1. EFFECTS OF VITAMIN D
TREATMENT ON THYROID
AUTOIMMUNITY
ANDY SAMEDY
EPI 623 01
2. BACKGROUND/RATIONALE
• Your thyroid is a butterfly shaped organ that is found in the front part of
your neck, thyroid glands produce and release hormones that affect
metabolic rates.
• Autoimmune thyroid disorders(AITD) are when your immune system
attacks your thyroid, which can cause hyperthyroidism or hypothyroidism.
• For biological reasons that are not particularly clear, Vitamin D may
prevent the autoimmune response against the thyroid.
4. STUDY DESIGN
• The 82 participants in the study were diagnosed with AITD and Vitamin D
deficiency by the Endocrinology outpatient clinics between April 2015 and June
2015.
• Participants in the study were randomly assigned into two groups. Group
1(replacement group) had 46 patients and Group 2(control group) had 36
patients.
• The first group(replacement group) was treated with Vitamin D for 1 month at
1000 IU/day, the second group(control group) was not treated with Vitamin D
replacement (only sunshine and diet)
• Serum TSH, T4, T3, TPO-ab, TgAb,) and vitamin D levels were measured at
the initiation(baseline) of the study and again at 1 month in all participants in
the study.
5. METHODS –INCLUSION CRITERIA
• INCLUSION
• 18 and over
• Diagnosed with AITD and Vitamin D deficiency
• All of the patients involved in the study had Graves Disease or Hashimoto’s
disease and Vitamin D deficiency(serum values <20ng/ml).
• EXCLUSION
• AITD patients whom have taken Vitamin D replacement in past 12 months
• Patients taking meds that affect thyroid function(L-thyroxine)
6. DESCRIPTION OF PARTICIPANTS
• Participants in the study
ranged from ages 23-46.
• 14 males, 68 females. 20%
males and 80% females.
• 68/82 of the participants had
Hashimoto’s disease and 14/82
had Graves Disease
7. STATISTICAL ANALYSIS
• Power analysis was performed prior to the the beginning of the study to
determine how many minimum patients would be necessary by group to
obtain any meaningful deductions from the study.
• Baseline characteristics of the treatment group and control group were
evaluated using two independent samples t-test or Chi-Square tests.
• Significant differences between the two related groups were evaluated at
end of study by Wilcoxon tests and paired sample t-tests.
• P value: P <0.05 was considered statistically significant
• Data from the study was analyzed with SPSS(Version 22, SPSS Inc.
Chicago, IL, USA)
9. CONCLUSION
• The study demonstrates that there may be an existence of a relationship
between Vitamin D deficiency and the development of AITDs due to the
fact that Vitamin D supplementation decreased antibody titers(Tgab,
TGABO)
• The study did not demonstrate a relationship between Vitamin D levels
and thyroid function (TSH)
• In the future Vitamin D may become part of AITD’s treatment, especially in
those with deficient Vitamin D.
• Further studies are required to better understand the mechanisms of AITD
and further understand the effects of Vitamin D on the development of
AITD and thyroid functions.
10. LIMITATIONS
• Extremely short study. Short intervention period (1 month) due to ethical
reasons.
• Small sample size(86 patients)
• Participants from same geographical region and ethnicity which may have
had lead to bias in results.
11. REFERENCES
• 1. Basit S. Vitamin D in health and disease: A literature review. Br J Biomed Sci. 2013;70:161–72.[PubMed]
• 2. Lemire JM, Adams JS, Sakai R, Jordan SC. 1 alpha, 25-dihydroxyvitamin D3 suppresses proliferation and immunoglobulin production
by normal human peripheral blood mononuclear cells. J Clin Invest. 1984;74:657–61. [PMC free article] [PubMed]
• 3. Deluca HF, Cantorna MT. Vitamin D: Its role and uses in immunology. Faseb J. 2001;15:2579–85.[PubMed]
• 4. Abou-Raya A, Abou-Raya S, Helmii M. The effect of Vitamin D supplementation on inflammatory and hemostatic markers and disease
activity in patients with systemic lupus erythematosus: A randomized placebo-controlled trial. J Rheumatol. 2013;40:265–72. [PubMed]
• 5. Grishkan IV, Fairchild AN, Calabresi PA, Gocke AR. 1,25-Dihydroxyvitamin D3 selectively and reversibly impairs T helper-cell CNS
localization. Proc Natl Acad Sci U S A. 2013;110:21101–6.[PMC free article] [PubMed]
• 6. Ananthakrishnan AN, Cagan A, Gainer VS, Cheng SC, Cai T, Szolovits P, et al. Higher plasma Vitamin D is associated with reduced
risk of Clostridium difficile infection in patients with inflammatory bowel diseases. Aliment Pharmacol Ther. 2014;39:1136–42. [PMC
free article][PubMed]
• 7. Skaaby T, Husemoen LL, Thuesen BH, Linneberg A. Prospective population-based study of the association between Vitamin D status
and incidence of autoimmune disease. Endocrine. 2015;50:231–8. [PubMed]
• 8. Verstuyf A, Carmeliet G, Bouillon R, Mathieu C. Vitamin D: A pleiotropic hormone. Kidney Int. 2010;78:140–5. [PubMed]
• 9. Muscogiuri G, Tirabassi G, Bizzaro G, Orio F, Paschou SA, Vryonidou A, et al. Vitamin D and thyroid disease: To D or not to D? Eur J
Clin Nutr. 2015;69:291–6. [PubMed]
• 10. Kivity S, Agmon-Levin N, Zisappl M, Shapira Y, Nagy EV, Dankó K, et al. Vitamin D and autoimmune thyroid diseases. Cell Mol
Immunol. 2011;8:243–7. [PMC free article] [PubMed]
Editor's Notes
First study on humans
Serum levels were quantified by liquid chromatography mass spectrometry and chemiluminescent immunoassay.
L-thyroxine replacement therapy was initiated if any of the patients had hypothyroidic symptoms and had TSG levels above normal range
Methiamozole was started if patients exhibited hyperthyroidic symptoms and had TSH levels under the normal range
All patients with symptoms of Vitamin D deficiency such as myalgia, sweating, and weakness were monitored.
The two groups are similar with regard to age, sex, and type of thyroid disease.
Power analysis identified that at least 30 people were necessary in both arms for this study.
Wilcoxon was used for each group analysis, Paired sample t-tests was used for between group analysis.
As expected the mean serum Vitamin D level in the replacement group had significantly increased from baseline to 1 month.
Thyroid antibodies TgAb and TPO-Ab significantly decreased for those in the replacement group. Statistically significant. (Wilcoxon Test)
Nothing between groups.
The study did not demonstrate a relationship between Vitamin D levels and thyroid function, only in thyroid antibodies.
Same geographical region of participants may have affected Vitamin D levels.
