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Research Article Open access CC BY 3.0

Vitamin D Deficiency may be a Risk Factor for Ophthalmopathy in Patients with Graves’ Hyperthyroidism But Not Hashimoto's Thyroiditis

Hooshang Lahooti, Bryan Wise, H. Tjiang, Bernard Champion, Jack Wall

Ophthalmology Research: An International Journal · pp. 10–17 · Published 15 Oct 2013

10.9734/OR/2014/4795

Abstract

Aims: Apart from its key role in bone metabolism vitamin D plays a role in immune function, cancer prevention and autoimmunity induction. Vitamin D insufficiency (25-50 nmol/L) and deficiency (serum level < 25 nmol/L) are very common in the West Sydney and Blue Mountains areas of Australia. Vitamin D deficiency may also play a role in the development of ophthalmopathy in patients with thyroid autoimmunity. Methods: We have studied a possible relationship between serum vitamin D level and ophthalmopathy in patients with Graves’ disease and Hashimoto`s thyroiditis. We studied 37 patients with Graves’ disease and 69 with Hashimoto`s thyroiditis at their first clinical visit, before any vitamin D replacement. Results: Overall, 70% of patients with Graves’ disease, 86% of those with Hashimoto`s thyroiditis and 88% of patients with Multi nodular goiter control group were vitamin D deficient or insufficient. Sixty-one % of Graves’ patients who were vitamin D deficient and 75% of those who were vitamin D insufficient had ophthalmopathy, defined as a NOSPECS class of two or more, compared to only 27% of patients who were vitamin D replete, this difference was significant by odds ratio [5.03 (confidence interval 1.06 – 23.8) P=0.03] and showed a trend to significance by X2 test (P = 0.08). Thirty nine % of Graves’ patients who were vitamin D deficient and 25% of those who were vitamin D insufficient had no ophthalmopathy, compared to 73% of patients who were vitamin D replete.  Eleven % of patients with Hashimoto`s thyroiditis who were vitamin D deficient and 22% of those who were vitamin D insufficient had ophthalmopathy, which was generally mild and often manifest as isolated upper eyelid retraction, compared to 20% of patients who were vitamin D replete, which was not significant. There was no close correlation between vitamin D status and either the activity or severity of the ophthalmopathy, for either Graves’ disease or Hashimoto’s thyroiditis. Conclusions: Vitamin D deficiency is significantly associated with ophthalmopathy in patients with Graves’ hyperthyroidism but not Hashimoto’s thyroiditis. The finding that a normal serum vitamin D level was associated with a decreased prevalence of ophthalmopathy in patients with Graves’ hyperthyroidism, but not Hashimoto’s thyroiditis, suggests that the pathogenesis of the eye changes in the two disorders may be different. It appears that Graves’ patients with ophthalmopathy have a greater propensity to vitamin D deficiency as compared to Graves’ patients without ophthalmopathy. While the significance of the findings needs to be addressed in a prospective study it seems that vitamin D deficiency is another risk factor for ophthalmopathy in patients with Graves` hyperthyroidism.  

Vitamin D Graves’ disease Hashimoto’s thyroiditis ophthalmopathy upper eyelid retraction

References (20)

  1. 1 Influence of Season and Latitude on the Cutaneous Synthesis of Vitamin D 3 : Exposure to Winter Sunlight in Boston and Edmonton Will Not Promote Vitamin D 3 Synthesis in Human Skin* [DOI]
  2. 2 Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach. [DOI]
  3. 3 Vitamin D insufficiency in a population of healthy western Canadians.
  4. 4 Vitamin D in rheumatoid arthritis [DOI]
  5. 5 Pathophysiology of Graves’ Ophthalmopathy: The Cycle of Disease [DOI]
  6. 6 Circannual vitamin d serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe.
  7. 7 Review: Vitamin D, immunity and lupus [DOI]
  8. 8 Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study [DOI]
  9. 9 EURODIAB Study Group Worldwide childhood type 1 diabetes incidence – what can we learn from epidemiology?
  10. 10 Serum vitamin D levels are decreased and associated with thyroid volume in female patients with newly onset Graves’ disease [DOI]
  11. 11 Classification of the Eye Changes of Graves' Disease [DOI]
  12. 12 The Association of Cigarette Smoking with Clinical Subtypes of Ophthalmic Gravesʼ Disease [DOI]
  13. 13 High Prevalence of Vitamin D Deficiency in Japanese Female Patients with Graves' Disease. [DOI]
  14. 14 Eye and Eyelid Abnormalities Are Common in Patients with Hashimoto's Thyroiditis [DOI]
  15. 15 Antibodies targeting the calcium binding skeletal muscle protein calsequestrin are specific markers of ophthalmopathy and sensitive indicators of ocular myopathy in patients with Graves’ disease [DOI]
  16. 16 Can Autoimmunity Against Calsequestrin Explain the Eye and Eyelid Muscle Inflammation of Thyroid Eye Disease? [DOI]
  17. 17 [High prevalence of secondary hyperparathyroidism due to vitamin D insufficiency in Graves' disease].
  18. 18 [Vitamin D insufficiency--possible etiologic factor of autoimmune diseases].
  19. 19 Vitamin D and multiple sclerosis: what is the clinical impact? [DOI]
  20. 20 Vitamin D and adult bone health in Australia and New Zealand: a position statement [DOI]

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