Proceedings Chapter
Reference
Dietary interventions for the treatment and management of autoimmune thyroid disease: A systematic review and meta-analysis
CORREIA, Jorge, et al.
Abstract
There is evidence that dietary interventions can reduce antibody levels in patients with autoimmune thyroid disease (ATD), which can have a beneficial effect on the clinical manifestations of the disease. The aim of this study was to review the literature regarding the different types of dietary supplementations and their effectiveness in the management of ATDs.
CORREIA, Jorge, et al . Dietary interventions for the treatment and management of autoimmune thyroid disease: A systematic review and meta-analysis. In: 22nd European Congress of Endocrinology (ECE2020) . 2020.
DOI : 10.1530/endoabs.70.AEP1106
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22nd European Congress of Endocrinology 2020
Endocrine Abstracts (2020) Vol 70 Results
The present study shows an association of MTHFR C677T polymorphism with NAH as T allele and CT genotype are more prevalent in patients then in control group (OR (CI) 3.75 (1.89 to 7.48), P = 0.0002 and OR(CI) 5.03 (2.87 to 8.83), P < 0.0001 respectively). On the other hand, our results sug- gest that hypermethylated loci (mCmC) at Alu elements are significantly lower (15%) in study group then in controls (37%) (P < 000.1). As for LINE- 1 the hypermethylated loci (mCmC) are also lower in study group (18%) then in controls (27%) (P < 000.1).
Conclusion
The results of this case-control study suggest that the MTHFR C677T vari- ant, was significantly associated with non-autoimmune hypothyroidism in Georgians. Also MTHFR 677TT genotype correlates with hypomethylation of Alu and LINE repetitive sequence in hypothyroid than in euthiroid in- dividuals. All above indicates that C677T polymorphism may predispose development of non-autoimmune hypothyroidism.
DOI: 10.1530/endoabs.70.AEP1105
AEP1106
Dietary interventions for the treatment and management of autoim- mune thyroid disease: A systematic review and meta-analysis Jorge Correia1, Hafsa Meraj2, Maaz Ahmad3, Lucia Mariela Marroquin Ramirez4, Laura Gómez Corral4, Laurence Genton Graf1 & Zoltan Pataky1
1Geneva University Hospitals and University of Geneva, Division of endocrinology, diabetes, nutrition and patient education, Geneva, Switzerland; 2Shifa College of Medicine, Islamabad, Pakistan; 3Sharif Medical & Dental College, Raiwind,, Pakistan; 4Queen Mary University of London, William Harvey Research Institute, Barts & the London School of Medicine,, London, United Kingdom
Background
There is evidence that dietary interventions can reduce antibody levels in pa- tients with autoimmune thyroid disease (ATD), which can have a beneficial effect on the clinical manifestations of the disease. The aim of this study was to review the literature regarding the different types of dietary supplementa- tions and their effectiveness in the management of ATDs.
Methods
Using a predefined search strategy, four databases were searched (PubMed, Web of Science, CINAHL and Cochrane central register of clinical trials).
Efficacy was assessed from randomized controlled trials and cluster ran- domized controlled trials including post-intervention mean, standard devi- ation and sample sizes for both the intervention and control group to calcu- late pooled effect sizes. Outcomes evaluated included serum levels of TSH, FT3 and FT4, levels of antibodies and change from baseline in symptoms of ATD. Risk of bias was assessed using the Cochrane tool for assessment of risk of bias.
Results
Twenty eight studies were included in the analyses, focusing on ATD (n = 9), Graves’ disease (n = 8), Hashimoto thyroiditis (n = 7), postpartum thyroid- itis (n = 3)and a prevention trial (n = 1).Treatments included supplementation with Selenium (n = 15), Vitamin C (n = 1), Nigella sativa (n = 1), a combi- nation of carotene, vitamin C, Vitamin E and Selenium (n = 2), Vitamin D (n = 4), anatabine lozenges (n = 1) and Myo-inositol plus L-selenomethionine (n = 1).
Selenium supplementation improved serum TSH levels –0.48 (95% CI : –0.87 to –0.03); anti-TPO antibody –1.056 (–1.76 to –0.35); and FT4 levels –0.259 (95% CI : –0.57 to 0.05). Improvement across other outcomes was not significant. Nigella Sativa supplementation also showed an improvement in TSH –0.77 (95% CI : –1.41 to –0.13) and FT4 levels 0.67 (95% CI : 0.04 to 1.31). Myoinositol and selenium combination revealed improvement in FT4 0.54 (95% CI : 0.24 to 0.85) and Anti Tg antibody levels –0.52 (955 CI : –0.83 to –0.21). Iodine supplementation yielded a statistical significance only for anti TR antibodies –0.76 (95% CI : –0.96 to –0.56). Use of Vitamin A improved Anti Tg antibody levels 0.46 (95% CI : 0.13 to 0.79). Vitamin C and D supplementation revealed no significant effect on outcomes.
Conclusion
Dietary interventions were found to have a limited role in the management of ATDs. The evidence was generally of poor quality. We recommend that higher quality trials be conducted in the future to build a solid evidence base for use of supplements in autoimmune thyroid conditions.
DOI: 10.1530/endoabs.70.AEP1106 Development of the fetal hypothalamic-pituitary-adrenal (HPA) axis is im-
portant for normal maturation of the fetus and the timing of parturition. In hypothyroid fetuses, gestational length may be prolonged and maturational processes delayed, although the role of the HPA axis is unknown. This study investigated the effects of hypothyroidism before birth on the structure and function of the anterior pituitary and adrenal glands in fetal sheep near term.
All procedures were performed under the UK Animals (Scientific Proce- dures) Act 1986. In 15 twin-bearing pregnant ewes at 102–110 days of ges- tation (d; term ∼145 d), one fetus was thyroidectomised (TX) while the other was sham-operated under general anaesthesia. At 143d, umbilical blood and fetal pituitary and adrenal glands were collected after euthanasia. Fractional volume and mass of adrenocorticotrophin (ACTH)-containing corticotrophs in the anterior pituitary gland were determined by immunohistochemistry and stereology. Adrenal zone composition, and adrenocortical and medul- lary mRNA abundances of key steroidogenic enzymes and growth factors, were determined by stereology and RT-qPCR, respectively. Data were as- sessed by Student’s t-test (P < 0.05). Plasma concentrations of thyroxine, triiodothyronine, ACTH and cortisol were lower in TX than sham fetuses.
Fetal hypothyroidism increased absolute and relative (to fetal body weight) masses of the anterior pituitary gland (sham 22.0 ± 1.5, TX 41.8 ± 3.1 mg/
kg) and corticotroph population (sham 6.8 ± 0.4, TX 10.6 ± 0.5 mg/kg).In the adrenal gland, absolute mass of the zona fasciculata was decreased (sham 117 ± 12, TX 86 ± 7 mg) and relative mass of the medulla was increased (sham 17.2 ± 1.4, TX 22.4 ± 0.8 mg/kg) by thyroid hormone deficiency, with- out any change in total adrenal mass. In TX fetuses, adrenocortical mRNA abundance was reduced by 42–63% for cholesterol transport protein StAR, steroidogenic enzymes CYP11A1, CYP17, 3β-hydroxysteroid dehydroge- nase, CYP21 and CYP11B1, and for insulin-like growth factor-I (IGFI) and IGF type 1 receptor. Fetalhypothyroidism had no effect on adrenocortical ACTH receptor, IGFII or IGF type 2 receptor, or adrenomedullary pheny- lethanolamine-N-methyltransferase, IGFI, IGFII or IGF receptor mRNA abundance. Thyroid hormones are important regulators of the structure and secretory capacity of the pituitary-adrenal axis before birth. In hypothyroid fetuses, low plasma cortisol may result from impaired adrenocortical growth and steroidogenic enzyme expression, secondary to low circulating ACTH concentration. Greater pituitary corticotroph population during fetal hypo- thyroidism indicates compensatory cell proliferation and abnormal corti- cotroph capacity for ACTH synthesis and/or impaired hypothalamic input.
Suppression of normal development of the fetal pituitary-adrenal axis by thyroid hormone deficiency may contribute to the delay in fetal maturation and delivery observed in hypothyroid offspring.
DOI: 10.1530/endoabs.70.AEP1104
AEP1105
MTHFR C677T polymorphism frequency and DNA methylation status in Georgian population with non-autoimmune hypothyroidism Tamar Kvaratskhelia1,2, Elene Abzianidze1, Mzeona Kakulia2, Sandro Surmava1, Ketevan Asatiani3 & Eka Kvaratskhelia1
1Tbilisi State Medical University, Molecular and Medical Genetics, Tbilisi, Georgia; 2Medical center ‘Medimedi’, Endocrinology, Tbilisi, Georgia;
3National Institute of Endocrinology, Endocrinology, Tbilisi, Georgia
Introduction
Methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism results in thermolabile, reduced functioning enzyme and predicts hyperho- mocisteinemia and altered DNA methylation. On the other hand, several studies indicated a higher plasma homocysteine (Hcy) levels in patients with primary hypothyroidism than in healthy, euthyroid individuals, including some experimental studies that indicated decreased MTHFR activity in hy- pothyroid patients. We conducted this study to see whether there is an asso- ciation between MTHFR C677T polymorphism, DNA methylation changes and non-autoimmune hypothyroidism (NAH) in Georgian population.
Materials and methods Study ethical approval was granted by Tbilisi State Medical University ethics committee. Informed written consent was obtained from all participants. Genomic DNA of 93 patients (mean age 51.3 ± 15.17) and 96 healthy controls (mean age 51.6 ± 16.65) were isolated using DNA blood Kit (Qiagen). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used for genotyping MTHFR C677T. DNA samples underwent bisulfite modification (Qiagen) and meth- ylation levels of Alu and LINE-1 were examined by the combined bisulfite restriction analysis-interspersed repetitive sequences (COBRA-IRS).
