queille ML, Carré M, Miravet L. Acute effects of Solanum malacoxylon on bone formation rates in growing rats. Calcif Tissue Int. 1979 Nov 6;28(3):239-43. doi: 10.1007/BF02441242.

Gromova OA, Torshin IYu, Zakharova IN, Spirichev VB, Limanova OA, Borovik TE, Yatsyk GV. Dosage of vitamin D in children and adolescents. Voprosy sovremennoj pediatrii. 2015;14(1):38-47. doi: 10.15690/vsp.v14i1.1261. (in Russian).

Zhang H, Liang L, Xie Z. Low Vitamin D Status is Associated with Increased Thyrotropin-Receptor Antibody Titer in Graves Disease. Endocr Pract. 2015 Mar;21(3):258-63. doi: 10.4158/EP14191.OR.

Xu MY, Cao B, Yin J, Wang DF, Chen KL, Lu QB. Vitamin D and Graves' disease: a meta-analysis update. Nutrients. 2015 May 21;7(5):3813-27. doi: 10.3390/nu7053813.

Cho YY, Chung YJ. Vitamin D supplementation does not prevent the recurrence of Graves' disease. Sci Rep. 2020 Jan 8;10(1):16. doi: 10.1038/s41598-019-55107-9.

Published

2020-11-25

How to Cite

Pankiv, V. (2020). Vitamin D deficiency and autoimmune thyroid disease: relationship and correction (literature review and clinical cases). INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 16(7), 556–563. https://doi.org/10.22141/2224-0721.16.7.2020.219010

Issue

Section

Literature Review

Most read articles by the same author(s)

<< < 1 2 3 4 5 6 7 8 9 10 > >>