Horm Metab Res 2019; 51(05): 296-301
DOI: 10.1055/a-0856-1044
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

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

Reza Chahardoli
1   School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Ali-Akbar Saboor-Yaraghi
2   Department of Immunology, School of Public Health Tehran University of Medical Science, Tehran, Iran
,
Atieh Amouzegar
3   Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Davood Khalili
3   Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Azita Zadeh Vakili
3   Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Fereidoun Azizi
3   Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
› Author Affiliations
Further Information

Publication History

received 29 December 2018

accepted 05 February 2019

Publication Date:
09 May 2019 (online)

Abstract

Hashimoto’s thyroiditis (HT) is the most prevalent autoimmune disorder characterized by the destruction of thyroid cells caused by leukocytes and antibody-mediated immune processes accompanied by hypothyroidism. 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 HT patients. The aim of this study was to investigate the effect of vitamin D on circulating thyroid autoantibodies and thyroid hormones profile (T4, T3, and TSH) in females with HT. Forty-two women with HT disease were enrolled in this randomized clinical trial study and divided into vitamin D and placebo groups. Patients in the vitamin D and placebo groups received 50 000 IU vitamin D and placebo pearls, weekly for 3 months, respectively. The serum levels of 25-hydroxy vitamin D [25(OH) D], Ca++ion, anti-thyroperoxidase antibody (anti-TPO Ab), anti-thyroglobulin antibody (anti-Tg Ab), T4, T3, and TSH were measured at the baseline and at the end of the study using enzyme-linked immunosorbent assays. The results of this study showed a significant reduction of anti-Tg Ab and TSH hormone in the Vitamin D group compared to the start of the study; however, there was a no significant reduction of anti-TPO Ab in the Vitamin D group compared to the placebo group (p=0.08). No significant changes were observed in the serum levels of T3 and T4 hormones. Therefore, vitamin D supplementation can be helpful for alleviation of the disease activity in HT patients; however, further well controlled, large, longitudinal studies are needed to determine whether it can be introduced in clinical practice.

Supplementary Material

 
  • References

  • 1 Shoenfeld Y, Cervera R, Gershwin ME. Diagnostic criteria in autoimmune diseases. Berlin: Springer Science & Business Media; 2010
  • 2 Aghini-Lombardi F, Antonangeli L, Martino E. et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab 1999; 84: 561-566
  • 3 Burek CL, Talor MV. Environmental triggers of autoimmune thyroiditis. J Autoimmun 2009; 33: 183-189
  • 4 Zaletel K. Determinants of thyroid autoantibody production in Hashimoto’s thyroiditis. Exp Rev Clin Immunol 2007; 3: 217-223
  • 5 Hocevar M, Auersperg M, Stanovnik L. The dynamics of serum thyroglobulin elimination from the body after thyroid surgery. Eur J Surg Oncol 1997; 23: 208-210
  • 6 Noal CB. Atividade de Enzimas que Degradam Nucleotídeos e Nucleosídeo de Adenina em Plaquetas de Pacientes com Tireoidite de Hashimoto em Tratamento com Levotiroxina Sódica. Ph.D. Thesis, Universidade Federal de Santa Maria, Santa Maria. Brazil: 2012
  • 7 Sawai Y, DeGroot LJ. Binding of human thyrotropin receptor peptides to a Graves’ disease-predisposing human leukocyte antigen class II molecule. J Clin Endocrinol Metab 2000; 85: 1176-1179
  • 8 Hamilton F, Black M, Farquharson M. et al. Spatial correlation between thyroid epithelial cells expressing class II MHC molecules and interferon-gamma-containing lymphocytes in human thyroid autoimmune disease. Clin Exp Immunol 1991; 83: 64-68
  • 9 Ajjan R, Watson P, McIntosh R. et al. Intrathyroidal cytokine gene expression in Hashimoto's thyroiditis. Clin Exp Immunol 1996; 105: 523-528
  • 10 Bettelli E, Korn T, Kuchroo VK. Th17: the third member of the effector T cell trilogy. Curr Opin Immunol 2007; 19: 652-657
  • 11 Nielsen CH, Hegedüs L, Rieneck K. et al. Production of interleukin (IL)-5 and IL-10 accompanies T helper cell type 1 (Th1) cytokine responses to a major thyroid self-antigen, Thyroglobulin, in health and autoimmune thyroid disease. Clin Exp Immunol 2007; 147: 287-295
  • 12 Nielsen CH, Brix TH, Leslie RGQ. et al. A role for autoantibodies in enhancement of pro-inflammatory cytokine responses to a self-antigen, thyroid peroxidase. Clin Immunol 2009; 133: 218-227
  • 13 Bossowski A, Otto-Buczkowska E. Schorzenia tarczycy o podłożu autoimmunologicznym. W: Pediatria-co nowego? Pod Redakcją Ewy Otto-Buczkowskiej 2007; 108-120
  • 14 Peretianu D. Antithyroid peroxidase antibodies (ATPO) in hashimoto thyroiditis: Variation of levels and correlation with echographic patterns-. Acta Endocrinol (1841-0987) 2005; 1
  • 15 Wacker M, Holick MF. Vitamin D—effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013; 5: 111-148
  • 16 van Etten E, Verlinden L, Giulietti A. et al. The vitamin D receptor gene FokI polymorphism: functional impact on the immune system. Eur J Immunol 2007; 37: 395-405
  • 17 Lopez ER, Zwermann O, Segni M. et al. A promoter polymorphism of the CYP27B1 gene is associated with Addison’s disease, Hashimoto’s thyroiditis, Graves’ disease and type 1 diabetes mellitus in Germans. Eur J Endocrinol 2004; 151: 193-197
  • 18 Aranow C. Vitamin D and the immune system. J Invest Med 2011; 59: 881-886
  • 19 Wang J, Lv S, Chen G. et al. Meta-analysis of the association between vitamin D and autoimmune thyroid disease. Nutrients 2015; 7: 2485-2498
  • 20 Mansournia N, Mansournia MA, Saeedi S. et al. The association between serum 25OHD levels and hypothyroid Hashimoto’s thyroiditis. J Endocrinol Invest 2014; 37: 473-476
  • 21 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
  • 22 Chailurkit L-o, Aekplakorn W, Ongphiphadhanakul B. High vitamin D status in younger individuals is associated with low circulating thyrotropin. Thyroid 2013; 23: 25-30
  • 23 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; 24: 655-661
  • 24 Zhang Q, Wang Z, Sun M. 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; 2014 631819
  • 25 Krysiak R, Kowalcze K, Okopien B. The effect of vitamin D on thyroid autoimmunity in non-lactating women with postpartum thyroiditis. Eur J Clin Nutr 2016; 70: 637
  • 26 Kivity S, Agmon-Levin N, Zisappl M. et al. Vitamin D and autoimmune thyroid diseases. Cell Mol Immunol 2011; 8: 243
  • 27 Unal AD, Tarcin O, Parildar H. et al. Vitamin D deficiency is related to thyroid antibodies in autoimmune thyroiditis. Cent Eur J Immunol 2014; 39: 493
  • 28 D'Aurizio F, Villalta D, Metus P. et al. Is vitamin D a player or not in the pathophysiology of autoimmune thyroid diseases?. Autoimmun Rev 2015; 14: 363-369
  • 29 Ma J, Wu D, Li C. et al. Lower serum 25-hydroxyvitamin D level is associated with 3 types of autoimmune thyroid diseases. Medicine (Baltimore) 2015; 94: e1639
  • 30 Effraimidis G, Badenhoop K, Tijssen JG. et al. Vitamin D deficiency is not associated with early stages of thyroid autoimmunity. Eur J Endocrinol 2012; 167: 43-48
  • 31 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
  • 32 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
  • 33 Knutsen KV, Madar AA, Brekke M. et al. Effect of Vitamin D on Thyroid Autoimmunity: A Randomized, Double-Blind, Controlled Trial Among Ethnic Minorities. J Endocr Soc 2017; 1: 470-479
  • 34 Schmidt M, Voell M, Rahlff I. et al. Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto's thyroiditis) treated with levothyroxine. Thyroid 2008; 18: 755-760
  • 35 Chen S, Sims GP, Chen XX. et al. Modulatory effects of 1, 25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol 2007; 179: 1634-1647
  • 36 Heine G, Niesner U, Chang HD. et al. 1,25–Dihydroxyvitamin D3 promotes IL-10 production in human B cells. Eur J Immunol 2008; 38: 2210-2218
  • 37 Berg JP, Liane KM, Bjørhovde SB. et al. Vitamin D receptor binding and biological effects of cholecalciferol analogues in rat thyroid cells. J Steroid Biochem Mol Biol 1994; 50: 145-150
  • 38 Smith MA, McHenry C, Oslapas R. et al. Altered TSH levels associated with increased serum 1,25-dihydroxyvitamin D3: a possible link between thyroid and parathyroid disease. Surgery 1989; 106: 987-991
  • 39 Talaei A, Ghorbani F, Asemi Z. The effects of Vitamin D supplementation on thyroid function in hypothyroid patients: A randomized, double-blind, placebocontrolled trial. Indian journal of endocrinology and metabolism 2018; 22: 584