Endocrine Abstracts

There is evidence that vitamin D has a variety of effects on immune system function, which may enhance innate immunity and inhibit the development of autoimmunity. It suppresses T-cell proliferation, and inhibits secretion of pro-inflammatory Th1- and Th2-related Cytokines. In Graves’ ophthalmopathy (GO), a diffuse infiltration of lymphocytes is seen in the orbital adipose tissues and extracellular muscles. Th1 and 2 appear to play a role GO.

Aim: To assess the relation between vitamin D deficiency and Graves’ disease with or without exophthalmos.

Method: 85 Egyptian individuals with Graves’ disease attending Ain Shams University Hospital Endocrinology clinic participated in this study, they were 3 groups: Group 1: 30 subjects with Graves’ disease with exophthalmos. Group 2: 30 subjects with Graves’ disease without exophthalmos. Group 3: 25 healthy individuals. Patients with chronic kidney or liver disease, diabetes or those taking vitamin D or any drugs affecting its level were excluded. Thorough history taking and full clinical examination was done. Measurement of vitamin D level and FT3, FT4, TSH.

Results: There was a highly significant difference between group 1 and 2 as regard their disease duration and carbimazole dose and duration (P=0.001) and TSH, FT3 and FT4 levels (P<0.05). Those in group 1 had longer duration of the disease, higher dose of carbimazole, higher FT3 and FT4 and lower TSH. There was significant difference between the 3 groups as regard vitamin D (P<0.01). All subjects in group 1 were vitamin D deficient (100%). In group 2 (66.7%) were deficient, 23.3% were insufficient and 10% were normal. In the control 56% were deficient, 40% were insufficient and 4% were normal. There is a significant difference within groups (1, 2) and (1, 3) (P<0.01) as regard vitamin D. There was a significant inverse correlation between vitamin D & the degree of exophthalmos (P<0.01) in group 1. There was a significant positive correlation between vitamin D and TSH (P<0.05) in group 2. TSH levels were independent predictor of vitamin D Levels in the studied subjects (P<0.01).

Conclusion: Vitamin D was deficient in subjects with Graves’ disease with exophthalmos than those without exophthalmos and control. The degree of exophthalmos is inversely correlated with the degree of vitamin D deficiency.