Title: Study on Association between Vitamin D Deficiency and Autoimmune Hypothyroidism

Authors: Sajan Christopher, Ratheesh Narayanan Santhanavally

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.45

Abstract

Background: Vitamin D deficiency is a global health problem with evidence being increasingly pointed towards vitamin D as a significant role in reducing the incidence of autoimmune diseases. Research on its role in autoimmune thyroid disease gives contradictory results. We aimed to study the association between vitamin D deficiency and autoimmune hypothyroidism by comparing vitamin D deficiency between anti TPO positive and negative hypothyroid patients and to assess the relation between vitamin D levels and anti TPO levels in anti TPO positive hypothyroidism.

Methods: A total of 100 patients, 50 of them anti-TPO positive and 50 anti-TPO negative were included in the study. Serum anti-TPO, serum 25(OH)D, serum fT4 and TSH was measured using immunoassay.

Results: The mean serum 25(OH)D level was 25.5ng/ml with a higher prevalence of vitamin D insufficiency (40%). A significant association could be demonstrated between vitamin D insufficiency and autoimmune hypothyroidism both in younger and older females of the reproductive age group but not in males and postmenopausal females We observed only a weak negative correlation between 25(OH)D and anti-TPO titres. TSH was found to be significantly higher in autoimmune hypothyroid patients than in non-autoimmune counterparts (t= 2.15, p =0.034) and a strong positive correlation noticed between anti-TPO titres and TSH levels (p = 0.016; r = 0.24*).

Conclusion: Autoimmunity is closely related to thyroid function and increasing autoimmunity directly related to worsening thyroid function. Noticeable association between vitamin D insufficiency and autoimmune hypothyroidism encourages vitamin D supplementation for them

Keywords: Vit D deficiency, hypothyroidism, autoimmunity.

References

  1. Anaya JM, Shoenfeld Y, Rojas-Villarraga A, Levy RA and Cervera R, Bogota (Colombia) Autoimmunity: From Bench to Bedside [Internet]: El Rosario University Press, 2013.
  2. Ravinder Goswami, Raman Kumar Marwaha, Nandita Gupta, Nikhil Tandon, Vishnubhatla Sreenivas, Neeraj Tomar Debarti Ray, Ratnesh Kanwar and Rashmi Agarwal, “Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey”, British Journal of Nutrition., 102, pp.382–386, Feb. 2009. DOI: https://doi.org/10.1017/S0007114509220824
  3. Unnikrishnan A G and Menon U V, “Thyroid Disorders in India: An Epidemiological Perspective”, Indian Journal of Endocrine Metabolism., vol 15, pp. 78-81, Jul. 2011. DOI: 10.4103/2230-8210.83329
  4. Shaye Kivity, Nancy Agmon-Levin, Michael Zisappl, Yinon Shapira, Endre V Nagy, Katalin Danko, Zoltan Szekanecz, Pnina Langevitz and Yehuda Shoenfeld, “Vitamin D and autoimmune thyroid diseases”, Cellular & Molecular Immunology.vol 8,pp 243–247,Jan.2011. DOI: 10.1038/cmi.2010.73
  5. Michael F Holick, “Vitamin D treatment guidelines”, The Association of Physicians of India. apiindia.org/medicine_update_2013/chap136.pdf.
  6. Thomas Cyriac, Peter Manoharan Chellappa, Sinnet P. R and Anish Immanuel, “Prevalence of hypothyroidism and its association with anti-thyroid peroxidase antibody among adult sea food consuming population attending a tertiary health care centre in Kerala”, International Journal of Biomedical and Advance Research. vol 6 No 9,pp 648-655, Sep. 2015. DOI: https://doi.org/10.7439/ijbar.v6i9.2480
  7. Aslı Dogruk Unal, Ozlem Tarcin, Hulya Parildar, Ozlem Cigerli, Hacer Eroglu and Nilgun Guvener Demirag, “Vitamin D deficiency is related to thyroid antibodies in autoimmune thyroiditis”, Central European Journal of Immunology.vol 39 No 4,pp 493-497, Dec. 2014. DOI: 10.5114/ceji.2014.47735
  8. Gomathi Priya J., Seenivasan Venkatasamy, Karamath S. Pyarejan and Jayachandran K, “Vitamin D status in children with autoimmune thyroiditis”, International Journal of Contemporary Pediatrics. Vol 4      No 5, pp 1595-1598, Sep.2017. DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20173125
  9. Gordon CM, De Peter KC, Feldman HA, Grace E and Emans SJ, “Prevalence of vitamin D deficiency among healthy Adolescents”, Archives of Pediatrics and Adolescent Medicine. Vol 158, pp 531–537., Jun.2004. doi:10.1001/archpedi.158.6.531
  10. Oren Y, Shapira Y, Agmon-Levin N, Kivity S, Zafrir Y, Altman A, Lerner A and Shoenfeld Y, “ Vitamin D insufficiency in a sunny environment: a demographic and seasonal analysis”, Israel Medical Association Journal, vol 12, pp751–756, Dec.2010
  11. Hagenau T, Vest R, Gissel TN, Poulsen CS, Erlandsen M, Mosekilde L and Vestergaard P, “Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis”, Osteoporosis International, vol 20, No 1, pp 133-140, Jan. 2009. DOI: 10.1007/s00198-008-0626-y
  12. Yun Mi Choi, Won Gu Kim, Tae Yong Kim, Sung Jin Bae, Hong-Kyu Kim, Eun Kyung Jang, Min Ji Jeon, Ji Min Han, Seung Hun Lee, Jung Hwan Baek, Young Kee Shong and Won Bae Kim,“Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women”, Thyroid, vol 24, No 4, pp 655- 661, Apr. 2014.DOI: https://doi.org/10.1089/thy.2013.0460
  13. Giorgia Bizzaro and Yehuda Shoenfeld, “Vitamin D and thyroid autoimmune diseases: the known and the obscure”, Immunologic Research, vol 61, No 1–2, pp 107–109, Feb.2015.DOI: 10.1007/s12026-014-8591-3.
  14. Amal Mohammed Husein Mackawy, Bushra Mohammed Al-ayed and Bashayer Mater Al-rashidi, “Vitamin D Deficiency and Its Association with Thyroid Disease”, International Journal of Health Sciences (Qassim,) vol 7, No 3,pp 267–275, Nov. 2013.
  15. Urvashi Mehlawat, Priyanka Singh and Shubhra Pande, “Current status of Vitamin-D deficiency in India”, Innovations in Pharmaceuticals and Pharmacotherapy vol 2, No 2, pp 328-335,2014.
  16. P Aparna, S Muthathal, Baridalyne Nongkynrih and Sanjeev Kumar Gupta, “Vitamin D deficiency in India”, Journal of Family Medicine and Primary Care, vol 7, No 2, pp324–330, Mar.-Apr. 2018. DOI: 10.4103/jfmpc.jfmpc_78_18

Corresponding Author

Ratheesh Narayanan Santhanavally