Abstract

Although both exogenous vitamin D and a gluten-free diet were found to reduce thyroid antibody titers, no study investigated interactions between gluten intake and vitamin D status in patients with autoimmune thyroid disorders. The aim of the present study was to assess whether the gluten-free diet determines the effect of vitamin D treatment on thyroid autoimmunity and thyroid function in young women with autoimmune (Hashimoto’s) thyroiditis. The study compared two groups of euthyroid premenopausal women with this disorder, matched for thyroid antibody titers: 31 women with non-celiac gluten sensitivity complying for at least 12 months with the gluten-free diet and 31 unaffected sisters of women with non-celiac gluten sensitivity remaining without any dietary intervention. Plasma titers of thyroid peroxidase and thyroglobulin antibodies, as well as plasma concentrations of thyrotropin, free thyroid hormones, prolactin, 25-hydroxyvitamin D and high-sensitive C-reactive protein were measured at entry and after a six-month follow-up. Moreover, at both time points, the structure parameters of thyroid homeostasis were assessed. Although exogenous vitamin D decreased titers of thyroid peroxidase and thyroglobulin antibodies and increased 25-hydroxyvitamin D levels in each treatment group, this effect was less pronounced in patients on the gluten-free diet than in patients not following any dietary recommendations. Only in the latter group of patients, vitamin D increased SPINA-GT. Treatment-induced changes in thyroid peroxidase and thyroglobulin antibodies correlated with the impact of treatment on 25-hydroxyvitamin D levels. The obtained results suggest that gluten-free diet may impair beneficial effects of exogenous vitamin D in individuals with Hashimoto’s thyroiditis.

摘要

尽管发现外源性维生素 D 和无麸质饮食均可降低甲状腺抗体滴度，但尚无研究调查自身免疫性甲状腺疾病患者的麸质摄入量与维生素 D 状态之间的相互作用。本研究的目的是评估无麸质饮食是否决定了维生素 D 治疗对患有自身免疫性（桥本氏）甲状腺炎的年轻女性的甲状腺自身免疫和甲状腺功能的影响。该研究比较了两组患有这种疾病的甲状腺功能正常的绝经前妇女，与甲状腺抗体滴度相匹配：31 名非腹腔麸质敏感的妇女遵守无麸质饮食至少 12 个月，以及 31 名未受影响的非腹腔麸质妇女的姐妹在没有任何饮食干预的情况下保持敏感性。甲状腺过氧化物酶和甲状腺球蛋白抗体的血浆滴度，以及在入组时和六个月随访后测量了促甲状腺激素、游离甲状腺激素、催乳素、25-羟基维生素 D 和高敏 C 反应蛋白的血浆浓度。此外，在两个时间点，都评估了甲状腺稳态的结构参数。尽管外源性维生素 D 降低了甲状腺过氧化物酶和甲状腺球蛋白抗体的滴度，并增加了每个治疗组的 25-羟基维生素 D 水平，但与未遵循任何饮食建议的患者相比，这种效果在接受无麸质饮食的患者中不太明显。只有在后一组患者中，维生素 D 增加了 SPINA-GT。治疗引起的甲状腺过氧化物酶和甲状腺球蛋白抗体的变化与治疗对 25-羟基维生素 D 水平的影响相关。