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Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis.

Abstract

BACKGROUND

Hashimoto's thyroiditis (HT) is considered to be the most common autoimmune disease. It is currently accepted that genetic susceptibility, environmental factors, and immune disorders contribute to its development. With regard to nutritional factors, evidence implicates high iodine intake and deficiencies of selenium and iron with a potential relevance of vitamin D status. To elucidate the role of nutritional factors in the risk, pathogenesis, and treatment of HT, PubMed and the Cochrane Library were searched for publications on iodine, iron, selenium, and vitamin D and risk/treatment of HT.

SUMMARY

Chronic exposure to excess iodine intake induces autoimmune thyroiditis, partly because highly iodinated thyroglobulin (Tg) is more immunogenic. Recent introduction of universal salt iodization can have a similar, though transient, effect. Selenoproteins are essential to thyroid action. In particular, the glutathione peroxidases protect the thyroid by removing excessive hydrogen peroxide produced for Tg iodination. Genetic data implicate the anti-inflammatory selenoprotein S in HT risk. There is evidence from observational studies and randomized controlled trials that selenium/selenoproteins can reduce thyroid peroxidase (TPO)-antibody titers, hypothyroidism, and postpartum thyroiditis. Iron deficiency impairs thyroid metabolism. TPO, the enzyme responsible for the production of thyroid hormones, is a heme (iron-containing) enzyme which becomes active at the apical surface of thyrocytes only after binding heme. HT patients are frequently iron deficient, since autoimmune gastritis, which impairs iron absorption, is a common co-morbidity. Treatment of anemic women with impaired thyroid function with iron improves thyroid-hormone concentrations, while thyroxine and iron together are more effective in improving iron status. Lower vitamin D status has been found in HT patients than in controls, and inverse relationships of serum vitamin D with TPO/Tg antibodies have been reported. However, other data and the lack of trial evidence suggest that low vitamin D status is more likely the result of autoimmune disease processes that include vitamin D receptor dysfunction.

CONCLUSIONS

Clinicians should check patients' iron (particularly in menstruating women) and vitamin D status to correct any deficiency. Adequate selenium intake is vital in areas of iodine deficiency/excess, and in regions of low selenium intake a supplement of 50-100 μg/day of selenium may be appropriate.

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  • Authors+Show Affiliations

    ,

    1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom . 2 Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi, China .

    1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom . 2 Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi, China .

    Source

    MeSH

    Diet
    Dietary Supplements
    Hashimoto Disease
    Humans
    Iron
    Nutritional Status
    Selenium
    Vitamin D

    Pub Type(s)

    Journal Article
    Review
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    28290237

    Citation

    Hu, Shiqian, and Margaret P. Rayman. "Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis." Thyroid : Official Journal of the American Thyroid Association, vol. 27, no. 5, 2017, pp. 597-610.
    Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. Thyroid. 2017;27(5):597-610.
    Hu, S., & Rayman, M. P. (2017). Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. Thyroid : Official Journal of the American Thyroid Association, 27(5), pp. 597-610. doi:10.1089/thy.2016.0635.
    Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. Thyroid. 2017;27(5):597-610. PubMed PMID: 28290237.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. AU - Hu,Shiqian, AU - Rayman,Margaret P, Y1 - 2017/04/06/ PY - 2017/3/16/pubmed PY - 2018/3/6/medline PY - 2017/3/15/entrez KW - Hashimoto's thyroiditis KW - autoimmune thyroiditis KW - iodine KW - iron KW - selenium KW - vitamin D SP - 597 EP - 610 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 27 IS - 5 N2 - BACKGROUND: Hashimoto's thyroiditis (HT) is considered to be the most common autoimmune disease. It is currently accepted that genetic susceptibility, environmental factors, and immune disorders contribute to its development. With regard to nutritional factors, evidence implicates high iodine intake and deficiencies of selenium and iron with a potential relevance of vitamin D status. To elucidate the role of nutritional factors in the risk, pathogenesis, and treatment of HT, PubMed and the Cochrane Library were searched for publications on iodine, iron, selenium, and vitamin D and risk/treatment of HT. SUMMARY: Chronic exposure to excess iodine intake induces autoimmune thyroiditis, partly because highly iodinated thyroglobulin (Tg) is more immunogenic. Recent introduction of universal salt iodization can have a similar, though transient, effect. Selenoproteins are essential to thyroid action. In particular, the glutathione peroxidases protect the thyroid by removing excessive hydrogen peroxide produced for Tg iodination. Genetic data implicate the anti-inflammatory selenoprotein S in HT risk. There is evidence from observational studies and randomized controlled trials that selenium/selenoproteins can reduce thyroid peroxidase (TPO)-antibody titers, hypothyroidism, and postpartum thyroiditis. Iron deficiency impairs thyroid metabolism. TPO, the enzyme responsible for the production of thyroid hormones, is a heme (iron-containing) enzyme which becomes active at the apical surface of thyrocytes only after binding heme. HT patients are frequently iron deficient, since autoimmune gastritis, which impairs iron absorption, is a common co-morbidity. Treatment of anemic women with impaired thyroid function with iron improves thyroid-hormone concentrations, while thyroxine and iron together are more effective in improving iron status. Lower vitamin D status has been found in HT patients than in controls, and inverse relationships of serum vitamin D with TPO/Tg antibodies have been reported. However, other data and the lack of trial evidence suggest that low vitamin D status is more likely the result of autoimmune disease processes that include vitamin D receptor dysfunction. CONCLUSIONS: Clinicians should check patients' iron (particularly in menstruating women) and vitamin D status to correct any deficiency. Adequate selenium intake is vital in areas of iodine deficiency/excess, and in regions of low selenium intake a supplement of 50-100 μg/day of selenium may be appropriate. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/28290237/Multiple_Nutritional_Factors_and_the_Risk_of_Hashimoto's_Thyroiditis_ L2 - https://www.liebertpub.com/doi/full/10.1089/thy.2016.0635?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -