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Vitamin D deficiency in Hashimoto's thyroiditis: mechanisms, immune modulation, and therapeutic implications.

  • 2025-08-01
  • Frontiers in endocrinology 16
    • Wencong Sun
    • Chao Ding
    • Yichen Wang
    • Guoqing Li
    • Zijie Su
    • Xinhui Wang

Study Design

Type
Review
Population
Hashimoto's thyroiditis (HT) patients

Background

To evaluate vitamin D's role in thyroid autoimmunity modulation, establish evidence-based supplementation protocols, and address surgical implications in Hashimoto's thyroiditis (HT) care. Vitamin D deficiency is prevalent in HT patients and correlates with accelerated autoimmune progression. This review synthesizes mechanistic insights and clinical implications of vitamin D repletion in HT management.

Objective

To evaluate vitamin D's role in thyroid autoimmunity modulation, establish evidence-based supplementation protocols, and address surgical implications in HT care.

Key findings

Pathogenic Mechanism: Vitamin D deficiency (25(OH)D <20 ng/mL) disrupts VDR-mediated Treg/Th17 balance, increasing anti-TPO titers by 40-60% and hypothyroidism progression risk. Therapeutic Window: Supplementation (2000-4000 IU/day) reduces antibodies by 15-30% only in euthyroid TPOAb+ patients with baseline deficiency (<20 ng/mL), but efficacy diminishes in overt hypothyroidism. Surgical Imperative: Preoperative optimization (25(OH)D >30 ng/mL) lowers post-thyroidectomy hypocalcemia risk by 50% in HT patients.

Conclusion

Vitamin D modulates HT through immune pathway regulation, yet response heterogeneity necessitates: Genotype-guided dosing (VDR-FokI FF carriers require 30% lower doses). Vitamin D supplementation has demonstrated potential to modulate immune responses, alleviate symptoms, and improve quality of life.

Research Insights

  • Vitamin D→Reduced Anti-Thyroid Peroxidase Antibody Level

    Supplementation (2000-4000 IU/day) reduces antibodies by 15-30% only in euthyroid TPOAb+ patients with baseline deficiency (<20 ng/mL)

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    2000-4000 IU/day
  • Vitamin D→Reduced Hypocalcemia Risk

    Preoperative optimization (25(OH)D >30 ng/mL) lowers post-thyroidectomy hypocalcemia risk by 50% in HT patients

    Effect
    Beneficial
    Effect size
    Large
    Dose
    2000-4000 IU/day
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