Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
Ophthalmic Plast Reconstr Surg. 2020 Jan/Feb;36(1):17-20. doi: 10.1097/IOP.0000000000001437.
Thyroid eye disease (TED) is an inflammatory orbitopathy with significant impact on visual function and quality of life. Although studies have shown that patients who are deficient in vitamin D are more likely to develop autoimmune conditions, there are no studies demonstrating a definitive correlation between serum 25-hydroxyvitamin D (25(OH)D) deficiency and an increased risk of TED.
This retrospective case-control study compared serum 25(OH)D levels among 4 groups: 1) Graves disease (GD) patients with TED (n = 89); 2) GD patients without TED (n = 89); and healthy control patients matched to 3) the TED group (n = 356); and 4) the GD group (n = 356). The authors compared 25(OH)D level in the TED group measured within 1 year of TED diagnosis to the most recently measured 25(OH)D level in the GD group using Student t test of the log transformation of serum levels. Linear regression was used to control for other risk factors. Thyroid eye disease patients and GD patients were compared separately to their matched healthy control patients with linear mixed models.
Thyroid eye disease patients displayed significantly lower serum 25(OH)D levels than GD patients (24.8 ± 13.2 ng/ml vs. 29.4 ± 13.3 ng/ml; p = 0.006). Controlling for smoking status and previous radioactive iodine treatment did not affect this statistically significant difference.
Low serum vitamin D is associated with TED diagnosis. Assessing and supplementing vitamin D levels may be an important addition to the early management of GD patients. Future research should include longitudinal studies and prospective clinical trials to further explore the mechanism responsible for the observed association.Thyroid eye disease is an inflammatory orbitopathy associated with Graves disease. Vitamin D is a known immune system regulator. The authors show that vitamin D deficiency is associated with the development of thyroid eye disease.
甲状腺眼病（TED）是一种炎症性眼眶病，对视觉功能和生活质量有重大影响。尽管研究表明维生素 D 缺乏的患者更有可能患上自身免疫性疾病，但没有研究表明血清 25-羟维生素 D（25（OH）D）缺乏与 TED 风险增加之间存在明确的相关性。
本回顾性病例对照研究比较了 4 组患者的血清 25（OH）D 水平：1）伴 TED 的格雷夫斯病（GD）患者（n=89）；2）不伴 TED 的 GD 患者（n=89）；3）与 TED 组相匹配的健康对照患者（n=356）；4）与 GD 组相匹配的健康对照患者（n=356）。作者比较了 TED 组在 TED 诊断后 1 年内测量的 25（OH）D 水平与 GD 组最近测量的 25（OH）D 水平，采用血清水平对数转换的学生 t 检验。采用线性回归控制其他危险因素。采用线性混合模型分别比较甲状腺眼病患者和 GD 患者与各自匹配的健康对照患者。
甲状腺眼病患者的血清 25（OH）D 水平明显低于 GD 患者（24.8±13.2ng/ml 比 29.4±13.3ng/ml；p=0.006）。控制吸烟状况和既往放射性碘治疗后，这一统计学差异仍具有显著性。
低血清维生素 D 与 TED 诊断相关。评估和补充维生素 D 水平可能是 GD 患者早期管理的重要补充。未来的研究应包括纵向研究和前瞻性临床试验，以进一步探讨观察到的相关性的机制。甲状腺眼病是一种与格雷夫斯病相关的炎症性眼眶病。维生素 D 是一种已知的免疫系统调节剂。作者表明，维生素 D 缺乏与甲状腺眼病的发生有关。
