Role of Dietary Supplements in Thyroid Diseases

Physical Activity, Nutritional Behaviours and Depressive Symptoms in Women with Hashimoto's Disease

An important element of supporting pharmacotherapy in hypothyroidism is a pro-health lifestyle, with rational nutrition and recreational physical activity playing important roles. Objectives: The aim of this study was to analyse selected behavioural determinants of depressive states in women with Hashimoto's disease. Methods: This study was conducted among 219 women aged 20-50 using the following: (i) the author's questionnaire of nutritional behaviours for people with hypothyroidism (QNB); (ii) the International Physical Activity Questionnaire (IPAQ); and (iii) the Beck Depression Scale (SDB). Statistical analysis was performed in Statistica 13.1 and JASP programmes, using Spearman's R correlation analysis, the Kruskal-Wallis analysis of variance and regression analysis at a significance level of α = 0.05. Results: It was found that depressive symptoms were weakly negatively associated with moderate physical activity. At the same time, women with low levels of depressive symptoms demonstrated higher levels of vigorous physical activity than women with moderate and high levels of depression. Depression symptoms decreased with the implementation of some dietary recommendations, including the consumption of products rich in iodine, iron, zinc, selenium, vitamin D, vitamin A and polyunsaturated omega-3 fatty acids. The occurrence of constipation, requiring a high-fibre diet, was positively associated with symptoms of depression. Regression analysis showed that the model consisting of all QNB items explained 18% of depression symptoms. Conclusions: In summary, among women with Hashimoto's disease, moderate physical activity and some rational dietary choices were associated with a lower intensity of depressive symptoms. Promoting a healthy lifestyle may help improve the mental state of patients with Hashimoto's disease.

Reducing early pregnancy loss with vitamin D3: an analysis of serum 1,25-(OH)D3 modulation and miscarriage risk

This case-control study of 124 early-pregnant women found that daily supplementation with 400 IU of vitamin D3 significantly increased serum 1,25-(OH)D3 levels and was associated with a lower incidence of threatened miscarriage. The study suggests that vitamin D3 supplementation could reduce the risk of early miscarriage and improve pregnancy outcomes by modulating immune responses and hormonal stability.

Does the island area also need to insist on salt iodization to prevent iodine deficiency disorders? a cross-sectional survey in Hainan Province, China

Background

To investigate the epidemiology and related factors of iodine deficiency disorders (IDD) in Hainan Province, to know the iodine nutrition status and thyroid disease status of residents, and to explore whether salt iodization should be adopted to prevent and control IDD in island areas. To provide a basis for the effective implementation of scientific iodine supplement prevention and control strategy.

Methods

All 21 cities, counties (districts) in the province were investigated. Superficial soil, residential drinking water, common food, urine samples of children, adults and pregnant women, household salt samples, thyroid B-ultrasound of adults and pregnant women, adult blood samples were collected. Soil iodine, water iodine, food iodine, urine iodine, daily salt intake, salt iodine, thyroid volume, nodules and thyroid function were measured.

Results

The median iodine content in soil was 4.37mg/kg, the median iodine content in drinking water was 6.0μg/L, the iodized salt coverage rate was 98.6%, and the consumption rate of qualified iodized salt was 97.9%. The median urinary iodine concentration (MUIC) in children and adults was 180.3μg/L and 151.6μg/L, respectively, which was the adequate level of iodine. The median urinary iodine in pregnant women was 144.6μg/L, which was slightly lower than the adequate level. The main source of iodine intake was salt iodine, which contributed 59.8% to total dietary iodine. Kelp, milk and seaweed, whose contribution rates were 8.2%, 7.3% and 6.6%, respectively. The total iodine contribution rate of other foods was 18.1%, among which the contribution rate of fish, shrimp and crabs was only 2.4%. The overall prevalence of thyroid diseases was 27.01%. The detection rates of subclinical hypothyroidism and subclinical hyperthyroidism in males were significantly higher than those in females, and the detection rates of thyroid nodules and goiter were significantly lower than those in females. The detection rates of thyroid nodules in central mountainous areas were significantly higher than those in eastern and western coastal areas.

Conclusions

At present, the iodine nutrition level in Hainan Province is generally in a suitable state, and the iodine intake of residents mainly comes from iodized salt. The strategy of salt iodization prevention and control of IDD should be adhered to in island area.

Vitamin D, selenium, and antidiabetic drugs in the treatment of type 2 diabetes mellitus with Hashimoto's thyroiditis

BACKGROUND

Diabetes and thyroiditis are closely related. They occur in combination and cause significant damage to the body. There is no clear treatment for type-2 diabetes mellitus (T2DM) with Hashimoto's thyroiditis (HT). While single symptomatic drug treatment of the two diseases is less effective, combined drug treatment may improve efficacy.

AIM

To investigate the effect of a combination of vitamin D, selenium, and hypo-glycemic agents in T2DM with HT.

METHODS

This retrospective study included 150 patients with T2DM and HT treated at The Central Hospital of Shaoyang from March 2020 to February 2023. Fifty patients were assigned to the control group, test group A, and test group B according to different treatment methods. The control group received low-iodine diet guidance and hypoglycemic drug treatment. Test group A received the control treatment plus vitamin D treatment. Test group B received the group A treatment plus selenium. Blood levels of markers of thyroid function [free T3 (FT3), thyroid stimulating hormone (TSH), free T4 (FT4)], autoantibodies [thyroid peroxidase antibody (TPOAB) and thyroid globulin antibody (TGAB)], blood lipid index [low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triacylglycerol (TG)], blood glucose index [fasting blood glucose (FBG), and hemoglobin A1c (HbA1c)] were measured pre-treatment and 3 and 6 months after treatment. The relationships between serum 25-hydroxyvitamin D3 [25 (OH) D3] level and each of these indices were analyzed.

RESULTS

The levels of 25 (OH) D3, FT3, FT4, and LDL-C increased in the order of the control group, test group A, and test group B (all P < 0.05). The TPOAB, TGAB, TC, TG, FBG, HbA1c, and TSH levels increased in the order of test groups B, A, and the control group (all P < 0.05). All the above indices were compared after 3 and 6 months of treatment. Pre-treatment, there was no divergence in serum 25 (OH) D3 level, thyroid function-related indexes, autoantibodies level, blood glucose, and blood lipid index between the control group, test groups A and B (all P > 0.05). The 25 (OH) D3 levels in test groups A and B were negatively correlated with FT4 and TGAB (all P < 0.05).

CONCLUSION

The combination drug treatment for T2DM with HT significantly improved thyroid function, autoantibody, and blood glucose and lipid levels.

Stress-Induced Graves Disease: Spontaneous Recovery After Stress Relief

Purpose

Emotional stress is a precipitating factor for Graves disease (GD). However, the influence of stress relief on the course of GD is unknown. Here, we present a series of patients diagnosed with stress-induced GD in whom stress relief alone led to remission of GD.

Cases

We report on 11 patients in whom hyperthyroid symptoms started just after severe emotional stress. All patients had suppressed thyroid-stimulating hormone (TSH) levels and elevated free thyroxine (FT4; 22.2-49.5 pmol/L) and TSH-receptor antibody (TRAb; 0.57-40 U/L) levels and were subsequently diagnosed with stress-induced GD. However, all patients declined antithyroid drug treatment. Surprisingly, clinical and biochemical remission was observed in 9 out of 11 patients after 1 to 3 and 2 to 7 months of self-reported stress relief, respectively. Five patients showed long-lasting remission (median follow-up 2.3 years). In 4 patients, remission was initially achieved, but GD relapsed 1 to 4 years afterwards. In 2 patients, treatment with antithyroid drugs was initiated because of rapidly increasing FT4 levels. Baseline FT4 and TRAb levels tended to be higher in patients who did not achieve remission. Furthermore, patients without long-lasting remission were more frequently known to have prior thyroid disease.

Conclusion

We report on a series of patients with stress-induced GD in whom stress relief alone led to remission of GD (thus without antithyroid drugs). This may indicate that clinicians could consider stopping antithyroid drug treatment or at least shortening the treatment period after stress relief in patients with stress-induced GD.

Vitamin B12 levels in thyroid disorders: A systematic review and meta-analysis

Background and aims

Numerous studies have found an association between vitamin deficiency and thyroid disorders (TD). The presence of anti-parietal cell antibodies is indicative of reduced ability to absorb vitamin B12. Thus, this study reviewed the existing studies with the objective of assessing differences in the serum levels of vitamin B12 among patients with and without TD, the frequency of vitamin B12 deficiency in patients with TD, and the presence of anti-parietal cell antibodies in patients with TD.

Methods

A meta-analysis of random-effects model was conducted to calculate pooled frequencies, mean differences (MD), and their respective 95% confidence intervals (CI). We identified 64 studies that met our inclusion criteria (n = 28597).

Results

We found that patients with hypothyroidism had lower vitamin B12 levels than healthy participants (MD: -60.67 pg/mL; 95% CI: -107.31 to -14.03 pg/mL; p = 0.01). No significant differences in vitamin B12 levels were observed between healthy participants and patients with hyperthyroidism (p = 0.78), autoimmune thyroid disease (AITD) (p = 0.22), or subclinical hypothyroidism (SH) (p = 0.79). The frequencies of vitamin B12 deficiency among patients with hypothyroidism, hyperthyroidism, SH, and AITD were 27%, 6%, 27%, and 18%, respectively.

Conclusions

Patients with hypothyroidism had lower levels of vitamin B12 than healthy participants. No significant differences were observed between vitamin B12 levels and hyperthyroidism, AITD, or SH.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324422, identifier (CRD42022324422).