The relationship between subclinical hypothyroidism and vitamin D

Abstract

Aim: Vitamin D (vitD) is primarily responsible for bone formation and mineralization. However, in recent years, it has been suggested that vitD may play a role as an immune modulator in the development of numerous diseases, including autoimmune diseases. It has been observed that there is an association between chronic autoimmune thyroiditis (AIT) and vitD levels. This study aims to investigate whether there are differences in the levels of 25-hydroxy vitamin D [25(OH)D], calcium, and phosphorus in patients with subclinical hypothyroidism (SCH) due to AIT, in patients with antibody-negative subclinical hypothyroidism (ANSCH), and in healthy control subjects. Material and Method: Data from 50 newly diagnosed patients with SCH (35 of whom AIT) and 50 euthyroid and antibody-negative healthy controls who presented to the Department of Endocrinology and Internal Medicine at our hospital between 2018 and 2020 were retrospectively reviewed. Calcium, phosphorus, and 25(OH)D levels of patients and controls were compared. Results: Serum 25(OH)D levels were significantly lower in patients compared to controls (16.2±7.8 ng/ml and 20.4±8.2 ng/ml, respectively; p=0.024). Serum levels of calcium (p=0.081) and phosphorus (p=0.712) did not differ between groups. In a subgroup analysis, patients with AIT had significantly lower 25(OH)D values than controls (p=0.009). Compared to controls, 25(OH)D levels were comparable in the ANSCH group (p=0.096). 25(OH)D level was higher in the AIT group than in the ANSCH group (p=0.01). Conclusion: Our results show that patients with SCH have lower 25(OH)D levels than healthy controls. However, this difference is significant in patients with AIT. It is recommended to screen for vitD deficiency in patients with SCH due to AIT.

Keywords

• Chronic autoimmune thyroiditis
• 25-hydroxy vitamin D
• subclinical hypothyroidism

References

1. Makariou S, Liberopoulos EN, Elisaf M, Challa A. Novel roles of vitamin D in disease: what is new in 2011? Eur J Intern Med 2011; 22: 355-62.
2. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-81.
3. Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab 2009; 94: 26-34.
4. Muscogiuri G, Tirabassi G, Bizzaro G, et al. Vitamin D and thyroid disease: to D or not to D?. Eur J Clin Nutr 2015; 69: 291-6.
5. Mackawy AM, Al-Ayed BM, Al-Rashidi BM. Vitamin d deficiency and its association with thyroid disease. Int J Health Sci (Qassim) 2013; 7: 267-75.
6. Kim D. Low vitamin D status is associated with hypothyroid Hashimoto’s thyroiditis. Hormones (Athens) 2016; 15: 385-93.
7. Aldossari K, Al-Ghamdi S, Al-Zahrani J, et al. Association between subclinical hypothyroidism and metabolic disorders: A retrospective chart review study in an emerging university hospital. J Clin Lab Anal 2019; 33: e22983.
8. 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: 1911-30.

9. Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 2008; 88: 582–6.
10. Khan N, Sultana S, Mou MH, Sarmin S. Serum Vitamin D Status in Newly Diagnosed Hypothyroid Patients. Bangladesh J Nucl Med 2019; 22: 47-52.
11. Elamawy M, Gouda AS. Vitamin D Deficiency in Subclinical Hypothyroid Dysfunction Patients: A Case Control Study. Benha medical journal 2021; 38: 137-145.
12. Kivity S, Agmon-Levin N, Zisappl M, et al. Vitamin D and autoimmune thyroid diseases. Cell Mol Immunol 2011; 8: 243-7.
13. Tamer G, Arik S, Tamer I, Coksert D. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid 2011; 21: 891-6.
14. Shin DY, Kim KJ, Kim D, Hwang S, Lee EJ. Low serum vitamin D is associated with anti-thyroid peroxidase antibody in autoimmune thyroiditis. Yonsei Med J 2014; 55: 476-81.
15. Mazokopakis EE, Papadomanolaki MG, Tsekouras KC, Evangelopoulos AD, Kotsiris DA, Tzortzinis AA. Is vitamin D related to pathogenesis and treatment of Hashimoto’s thyroiditis? Hell J Nucl Med 2015; 18: 222-7.
16. Bozkurt NC, Karbek B, Ucan B, et al. The association between severity of vitamin D deficiency and Hashimoto’s thyroiditis. Endocr Pract 2013; 19: 479-84.
17. Arslan MS, Topaloglu O, Ucan B, et al. Isolated vitamin D deficiency is not associated with nonthyroidal illness syndrome, but with thyroid autoimmunity. Scientific World Journal 2015; 2015: 239815.
18. Yasuda T, Okamoto Y, Hamada N, et al. Serum vitamin D levels are decreased and associated with thyroid volume in female patients with newly onset Graves’ disease. Endocrine 2012; 42: 739-41.
19. D’Aurizio F, Villalta D, Metus P, Doretto P, Tozzoli R. Is vitamin D a player or not in the pathophysiology of autoimmune thyroid diseases? Autoimmun Rev 2015; 14: 363-9.
20. Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients 2013; 5: 2502-21.
21. Hewison M. An update on vitamin D and human immunity. Clin Endocrinol (Oxf) 2012; 76: 315-25.
22. Mathieu C, Adorini L. The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents. Trends Mol Med 2002; 8: 174-9.
23. Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol 2010; 10: 482-96.
24. Dankers W, Colin EM, van Hamburg JP, Lubberts E. Vitamin D in autoimmunity: molecular mechanisms and therapeutic potential. Front Immunol 2017; 7: 697.
25. Simsek Y, Cakır I, Yetmis M, Dizdar OS, Baspinar O, Gokay F. Effects of vitamin D treatment on thyroid autoimmunity. J Res Med Sci 2016; 21: 85.
26. Ucan B, Sahin M, Sayki Arslan M, et al. Int J Vitam Nutr Res 2016; 86: 9-17.
27. Mansournia N, Mansournia MA, Saeedi S, Dehghan J. The association between serum 25OHD levels and hypothyroid Hashimoto’s thyroiditis. J Endocrinol Invest 2014; 37: 473-6.
28. Barchetta I, Baroni MG, Leonetti F, et al. TSH levels are associated with vitamin D status and seasonality in an adult population of euthyroid adults. Clin Exp Med 2015; 15: 389-6.