Investigation of Vitamin D Levels and Metabolic Parameters in Patients With Subclinical Hyperthyroidism

Öz

Objectives: Subclinical hyperthyroidism is a major health problem that is common in the population and requires long-term follow-up due to various complications including atrial fibrillation and osteoporosis. In recent years, vitamin D has been investigated in the pathogenesis of autoimmune diseases including endocrine system beside well known skeletal effects. The aim of this study is to investigate vitamin D levels, metabolic parameters and the relationship between these parameters and vitamin D and TSH levels in patients with subclinical hyperthyroidism.
Materials and Methods:  A total of 128 subjects were included in the study between April 2017 and April 2018 which are 39 patients with subclinical hyperthyroidism diagnosed with toxic adenoma, toxic multinodular goiter (TMNG), toxic diffuse goiter (TDG) and 35 subject 1≤TSH<4 (control 1), 54 subject 0,5≤TSH<1 (control 2) which is healthy controls. Glucose, creatinine, AST, ALT, GFR, vitamin D, thyroid autoantibody levels were retrospectively analyzed.
Results: There was no statistically significant difference between the groups in terms of median vitamin D levels (p = 0.928). Between groups; there was no statistically significant difference in median glucose, creatinine, ALT, GFR levels (p = 0.857, p = 0.124, p = 0.355, p = 0.553). In group 2 (control 2), we found a significant increase in GFR as fT3 levels increased. In the subclinical hyperthyroidism group (Group 3) there was a positive correlation between fT3 and creatine (r=0.502 and p<0.001, r=0.362 and p=0.024).
Conclusion: Vitamin D levels and metabolic parameters in subclinical hyperthyroid patients were similar to healthy controls. No significant change was found the control group, according to different TSH levels in metabolic parameters.

Anahtar Kelimeler

• Subclinical hyperthyroidism,vitamin D,metabolic parameters

Subklinik Hipertiroidili Hastalarda Vitamin D Düzeyinin ve Metabolik Parametrelerin İncelenmesi

Öz

Amaç: Subklinik hipertiroidi toplumda oldukca sık görülen, atriyal fibrilasyon ve osteoporoz gibi çeşitli komplikasyonlar nedeni ile uzun süreli takip gereken önemli bir sağlık problemidir. Vitamin D ise endokrin sistemi de kapsayan otoimmün hastalıkların patogenezindeki yeri, son yıllarda daha çok araştırılmaktadır. Çalışmamızda, subklinik hipertiroidili hastalarda vitamin D düzeylerini ve çeşitli biyokimyasal parametreleri incelemeyi amaçladık. Ayrıca vitamin D ile biyokimyasal parametreler ve tiroid fonksiyon testleri arasındaki ilişkiyi inceledik.
Materyal ve Metot: Nisan 2017-Nisan 2018 tarihleri arasında endokrinoloji polikliniğine başvuran ve subklinik hipertiroidi tanısı almış; toksik adenom, toksik multinodüler guatr (TMNG), toksik diffuz guatr (TDG) tanılı 39 hasta ile 89 sağlıklı kontrol grubu dahil edildi. Kontrol grubu ayrıca TSH düzeyleri 1≤TSH<4 (Grup 1) ve 0,5≤TSH<1 (Grup 2) olacak şekilde 2 gruba ayrıldı. Tüm hastalarda ve kontrol grubunda serum glukoz, kreatinin, AST, ALT, GFR, vitamin D, tiroid otoantikor düzeyleri hastanemiz kayıtlarından not edildi.
Bulgular: Subklinik hipertiroidi ve sağlıklı kontrol grubu arasında vitamin D düzeyleri açısından istatistiksel olarak anlamlı farklılık yoktu (p=0,928). Sırasıyla; açlık kan şekeri (AKŞ), kreatinin, glomerüler filtrasyon hızı (GFR) ve ALT düzeyleri her iki grupta benzerdi (p=0,857, p=0,124, p=0,355, p=0,553). Grup 2- kontrol grubu içerisinde AST düzeyleri grup-1 kontrol grubu ve subklinik hipertiroidi grubuna göre daha düşüktü (p=0,024). Grup 2- kontrol grubu içerisinde kreatinin düzeyi ile vitamin D arasında (r=0,366 ve p=0,007), GFR ile TSH (r=0,345, p=0,011) ve sT3 ( r= 0,300, p= 0,028) arasında pozitif bir korelasyon vardı. Subklinik hipertiroidi grubunda (Grup 3) sT3 ile kreatin ve ALT arasında pozitif bir korelasyon mevcuttu (r=0,502 ve p<0,001, r=0,362 ve p=0,024).
Sonuç: Çalışmamızda subklinik hipertiroidili hastalarda vitamin D düzeyleri ve metabolik parametreler sağlıklı kontrollerle benzer düzeydeydi. Sağlıklı kontrol grubunda ise farklı TSH düzeylerinde metabolik parametrelerde önemli bir değişiklik saptanmadı.

Anahtar Kelimeler

• Subklinik hipertiroidi,vitamin D,metabolik parametreler

Kaynakça

1. Biondi, Cooper. Subclinical Hyperthyroidism. N Engl J Med. 2018 Oct 11;379(15):1485-6.
2. Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab (Seoul). 2014 Mar;29(1):20-9.
3. Demet Yavuz D,Mete T, Yavuz R, Altunoğlu A. D Vitamini, Kalsiyum ve Mineral Metabolizması, D Vitaminin İskelet Dışı Etkileri ve Kronik Böbrek Yetmezliğinde Nutrisyonel D Vitamini Kullanımı. Ankara Med J, 2014, 14(4): 162-71.
4. Dilekçi E, Dilekçi EA, Demirkol ME, Öğün MN. Evde sağlık hastalarında D vitamin düzeyleri. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 2018; 20 (2):101-5.
5. Kim D. The role of vitamin D in thyroid diseases. Int.J. Mol. Sci. 2017;18,1949.
6. Velentzas GC. Some observations on vitamin D3 metabolism in thyrotoxicosis. Acta Vitaminol Enzymol. 1983; 5(3):159-63
7. Das G, Ojewuyi TA, Baglioni P, Geen J, Premawardhana LD, Okosieme OE. Serum thyrotrophin at baseline predicts the natural course of subclinical hyperthyroidism. Clin Endocrinol (Oxf). 2012 Jul;77(1):146-51.
8. De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016 Aug 27;388(10047):906-18.

9. Lillevang-Johansen M, Abrahamsen B, Jørgensen HL, Brix TH, Hegedüs L. Excess Mortality in Treated and Untreated Hyperthyroidism Is Related to Cumulative Periods of Low Serum TSH. J Clin Endocrinol Metab. 2017 Jul 1;102(7):2301-9.
10. Muscogiuri G, Bhattoa HP. Vitamin D and endocrine disorders: routine laboratory diagnostic implications. EJIFCC. 2018 Jul 11;29(2):111-6.
11. Ma J, Wu D, Li C, Fan C, Chao N, Liu J, Li Y, Wang R, Miao W, Guan H, Shan Z, Teng W. Lower Serum 25-Hydroxyvitamin D Level is Associated With 3 Types of Autoimmune Thyroid Diseases. Medicine (Baltimore). 2015 Sep;94(39):e1639.
12. Vondra K, Stárka L, Hampl R. Vitamin D and thyroid diseases. Physiol Res. 2015;64 Suppl 2:S95-S100.
13. Mangaraj S, Choudhury AK, Swain BM, Sarangi PK, Mohanty BK, Baliarsinha AK. Evaluation of Vitamin D Status and its Impact on Thyroid Related Parameters in New Onset Graves' Disease- A Cross-sectional Observational Study. Indian J Endocrinol Metab. 2019 Jan-Feb;23(1):35-9.
14. 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):581-7.
15. 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.
16. Yasuda T, Okamoto Y, Hamada N, Miyashita K, Takahara M, Sakamoto F, Miyatsuka T, Kitamura T, Katakami N, Kawamori D, Otsuki M, Matsuoka TA, Kaneto H, Shimomura I. Serum vitamin D levels are decreased and associated with thyroid volume in female patients with newly onset Graves' disease. Endocrine. 2012 Dec;42(3):739-41.
17. Mitrou P, Raptis SA, Dimitriadis G. Insulin action in hyperthyroidism: a focus on muscle and adipose tissue. Endocr Rev. 2010 Oct;31(5):663-79.
18. Roubsanthisuk W, Watanakejorn P, Tunlakit M, Sriussadaporn S. Hyperthyroidism induces glucose intolerance by lowering both insulin secretion and peripheral insulin sensitivity. J Med Assoc Thai. 2006 Nov;89 Suppl 5:S133-40.
19. Mehran L, Amouzegar A, Rahimabad PK, Tohidi M, Tahmasebinejad Z, Azizi F. Thyroid Function and Metabolic Syndrome: A Population-Based Thyroid Study. Horm Metab Res. 2017 Mar;49(3):192-200.
20. Ohguni S, Notsu K, Kato Y. Correlation of plasma free thyroxine levels with insulin sensitivity and metabolic clearance rate of insulin in patients with hyperthyroid Graves' disease. Intern Med. 1995 May;34(5):339-41.
21. Ozdemir D, Dagdelen S, Usman A. Serum Adiponectin Levels and Changes in Glucose Metabolism before and after Treatment for Thyroid Dysfunction. Intern Med. 2015;54(15):1849-57.
22. Dimitriadis GD, Raptis SA. Thyroid hormone excess and glucose intolerance. Exp Clin Endocrinol Diabetes. 2001;109 Suppl 2:S225-39.
23. Pani MA, Regulla K, Segni M, Hofmann S, Hüfner M, Pasquino AM, Usadel KH, Badenhoop K. A polymorphism within the vitamin D-binding protein gene is associated with Graves' disease but not with Hashimoto's thyroiditis. J Clin Endocrinol Metab. 2002 Jun;87(6):2564-7.
24. Ban Y, Taniyama M, Ban Y. Vitamin D receptor gene polymorphism is associated with Graves' disease in the Japanese population. J Clin Endocrinol Metab. 2000 Dec;85(12):4639-43.
25. Dousdampanis P, Trigka K, Vagenakis GA, Fourtounas C. The thyroid and the kidney: a complex interplay in health and disease. Int J Artif Organs. 2014 Jan;37(1):1-12.
26. Iglesias P, Bajo MA, Selgas R, Díez JJ. Thyroid dysfunction and kidney disease: An update. Rev Endocr Metab Disord. 2017 Mar;18(1):131-44.
27. Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol. 2012 Jan;23(1):22-6.
28. Basu G, Mohapatra A. Interactions between thyroid disorders and kidney disease. Indian J Endocrinol Metab. 2012 Mar;16(2):204-13.
29. Hollander JG, Wulkan RW, Mantel MJ, Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf). 2005 Apr;62(4):423-7.