While VDR gene polymorphism was found to associate with autoimmune thyroid diseases AITDsfew studies examined levels of vitamin D in these patients and those that did yielded conflicting results. Antithyroid antibodies, thyroid functions and demographic parameters were evaluated in all patients. Vitamin D deficiency also correlated to the presence of antithyroid antibodies P Significantly low levels of vitamin D were documented in patients with AITDs that were related to the presence of anti thyroid antibodies and abnormal thyroid function tests, suggesting the involvement of vitamin D in the pathog; enesis of AITDs and the advisability of supplementation.
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Vitamin D supplement appears to reduce the incidence of these morbidities and may reduce all-cause mortality. E-mail: shoenfel post. Blood was drawn during the first 2 weeks of March Fifty patients were found to have AITDs evidenced by autoimmune features or elevated antithyroid peroxidase or antithyroglobulin antibodies and 42 showed no evidence of autoimmunity non-AITDs.
Gender, age and thyroid function tests and specific autoantibodies associated with AITDs were determined for each patient on the day the blood was drawn.
Sera from 98 agematched matched healthy donors served as controls. The study was approved by the local ethics committee, and complied with the guidelines of the most recent Helsinki declaration Edinburgh, Thyroid function tests were evaluated by routine endocrine laboratory investigations.
Figure 1 Prevalence of vitamin D deficiency among healthy subjects and patients with thyroid disease. Continuous variables are expressed as mean6standard deviation s. The non-parametric Mann—Whitney U test was performed for comparison of levels between groups. P values ,0. The quantitative determination of OH vitamin D was carried out by a direct, competitive chemiluminescence immunoassay.
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Magnetic particles solid phase are coated with a specific antibody to vitamin D, and vitamin D is viszketés és vörös foltok a bőrön to an isoluminol derivative. During the incubation, OH vitamin D is dissociated from its binding protein and competes with labeled vitamin D for binding sites on the antibody.
After the incubation, the unbound material is removed with a wash cycle, the starter reagents are added, and a flash chemiluminescent reaction is initiated. The light signal is measured by a photomultiplier as relative light units and is inversely proportional to the concentration of OH vitamin D present in calibrators, controls or samples. Vitamin D levels in all patients with thyroid disease There was no significant correlation between vitamin D deficiency and age or gender in the 92 patients referred to the endocrinology clinic Table 1.
Fifty of the total 92 patients were diagnosed with AITDs.
Table 1 The 92 patients with thyroid disease by vitamin D level, age and gender No. Thyroid-stimulating hormone TSH levels tended to have a direct relation to vitamin D status. Thyroid hormone levels T3 and T4 did not correlate with vitamin D levels in any of the groups. The pathogenesis of AITDs, like other autoimmune diseases, is multifactorial, combining genetic, immune, environmental and hormonal influences such as vitamin D.
In addition, we report, for the first time, to the best of our knowledge, a link between vitamin D deficiency and the presence of antithyroid antibodies. An association was also found between vitamin D deficiency and TSH levels, although not significant. The lack of statistical significance may be due to the relatively small group of patients, especially after subgroup analysis.
The biologically active form of vitamin D, a secosteroid hormone essential for bone and mineral homeostasis, has been shown to have immunoregulatory and anti-inflammatory properties. Dendritic cells are a primary target for the immunomodulatoric activity of vitamin D. Thus, we are able to estimate the impact of vitamin D deficiency on the pathogenesis of different diseases in a relative rather than quantitative manner by comparing levels of vitamin D in healthy and diseased subjects. Our data indicate an association between vitamin D deficiency and thyroid dysfunction, specifically when caused by an autoimmune disease.
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The explanation for these findings is not clear: low levels of vitamin D may be a primary phenomenon involved in the pathogenesis of the disease, or they may simply represent a consequence of the disease. Low vitamin D levels in other autoimmune diseases can be explained by malabsorption e. Furthermore, in diseases that cause disability, such as rheumatoid arthritis and MS, reduced outdoor activity and chronic corticosteroid treatment per se might induce low vitamin D levels.
However, most patients with thyroid disease generally do not suffer from significant skin disease, malabsorption or reduced outdoor activity. Another plausible explanation is that accelerated bone turnover in patients with hyperthyroidism may lead to high calcium levels and a negative feedback on parathyroid hormone and 1,25 OH 2D3 synthesis.
Therefore, it seems that a primary role for dermatitis a kezeken a testen az arcon vörös foltok formájában D deficiency in the pathogenesis of thyroid disease should be considered. Allelic variations within the VDR gene have been implicated in mediating susceptibility to several endocrine autoimmune disorders.
Stefanic et al. Nevertheless, it seems that the evidence links vitamin D deficiency to AITDs either via gene polymorphism or via lack of environmental uptake, supporting the notion that the effects of vitamin D on the immune system may play a role in the pathogenesis of AITDs.
Deficiency of vitamin D was linked to the presence of antithyroid antibodies and abnormal thyroid functions.
Our data and those of others pointing to the involvement of vitamin D in the pathogenesis of AITDs argue for screening for vitamin D levels in patients with thyroid diseases. Moreover, as treatment with vitamin D is inexpensive and carries minimal side effects, vitamin D supplements may be recommended for AITD patients. Further research is needed to evaluate the beneficial effects of such treatment as well as the optimal doses, including a high-dose regimen of vitamin D recently found to be effective and safe, and to increase compliance in these patients.
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