Vitamin D and Hashimoto thyroiditis

reference

chahahadoli r, saboor-yaraghi aa, amouzegar A, Khalili D, Vakili azi F. Hashimoto thyroid gland? A double -blind, randomized clinical study. horm metab res . 2019; 51 (5): 296-301.

draft

randomized, double blind, placebo -controlled clinical study.

participant

The study included 42 women between the ages of 18 and 48 with Hashimoto thyroiditis. All participants were treated with levothyroxine for hypothyroidism. Exclusion criteria were diseases of the immune system, liver dysfunction, malnutrition, body mass index (BMI) 40 and other autoimmune diseases, including type 1 diabetes, inflammatory bowel diseases and multiple sclerosis. Women who had taken dietary supplements with vitamin D, vitamin A or omega-3 fatty acids in the past 6 months were also excluded from the study.

study parameters evaluated

The participants were divided into 2 groups on a random principle. A group received oral 50,000 IE vitamin D pearls per week for 3 months. The other group received a placebo pearl made of edible paraffin oil.

At the beginning and at the end of the study, the researchers measured the serum levels of TSH (thyroid-stimulating hormone), T 4 (left-wing thyroxine), t _{3 (trijodthyronin), 25-hydroxy-vitamin D [25 (oh) d], calcium, Antithyreoglobulin antibodies (anti-TG-AB) and antithyropic oxidase antibodies (anti-tpo-AB). They also rated solar exposure (in hours/day) at the beginning and at the end of the study and the food intake of vitamin D (via nutritional records).}

Primary result measurements

The primary endpoints were all changes that were observed in the blood tests mentioned above.

important knowledge

After 3 months of supplementation, the vitamin D group had increased serum levels from vitamin D and calcium. In the course of the study there was a significant reduction in anti-TG-AK and TSH. There were no significant changes in the anti-TPO AK levels in the vitamin D group compared to placebo. No significant changes in T 3 or T 4 level occurred in both groups.

practice implications

This is the latest of several studies that have shown that vitamin D can influence hashimoto thyroiditis. ^{1.2 In addition to the known effects of vitamin D on calcium metabolism, vitamin D plays an essential role in regulation of the immune system. the course of autoimmunity, especially with regard to the thyroid.}

vitamin D receptors can be found in lymphocytes, macrophages and antigen-presenting cells. ^{4 also 1-alpha-hydroxylase, which occurs in antigen-presenting cells, is necessary to convert vitamin D into its active shape. Vitamin D also regulates the production of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) and reduces the T cell proliferation. Nettore et al. It is clear that congenital immunity strengthens and the acquired immune response (as found in Hashimoto thyroiditis) is suppressed in the presence of vitamin D.}

Regardless of the specific cause and effect, a reduced autoimmune reaction is generally associated with higher vitamin D levels in the literature.

The antibodies that are found in autoimmune diseases of the thyroid gland are TPO antibodies and TG antibodies. TPO is an enzyme that the synthesis of T 4 and T 3 . Anti-TPO from increasing the production of TNF-α and interferon-gamma (IFN-γ). As mentioned above, it has been shown that vitamin D inhibits these inflammatory cytokines.

Tg is a glycoprotein that occurs in the thyroid gland, where thyroid hormones are synthesized. An increase in anti-TG-AK is associated with a highly regulated TH1 and TH2 response. Here, too, vitamin D suppresses these reactions. In this study, the effect of vitamin D on anti-TG-AK was more pronounced than on anti-TPO-AK. Other studies have found a greater influence on anti-TPO-AK, 5.6 and another study theorized that increased thyroid antibodies cause a decrease in systemic vitamin D. ^{7 regardless of the specific cause and effect in the literature in general, a reduced autoimmune reaction with higher vitamin D mirror is in conjunction brought.}

It is important to remember that vitamin D is not the only nutrient that plays a role in maintaining and restoring thyroid health. In addition to the obvious substrates for the thyroid hormone production (iodine and tyrosine), selenium helps to reduce the antibody titer in Hashimoto thyroiditis.

If we look at the role of vitamin D in the treatment of Hashimoto thyroid disease, it makes sense against this background to remember that its mechanism is probably in the modification of the immune response. In the study checked here there was a certain change in TSH and thyroid hormone production, but the main advantage was seen in the reduction of the antibodies. Vitamin D is only part of a treatment protocol that appeals to the whole person. Strategic therapies to reduce the initiation of the autoimmune response, to improve the production of T 4 and T 3 and optimize the conversion of t 4 3 is necessary. The treatment of stressors, other endocrine imbalances, metabolism, environmental influences, etc. is also a decisive part of a holistic approach for autoimmune diseases of the thyroid.