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Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü

Yıl 2022, Cilt: 7 Sayı: 1, 179 - 184, 31.01.2022

Öz

Otoimmünite, immün sistemi hücrelerinin vücudun kendi hücrelerini tanıması ve kendi hücrelerine karşı tolerans geliştirerek ayırt edebilmesine dayanmaktadır. Bu durum immün self tolerans olarak da bilinmektedir. Son yıllarda genetik ve çevresel faktörlerin etkisiyle immün sistem hücrelerinde self toleransın azalmasına bağlı olarak kronik otoimmün hastalıkların prevalansında artış görülmektedir. D vitamini ise sterol türevi bir vitamin olup ilk olarak kemik ve iskelet sağlığında rol alan bir vitamin olarak tanımlanmıştır. D vitamini fonksiyonlarını vücutta vitamin D reseptörlerine (VDR) bağlanarak göstermektedir. Yapılan araştırmalarda iskelet sistemi dışında sinir sistemi, immün sistem ve endokrin sistemdeki bazı doku ve organ hücrelerinde de D vitamini reseptörlerinin yer aldığı belirlenmiş ve böylece iskelet sistemi dışındaki rolleri öne çıkmıştır. Bu nedenle eksikliği vücutta çeşitli doku ve organların sağlıklı işleyişini etkilemektedir. Özellikle immün sistem hücrelerinde ve endokrin organ hücrelerinde D vitamini reseptörlerinin bulunması D vitamini eksikliğinin otoimmün endokrin hastalıklarda potansiyel rolünü güçlendirmiştir. Otoimmün endokrin hastalıkların başında tiroid bezinin otoimmün hastalıkları gelmektedir. Otoimmün tiroid hastalıkları (OİTH) arasında Hashimoto tiroidit (HT), Graves hastalığı (GH) ve postpartum tiroidit (PPT) en yaygın türleridir. D vitamininin otoimmün tiroiditlerde rolü henüz tam olarak aydınlatılmasa da immün ve immün sistem dışı bazı rolleri ile otoimmün tiroid hastalıklarında olumlu etkileri olabileceğini gösteren çalışmalar bulunmaktadır. Ayrıca D vitamininin eksiklik ve/veya yetersizlik düzeylerinin hastalık klinik tablosunu olumsuz etkileyebileceğini gösteren çalışmalar yapılmıştır. Bu derleme makalede D vitamininin otoimmün tiroid hastalıklarında etkilediği mekanizmalar ile bazı otoimmün tiroid hastalıklarla ilişkisi güncel yaklaşımlara göre değerlendirilmiştir.

Kaynakça

  • Mele C., Caputo, M., Bisceglia, A., Samà, M. T., Zavattaro, M., Aimaretti, G., & Marzullo, P. Immunomodulatory Effects of Vitamin D in Thyroid Diseases. Nutrients, 2020;12(5), 1444. https://doi.org/10.3390/ nu12051444
  • Anaya, J. M., Shoenfeld, Y., Rojas-Villarraga, A., Levy, R. A., & Cervera, R. Autoimmunity: from bench to bedside. Autoimmun Throid Disorders. El Rosario University Press. 2013. PMID: 29087650
  • Antonelli, A., Ferrari, S. M., Corrado, A., Di Domenicantonio, A., & Fallahi, P. Autoimmune thyroid disorders. Autoimmun Rev. 2015; 14(2), 174-180. https://doi.org/10.1016/j.autrev.2014.10.016
  • Mazokopakis, E. E., Papadomanolaki, M. G., Tsekouras, K. C., Evangelopoulos, A. D., Kotsiris, D. A., & Tzortzinis, A. A. Is vitamin D related to pathogenesis and treatment of Hashimoto’s thyroiditis. Hell J Nucl Med. 2015; 18(3), 222-7. PMID: 26637501
  • Gallo, D., Mortara, L., Gariboldi, M. B., Cattaneo, S. A. M., Rosetti, S., Gentile, L., ... & Bartalena, L. Immunomodulatory effect of vitamin D and its potential role in the prevention and treatment of thyroid autoimmunity: A narrative review. J Endocrinol Invest. 2019; 1-17. https://doi.org/10.1007/s40618-019-01123-5
  • Murdaca, G., Tonacci, A., Negrini, S., Greco, M., Borro, M., Puppo, F., & Gangemi, S. Emerging role of vitamin D in autoimmune diseases: an update on evidence and therapeutic implications. Autoimmun Rev. 2019; 18(9), 102350. https://doi.org/10.1016/j.autrev.2019.102350
  • Borissova AM, Shinkov A, Vlahov J. Vitamin D status in Bulgaria winter data. Arch Osteoporos. 2013; 8: 133. https://doi.org/10.1007/s11657- 013-0133-4
  • Bikle, D.D. Vitamin D metabolism, mechanism of action, and clinical applications. Chem. Biol. 2014; 21,319–329. https://doi.org/10.1016/j. chembiol.2013.12.016
  • Nettore, I.C.; Albano, L.; Ungaro, P.; Colao, A.; Macchia, P.E. Sunshine vitamin and thyroid. Rev. Endocr.Metab. Disord. 2017; 18, 347–354. https://doi.org/10.1007/s11154-017-9406-3
  • Bishop, E., Ismailova, A., Dimeloe, S., Hewison, M., & White, J. H. Vitamin D and immune regulation: antibacterial, antiviral, anti‐inflammatory. JBMR plus, 2020; e10405. https://doi.org/10.1002/ jbm4.10405
  • Pludowski, P., Holick, M. F., Grant, W. B., Konstantynowicz, J., Mascarenhas, M. R., Haq, A., & Rudenka, E. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018; 175, 125-135. https://doi. org/10.1016/j.jsbmb.2017.01.021
  • Türkiye Endokrinoloji ve Metabolizma Derneği Tıbbi Beslenme ve Egzersiz Metabolizması Kılavuzu.[İnternet].2020. Erişim Tarihi: 15.03.2021. Erişim Linki: https://temd.org.tr/admin/uploads/tbl_ kilavuz/202101041431052021tbl_kilavuzada2d60e b.pdf
  • Skrobot, A., Demkow, U., & Wachowska, M. Immunomodulatory role of vitamin D: a review. In Current Trends in Immunity and Respiratory Infections. 2018; 13-23. https://doi.org/10.1007/5584_2018_246
  • Wang, T.T.; Nestel, F.P.; Bourdeau, V.; Nagai, Y.;Wang, Q.; Liao, J.; Tavera-Mendoza, L.; Lin, R.; Hanrahan, J.W.; Mader, S.; et al. Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J. Immunol. 2004; 173, 2909–2912. https:// doi.org/10.3390/nu7042485
  • Audiger, C., Rahman, M. J., Yun, T. J., Tarbell, K. V., & Lesage, S. The importance of dendritic cells in maintaining immune tolerance. J. Immunol. 2017; 198(6), 2223-2231. https://doi.org/10.4049/ jimmunol.1601629.
  • Bivona, G., Agnello, L., & Ciaccio, M. The immunological implication of the new vitamin D metabolism. Cent Eur J Public Health. 2018; 43(3), 331. https://doi.org/10.5114/ceji.2018.80053
  • Rydzewska, M., Jaromin, M., Pasierowska, I. E., Stożek, K., & Bossowski, A. Role of the T and B lymphocytes in pathogenesis of autoimmune thyroid diseases. Thyroid Res. 2018; 11(1), 1-11. https://doi.org/10.1186/ s13044-018-0046-9
  • Miteva, M. Z., Nonchev, B. I., Orbetzova, M. M., & Stoencheva, S. D. Vitamin D and Autoimmune Thyroid Diseases-a Review. Folia Med. 2020; 62, 223. https://doi.org/10.3897/folmed.62.e47794
  • Luty, J., Ruckemann-Dziurdzińska, K., Witkowski, J. M., & Bryl, E. Immunological aspects of autoimmune thyroid disease–Complex interplay between cells and cytokines. Cytokine. 2019; 116, 128-133. https://doi.org/10.1016/j.cyto.2019.01.003
  • Ferreira, G.B.; Gysemans, C.A.; Demengeot, J.; Da Cunha, J.P.M.C.M.; Vanherwegen, A.-S.; Overbergh, L.;Van Belle, T.L.; Pauwels, F.; Verstuyf, A.; Korf, H.; et al. 1,25-Dihydroxyvitamin D3 Promotes Tolerogenic Dendritic Cells with Functional Migratory Properties in NOD Mice. J. Immunol. 2014, 192, 4210–4220. https://doi.org/10.4049/jimmunol.1302350
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  • Gao, X.R.; Yu, Y.G. Meta-Analysis of the Association between Vitamin D Receptor Polymorphisms and the Risk of Autoimmune Thyroid Disease. Int. J. Endocrinol. 2018; 2846943. https://doi.org/10.1155/2018/2846943
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The Role Of Vitamin D in Autoimmune Thyroid Diseases

Yıl 2022, Cilt: 7 Sayı: 1, 179 - 184, 31.01.2022

Öz

Autoimmunity is the ability of immune system cells to recognize body’s own cells by developing immun tolerance. This situation is also known as immune self-tolerance. In recent years, an increase has been observed in prevalence of autoimmune diseases due to the decrease in self-tolerance of immune system cells. Vitamin D, is a sterol-derived vitamin and was first defined with its role in bone and skeletal health. It acts as by binding to vitamin D receptors(VDR) in the body. Studies have shown that vitamin D receptors are involved in cells in the nervous system, immune system, and endocrine system as well as skeletal system. Therefore, vitamin D deficiency affects healthy functioning of several systems in body. The presence of vitamin D receptors, especially in immune system cells and endocrine cells, has strengthened role of vitamin D deficiency in autoimmune endocrine diseases. Autoimmune thyroid diseases (AITD) are among autoimmune endocrine diseases. Hashimoto thyroiditis (HT), Graves’ disease (GD), postpartum thyroiditis (PPT) are common autoimmune thyroid diseases. Although the role of vitamin D in autoimmune thyroid diseases has not been fully elucidated yet, there are studies showing that it may have positive effects in autoimmune thyroiditis’ with its roles on immune and non-immune system Additionally, it has been indicated that vitamin D deficiency and/or insufficiency may adversely affect the clinical progression of AITD. In this review article, the mechanisms that vitamin D affects in autoimmune thyroid diseases and its relationship with some autoimmune thyroid diseases were evaluated according to current approaches.

Kaynakça

  • Mele C., Caputo, M., Bisceglia, A., Samà, M. T., Zavattaro, M., Aimaretti, G., & Marzullo, P. Immunomodulatory Effects of Vitamin D in Thyroid Diseases. Nutrients, 2020;12(5), 1444. https://doi.org/10.3390/ nu12051444
  • Anaya, J. M., Shoenfeld, Y., Rojas-Villarraga, A., Levy, R. A., & Cervera, R. Autoimmunity: from bench to bedside. Autoimmun Throid Disorders. El Rosario University Press. 2013. PMID: 29087650
  • Antonelli, A., Ferrari, S. M., Corrado, A., Di Domenicantonio, A., & Fallahi, P. Autoimmune thyroid disorders. Autoimmun Rev. 2015; 14(2), 174-180. https://doi.org/10.1016/j.autrev.2014.10.016
  • Mazokopakis, E. E., Papadomanolaki, M. G., Tsekouras, K. C., Evangelopoulos, A. D., Kotsiris, D. A., & Tzortzinis, A. A. Is vitamin D related to pathogenesis and treatment of Hashimoto’s thyroiditis. Hell J Nucl Med. 2015; 18(3), 222-7. PMID: 26637501
  • Gallo, D., Mortara, L., Gariboldi, M. B., Cattaneo, S. A. M., Rosetti, S., Gentile, L., ... & Bartalena, L. Immunomodulatory effect of vitamin D and its potential role in the prevention and treatment of thyroid autoimmunity: A narrative review. J Endocrinol Invest. 2019; 1-17. https://doi.org/10.1007/s40618-019-01123-5
  • Murdaca, G., Tonacci, A., Negrini, S., Greco, M., Borro, M., Puppo, F., & Gangemi, S. Emerging role of vitamin D in autoimmune diseases: an update on evidence and therapeutic implications. Autoimmun Rev. 2019; 18(9), 102350. https://doi.org/10.1016/j.autrev.2019.102350
  • Borissova AM, Shinkov A, Vlahov J. Vitamin D status in Bulgaria winter data. Arch Osteoporos. 2013; 8: 133. https://doi.org/10.1007/s11657- 013-0133-4
  • Bikle, D.D. Vitamin D metabolism, mechanism of action, and clinical applications. Chem. Biol. 2014; 21,319–329. https://doi.org/10.1016/j. chembiol.2013.12.016
  • Nettore, I.C.; Albano, L.; Ungaro, P.; Colao, A.; Macchia, P.E. Sunshine vitamin and thyroid. Rev. Endocr.Metab. Disord. 2017; 18, 347–354. https://doi.org/10.1007/s11154-017-9406-3
  • Bishop, E., Ismailova, A., Dimeloe, S., Hewison, M., & White, J. H. Vitamin D and immune regulation: antibacterial, antiviral, anti‐inflammatory. JBMR plus, 2020; e10405. https://doi.org/10.1002/ jbm4.10405
  • Pludowski, P., Holick, M. F., Grant, W. B., Konstantynowicz, J., Mascarenhas, M. R., Haq, A., & Rudenka, E. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018; 175, 125-135. https://doi. org/10.1016/j.jsbmb.2017.01.021
  • Türkiye Endokrinoloji ve Metabolizma Derneği Tıbbi Beslenme ve Egzersiz Metabolizması Kılavuzu.[İnternet].2020. Erişim Tarihi: 15.03.2021. Erişim Linki: https://temd.org.tr/admin/uploads/tbl_ kilavuz/202101041431052021tbl_kilavuzada2d60e b.pdf
  • Skrobot, A., Demkow, U., & Wachowska, M. Immunomodulatory role of vitamin D: a review. In Current Trends in Immunity and Respiratory Infections. 2018; 13-23. https://doi.org/10.1007/5584_2018_246
  • Wang, T.T.; Nestel, F.P.; Bourdeau, V.; Nagai, Y.;Wang, Q.; Liao, J.; Tavera-Mendoza, L.; Lin, R.; Hanrahan, J.W.; Mader, S.; et al. Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J. Immunol. 2004; 173, 2909–2912. https:// doi.org/10.3390/nu7042485
  • Audiger, C., Rahman, M. J., Yun, T. J., Tarbell, K. V., & Lesage, S. The importance of dendritic cells in maintaining immune tolerance. J. Immunol. 2017; 198(6), 2223-2231. https://doi.org/10.4049/ jimmunol.1601629.
  • Bivona, G., Agnello, L., & Ciaccio, M. The immunological implication of the new vitamin D metabolism. Cent Eur J Public Health. 2018; 43(3), 331. https://doi.org/10.5114/ceji.2018.80053
  • Rydzewska, M., Jaromin, M., Pasierowska, I. E., Stożek, K., & Bossowski, A. Role of the T and B lymphocytes in pathogenesis of autoimmune thyroid diseases. Thyroid Res. 2018; 11(1), 1-11. https://doi.org/10.1186/ s13044-018-0046-9
  • Miteva, M. Z., Nonchev, B. I., Orbetzova, M. M., & Stoencheva, S. D. Vitamin D and Autoimmune Thyroid Diseases-a Review. Folia Med. 2020; 62, 223. https://doi.org/10.3897/folmed.62.e47794
  • Luty, J., Ruckemann-Dziurdzińska, K., Witkowski, J. M., & Bryl, E. Immunological aspects of autoimmune thyroid disease–Complex interplay between cells and cytokines. Cytokine. 2019; 116, 128-133. https://doi.org/10.1016/j.cyto.2019.01.003
  • Ferreira, G.B.; Gysemans, C.A.; Demengeot, J.; Da Cunha, J.P.M.C.M.; Vanherwegen, A.-S.; Overbergh, L.;Van Belle, T.L.; Pauwels, F.; Verstuyf, A.; Korf, H.; et al. 1,25-Dihydroxyvitamin D3 Promotes Tolerogenic Dendritic Cells with Functional Migratory Properties in NOD Mice. J. Immunol. 2014, 192, 4210–4220. https://doi.org/10.4049/jimmunol.1302350
  • Kim, D. The role of vitamin D in thyroid diseases. Int J Mol Sci. 2017; 18(9), 1949. https://doi.org/10.3390/ijms18091949
  • van Etten, E.; Verlinden, L.; Giulietti, A.; Ramos-Lopez, E.; Branisteanu, D.D.; Ferreira, G.B.; Overbergh, L.; Verstuyf, A.; Bouillon, R.; Roep, B.O.; et al. The vitamin D receptor gene FokI polymorphism: Functional impact on the immune system. Eur. J. Immunol. 2007; 37, 395–405. https://doi. org/10.1002/eji.200636043
  • Gao, X.R.; Yu, Y.G. Meta-Analysis of the Association between Vitamin D Receptor Polymorphisms and the Risk of Autoimmune Thyroid Disease. Int. J. Endocrinol. 2018; 2846943. https://doi.org/10.1155/2018/2846943
  • Lin WY, Wan L, Tsai CH, Chen RH, Lee CC, Tsai FC. Vitamin D receptor gene polymorphisms are associated with risk of Hashimoto’s thyroiditis in Chinese patients in Taiwan. J Clin Lab Anal. 2006; 20: 109- 12. https:// doi.org/10.1002/jcla.20110
  • Xiaoxi Ma, Zhiguo Xie, Jiabi Qin, Shuoming Luo, Zhiguang Zhou, Association of Vitamin D Pathway Gene CYP27B1 and CYP2R1 Polymorphisms with Autoimmune Endocrine Disorders: A Meta- Analysis. J Clin Endocrinol Metab. 2020;105(11), 3575–3587. https://doi. org/10.1210/clinem/dgaa525
  • Guleryuz, B., Akin, F., Tunc Ata, M., Mergen Dalyanoglu, M., & Turgut, S. Vitamin-D receptor (VDR) gene polymorphisms (TaqI, FokI) in Turkish patients with Hashimoto’s thyroiditis: relationship to the levels of Vit-D and cytokines. Endocr Metab Immune Disord Drug Targets 2016; 16(2),131-139. https://doi.org/10.2174/1871530316666160728092613.
  • Zhou, H.; Xu, C.; Gu, M. Vitamin D receptor (VDR) gene polymorphisms and Graves’ disease: A meta-analysis. Clin. Endocrinol. 2009; 70, 938– 945. https://doi.org/10.1111/j.1365-2265.2008.03413.x
  • Veneti, S.; Anagnostis, P.; Adamidou, F.; Artzouchaltzi, A.-M.; Boboridis, K.; Kita, M. Association between vitamin D receptor gene polymorphisms and Graves’ disease: A systematic review and meta-analysis. Endocrine. 2019; 65, 244–251. https://doi.org/10.1007/s12020- 019-01902-3
  • Pop, L. C., Shapses, S. A., Chang, B., Sun, W., & Wang, X. Vitamin D-binding protein in healthy pre-and postmenopausal women: relationship with estradiol concentrations. Endocr Pract. 2015; 21(8), 936-942. https://doi.org/10.4158/EP15623.OR
  • Vieira, I. H., Rodrigues, D., & Paiva, I. Vitamin D and Autoimmune Thyroid Disease—Cause, Consequence, or a Vicious Cycle?. Nutrients. 2020; 12(9), 2791. https://doi.org/10.3390/nu12092791
  • Kimball, S. M., & Holick, M. F. Official recommendations for vitamin D through the life stages in developed countries. Eur J Clin Nutr. 2020;74(11), 1514-1518. https://doi.org/10.1038/s41430-020-00706-3
  • Sencar, M.E., Calapkulu, M., Sakiz, D. et al. An Evaluation of the Results of the Steroid and Non-steroidal Anti-inflammatory Drug Treatments in Subacute Thyroiditis in relation to Persistent Hypothyroidism and Recurrence. Sci Rep. 2019; 9, 16899. https://doi.org/10.1038/s41598- 019-53475-w
  • Ragusa, F., Fallahi, P., Elia, G., Gonnella, D., Paparo, S. R., Giusti, C., ... & Antonelli, A. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019; 33(6), 101367. https://doi.org/10.1016/j.beem.2019.101367.
  • Nalbant A, Gokosmanoglu F, Cinemre H, Varim C, Kaya T, Ergenc H. The relation between serum vitamin D levels and Hashimoto thyroiditis in women. Kuwait Med J. 2017; 49:223–226.
  • Rezaee H, Najafipour F, Ranjdoust F, Sadra V, Hamishekar H, Najafipour M, Zareizadeh J, Janipour M. Evaluation ofserum vitamin D levels in patients with Hashimoto’s thyroiditis. Int J Adv Biotechnol Res. 2017; 8:890–895.
  • Mackawy, A.M.; Al-Ayed, B.M.; Al-Rashidi, B.M. Vitamin D deficiency and its association with thyroid disease. Int. J. Health Sci. 2013;7, 267– 275. https://doi.org/10.12816/0006054
  • Stefanic M., & Tokic S. Serum 25-hydoxyvitamin D concentrations in relation to Hashimoto’s thyroiditis: a systematic review, meta-analysis and meta-regression of observational studies. Eur J Nutr. 2020; 59(3), 859-872. https://doi.org/10.1007/s00394-019-01991-w
  • Bayrak İ. Farklı D Vitamini Düzeylerinde Tiroid Hastalıkları Sıklığının Belirlenmesi [Uzmanlık Tezi]. Ankara: Ankara Yıldırım Beyazıt Üniversitesi İç Hastalıkları Ana bilim dalı;2020. [Erişim tarihi: 08.03.2020]. https://tez.yok.gov.tr/UlusalTezMerkezi/ DotyKRdYv1JKIduwE1KjW5SuOSepqNwJl1CU0Zq9TOdCAQAXEWel9
  • Krysiak, R.; Szkrobka, W.; Okopie n, B. The Effect of Vitamin D on Thyroid Autoimmunity in Levothyroxine-Treated Women with Hashimoto’s Thyroiditis and Normal Vitamin D Status. Exp. Clin. Endocrinol. Diabetes. 2017; 125, 229–233. https://doi.org/10.1038/ ejcn.2015.214 .
  • Simsek, Y.; Cakır, I.; Yetmis, M.; Dizdar, O.S.; Baspinar, O.; Gokay, F. Effects of vitamin D treatment on thyroid autoimmunity. J. Res. Med. Sci. 2016; 21, 85. https://doi.org/10.4103/1735-1995.192501
  • Chahardoli, R., Saboor-Yaraghi, A. A., Amouzegar, A., Khalili, D., Vakili, A. Z., & Azizi, F. Can supplementation with vitamin D modify thyroid autoantibodies (Anti-TPO Ab, Anti-TG Ab) and thyroid profile (T3, T4, TSH) in Hashimoto’s thyroiditis? A double blind, Randomized clinical trial. Hormone and Metabolic Research, 2019; 51(05), 296-301. https:// doi.org/10.1055/a-0856-1044
  • Ko, Y. J., Kim, J. Y., Lee, J., Song, H. J., Kim, J. Y., Choi, N. K., & Park, B. J. Levothyroxine dose and fracture risk according to the osteoporosis status in elderly women. J Prev Med Public Health. 2014; 47(1), 36. https://doi.org/10.3961/jpmph.2014.47.1.36
  • Wemeau, J. L., Klein, M., Sadoul, J. L., Briet, C., & Vélayoudom-Céphise, F. L. Graves’ disease: Introduction, epidemiology, endogenous and environmental pathogenic factors. In Ann Endocrinol. 2018;79(6),599- 607. https://doi.org/10.1016/j.ando.2018.09.002
  • Yasuda, T.; Okamoto, Y.; Hamada, N.; Miyashita, K.; Takahara, M.; Sakamoto, F.; Miyatsuka, T.; Kitamura, T.; Katakami, N.; Kawamori, D.; et al. Serum vitamin D levels are decreased and associated with thyroid volume in female patients with newly onset Graves’ disease. Endocrine. 2012, 42, 739–741. https://doi.org/10.1007/s12020-012-9679y.
  • Dhanwal, D. K. Thyroid disorders and bone mineral metabolism. Indian J Endocrinol Metab., 2011;15(2), 107. https://doi. org/10.4103/2230-8210.83339
  • Jyotsna, V. P., Sahoo, A., Ksh, S. A., Sreenivas, V., & Gupta, N. Bone mineral density in patients of Graves disease pre- & post-treatment in a predominantly vitamin D deficient population. Indian J Med Res. 2012; 135(1), 36–41. https://doi.org/10.4103/0971-5916.93422 .
  • Xu, M.Y.; Cao, B.; Yin, J.;Wang, D.F.; Chen, K.L.; Lu, Q.B. Vitamin D and Graves’ disease: A meta-analysis update. Nutrients. 2015; 7, 3813–3827. https://doi.org/10.3390/nu7053813
  • Sheriba, N. A., Elewa, A. A., Mahdy, M. M., El Din, A. M. B., Ibrahim, N. A., Marawan, D. A., & Abd El Moneim, T. M. Effect of vitamin D3 in treating hyperthyroidism in patients with graves’ disease. Egypt J Intern Med. 2017; 29(2), 64. https://doi.org/10.4103/ejim.ejim_10_17
  • Cho, Y.Y.; Chung, Y.J. Vitamin D supplementation does not prevent the recurrence of Graves’ disease. Sci. Rep.2020; 10, 16. https://doi. org/10.1038/s41598-019-55107-9
  • Nguyen, C. T., & Mestman, J. H. Postpartum thyroiditis. Clin. Obstet. Gynecol. 2019; 62(2), 359-364. https://doi.org/10.1097/ GRF.0000000000000430
  • Krysiak, R.; Kowalcze, K.; Okopien, B. The effect of vitamin D on thyroid autoimmunity in non-lactating women with postpartum thyroiditis. Eur. J. Clin. Nutr. 2016; 70, 637–639. https://doi.org/10.1038/ejcn.2015.214
Toplam 51 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Yeşim Öztekin 0000-0001-6179-8720

Aylin Ayaz 0000-0002-3543-7881

Erken Görünüm Tarihi 30 Ocak 2022
Yayımlanma Tarihi 31 Ocak 2022
Gönderilme Tarihi 27 Mart 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 7 Sayı: 1

Kaynak Göster

APA Öztekin, Y., & Ayaz, A. (2022). Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 7(1), 179-184.
AMA Öztekin Y, Ayaz A. Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü. İKÇÜSBFD. Ocak 2022;7(1):179-184.
Chicago Öztekin, Yeşim, ve Aylin Ayaz. “Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 7, sy. 1 (Ocak 2022): 179-84.
EndNote Öztekin Y, Ayaz A (01 Ocak 2022) Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 7 1 179–184.
IEEE Y. Öztekin ve A. Ayaz, “Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü”, İKÇÜSBFD, c. 7, sy. 1, ss. 179–184, 2022.
ISNAD Öztekin, Yeşim - Ayaz, Aylin. “Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 7/1 (Ocak 2022), 179-184.
JAMA Öztekin Y, Ayaz A. Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü. İKÇÜSBFD. 2022;7:179–184.
MLA Öztekin, Yeşim ve Aylin Ayaz. “Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, c. 7, sy. 1, 2022, ss. 179-84.
Vancouver Öztekin Y, Ayaz A. Otoimmün Tiroid Hastalıklarında D Vitamininin Rolü. İKÇÜSBFD. 2022;7(1):179-84.