Vitamin D and the Pathogenesis of Primary Hypothyroidism
DOI:
https://doi.org/10.32007/jfacmedbaghdad3123Keywords:
25(OH) D, Hypothyroidism, Immunoassay, Serum TSH, SubclinicalAbstract
Background: Vitamin D deficiency is a risk factor for neuropsychiatric disorders and autoimmune diseases.
Objectives: This study aimed to investigate the relationship between vitamin D and the pathogenesis of primary hypothyroidism.
Methods: A case-control study was conducted at the Department of Biochemistry, College of Medicine, University of Baghdad, and Endocrinology and Diabetes Clinic. The study involved 81 patients aged 29-62 years, with 24 newly diagnosed hypothyroidism, 33 had established hypothyroidism, and 24 had subclinical hypothyroidism. The control group consisted of 40 healthy individuals aged 29-62 years. The study used the MAGLUMI® 800 analyzer Chemiluminescence Immunoassay System, which uses Acridinium Ester-based Immunoassay technology for high sensitivity and specificity (True Negative Rate). Thyroid peroxidase antibodies and 25- hydroxyvitamin D were also tested using the Enzyme-Linked Immunosorbent Assay technique.
Results: The results revealed that the median and 1st -3rd quartile range values of serum 25 hydroxyvitamin D levels of newly diagnosed, established, and subclinical primary hypothyroidism were significantly decreased compared to controls (for all, p<0.0001). However, there were non-significant differences between newly diagnosed and subclinical, newly diagnosed and established, and between subclinical and established. There was a significant negative correlation between 25-hydroxyvitamin D and thyroid stimulating hormone in newly diagnosed and significant positive correlation in subclinical. Also, there were significant positive correlations between 25-hydroxyvitamin D and freeT4 in established and subclinical.
Conclusion: Vitamin D deficiency may play an important role in the pathogenesis of primary hypothyroidism, whether it is a newly diagnosed, established, or subclinical one.
Received: Feb. 2025
Revised: May 2025
Accepted: June 2025
Published Online: June 2025
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References
1. Appunni S, Rubens M, Ramamoorthy V, Saxena A, Tonse R, Veledar E, et al. Association between vitamin D deficiency and hypothyroidism: results from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. BMC Endocr Disord. 2021;21:1-9. https://doi.org/10.1186/s12902-021-00897-1.
2. Ibraheem RM, Hamdi RA, Kadam SM. Measurement of Serum Stromelysin-2 Level in Iraqi Patients with Subclinical and Clinical Hypothyroidism. J Fac Med Baghdad. 2024;66(1):67-72. https://doi.org/10.32007/jfacmedbagdad.6612177.
3. Louzada RA, Carvalho DP. Similarities and differences in the peripheral actions of thyroid hormones and their metabolites. Front Endocrinol (Lausanne). 2018;9:394. https://doi.org/10.3389/fendo.2018.00394.
4. Brent GA. Mechanisms of thyroid hormone action. J Clin Invest. 2012;122(9):3035-43. https://doi.org/10.1172/JCI60047.
5. Sirikul W, Sapbamrer R. Exposure to pesticides and the risk of hypothyroidism: a systematic review and meta-analysis. BMC Public Health. 2023;23(1):1867. https://doi.org/10.1186/s12889-023-16721-5.
6. Van Uytfanghe K, Ehrenkranz J, Halsall D, Hoff K, Loh TP, Spencer CA, et al. Thyroid stimulating hormone and thyroid hormones (triiodothyronine and thyroxine): an American Thyroid Association-commissioned review of current clinical and laboratory status. Thyroid. 2023;33(9):1013-28. https://doi.org/10.1089/thy.2023.0169.
7. Vanderpump MPJ. The epidemiology of thyroid disease. Br Med Bull. 2011; 99(1). https://doi.org/10.1093/bmb/ldr030.
8. Pfotenhauer KM, Shubrook JH. Vitamin D deficiency, its role in health and disease, and current supplementation recommendations. J Osteopath Med. 2017;117(5):301-5. https://doi.org/10.7556/jaoa.2017.055.
9. Mendes MM, Charlton K, Thakur S, Ribeiro H, Lanham-New SA. Future perspectives in addressing the global issue of vitamin D deficiency. Proc Nutr Soc. 2020;79(2):246-51. https://doi.org/10.1017/S0029665119001538.
10. Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol. 2007;103(3-5):620-5. https://doi.org/10.1016/j.jsbmb.2006.12.076.
11. Giustina A, Bouillon R, Dawson-Hughes B, Ebeling PR, Lazaretti-Castro M, Lips P, et al. Vitamin D in the older population: a consensus statement. Endocrine. 2023;79(1):31-44. https://doi.org/10.1007/s12020-022-03208-3.
12. Alonso N, Zelzer S, Eibinger G, Herrmann M. Vitamin D metabolites: analytical challenges and clinical relevance. Calcif Tissue Int. 2023;112(2):158-77. https://doi.org/10.1007/s00223-022-00961-5.
13. Arif MA, Rasheed MK, Ismaeel AA. Study some biochemical parameters in patients with Coronary artery disease with and without Type 2 diabetes. J Fac Med Baghdad. 2024;66(1):51-7. https://doi.org/10.32007/jfacmedbagdad.6612173.
14. Wang H, Chen W, Li D, Yin X, Zhang X, Olsen N, et al. Vitamin D and chronic diseases. Aging Dis. 2017;8(3):346. https://doi.org/10.14336/AD.2016.1021.
15. Bellan M, Andreoli L, Mele C, Sainaghi PP, Rigamonti C, Piantoni S, et al. Pathophysiological role and therapeutic implications of vitamin D in autoimmunity: focus on chronic autoimmune diseases. Nutrients. 2020;12(3):789. https://doi.org/10.3390/nu12030789.
16. Jhun J, Woo JS, Kwon JY, Na HS, Cho KH, Kim SA, et al. Vitamin D attenuates pain and cartilage destruction in OA animals via enhancing autophagic flux and attenuating inflammatory cell death. Immune Netw. 2022;22(4).
https://doi.org/10.4110/in.2022.22.e34.
17. Klubo-Gwiezdzinska J, Wartofsky L. Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment. Polish Arch Intern Med. 2022;132(3). https://doi.org/10.20452/pamw.16222.
18. Ghaseminejad-Raeini A, Ghaderi A, Sharafi A, Nematollahi-Sani B, Moossavi M, Derakhshani A, et al. Immunomodulatory actions of vitamin D in various immune-related disorders: a comprehensive review. Front Immunol. 2023; 14:950465. https://doi.org/10.3389/fimmu.2023.950465.
19. Zhao R, Zhang W, Ma C, Zhao Y, Xiong R, Wang H, et al. Immunomodulatory function of vitamin D and its role in autoimmune thyroid disease. Front Immunol. 2021;12:574967. https://doi.org/10.3389/fimmu.2021.574967.
20.Mallick RL, Gaire CP. Comparative analysis of ELISA, FEIA and CLIA techniques in diagnostic immunoassays for thyroid stimulating hormone: A cross-sectional study form Morang, Nepal. J Biomed Sci. 2023;10(1):16-20. https://doi.org/10.3126/jbs.v10i1.57050.
21.Tabatabaei MS, Ahmed M. Enzyme-linked immunosorbent assay (ELISA). In: Cancer cell biology: Methods and protocols. Springer; 2022: 115-34. https://doi.org/10.1007/978-1-0716-2376-3_10.
22. Zamwar UM, Muneshwar KN. Epidemiology, types, causes, clinical presentation, diagnosis, and treatment of hypothyroidism. Cureus. 2023;15(9). https://doi.org/10.7759/cureus.4624.
23. Fang Y, Wen X, You H, Huang Y, Qu S, Wang X, et al. Decreased Vitamin D increase the risk for subclinical hypothyroidism in individuals with T2DM: a cross-sectional study. Front Nutr. 2025; 12:1509465. https://doi.org/10.3389/fnut.2025.1509465.
24. Shaji B, Joel JJ, Sharma R. Relationship between Vitamin D Deficiency and Hypothyroidism-A Review. J Young Pharm. 2024;16(3):425-30. https://doi.org/10.5530/jyp.2024.16.55.
25. Sulejmanovic M, Begić A, Mujaric-Bousbia F, Salkic S, Ramas A. The relationship between thyroid antibodies and vitamin D level in primary hypothyroidism. Med Arch. 2020;74(5):359. https://doi.org/10.5455/medarh.2020.74.359-362.
26. Pleić N, Babić Leko M, Gunjača I, Zemunik T. Vitamin D and thyroid function: A mendelian randomization study. PLoS One. 2024;19(6):e0304253. https://doi.org/10.1371/journal.pone.0304253.
27. Aktaş HŞ. Vitamin B12 and vitamin D levels in patients with autoimmune hypothyroidism and their correlation with anti-thyroid peroxidase antibodies. Med Princ Pract. 2020;29(4):364-70. https://doi.org/10.1159/000505094.
28. Zhang Q, Wang Z, Sun M, Cao M, Zhu Z, Fu Q, et al. Association of High Vitamin D Status with Low Circulating Thyroid‐Stimulating Hormone Independent of Thyroid Hormone Levels in Middle‐Aged and Elderly Males. Int J Endocrinol. 2014;2014(1):631819. https://doi.org/10.1155/2014/631819.
29. Chao G, Zhu Y, Fang L. Correlation Between Hashimoto's Thyroiditis-Related Thyroid Hormone Levels and 25-Hydroxyvitamin D. Front Endocrinol (Lausanne). 2020;11:4. https://doi.org/10.3389/fendo.2020.00004.
30. Donayeva A, Kulzhanova D, Amanzholkyzy A, Abdelazim IA, Abilov T, Baubekov Z, et al. Relationship between vitamin D and adolescents' hypothyroidism-a cross-sectional study. Menopause Rev Menopauzalny. 2023;22(1). https://doi.org/10.5114/pm.2023.133280
31. Chen S, Yang W, Guo Z, Lv X, Zou Y. Association between serum vitamin D levels and sensitivity to thyroid hormone indices: a cross-sectional observational study in NHANES 2007-2012. Front Endocrinol (Lausanne). 2023;14:1243999. https://doi.org/10.3389/fendo.2023.1243999
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