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The Study On the Relation Between Vitamin D3Level and Immune Disorder in Patients With Autoimmune Thyroid Diseases

Author: LiuXinHui
Tutor: ZhangHuiJuan
School: Zhengzhou University
Course: Internal Medicine
Keywords: Autoimmune thyroid diseases 25-hydroxyvitamin D3 Thyroidantibodies Thyroid function
CLC: R581
Type: Master's thesis
Year: 2012
Downloads: 198
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Background and ObjectiveGraves’disease (GD) and Hashimoto’s thyroiditis (HT).are two of the most common clinically organ-specific autoimmune thyroid diseases (AITD). Self immune tolerance mechanism is destructed in the interaction of genetic factors and environmental factors.and dysfunction or decline of suppressor T lymphocyte reduces the inhibition of thyroid helper T cell (Th) and B lymphocytes,so that B lymphocytes in the secondary of the Th cell proliferate and secrete a large number of anti-thyroid autoantibodies,which trigger the immune response in thyroid gland.The traditional view is that1,25-(OH)2D3as the active form of vitamin D3plays an important role in body bone calcium metabolism and cell growth, differentiation,But a recent study found that1,25-(OH)2D3has the characteristics of immune regulation and the supplement of vitamin D3can prevent the occurrence of various autoimmune diseases. We explore the relationship between25-(OH)D3deficiency and humoral immune disorders in the clinical diagnosis untreated GD and HT patients with lower fasting serum25-(OH)D3level. We also explore whether it can effectively inhibit the development of the thyroid autoimmune response and it can get collaborative treatment of AITD when replenishing the vitamin D3in the GD hyperthyroidism by methimazole treatment or HT hypothyroidism by levothyroxine treatment at the same time.Methods80cases of untreated GD group and80cases of untreated HT group were collected between Oct2010and Jun2011from Endocrinology in the first affiliated hospital of Zhengzhou university.165cases group of qualified medical personnel examination as normal control were selected.All selected objects are extracted early in the morning fasting blood.The serum concentrations of25-hydroxyvitamin D3, antibodies against receptor for TSH, thyroglobulin antibody, thyro peroxidase antibodies,free triiodothyronine(FT3), free thyroxin(FT4),thyroid-stimulating hormone(TSH) were assayed.Select patients with serum25-hydroxyvitamin D3below the lower limit of normal, and then divided into the GD1groups, GD2groups, HT1and HT2groups.GDl group of30cases, a simple application of methimazole treatment; GD2in30cases on the basis of the application methimazole treatment plus oral calcitriol soft capsule (0.25ug/day); HT1group of30patients, a simple application of the levothyroxine treatment; HT2in30cases on the basis of the the application of levothyroxine therapy plus oral calcitriol soft capsule(0.25ug/day).All the data were counted and analyzed with SPSS17.0statistics software package and the obvious test level a is0.05.Results1. Compare with controls, the serum concentrations of25-hydroxyvitamin D3in GD and HT groups were remarkably decreased.(P<0.05), while between GD group and HT group, the differences have no obvious meaning (P>0.05).2. According to relevant analysis:In the GD group, the concentration of25-hydroxyvitamin D3was negatively associated with the TRAb, FT3, FT4(r=-0.479, r=-0.688, r=-0.574, P<0.01), and was positively associated with TSH(r=0.259, P<0.05).In the HT group, the concentration of25-hydroxyvitamin D3was negatively associated with the TGAb, TPOAb, TSH(r=-0.516, r=-0.642, r=-0.059, P<0.01), and was positively associated with FT3, FT4(r=0.387, r=0.175,P<0.05).3.GD group was treated with methimazole and HT patients by levothyroxine treatment, addition of oral calcitriol soft capsule(0.25ug/day) for six monthes, the results showed the serum levels of25-hydroxyvitamin D3in GD patients plus oral calcitriol soft capsule were significantly higher than the single use of methimazole in GD group and associated with significantly lower levels of serum TRAb (P<0.05); the serum levels of25-hydroxyvitamin D3in HT patients plus oral calcitriol soft capsule were significantly higher than the single use of levothyroxine in HT group and associated with significantly lower levels of serum TGAb and TPOAb.(P<0.05).Conclusion1. The patients with AITD had25-hydroxyvitamin D3deficiency, which had connection with humoral immune disorders, and indicated25-hydroxyvitamin D3deficiency played an important role in the development of AITD thyroid autoimmune.2. When using methimazole to treat people with GD hyperthyroidism and levothyroxine to treat people with HT hypothyroidism, we can give supplementary active vitamin D3to help treat AITD by reducing the serum thyroid autoantibody levels.

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