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      Immunomodulatory Effects of Vitamin D in Thyroid Diseases

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          Abstract

          Vitamin D is a secosteroid with a pleiotropic role in multiple physiological processes. Besides the well-known activity on bone homeostasis, recent studies suggested a peculiar role of vitamin D in different non-skeletal pathways, including a key role in the modulation of immune responses. Recent evidences demonstrated that vitamin D acts on innate and adaptative immunity and seems to exert an immunomodulating action on autoimmune diseases and cancers. Several studies demonstrated a relationship between vitamin D deficiency, autoimmune thyroid disorders, and thyroid cancer. This review aims to summarize the evidences on the immunomodulatory effect of vitamin D on thyroid diseases.

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          Most cited references106

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          Thyroid cancer

          Thyroid cancer is the fifth most common cancer in women in the USA, and an estimated over 62 000 new cases occurred in men and women in 2015. The incidence continues to rise worldwide. Differentiated thyroid cancer is the most frequent subtype of thyroid cancer and in most patients the standard treatment (surgery followed by either radioactive iodine or observation) is effective. Patients with other, more rare subtypes of thyroid cancer-medullary and anaplastic-are ideally treated by physicians with experience managing these malignancies. Targeted treatments that are approved for differentiated and medullary thyroid cancers have prolonged progression-free survival, but these drugs are not curative and therefore are reserved for patients with progressive or symptomatic disease.
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            Induction and effector functions of T(H)17 cells.

            T helper (T(H)) cells constitute an important arm of the adaptive immune system because they coordinate defence against specific pathogens, and their unique cytokines and effector functions mediate different types of tissue inflammation. The recently discovered T(H)17 cells, the third subset of effector T helper cells, have been the subject of intense research aimed at understanding their role in immunity and disease. Here we review emerging data suggesting that T(H)17 cells have an important role in host defence against specific pathogens and are potent inducers of autoimmunity and tissue inflammation. In addition, the differentiation factors responsible for their generation have revealed an interesting reciprocal relationship with regulatory T (T(reg)) cells, which prevent tissue inflammation and mediate self-tolerance.
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              Hashimoto thyroiditis: clinical and diagnostic criteria.

              Hashimoto thyroiditis (HT), now considered the most common autoimmune disease, was described over a century ago as a pronounced lymphoid goiter affecting predominantly women. In addition to this classic form, several other clinico-pathologic entities are now included under the term HT: fibrous variant, IgG4-related variant, juvenile form, Hashitoxicosis, and painless thyroiditis (sporadic or post-partum). All forms are characterized pathologically by the infiltration of hematopoietic mononuclear cells, mainly lymphocytes, in the interstitium among the thyroid follicles, although specific features can be recognized in each variant. Thyroid cells undergo atrophy or transform into a bolder type of follicular cell rich in mitochondria called Hürthle cell. Most HT forms ultimately evolve into hypothyroidism, although at presentation patients can be euthyroid or even hyperthyroid. The diagnosis of HT relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features. The treatment remains symptomatic and based on the administration of synthetic thyroid hormones to correct the hypothyroidism as needed. Surgery is performed when the goiter is large enough to cause significant compression of the surrounding cervical structures, or when some areas of the thyroid gland mimic the features of a nodule whose cytology cannot be ascertained as benign. HT remains a complex and ever expanding disease of unknown pathogenesis that awaits prevention or novel forms of treatment.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                16 May 2020
                May 2020
                : 12
                : 5
                : 1444
                Affiliations
                [1 ]Department of Translational Medicine, University of Piemonte Orientale UPO, 28100 Novara, Italy; chiara.mele1989@ 123456gmail.com (C.M.); gianluca.aimaretti@ 123456med.uniupo.it (G.A.)
                [2 ]Division of General Medicine, S. Giuseppe Hospital, I.R.C.C.S. Istituto Auxologico Italiano, 28824 Verbania, Italy
                [3 ]Department of Health Sciences, University of Piemonte Orientale UPO, 28100 Novara, Italy; marina.caputo@ 123456uniupo.it (M.C.); flavia.prodam@ 123456med.uniupo.it (F.P.)
                [4 ]Division of Endocrinology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; mariateresa.sama@ 123456maggioreosp.novara.it (M.T.S.); marco.zavattaro@ 123456med.uniupo.it (M.Z.)
                [5 ]Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; bisce90@ 123456hotmail.it (A.B.); loredana.pagano@ 123456med.uniupo.it (L.P.)
                Author notes
                [* ]Correspondence: paolo.marzullo@ 123456med.uniupo.it ; Tel.: +39-03-2351-4436
                Author information
                https://orcid.org/0000-0001-9660-5335
                https://orcid.org/0000-0003-3215-5747
                Article
                nutrients-12-01444
                10.3390/nu12051444
                7284826
                32429416
                2f2201ed-39d3-4b69-a2e6-ea4d30ddf0ae
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 19 April 2020
                : 14 May 2020
                Categories
                Review

                Nutrition & Dietetics
                vitamin d,immune system,thyroid autoimmunity,thyroid cancer
                Nutrition & Dietetics
                vitamin d, immune system, thyroid autoimmunity, thyroid cancer

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