The Impact of Vitamin D Supplementation on Thyroid Autoimmunity in Patients with Newly Diagnosed AITD

Date:  2021-03-19 06:52:18
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Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease (AITD): an open-labelled randomized controlled trial is an article describing the impact of vitamin D supplementation on thyroid autoimmunity in patients with newly diagnosed AITD. According to the authors, vitamin D insufficiency is widely linked to insulin resistance, cardiovascular disease, fatty liver diseases, type -2 diabetes and cancer. From the previous research, it is concluded that it also causes autoimmune disorders such as AITD. However, data on impacts of vitamin D supplementation on thyroid peroxidase antibody (TPO-Abs) in patients with AITD is not sufficient, which demanded a study to address the issue. The study was conducted in a randomized controlled trial (RCT) where about nine hundred and eighty-one patients were evaluated and among them, 102 patients diagnosed with AITD gave a well-informed written consent on the matter.

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After three months of the study the follow-up data available was from 100 patients where sixty-eight of them had baseline serum TSH<10Miu/l and were grouped together as group A. The remaining 32 had a baseline serum TSH>10m IU/L and were included in group B. Ninety-three percent of the patients in this study had Vitamin D insufficiency. All the included patients, on the other hand, had TPO-Ab titer>34 k IU/L and had TPO-Ab titer> 34K IU/L, which was highest among AITD patients. After the analysis, a correlation was drawn between 25(OH) D and TPO-Ab titer especially after adjusting age approaching statistical significance. It was observed that anthropometry thyroid function and 25 (OH) D levels were much comparable in between the two groups where group A comprised those under treatment while group B were those under control. In three months those under treatment indicated significant fall in serum TPO-Ab titer as compared to the other group. Also, it was observed that Vitamin D supplementation led to significant increase in serum 25 (OH) D titer with a corresponding fall in plasma I-PTH levels in group A.

From the prior studies, vitamin D insufficiency has been linked to autoimmune disorders. The authors designated that 74% prevalence of Vitamin D inadequacy is normal in the Eastern India population. In their study, the frequency of vitamin D deficiency among patients with AITD is about ninety-three percent, which is meaningfully higher and is in harmony with earlier reports in patients with Hashimotos thyroiditis and Graves disease. Also, a recent research in Korea indicated increased prevalence of TPO-Ab positively along with ultrasonography features of AITD in premenopausal women with vitamin D deficiency and insufficiency as compared to those with enough Vitamin D in their bodies. In Thailand, it was observed that there was increased occurrence of Vitamin D deficiency and insufficiency among TPO-Ab or thyroglobulin antibody, positive persons, as compared to those with negative antibody status.

A cross-sectional population-based study in China did not observe any relationship between TPO-Ab and Vitamin D status positively. In that study, an inverse relation was evident between Thyroid stimulating hormone (TSH) and 25 (OH). Also, in a research conducted at Holland early stages of thyroid autoimmunity were not associated with Vitamin D insufficiency. The above studies show how different ethnicities, disease heterogeneity, age, and varying severity holds varying outcomes warranting for an interventional study to harmonize the issue. Lastly, on other studies in India, it was concluded that there is a weak inverse relation between Vitamin D status and TPO-Ab.

From the authors study, it is evident there is a weak inverse relationship between 25 (OH) D levels and TPO-Ab, which approached statistical significance. The research was the first ever to validate that Vitamin D supplementation in therapeutic doses is related with a momentous reduction in TPO-Ab titers in patients with AITD. However, the study faced some challenges especially with the open labeled design of RCT, short follow-ups, lack of use of placebo and assessment of the outcomes mainly on TPO-Ab titers. Today, TPO-Ab titers are the best measures of thyroid autoimmunity in AITD. Also, reduction in TPO-Ab titers in patients with TSH<10m IU/L and those not under levothyroxine reinforces the role of Vitamin D in achieving the reduction. Therefore, the authors campaign the need for further long-term intrusion with Vitamin D to evaluate if the reduction in TPO-Ab titers translates into reduced progression of subclinical in inducing remission of hypothyroidism or explicit primary hypothyroidism.

One can conclude that Vitamin D insufficiency and deficiency is common among the AITD patients, but the situation is reversible. Also, supplementation of Vitamin D among them is associated with beneficial effects on autoimmunity due to reduced circulation effects of TPO-Ab titers. Therefore, Vitamin D supplementation is recommendable to patients newly diagnosed with AITD. In conclusion, there is a need for a consolidated report to solve the puzzle around different findings associated with the effects of Vitamin D status and AITD. Today it is evident that the relationship between Vitamin D status and TPO-Ab is paramount especially to patients suffering from AITD.

References

Dutta, Deep, Samim Ali Mondal, Subhadip Choudhuri, Indira Maisnam, Abu Hena Hasanoor Reza, Basudeb Bhattacharya, Subhankar Chowdhury, and Satinath Mukhopadhyay. 2014. "Vitamin-D Supplementation in Prediabetes Reduced Progression to Type 2 Diabetes and Was Associated With Decreased Insulin Resistance and Systemic Inflammation: An Open Label Randomized Prospective Study from Eastern India". Diabetes Research and Clinical Practice 103 (3): e18-e23.

Effraimidis, G., K. Badenhoop, J. G. P. Tijssen, and W. M. Wiersinga. 2012. "Vitamin D Deficiency Is Not Associated With Early Stages Of Thyroid Autoimmunity". European Journal of Endocrinology 167 (1): 43-48.

Goswami, Ravinder, Raman Kumar Marwaha, Nandita Gupta, Nikhil Tandon, Vishnubhatla Sreenivas, Neeraj Tomar, Debarti Ray, Ratnesh Kanwar, and Rashmi Agarwal. 2009. "Prevalence of Vitamin D Deficiency and Its Relationship with Thyroid Autoimmunity in Asian Indians: A Community-Based Survey". BJN 102 (03): 382.

Jahnsen, J., J. A. Falch, P. Mowinckel, and E. Aadland. 2002. "Vitamin D Status, Parathyroid Hormone and Bone Mineral Density in Patients with Inflammatory Bowel Disease".Scandinavian Journal of Gastroenterology 37 (2): 192-199.

Zhang, Hong, Lingyun Liang, and Zhongjian Xie. 2015. "Low Vitamin D Status Is Associated With Increased Thyrotropin-Receptor Antibody Titer In Graves Disease". Endocrine Practice 21 (3): 258-263.

Zhang, Qingqing, Zhixiao Wang, Min Sun, Mengdie Cao, Zhenxin Zhu, Qi Fu, and Yuan Gao et al. 2014. "Association Of High Vitamin D Status With Low Circulating Thyroid-Stimulating Hormone Independent Of Thyroid Hormone Levels In Middle-Aged And Elderly Males". International Journal of Endocrinology 2014: 1-6.

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