Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labeled randomized controlled trial.
Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labeled randomized controlled trial.
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DOI：
10.4103/2230-8210.179997
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发表时间：
2016-05-01
影响因子：
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通讯作者：
Mukhopadhyay, Satinath
中科院分区：
文献类型：
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作者：
Chaudhary, Sandeep;Dutta, Deep;Mukhopadhyay, Satinath
背景和目标：虽然维生素D缺乏与自身免疫性甲状腺疾病（AITD）有关，但维生素D补充剂对甲状腺自身免疫的影响尚不清楚。本研究旨在评价补充维生素D对甲状腺自身免疫的影响（甲状腺过氧化物酶抗体[TPO-Ab]滴度）在新诊断的AITD患者的随机对照试验。102例新诊断的AITD患者（TPO-Ab > 34 kIU/L和/或甲状腺炎的超声证据）患者被随机分为组1（干预组）和组2（对照组）。第1组接受胆钙化醇60，000 IU每周一次和钙500 mg/天，持续8周;第2组接受钙500 mg/天，持续8周。应答者定义为TPO-Ab滴度下降≥25%。对至少随访3个月的个体进行了分析。ctri.nic.in结果：分析了100例AITD患者的数据（68例促甲状腺激素[TSH] ≤10 mIU/L，32例TSH > 10 mIU/L），93%存在维生素D不足。TPO-Ab滴度在25-羟基维生素D最低四分位数的患者中最高（P = 0.084）。在3个月随访时，与组2（-16.6%）相比，组1（-46.73%）的TPO-Ab显著下降（P = 0.028）。第1组68%的患者为应答者，而第2组为44%（P = 0.015）。Kaplan-Meier分析显示组1的缓解率显著更高（P = 0.012）。与TSH > 10 mIU/L相比，在TSH ≤ 10 mIU/L的AITD中观察到TPO-Ab滴度的显著更大降低。考克斯回归分析显示，第1组，其次是TPO抗体和游离四碘甲状腺原氨酸水平是一个很好的预测治疗反应（P = 0.042，0.069，和0.074，分别）。结论：维生素D补充AITD可能对自身免疫的证据，显着降低TPO抗体滴度的有益效果。
BACKGROUND AND AIMS: Although Vitamin D deficiency has been linked to autoimmune thyroid disorders (AITD), the impact of Vitamin D supplementation on thyroid autoimmunity is not known. This study aimed to evaluate the impact of Vitamin D supplementation on thyroid autoimmunity (thyroid peroxidase antibody [TPO-Ab] titers) in patients with newly diagnosed AITD in a randomized controlled trial.MATERIALS AND METHODS: One hundred two patients with newly diagnosed AITD (TPO-Ab > 34 kIU/L and/or sonographic evidence of thyroiditis) patients were randomized into Group-1 (intervention group) and Group-2 (control group). Group-1 received cholecalciferol 60,000 IU weekly and calcium 500 mg/day for 8 weeks; Group-2 received calcium 500 mg/day for 8 weeks. Responders were defined as ≥25% fall in TPO-Ab titers. Individuals with at least 3-month follow-up were analyzed. Trial is registered at ctri.nic.in (CTRI/2015/04/005713).RESULTS: Data from 100 AITD patients (68 with thyroid stimulating hormone [TSH] ≤10 mIU/L, 32 with TSH > 10 mIU/L), 93% having Vitamin D insufficiency, were analyzed. TPO-Ab titers were highest among patients in the lowest 25-hydroxyvitamin D quartile (P = 0.084). At 3 months follow-up, there was significant fall in TPO-Ab in Group-1 (-46.73%) as compared to Group-2 (-16.6%) (P = 0.028). Sixty-eight percentage patients in Group-1 were responders compared to 44% in Group-2 (P = 0.015). Kaplan-Meier analysis revealed significantly higher response rate in Group-1 (P = 0.012). Significantly greater reduction in TPO-Ab titers was observed in AITD with TSH ≤ 10 mIU/L compared to TSH > 10 mIU/L. Cox regression revealed Group-1 followed by TPO-Ab and free tetraiodothyronine levels to be a good predictor of response to therapy (P = 0.042, 0.069, and 0.074, respectively).CONCLUSION: Vitamin D supplementation in AITD may have a beneficial effect on autoimmunity as evidence by significant reductions in TPO-Ab titers.