Vitamin D Levels and Thyroid Function in Patients with Hyperthyroidism and Hypothyroidism

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Over a billion people worldwide are vitamin D deficient or insufficient. Recent studies indicate that 1,25(OH)2D, the biologically active form of vitamin D, is a modulator of both the innate and adaptive immune system. Immune cells such as monocytes, macrophages, dendritic cells, T- lymphocytes, and B-lymphocytes are targets for the active vitamin D [ 13 ]. Low vitamin D intake and vitamin D deficiency have been identified as a risk factor for autoimmune thyroid disease including Graves’ disease and Hashimoto’s thyroiditis. Methods This is a prospective study conducted in Arogyam Medical College and Hospital (AMCH), Roorkee, India. This study was carried out over a period of 4 months extending from March 2023 to July 2023. During which 100 samples were taken. Venous blood was collected and biochemical parameters like Vitamin D, T3, T4 and TSH are analyzed using chemilumenescence assay. Data was analyzed using SPSS version 20. Results Total 100 patients were reported to the Arogyam Medical College and Hospital, Roorkee, India. In these patients, we found the mean ± SD of Vitamin D levels were as low as 16.268 ± 10.50 µl/ml in hypothyroidism patients as compared to control mean ± SD (32.641 ± 2.26). In hyperthyroidism patient the mean ± SD of Vitamin D was (39.35 ± 7.50) which is within the normal range and was statistically insignificant. TSH level was significantly high in hypothyroidism patients with the value of mean ± SD (10.03 ± 5.6) as compared in control whose Mean ± SD was 3.16 ± 1.40. Mean ± SD of TSH level in hyperthyroidism patient was 0.226 ± 0.115. Conclusion Vitamin D has been shown to have a potential beneficial role in the treatment of various autoimmune diseases. In the case of deficiency or insufficiency, supplementation is needed and either vitamin D2 or vitamin D3 can be used. Evidence on this issue deriving from clinical association studies must be taken with great caution. In fact, there are many confounding factors able to influence vitamin D concentration that have not always been properly considered in the relevant works and that can affect the relationship between vitamin D levels and thyroid diseases. Although several findings support the role of vitamin D in the pathogenesis of thyroid diseases, no guidelines are currently available for or against recommending vitamin D supplementation in the prevention or therapy of thyroid disease. Endocrinology & Metabolism Vitamin D deficiency Thyroid function Hyperthyroidism Hypothyroidism Hashimoto’s thyroiditis Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Background of the study The thyroid is a butterfly shaped gland located in the front of the neck just above the trachea. The fully developed thyroid gland is composed of two lobes that are connected by a thin band of tissue, isthmus. The thyroid gland secretes principally two hormones: Thyroxine (Tetra-iodothyronine) (T4) and Tri-iodothyronine (T3) along with certain amount of reverseT3, Monoiodotyrosine [ 1 ]. Thyroid hormones exert effect on almost every cells of the body and hence have much important biological effect. The most important ones are in control of basal metabolic rate (BMR) and calorigenesis. The synthesis and release of thyroid hormones is closely regulated by hypothalamus-pituitary-thyroid axis. Plasma levels of T4 and T3 are regulated by a feedback mechanism, in which hypothalamic thyrotrophin-releasing hormone (TRH) stimulates the synthesis and release of thyrotrophin (TSH) by the anterior pituitary, thus stimulating the secretion of T4 and T3 by the thyroid gland. T3 inhibits the synthesis and secretion of TRH and TSH to complete the feedback loop. T4 and T3 activity in many tissues is regulated by the selenoenzyme family of iodothyronine deiodinases. The deiodination of T4 forms T3, the most metabolically active thyroid hormone, and reverse T3, which is thought to be hormonally inactive and possibly inhibitory on T3 activity at cellular level.[ 2 ] Vitamin D deficiency is a global health problem. Over a billion people worldwide are vitamin D deficient or insufficient [ 3 ]. It is recognized to be involved in various immune functions as well as bone and muscle development [ 4 ]. Vitamin D is a steroidal hormone, introduced in the body through food, but major synthesis occurs through exposure of skin to solar ultraviolet light [ 5 ]. Vitamin D obtained from skin or diet, is converted by the liver to 25(OH) D and is metabolized in the kidneys by the enzyme 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1) to its active form 1,25- dihydroxy vitamin D [ 6 ]. Vitamin D mediates its effect through binding to vitamin D receptor (VDR), and activation of VDR-responsive genes [ 7 – 8 ]. Apart from its main function in regulation of calcium absorption and homeostasis, it also has a role in regulating cell proliferation and differentiation [ 9 ]. Many tissues and cells in the body express the vitamin D receptor, resulting in growing interest in extra-skeletal conditions like cancers, cardiovascular diseases and auto-immune diseases [ 10 , 11 , 12 , 13 ]. Recent studies indicate that 1,25(OH)2D, the biologically active form of vitamin D, is a modulator of both the innate and adaptive immune system. Immune cells such as monocytes, macrophages, dendritic cells, T- lymphocytes, and B-lymphocytes are targets for the active vitamin D [ 13 ]. Low vitamin D intake and vitamin D deficiency have been identified as a risk factor for type 1 diabetes, multiple sclerosis, Crohn’s disease, and rheumatoid arthritis [ 14 – 19 ]. Hypothyroidism occurs due to reduced functioning of thyroid gland which may be primary (disease of thyroid gland) or less commonly secondary to hypothalamic or pituitary disease, seen more common in females with its incidence increasing as the age advances. Most common cause of hypothyroidism is autoimmune thyroiditis.[ 20 ]. Measurement of plasma TSH concentration is the principal test for biochemical evaluation of hypothyroidism. Normal level of TSH is 0.3–3.5 mU/l and > 10 mU/l are observed in hypothyroidism. Importantly, both vitamin D and thyroid hormone bind to receptors which are similar in structure. A different gene in vitamin D receptor was shown to predispose people to autoimmune thyroid disease including Grave’s disease and Hashimoto’s thyroiditis. thus, it becomes essential to understand how the vitamin D system works. VDR gene polymorphism was found to associate with autoimmune thyroid diseases. In hypothyroidism, intestinal absorption of nutrients is affected both by reduction in rate of absorption, so vitamin D deficiency is commonly seen [ 21 ]. Reports have proved a correlation between vitamin D and TSH, especially in patients with thyroid diseases [ 22 ]. Serum concentration of 25(OH)D is the best indicator of vitamin D status [ 23 ]. It has a half-life of 15 days [ 24 ]. Whereas, circulating 1,25(OH)2D is not a good indicator of Vitamin D status due to its short half-life of 15 hours and its level being regulated by parathyroid hormone, calcium and phosphate [ 25 ]. Levels of vitamin D more than 30ng/ml is considered to be normal, levels of 20-29ng/ml (< 50nmol/L) is insufficient and if it is less than 10 ng/ml(12.5nmol/L) signifies severe deficiency [ 26 ] Statement of Problem Vitamin D deficiency is a global health problem. Over a billion people worldwide are vitamin D deficient or insufficient [ 27 ]. Yet no international health organization or governmental body has declared a health emergency to warn the public about the urgent need of achieving sufficient vitamin D blood levels [ 28 ]. Understanding of the role of vitamin D has been evolving since its discovery in the early 20th century from being a simple vitamin to a steroid pro-hormone. It has been recognized to be involved in various immune functions as well as bone and muscle development [ 29 ]. Vitamin D deficiency has been shown to be associated with autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), multiple sclerosis (MS) and type 1 diabetes (T1DM), and that vitamin D supplementation prevents the onset and/or development of these autoimmune diseases. [ 30 ] Furthermore, it was reported that patients with Hashimoto’s thyroiditis, an autoimmune thyroid disease had lower vitamin D levels [ 31 ]. Vitamin D also play an important role in calcium hemostasis and the development and maintenance of skeletal [ 32 ]. Importantly, both vitamin D and thyroid hormone bind to similar receptors called steroid hormone receptors. A different gene in the Vitamin D receptor was shown to predispose people to autoimmune thyroid disease including Graves’ disease and Hashimoto’s thyroiditis. For these reasons, it is important for patients with thyroid problems to understand how the vitamin D system works. Vitamin D mediates its effect though binding to vitamin D receptor (VDR), and activation of VDR-responsive genes. While VDR gene polymorphism was found to associate with autoimmune thyroid diseases (AITDs) [ 33 ] Rationale of study Day by day there has been increment in number of patients presenting with symptoms of thyroid dysfunction. This study was undertaken to evaluate the level of vitamin D in hypothyroidism. Patients with hypothyroidism suffered from hypovitaminosis D. Hence, this study is necessary to encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency for all hypothyroid patients This study's main goal is to find out how much vitamin D people with thyroid disease have. The study specifically seeks to ascertain the vitamin D level in hypothyroidism patients. Among the scientific questions addressed are: Is hypothyroidism and hypovitaminosis D significantly correlated? Does hypothyroidism cause a decrease in vitamin D levels? Hypothyroidism and hyperthyroidism are the dependent factors in this study, whereas age, gender (female), autoimmune illnesses, family history, iodine deficiency, and sun exposure are the independent variables. Operational definition Autoimmunity refers to a failure of the body's immune system to recognize its own cells and tissues as “self”. Hypothyroidism Defined as raised TSH level along with a decreased serum thyroid hormone level (any of T3 or T4 or both). Subclinical hypothyroidism Defined as raised TSH level along with normal serum thyroid hormone levels. Hyperthyroidism Defined as high T3 and low TSH. Euthyroid sick syndrome Defined as low T4 or low T3 and normal TSH. Euthyroid Normal levels of both T3 and T4 along with normal TSH level. Goiter Diffuse enlargement of thyroid gland. Hypovitaminosis Hypovitaminosis is insufficiency of one or more essential vitamins. Hypovitaminosis D deficiency of vitamin D. METHODOLOGY The Department of Biochemistry at Arogyam Medical College and Hospital (AMCH) in Roorkee, India, would be the site of this cross-sectional retrospective interventional study. During the study period, individuals with complaints linked to thyroid dysfunction who attend the CMCTH departments of internal medicine and ENT will make up the study population. These patients will provide about 100 samples that will be taken for examination. In eight months, from February to September, the research project is anticipated to be finished. Inclusion Criteria All of the individuals either confirmed cases of thyroid disorders, or under-treatment, recently diagnosed cases, as well as those with overt/subclinical thyroid anomalies will be included. Age, gender, occupation, locality, any other disease forms, pregnancy data will be collected and correlated with the assessments, where applicable. Exclusion criteria Care will be taken that none of the patients had any history of operations, malignancies, liver or renal disease, interferon therapies or -blockers usage. Sample collection About 5ml of venous blood sample will be collected from patients using aseptic technique into a clot activator tube (Yellow capped vial). The serum sample will then be separated and utilized for analysis of variables. Laboratory analysis test procedure Serum TSH measurement Principle The ADVIA Centaur TSH assay is a two-site sandwich immunoassay using direct chemiluminometric technology, which uses constant amounts of two antibodies. The first antibody, in the Lite Reagent, is a monoclonal mouse anti-TSH antibody labelled with acridinium ester. The second antibody, in the Solid Phase, is a polyclonal sheep anti-TSH antibody which is covalently coupled to paramagnetic particles. Procedure The system automatically performs the following steps: Dispenses 200 µL of sample into a cuvette. Dispenses 50 µL of Lite Reagent and 225 µL of Solid Phase and incubates for 7.5 minutes at 37°C. Separates, aspirates, and washes the cuvettes with reagent water. Dispenses 300 µL each of Acid Reagent and Base Reagent to initiate the chemiluminescent reaction. Reports results according to the selected option; A direct relationship exists between the amount of TSH present in the patient sample and the amount of relative light units (RLUs) detected by the system. Serum fT3 measurement Principle The ADVIA Centaur FT3 assay is a competitive immunoassay using direct chemiluminescent technology. FT3 in the sample competes with a T3 analog, which is covalently coupled to paramagnetic particles in the Solid Phase for a limited amount of a combination of acridinium ester-labelled monoclonal mouse anti-T3 antibodies in the Lite Reagent. Procedure The system automatically performs the following actions: Dispenses 50 µL of sample into a cuvette. Dispenses 100 µL of Lite Reagent and incubates for 5.0 minutes at 37°C. Dispenses 450 µL of Solid Phase and incubates for 2.5 minutes at 37°C. Separates, aspirates, and washes the cuvettes with reagent water. Dispenses 300 µL each of Acid Reagent and Base Reagent to initiate the chemiluminescent reaction. Reports results according to the selected option, an inverse relationship exists between the amount of FT3 present in the patient sample and the amount of relative light units (RLUs) detected by the system. Serum fT4 measurement Principle The ADVIA Centaur FT4 assay is a competitive immunoassay using direct chemiluminescent technology. FT4 in the patient sample competes with acridinium ester-labelled T4 in the Lite Reagent for a limited amount of biotinylated polyclonal rabbit anti-T4 antibody. Biotin-labelled anti-T4 is bound to avidin that is covalently coupled to paramagnetic particles in the Solid Phase. Procedures The system automatically performs the following steps: Dispenses 25 µL of sample into a cuvette. Dispenses 100 µL of Lite Reagent and 300 µL of Solid Phase and incubates for 7.5 minutes at37°C. Separates, aspirates, and washes the cuvettes with reagent water. Dispenses 300 µL each of Acid Reagent and Base Reagent to initiate the chemiluminescent reaction. Reports results according to the selected option; an inverse relationship exists between the amount of FT4 present in the patient sample and the amount of relative light units (RLUs) detected by the system. Serum vitamin D measurement: The ADVIA Centaur® vitamin D assay is an 18-minute antibody competitive immunoassay that uses an anti-fluorescein monoclonal mouse antibody covalently bound to paramagnetic particles (PMP) an anti-25(OH)vitamin D monoclonal mouse antibody labelled with fluorescein. An inverse relationship exists between the amount of vitamin D present in the patient sample and the amount of relative light units (RLU) detected by the system. Data Analysis Procedure The collected data was checked, reviewed and organized for its accuracy, completeness and consistency. All the data was coded and organized and then entered into SPSS IBM version 20.0. All collected data was analyzed and interpreted in descriptive statistics (frequency, percentage, mean, standards deviation) and inferential statistics (correlation) as per the nature of data. The findings were presented in tables and diagrams. Validity and Reliability of study The supervisor approved the research proposal. Questionnaire was verified by the supervisor. Research was conducted under the guidance of supervisor. The supervisor was directly involved in data collection. A laboratory procedure was performed according to standard operating procedures. Reagents and analyser were routinely calibrated. Observation Table showing mean Standard deviation and significant changes between Control, hypothyroidism and hyperthyroidism subjects. Table No 1: Showing over all status of Vitamin D, T3, T4 & TSH in control subjects. n = 50 Overall Status VITD T3 T4 TSH Minimum 30 2.59 0.92 1.3 Maximum 36.76 3.31 1.66 4.59 Mean 32.6416 2.8544 1.2812 3.1724 SD 2.26555 .24687 0.37 1.40 SEM .45307 .04937 .14852 .09912 VITD=?????, T3=?????, T4=?????TSH=?????? (explain it) Above table 1 shows that minimum VITD 30??????????????????????? Table No. 1: Over all status of Vitamin D, T3, T4 and TSH in control subjects (N = 50). Table No 2: Showing over all status of Vitamin D, T3, T4 & TSH in hypothyroidism subjects. n = 50 Overall Status VITD T3 T4 TSH Minimum 4.21 0.94 0.65 5.66 Maximum 53.89 4.21 1.52 24.43 Mean 16.2680 3.0528 1.0520 10.0344 SD 10.5038 .68330 .24262 5.61994 SEM 2.10076 .13666 .04852 1.12399 VITD=?????, T3=?????, T4=?????TSH=?????? (explain it) Table No 3: Showing over all status of Vitamin D, T3, T4 & TSH in hyperthyroidism subjects. n = 50 Overall Status VITD T3 T4 TSH Minimum 9.35 3.04 0.76 0.01 Maximum 47.86 4.89 2.88 0.34 Mean 39.3508 3.9244 1.8192 .2264 SD 7.50870 .66284 .59984 .11561 SEM 1.50174 .13257 .11997 .02312 VITD=?????, T3=?????, T4=?????TSH=?????? (explain it) Table No 4: Showing the comparative changes of Vitamin D, T3, T4 & TSH in control & Hypothyroidism subjects. Group VITD T3 T4 TSH Control Minimum 30 2.59 0.92 1.3 Maximum 36.76 3.31 1.66 4.59 Mean 32.6416 2.8544 1.2812 3.1724 SD 2.26535 .24687 0.37 1.40 Hypothyroidism Minimum 4.21 0.94 0.65 5.66 Maximum 53.89 4.21 1.52 24.43 Mean 16.2680* 3.0528* 1.0520NS 10.0344* SD 10.50380 .68330 .24262 5.61994 *Significant at P < 0.05, NS : Non significant, VITD=?????, T3=?????, T4=?????TSH=?????? (explain it) Table no 5 : Showing the comparative changes of VITD, T3, T4 & TSH in control & Hyperthyroidism Group VITD T3 T4 TSH Control Minimum 30 2.59 0.92 1.3 Maximum 36.76 3.31 1.66 4.59 Mean 32.6416 2.8544 1.2812 3.1724 SD 2.26535 .24687 0.37 1.40 Hyperthyroidism Minimum 9.35 3.04 0.76 0.01 Maximum 47.86 4.89 2.88 0.34 Mean 39.3508 3.9244 1.8192 .2264 SD 7.508700 .662844 .11561 .11561 RESULTS Table No. 1: Showing over all status of Vitamin D, T3, T4 & TSH in control subjects Table No. 2: Over all status of Vitamin D, T3, and T4 & TSH in hypothyroidism subjects (N = 50). Table No. 3: Over all status of Vitamin D, T3, T4 & TSH in hyperthyroidism subjects (N = 50). Table No. 4: Showing the comparative changes of Vitamin D, T3, T4 & TSH in control and hypothyroidism subjects. In our study Vitamin D, T3 & TSH were statistically significant in hypothyroidism subjects as compared with control group. T4 was no statistically significant in control and hypothyroidism subjects. Table No. 5: Showing the comparative changes of Vitamin D, T3, T4 & TSH in control and Hyperthyroidism subjects. In our study Vitamin D, T3 & TSH were statistically significant in hyperthyroidism subjects as compared with control group. T4 was no statistically significant in control and hyperthyroidism subjects. Graph NO.1: Showing Vitamin D level in control, hypothyroidism, and hyperthyroidism subjects. Mean vitamin D level in control subject was 32.64 as compared to Hypothyroidism whose mean was 16.26 and mean vitamin D of hyperthyroidism was 39.35. Graph NO.2: Showing T3 level in control, hypothyroidism, and hyperthyroidism subjects. Mean T3 level in control subject was 2.85 as compared to hypothyroidism whose mean was 3.05 and mean T3 of hyperthyroidism was 3.92. Graph NO.3: Showing T4 level in control, hypothyroidism, and hyperthyroidism subjects. Mean T4 level in control subject was 1.28 as compared to hypothyroidism whose mean was 1.05 and mean T4 of hyperthyroidism was 1.81. Graph NO.4: Showing TSH level in control, hypothyroidism, and hyperthyroidism subjects. Mean TSH level in control subject was 3.17 as compared to hypothyroidism whose mean was 10.03 and mean TSH of hyperthyroidism was 0.22. DISCUSSION Vitamin D deficiency is a global health problem. Because an estimated one billion people worldwide have vitamin D deficiency or insufficiency, vitamin D has become an important focus of current medical research. In particular, vitamin D deficiency is defined by the US Endocrine Society guideline as 25 (OH)D less than 20 ng/ml (50 nmol/l), vitamin D insufficiency as 25 (OH)D between 21 and 29 ng/ml, and the upper cutoff to minimize the risk of adverse effects as 25(OH)D equal to 100 ng/ml (250 nmol/l).[ 69 ]. In our study, it was observed that, the mean ± SD of Vitamin D levels were as low as 16.268 ± 10.50µl/ml in hypothyroidism patients as compared to control mean ± S.D 32.641 ± 2.26. In hyperthyroidism patient the mean ± S.D of vitamin D was 39.35 ± 7.50, which is within the normal range and was statistically insignificant. Low levels of vitamin D in hypothyroidism were in consistency with Joseph Yasmeh et al. 2006[ 70 ] and Mackawy et al.2013.[ 71 ] Vitamin D is a lipid soluble vitamin which affects via vitamin D receptor (VDR). Vitamin D receptor is an intracellular receptor which belongs to the steroid/thyroid nuclear receptor family. This receptor is located in many immune cells, such as neutrophils, macrophages, dendritic cells, T and B cells. Vitamin D has potent immunomodulatory effects both on the innate and adaptive immune system. Vitamin D inhibits pro-inflammatory processes by suppressing the over-activity of CD4+, Th1, Th2 and Th17 cells and the production of their related cytokines by the activation of VDR. Finally, 1,25(OH)2D inhibits B cell proliferation and differentiation into plasma cells, immunoglobulin secretion (IgG and IgM), memory B cell generation, and also induces B cell apoptosis. The ability of 1,25(OH)2D to suppress the adaptive immune system promotes immune tolerance and appears to be beneficial for a number of autoimmune disease ( Baeke et al. 2010 [ 72 ] and Hewison etal.2012 [ 73 ] ). Although the biological activities of vitamin D are mainly manifested in the regulation of calcium-phosphorus metabolism, studies in the past 30 years indicate vitamin D may play an important role in the immune system. In the past two decades, vitamin D receptors have been found not only in bone, kidney, and intestine, but also in the immune system (T and B cells, macrophages, and monocytes), reproductive system, endocrine system, muscles, brain, skin, and liver, suggesting that the role of vitamin D is not limited to the skeletal system. Low levels of vitamin D have also been associated with thyroid disease, such as Hashimoto’s thyroiditis. Similarly, patients with new-onset Graves’ disease were found to have decreased 25-hydroxyvitamin D concentrations. (Jiying Wang et al 2015).[ 74 ] Graves’ disease is a multifactorial disease caused by a complex interaction between genetic and environmental factors that lead to the loss of immune tolerance to thyroid antigens, and therefore to the initiation of an immune reaction against the thyroid. In GD, lymphocytic infiltration is mild and involves mainly CD4 + type 2 T-helper (Th2) cells, which induce the production of antibodies to bind to the thyroid stimulating hormone (TSH) receptor. This stimulates the growth and function of thyroid follicular cells leading to hyperthyroidism, indicating a humoral immune response. Vitamin D may counteract the onset of GD, as Th1 dominance seems to be involved in the induction of the disease. ( Dohee Kim 2017) [ 75 ] TSH levels are the most sensitive indicator of thyroid dysfunction but cannot be used in patients with pituitary disease. TSH used alone as a first line test will miss (levels ‘normal’) unsuspected cases of secondary hypothyroidism and some laboratories therefore combine TSH and T4 as first line tests.[ 76 ] TSH level was significantly high in hypothyroidism patients with the value of mean ± SD 10.03 ± 5.6 as compared in control whose mean ± SD was 3.16 ± 1.40. Mean ± SD TSH level in hyperthyroidism patient was 0.226 ± 0.115. Measurements of serum [TSH] provide the best screening test. A normal result excludes primary thyroid disease. If, at the time the test is performed, the patient is not recovering from a recent non thyroidal illness (NTI), a serum [TSH] > 10 mU/L indicates that the patient has hypothyroidism and may require treatment with thyroxine. If the serum [TSH] < 0.1 mU/L, serum [FT4] or [total T4] and serum [total T3] or [FT3] should be measured. If the results for either the T4 or T3 measurements are raised, the patient should be referred for specialist advice, as treatment for hyperthyroidism may be required. If, however, the results for the T4 and T3 measurements are normal or low, this suggests that the cause of the serum [TSH] is NTI, subclinical hyperthyroidism, rarely, secondary hypothyroidism.[ 77 ] Thyroid disorders are commonly separated into two major categories, hyperthyroidism and hypothyroidism, depending on whether serum thyroid hormone levels (T4 and T3) are increased or decreased, respectively. In our study mean ± SD of T4 was 1.052 ± 0.242 in hypothyroidism patient as compared to control whose mean ± SD was 1.2812 ± 0.37. In hyperthyroidism patient mean ± SD of T4 was 1.8192 ± 0.59. Mean ± S.D of T3 level was 3.05 ± 0.68 in hypothyroidism patient as compared to control whose mean ± S.D was 2.854 ± 0.24. In hyperthyroidism patient mean ± SD of T3 was 3.92 ± 0.66. Free T3 and T4 tests (FT3, FT4) are now more reliable and preferred to total T3 or T4 measurements. The normal values for FT4 in adults range from 1.0 to 3.0 ng/dL (13 to 39 pmol/L). A minute amount of thyroid hormone circulates in the blood in a free form, not bound to serum proteins. It is in reversible equilibrium with the bound hormone and represents the diffusible fraction of the hormone capable of traversing cellular membranes to exert its effects on body tissues. Although changes in serum hormone-binding proteins affect both the total hormone concentration and the corresponding fraction circulating free in the euthyroid person, the absolute concentration of free hormone remains constant and correlates with the tissue hormone level and its biologic effect. Serum FT4 may be suppressed in the patients with thyroidal illness and transiently rise in acute thyroidal illness, when FT3 normal adult reference value is 0.25–0.65 ng/dL (3.8–10 nmol/L). It measures the very tiny amount of T3 that circulates unbound. It is useful in looking for hyperthyroidism or thyroxine overplacement in women who are pregnant or taking any effective drugs that varies the TBG like estrogen. More consistently, patients with a variety of non-thyroidal illnesses have low FT3 levels. This decrease is characteristic of all conditions associated with depressed serum TT3 concentrations due to a diminished conversion of T4 to T3 in peripheral tissues. Marked elevations in both FT4 and FT3 concentrations in the absence of hypermetabolism are typical of patients with resistance to thyroid hormone. The FT3 concentration is usually normal or even high in hypothyroid persons living in areas of severe endemic iodine deficiency and their FT4 levels are, however, normal or low.(G. SHIVARAJ 2009).[ 78 ] CONCLUSION AND RECOMMENDATION Vitamin D has been shown to have a potential beneficial role in the treatment of various autoimmune diseases. In the case of deficiency or insufficiency, supplementation is needed and either vitamin D2 or vitamin D3 can be used. Adults who are vitamin D-deficient should be treated with 50 000 IU of vitamin D2 or vitamin D3 once a week for 8 weeks or its equivalent of 6000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25 (OH)D above 30 ng/ml. Evidence on this issue deriving from clinical association studies must be taken with great caution. In fact, there are many confounding factors able to influence vitamin D concentration that have not always been properly considered in the relevant works and that can affect the relationship between vitamin D levels and thyroid diseases. Although several findings support the role of vitamin D in the pathogenesis of thyroid diseases, no guidelines are currently available for or against recommending vitamin D supplementation in the prevention or therapy of thyroid disease. Declarations Funding This work was Self-Funded Author information Authors and Affiliations Department of Medical Laboratory Technology, UIAHS, Chandigarh University, Mohali, Punjab India Department of Physiotherapy, UIAHS, Chandigarh University, Mohali, Punjab India Contributions Vikas Tiwari: acquired the data, or analysis and interpretation of data, designed and drafted the work and substantively revised it for content Jaishree Tiwari: revised the manuscript, worked on the English, and made the final version. All authors contributed to the article and approved the submitted version. Corresponding author Correspondence to Vikas Tiwari at [email protected] Conflict of interests The authors declare no conflict of interests. Ethical Consideration The AMCH Institutional Ethical Committee (AMCH-IEC/23-108) provided ethical approval. Before any data was collected, the participants received a thorough explanation of the study's objectives and methodology. The participants' privacy and confidentiality were guaranteed and upheld. At any point during the data collection process, participants were made aware of their right to withdraw from the study or to refuse to participate. Participants were guaranteed of the anonymity of their answers, and no personal information was recorded. Prior to the collection of data, the participants provided written informed consent. References Demers LM, Spencer C The Thyroid: Pathophysiology and Thyroid Function Testing. Teitz Textbook of clinical chemistry and molecular diagnostics. 4th ed Woeber KA Treatment of hypothyroidism. In: Braverman LE, Utiger RD (eds). Werner and Ingbar’s the Thyroid, a Fundamental and Clinical Text, 9th edn. Philadelphia, USA: Lippincott Williams&Wilkins,2005,864–9. Hollick MF, Chen TC (2008) Vitamin D deficiency a worldwide problem with health consequences. Am J Clin Nutr 87:10805–10868 Deluca HF (2008) Evolution of our understanding of vitamin D. 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JAMA 296:2832–2838 Cutolo M, Otsa K, Laas K, Yprus M, Lehtme R, Secchi ME, Sulli A, Paolino S & Seriolo B. Circannual vitamin D serum levels and disease activity in rheumatoid arthritis: northern versus Southern Europe (2006) Clin Exp Rheumatol 24:702–704 Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D (2007) Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory poly arthritis. Arthritis Rheum 56:2143–2149 Praveen Kumar & Micheal Clark Endocrine Disease – Hypothyroidism.Essentials of Clinical Medicine- ELSEVIER publication.5TH Edition William J, Marshall SK Bangert.Thyroid dysfunction Clinical Biochemistry – Metabolic and clinical ndaspects. 2 Edition.414–418 Duque G, Abdaimi KE, Macoritto M et al (2002) Estrogen (E2) regulate expression and response of 1,25 – dihydroxyvitamin D3 receptor in bone cells: changes with aging and hormone deprivation. Biochem Biophys Res Commum 299:446–454 Institute of Medicine (2010) Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. national Academy, Washington, DC Jones G (2008) Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 88:582–586 Marshall WJ Stephen K Bangert.The clinical biochemistry of nutrition Clinical Biochemistry – nd Metabolic and clinical aspects. 2nd Edition.204 Hollick MF, Chen TC (2008) Vitamin D deficiency a worldwide problem with health consequences. Am J Clin Nutr. ; 87-10805-68 Naeem Z (2010) Vitamin D Deficiency- An Ignored Epidemic. Int J Health Sci (Qassim) 4(1):5–6 Deluca HF (2008) Evolution of our understanding of vitamin D. Nutr Rev 66(10):73–87 Baeke F, Takiishi, Korf H, Gysemans C, Mahieu C (2010) Vitamin D: modulator of the immune system. Curr Opin Pharmacol 10(4):482–496 Tamer G, Arik S, Tamer I, Coksert D (2011) Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid 21(8):891–896 Cranney A, Horsley T, O'Donnell S (2008) Effectiveness and Safety of Vitamin D in Relation to Bone Health. Evid Reports/Technology Assessments 158:543–550 Theodore C Friedman. Vitamin D Deficiency and Thyroid Disease. www.goodhormonehealth.com/VitaminD Thyroid History Timeline – American Thyroid Association www thyroid org Retrieved 13 November (2016) Niazi AK, Kalra S, Irfan A, Islam A (2016) -11-13). Thyroidology over the ages. Indian J Endocrinol Metabol 15(Suppl2):S121–S126 Anderson DM (2000) Dorland's illustrated medical dictionary (29th edition). Philadelphia/London/Toronto/Montreal/Sydney/Tokyo: W.B. Saunders Company His W (1895) Die anatomische Nomenclatur. Nomina Anatomica. Der von der Anatomischen Gesellschaft auf ihrer IX. Versammlung in Basel angenommenen Namen. Verlag Veit & Comp, Leipzig Liddell HG, Scott R (1940) A Greek-English Lexicon. revised and augmented throughout by Sir Henry Stuart Jones. with the assistance of. Roderick McKenzie. Clarendon, Oxford Magner J (2014) Historical Note: Many Steps Led to the 'Discovery' of Thyroid-Stimulating Hormone. European Thyroid Journal The Nobel Prize in Physiology or Medicine 1909. Nobel Foundation. Retrieved 2007-07-28. Baeke F, Takiishi, Korf H, Gysemans C, Mahieu C (2010) Vitamin D: modulator of the immune system. Curr Opin Pharmacol 10(4):482–496 Tamer G, Arik S, Tamer I, Coksert D (2011) Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid 21(8):891–896 Cranney A, Horsley T, O'Donnell S (2008) Effectiveness and Safety of Vitamin D in Relation to Bone Health. Evid Reports/Technology Assessments 158:543–550 Theodore C Friedman. Vitamin D Deficiency and Thyroid Disease. www.goodhormonehealth.com/VitaminD How Your Thyroid Works A Delicate Feedback Mechanism. Updated 2009-05-21 Ganong's review of medical physiology Edition 25 Robbins J (1981) Factors altering thyroid hormone metabolism. Environ Health Perspect 38:65–70 Kohrle J, Spanka M, Irmscher K, Hesch RD (1988) Flavonoid effects on transport, metabolism and action of thyroid hormones. Prog Clin Biol Res 280:323–340 Visser TJ (1996) Pathways of thyroid hormone metabolism. Acta Med Austriaca 23:10–16 Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378 Matsuoka LY, Ide L, Wortsman J et al (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64:1165–1168 Matsuoka LY, Wortsman J, Dannenberg MJ et al (1992) Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab 75:1099–1103 Prosser DE, Jones G (2004) Enzymes involved in the activation and inactivation of vitamin D. Trends Biochem Sci 29:664–673 Omdahl JL, Morris HA, May BK (2002) Hydroxylase enzymes of the vitamin D pathway: expression, function, and regulation. Annu Rev Nutr 22:139–166 Cheng JB, Levine MA, Bell NH et al (2004) Genetic evidence that the human CYP2R1 enzyme is a key vitamin D 25-hydroxylase. Proc Natl Acad Sci U S A 101:7711–7715 Nykjaer A, Dragun D, Walther D et al An endocytic pathway essential for renal (1999) uptake and activation of the steroid 25-(OH) vitamin D3. Cell 96:507–515 Weisman Y, Harell A, Edelstein S et al (1979) 1 alpha, 25-Dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 in vitro synthesis by human decidua and placenta. Nature 281:317–319 Gray TK, Lester GE, Lorenc RS (1979) Evidence for extra-renal 1 alpha-hydroxylation of 25-hydroxyvitamin D3 in pregnancy. Science 204:1311–1313 Stoffels K, Overbergh L, Bouillon R et al (2007) Immune regulation of 1alpha-hydroxylase in murine peritoneal macrophages: unravelling the IFNgamma pathway. J Steroid Biochem Mol Biol 103:567–571 Kitanaka S, Takeyama K, Murayama A et al (1998) Inactivating mutations in the 25-hydroxyvitamin D3 1alpha-hydroxylase gene in patients with pseudovitamin D-deficiency rickets. N Engl J Med 338:653–661 Shaye Kivity N, Agmon-Levin M, Zisappl Y, Shapira EV, Nagy Katalin, Danko (2011) Zoltan Szekanecz Pnina Langevitz and Yehuda Shoenfeld. Cell Mol Immunol 8:243–247. 10.1038/cmi.2010.73; published online 31 January 2011 Dr Amal Mohammed Husein Mackawy, Bushra Mohammed Al-ayed, Bashayer Mater Al-rashidi. Int J Health Sci Qassim Univ, Vol. 7 Department of Internal Medicine Dankook University College of Medicine, Department of Kinesiologic Medical Science, Graduate, Dankook University, Cheonan, 330–714, Repub Korea 10.14310/horm.2002.1681 Ravinder Goswami RK, Marwaha N, Gupta N, Tandon V, Sreenivas N, Tomar (2009) Debarti Ray, Ratnesh Kanwar and Rashmi Agarwal British Journal of Nutrition 102, 382–386, dio: 10.1017/S0007114509220824 GULAB KANWAR, MONIKA SHEKHAWAT, NIDHI SHARMA RINKI, HADA & CHANDERJEET SINGH CHANDEL : International Journal of Research in Applied, Natural and Social Sciences (IMPACT: IJRANSS) ISSN(E): 2321–8851; ISSN(P): 2347–4580 Vol. 3, Issue 11, Nov Nirensingh Koch J, Kaur A, Mittal A, Gupta Inder Pal Kaur Shikha Agarwal Assistant Professor, Resident, Dept. of Biochemistry, Subharti Medical College. Meerut International J Clin Biochem Research (2016) ;3(3):295–298 Shaye Kivity N, Agmon-Levin M, Zisappl Y, Shapira EV (2011) Nagy Katalin Danko, Zoltan Szekanecz Pnina Langevitz and Yehuda Shoenfeld. Cell Mol Immunol 8:243–247 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al (2011) Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930 Yasmeh J, Farpour F, Rizzo V, Kheradnam S, Sachmechi I ((2016)) HASHIMOTO THYROIDITIS NOT ASSOCIATED WITH VITAMIN D DEFICIENCY. Endocr Practice: July 2016, 22, 7, 809–813 Mackawy A, Al-ayed B, Al-rashidi B (2013) November 19). Vitamin D Deficiency and Its Association with Thyroid Disease. Int J Health Sci, 7 (3) Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C, Vitamin D (2010) Modulator of the immune system. Curr Opin Pharmacol 10:482–496 Hewison M (2012) An update on vitamin D and human immunity. Clin Endocrinol 76:315–325 Jiying Wang S, Lv G, Chen C, Gao J, He Haihua Zhong and Yong Xu, Department of Endocrinology and Metabolism, Affiliated Hospital of Luzhou Medical College, Luzhou 646000, China 15 January (2015) Dohee Kim,Division of Endocrinology, Department of Internal Medicine, Dankook University College of Medicine, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 330–714, Korea; Int. J. Mol. Sci. (2017) 18 (9), 1949; 10.3390/ijms18091949 Jim Stockigt MD FRACP, FRCPA Monash university and Alfred and Epworth Hospital Melbourne, Australia Lecture Notes on Clinical Biochemistry, Alistaire A, Smith F, Beckett G, Walker SW (1998) Peter Rae Edition 6, Wiley, illustrated ISBN 0632048344, 9780632048342 SHIVARAJ G, DESAI PRAKASH B, SONAL V, SHRUTHI K, VINAYAK H M. AVINASH Department of biochemistry. J N Med Coll Belgaum 590010, Karnataka (India). Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8992274","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":598413029,"identity":"97bd0040-424b-45bb-92e1-6085cf14673e","order_by":0,"name":"Dr Vikas 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University","correspondingAuthor":false,"prefix":"Dr.","firstName":"Jaishree","middleName":"","lastName":"Tiwari","suffix":""}],"badges":[],"createdAt":"2026-02-28 05:05:57","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-8992274/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8992274/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104176650,"identity":"c0da664b-d11b-454e-991c-06d955ea6f4c","added_by":"auto","created_at":"2026-03-08 16:38:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40976,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph No 1: \u003c/strong\u003eShowing Vitamin D level in control, hypothyroidism, and hyperthyroidism subjects.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8992274/v1/e376e441353c97f38d60dcbe.png"},{"id":104176553,"identity":"c1c08ff5-465e-44fa-b291-88b81be2efdf","added_by":"auto","created_at":"2026-03-08 16:38:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39345,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph No 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShowing T3 level in control, hypothyroidism, and hyperthyroidism subject\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8992274/v1/60495e2f2cb91af1aee23a79.png"},{"id":104176554,"identity":"6cf9d78f-fad7-4e68-bb91-d7210316caa4","added_by":"auto","created_at":"2026-03-08 16:38:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":51502,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph No 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShowing T4 level in control, hypothyroidism, and hyperthyroidism subjects.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8992274/v1/7a450239465afef25c1dae24.png"},{"id":104176545,"identity":"1ad53b18-b516-41ee-a91e-4705c21c826c","added_by":"auto","created_at":"2026-03-08 16:38:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":28261,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph No 4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShowing TSH level in control, hypothyroidism, and hyperthyroidism subjects.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8992274/v1/413872af86c24519c4533237.png"},{"id":104404703,"identity":"4ec6900e-ad36-436d-8de8-6f52a858a618","added_by":"auto","created_at":"2026-03-11 12:20:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1183319,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8992274/v1/e58d7f1d-9f48-4775-ab00-db797f7ea1bc.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eVitamin D Levels and Thyroid Function in Patients with Hyperthyroidism and Hypothyroidism\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\n\u003ch3\u003eBackground of the study\u003c/h3\u003e\n\u003cp\u003eThe thyroid is a butterfly shaped gland located in the front of the neck just above the trachea. The fully developed thyroid gland is composed of two lobes that are connected by a thin band of tissue, isthmus. The thyroid gland secretes principally two hormones: Thyroxine (Tetra-iodothyronine) (T4) and Tri-iodothyronine (T3) along with certain amount of reverseT3, Monoiodotyrosine [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Thyroid hormones exert effect on almost every cells of the body and hence have much important biological effect. The most important ones are in control of basal metabolic rate (BMR) and calorigenesis. The synthesis and release of thyroid hormones is closely regulated by hypothalamus-pituitary-thyroid axis. Plasma levels of T4 and T3 are regulated by a feedback mechanism, in which hypothalamic thyrotrophin-releasing hormone (TRH) stimulates the synthesis and release of thyrotrophin (TSH) by the anterior pituitary, thus stimulating the secretion of T4 and T3 by the thyroid gland. T3 inhibits the synthesis and secretion of TRH and TSH to complete the feedback loop. T4 and T3 activity in many tissues is regulated by the selenoenzyme family of iodothyronine deiodinases. The deiodination of T4 forms T3, the most metabolically active thyroid hormone, and reverse T3, which is thought to be hormonally inactive and possibly inhibitory on T3 activity at cellular level.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eVitamin D deficiency is a global health problem. Over a billion people worldwide are vitamin D deficient or insufficient [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is recognized to be involved in various immune functions as well as bone and muscle development [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Vitamin D is a steroidal hormone, introduced in the body through food, but major synthesis occurs through exposure of skin to solar ultraviolet light [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Vitamin D obtained from skin or diet, is converted by the liver to 25(OH) D and is metabolized in the kidneys by the enzyme 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1) to its active form 1,25- dihydroxy vitamin D [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Vitamin D mediates its effect through binding to vitamin D receptor (VDR), and activation of VDR-responsive genes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Apart from its main function in regulation of calcium absorption and homeostasis, it also has a role in regulating cell proliferation and differentiation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Many tissues and cells in the body express the vitamin D receptor, resulting in growing interest in extra-skeletal conditions like cancers, cardiovascular diseases and auto-immune diseases [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Recent studies indicate that 1,25(OH)2D, the biologically active form of vitamin D, is a modulator of both the innate and adaptive immune system. Immune cells such as monocytes, macrophages, dendritic cells, T- lymphocytes, and B-lymphocytes are targets for the active vitamin D [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Low vitamin D intake and vitamin D deficiency have been identified as a risk factor for type 1 diabetes, multiple sclerosis, Crohn\u0026rsquo;s disease, and rheumatoid arthritis [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Hypothyroidism occurs due to reduced functioning of thyroid gland which may be primary (disease of thyroid gland) or less commonly secondary to hypothalamic or pituitary disease, seen more common in females with its incidence increasing as the age advances. Most common cause of hypothyroidism is autoimmune thyroiditis.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Measurement of plasma TSH concentration is the principal test for biochemical evaluation of hypothyroidism. Normal level of TSH is 0.3\u0026ndash;3.5 mU/l and \u0026gt;\u0026thinsp;10 mU/l are observed in hypothyroidism. Importantly, both vitamin D and thyroid hormone bind to receptors which are similar in structure. A different gene in vitamin D receptor was shown to predispose people to autoimmune thyroid disease including Grave\u0026rsquo;s disease and Hashimoto\u0026rsquo;s thyroiditis. thus, it becomes essential to understand how the vitamin D system works. VDR gene polymorphism was found to associate with autoimmune thyroid diseases. In hypothyroidism, intestinal absorption of nutrients is affected both by reduction in rate of absorption, so vitamin D deficiency is commonly seen [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Reports have proved a correlation between vitamin D and TSH, especially in patients with thyroid diseases [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Serum concentration of 25(OH)D is the best indicator of vitamin D status [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It has a half-life of 15 days [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Whereas, circulating 1,25(OH)2D is not a good indicator of Vitamin D status due to its short half-life of 15 hours and its level being regulated by parathyroid hormone, calcium and phosphate [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Levels of vitamin D more than 30ng/ml is considered to be normal, levels of 20-29ng/ml (\u0026lt;\u0026thinsp;50nmol/L) is insufficient and if it is less than 10 ng/ml(12.5nmol/L) signifies severe deficiency [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eStatement of Problem\u003c/h3\u003e\n\u003cp\u003eVitamin D deficiency is a global health problem. Over a billion people worldwide are vitamin D deficient or insufficient [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Yet no international health organization or governmental body has declared a health emergency to warn the public about the urgent need of achieving sufficient vitamin D blood levels [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Understanding of the role of vitamin D has been evolving since its discovery in the early 20th century from being a simple vitamin to a steroid pro-hormone. It has been recognized to be involved in various immune functions as well as bone and muscle development [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Vitamin D deficiency has been shown to be associated with autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), multiple sclerosis (MS) and type 1 diabetes (T1DM), and that vitamin D supplementation prevents the onset and/or development of these autoimmune diseases. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Furthermore, it was reported that patients with Hashimoto\u0026rsquo;s thyroiditis, an autoimmune thyroid disease had lower vitamin D levels [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Vitamin D also play an important role in calcium hemostasis and the development and maintenance of skeletal [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Importantly, both vitamin D and thyroid hormone bind to similar receptors called steroid hormone receptors. A different gene in the Vitamin D receptor was shown to predispose people to autoimmune thyroid disease including Graves\u0026rsquo; disease and Hashimoto\u0026rsquo;s thyroiditis. For these reasons, it is important for patients with thyroid problems to understand how the vitamin D system works. Vitamin D mediates its effect though binding to vitamin D receptor (VDR), and activation of VDR-responsive genes. While VDR gene polymorphism was found to associate with autoimmune thyroid diseases (AITDs) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eRationale of study\u003c/h2\u003e \u003cp\u003eDay by day there has been increment in number of patients presenting with symptoms of thyroid dysfunction. This study was undertaken to evaluate the level of vitamin D in hypothyroidism. Patients with hypothyroidism suffered from hypovitaminosis D. Hence, this study is necessary to encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency for all hypothyroid patients\u003c/p\u003e \u003cp\u003eThis study's main goal is to find out how much vitamin D people with thyroid disease have. The study specifically seeks to ascertain the vitamin D level in hypothyroidism patients. Among the scientific questions addressed are: Is hypothyroidism and hypovitaminosis D significantly correlated? Does hypothyroidism cause a decrease in vitamin D levels? Hypothyroidism and hyperthyroidism are the dependent factors in this study, whereas age, gender (female), autoimmune illnesses, family history, iodine deficiency, and sun exposure are the independent variables.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOperational definition\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eAutoimmunity\u003c/strong\u003e \u003cp\u003erefers to a failure of the body's immune system to recognize its own cells and tissues as \u0026ldquo;self\u0026rdquo;.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothyroidism\u003c/strong\u003e \u003cp\u003eDefined as raised TSH level along with a decreased serum thyroid hormone level (any of T3 or T4 or both).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSubclinical hypothyroidism\u003c/strong\u003e \u003cp\u003eDefined as raised TSH level along with normal serum thyroid hormone levels.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHyperthyroidism\u003c/strong\u003e \u003cp\u003eDefined as high T3 and low TSH.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEuthyroid sick syndrome\u003c/strong\u003e \u003cp\u003eDefined as low T4 or low T3 and normal TSH.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEuthyroid\u003c/strong\u003e \u003cp\u003eNormal levels of both T3 and T4 along with normal TSH level.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGoiter\u003c/strong\u003e \u003cp\u003eDiffuse enlargement of thyroid gland.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypovitaminosis\u003c/strong\u003e \u003cp\u003eHypovitaminosis is insufficiency of one or more essential vitamins.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypovitaminosis D\u003c/strong\u003e \u003cp\u003edeficiency of vitamin D.\u003c/p\u003e \u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eThe Department of Biochemistry at Arogyam Medical College and Hospital (AMCH) in Roorkee, India, would be the site of this cross-sectional retrospective interventional study. During the study period, individuals with complaints linked to thyroid dysfunction who attend the CMCTH departments of internal medicine and ENT will make up the study population. These patients will provide about 100 samples that will be taken for examination. In eight months, from February to September, the research project is anticipated to be finished.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eAll of the individuals either confirmed cases of thyroid disorders, or under-treatment, recently diagnosed cases, as well as those with overt/subclinical thyroid anomalies will be included. Age, gender, occupation, locality, any other disease forms, pregnancy data will be collected and correlated with the assessments, where applicable.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eCare will be taken that none of the patients had any history of operations, malignancies, liver or renal disease, \u003cem\u003einterferon\u003c/em\u003e therapies or -blockers usage.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSample collection\u003c/h2\u003e\n \u003cp\u003eAbout 5ml of venous blood sample will be collected from patients using aseptic technique into a clot activator tube (Yellow capped vial). The serum sample will then be separated and utilized for analysis of variables.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eLaboratory analysis test procedure\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eSerum TSH measurement\u003c/h2\u003e\n \u003cp\u003ePrinciple\u003c/p\u003e\n \u003cp\u003eThe ADVIA Centaur TSH assay is a two-site sandwich immunoassay using direct chemiluminometric technology, which uses constant amounts of two antibodies. The first antibody, in the Lite Reagent, is a monoclonal mouse anti-TSH antibody labelled with acridinium ester. The second antibody, in the Solid Phase, is a polyclonal sheep anti-TSH antibody which is covalently coupled to paramagnetic particles.\u003c/p\u003e\n \u003cp\u003eProcedure\u003c/p\u003e\n \u003cp\u003eThe system automatically performs the following steps:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 200 \u0026micro;L of sample into a cuvette.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABsAAAAkCAMAAABPJrEfAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAFcUExURQAAAAAAAAAAAEp+ukp+uwAAAEp+uQAAAAAAAEp9uIaw7ZrA/gAAAEl8toWv7Zi//QAAAAAAAAAAAEh6tIOu7Ja9/AAAAAAAAAAAAAAAAEd5s4Ks6pS7+gAAAAAAAEd4sX+q6ZC4+AAAAAAAAAAAAEZ3sHyo54y19QAAAHil5Iex8QAAAAAAAHSh4YKs7m+d3nun6muZ23Wi5mWV2G2c4V+R1WaX3QAAAFmN0l6S2kBxo0d5tER0rkFvpUh6t1SKz1eO1kV2rEZ4s1CHzlGK1Eh7tgAAAENzq0p/v0uFzkuG0UuBwEZ4sj9soUiByEeE0EiCykp+vENzqgAAAAAAAAAAAAAAADxmmUeAw0BvpAAAADpjkz9soAAAAAAAAAAAAAAAAAAAAAAAAAAAADlhkT9soAAAAAAAAAAAAAAAAAAAAC5OdAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAO38M68AAAB0dFJOUwABAsD/BMEFCML//w3E//8GCxTG//8DBw4ZyP//EB3K//8JEh/L//8g//8TIf////////////8K//8khYqR5f//NIb//6QPjP////+olf////6vHgwVLp3/tjujujwvIhYrOEOlu0Q5LSUxfzImGxEnKCwa2oXPywAAAAlwSFlzAAAXEQAAFxEByibzPwAAAa5JREFUOE+l011T00AUBuDu8i5ZMOAm4IaCDZg0EEwBETEoXwJaRUHBJlWBolIVQRDE/z/jLI7mg/bC8dzk4pmTM7vv2ULhf4v8qTwUCoR2QFUHvYKEss5L62R5JFTjXei+1o0urmWREMb1HvRe70WPzllmJqHCMPvQf6MffaYhMo1EWgPFQQzdHMJgccCSWeMlexgjt0YwbJd4zhy37GF0bBRe2XWyxhzX9zB+exye7zosZ0HFw8TkBLxK0NKm7ky1tem7021t5t5MW5u9P3vVKAuVzT2YUxYymmqjD+cXFpew/GgZS4sL8yupSyNSrKp81h6vqc8TkTo8Ybz6FHi2/nz9BbBR5UmGhGqha28CL19tbeN1zQ2TCAkVUezX3wBvt/GuXomj5KdEiiiu1Hd2Aew19t9/0JOULpMtfzxofsLnL4df/ThK0iWUOaXi0XGj+a3ZODn9fuakVoZIYQT2+fHBzuHJj5qZGqdWSVqRaR9d1C9Oa7FuZdaQUGZFQbHml3+aeup0f9GoBmZQirJdv1EKHhohFzJPaiaVmqYx2uqxKKW05TtS1Rb+rX4BJj88aXbEnU0AAAAASUVORK5CYII=\"\u003e\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 50 \u0026micro;L of Lite Reagent and 225 \u0026micro;L of Solid Phase and incubates for 7.5 minutes at 37\u0026deg;C.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eSeparates, aspirates, and washes the cuvettes with reagent water.\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 300 \u0026micro;L each of Acid Reagent and Base Reagent to initiate the chemiluminescent reaction.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eReports results according to the selected option; A direct relationship exists between the amount of TSH present in the patient sample and the amount of relative light units (RLUs) detected by the system.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSerum fT3 measurement\u003c/h2\u003e\n \u003cp\u003ePrinciple\u003c/p\u003e\n \u003cp\u003eThe ADVIA Centaur FT3 assay is a competitive immunoassay using direct chemiluminescent technology. FT3 in the sample competes with a T3 analog, which is covalently coupled to paramagnetic particles in the Solid Phase for a limited amount of a combination of acridinium ester-labelled monoclonal mouse anti-T3 antibodies in the Lite Reagent.\u003c/p\u003e\n \u003cp\u003eProcedure\u003c/p\u003e\n \u003cp\u003eThe system automatically performs the following actions:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 50 \u0026micro;L of sample into a cuvette.\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 100 \u0026micro;L of Lite Reagent and incubates for 5.0 minutes at 37\u0026deg;C.\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 450 \u0026micro;L of Solid Phase and incubates for 2.5 minutes at 37\u0026deg;C.\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eSeparates, aspirates, and washes the cuvettes with reagent water.\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 300 \u0026micro;L each of Acid Reagent and Base Reagent to initiate the chemiluminescent reaction.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eReports results according to the selected option, an inverse relationship exists between the amount of FT3 present in the patient sample and the amount of relative light units (RLUs) detected by the system.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eSerum fT4 measurement\u003c/h2\u003e\n \u003cp\u003ePrinciple\u003c/p\u003e\n \u003cp\u003eThe ADVIA Centaur FT4 assay is a competitive immunoassay using direct chemiluminescent technology. FT4 in the patient sample competes with acridinium ester-labelled T4 in the Lite Reagent for a limited amount of biotinylated polyclonal rabbit anti-T4 antibody. Biotin-labelled anti-T4 is bound to avidin that is covalently coupled to paramagnetic particles in the Solid Phase.\u003c/p\u003e\n \u003cp\u003eProcedures\u003c/p\u003e\n \u003cp\u003eThe system automatically performs the following steps:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 25 \u0026micro;L of sample into a cuvette.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 100 \u0026micro;L of Lite Reagent and 300 \u0026micro;L of Solid Phase and incubates for 7.5 minutes at37\u0026deg;C.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eSeparates, aspirates, and washes the cuvettes with reagent water.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eDispenses 300 \u0026micro;L each of Acid Reagent and Base Reagent to initiate the chemiluminescent reaction.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eReports results according to the selected option; an inverse relationship exists between the amount of FT4 present in the patient sample and the amount of relative light units (RLUs) detected by the system.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eSerum vitamin D measurement:\u003c/h2\u003e\n \u003cp\u003eThe ADVIA Centaur\u0026reg; vitamin D assay is an 18-minute antibody competitive immunoassay that uses an anti-fluorescein monoclonal mouse antibody covalently bound to paramagnetic particles (PMP) an anti-25(OH)vitamin D monoclonal mouse antibody labelled with fluorescein.\u003c/p\u003e\n \u003cp\u003eAn inverse relationship exists between the amount of vitamin D present in the patient sample and the amount of relative light units (RLU) detected by the system.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis Procedure\u003c/h2\u003e\n \u003cp\u003eThe collected data was checked, reviewed and organized for its accuracy, completeness and consistency. All the data was coded and organized and then entered into SPSS IBM version 20.0. All collected data was analyzed and interpreted in descriptive statistics (frequency, percentage, mean, standards deviation) and inferential statistics (correlation) as per the nature of data. The findings were presented in tables and diagrams.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eValidity and Reliability of study\u003c/h2\u003e\n \u003cp\u003eThe supervisor approved the research proposal. Questionnaire was verified by the supervisor. Research was conducted under the guidance of supervisor. The supervisor was directly involved in data collection. A laboratory procedure was performed according to standard operating procedures. Reagents and analyser were routinely calibrated.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eObservation\u003c/h2\u003e\n \u003cp\u003eTable showing mean Standard deviation and significant changes between Control, hypothyroidism and hyperthyroidism subjects.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No 1: Showing over all status of Vitamin D, T3, T4 \u0026amp; TSH in control subjects.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall Status\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVITD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTSH\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.6416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.2812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.1724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.26555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.24687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSEM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.45307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.04937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.14852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.09912\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eVITD=?????, T3=?????, T4=?????TSH=?????? (explain it)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAbove table 1 shows that minimum VITD 30???????????????????????\u003c/p\u003e\n \u003cp\u003eTable No. 1: Over all status of Vitamin D, T3, T4 and TSH in control subjects (N\u0026thinsp;=\u0026thinsp;50).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No 2: Showing over all status of Vitamin D, T3, T4 \u0026amp; TSH in hypothyroidism subjects.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall Status\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVITD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTSH\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.2680\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.0528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.0520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.0344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.5038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.68330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.24262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.61994\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSEM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.10076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.13666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.04852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.12399\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eVITD=?????, T3=?????, T4=?????TSH=?????? (explain it)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable No 3: Showing over all status of Vitamin D, T3, T4 \u0026amp; TSH in hyperthyroidism subjects.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;50\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall Status\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVITD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTSH\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.3508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.9244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.8192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.2264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.50870\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.66284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.59984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.11561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSEM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.50174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.13257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.11997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.02312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003eVITD=?????, T3=?????, T4=?????TSH=?????? (explain it)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable No 4: Showing the comparative changes of Vitamin D, T3, T4 \u0026amp; TSH in control \u0026amp; Hypothyroidism subjects.\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabd\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVITD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTSH\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.6416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.1724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.26535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.24687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eHypothyroidism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.2680*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.0528*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0520NS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.0344*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.50380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.68330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.24262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.61994\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e*Significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, NS : Non significant, VITD=?????, T3=?????, T4=?????TSH=?????? (explain it)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable no 5 : Showing the comparative changes of VITD, T3, T4 \u0026amp; TSH in control \u0026amp; Hyperthyroidism\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabe\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVITD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTSH\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.6416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.2812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.1724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.26535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.24687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eHyperthyroidism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.3508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.9244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.8192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.2264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.508700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.662844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.11561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.11561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable No. 1: Showing over all status of Vitamin D, T3, T4 \u0026amp; TSH in control subjects\u003c/p\u003e \u003cp\u003eTable No. 2: Over all status of Vitamin D, T3, and T4 \u0026amp; TSH in hypothyroidism subjects (N\u0026thinsp;=\u0026thinsp;50).\u003c/p\u003e \u003cp\u003eTable No. 3: Over all status of Vitamin D, T3, T4 \u0026amp; TSH in hyperthyroidism subjects (N\u0026thinsp;=\u0026thinsp;50).\u003c/p\u003e \u003cp\u003eTable No. 4: Showing the comparative changes of Vitamin D, T3, T4 \u0026amp; TSH in control and hypothyroidism subjects. In our study Vitamin D, T3 \u0026amp; TSH were statistically significant in hypothyroidism subjects as compared with control group. T4 was no statistically significant in control and hypothyroidism subjects.\u003c/p\u003e \u003cp\u003eTable No. 5: Showing the comparative changes of Vitamin D, T3, T4 \u0026amp; TSH in control and Hyperthyroidism subjects. In our study Vitamin D, T3 \u0026amp; TSH were statistically significant in hyperthyroidism subjects as compared with control group. T4 was no statistically significant in control and hyperthyroidism subjects.\u003c/p\u003e \u003cp\u003eGraph NO.1: Showing Vitamin D level in control, hypothyroidism, and hyperthyroidism subjects. Mean vitamin D level in control subject was 32.64 as compared to\u003c/p\u003e \u003cp\u003eHypothyroidism whose mean was 16.26 and mean vitamin D of hyperthyroidism was 39.35.\u003c/p\u003e \u003cp\u003eGraph NO.2: Showing T3 level in control, hypothyroidism, and hyperthyroidism subjects. Mean T3 level in control subject was 2.85 as compared to hypothyroidism whose mean was 3.05 and mean T3 of hyperthyroidism was 3.92.\u003c/p\u003e \u003cp\u003eGraph NO.3: Showing T4 level in control, hypothyroidism, and hyperthyroidism subjects. Mean T4 level in control subject was 1.28 as compared to hypothyroidism whose mean was 1.05 and mean T4 of hyperthyroidism was 1.81.\u003c/p\u003e \u003cp\u003eGraph NO.4: Showing TSH level in control, hypothyroidism, and hyperthyroidism subjects. Mean TSH level in control subject was 3.17 as compared to hypothyroidism whose mean was 10.03 and mean TSH of hyperthyroidism was 0.22.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eVitamin D deficiency is a global health problem. Because an estimated one billion people worldwide have vitamin D deficiency or insufficiency, vitamin D has become an important focus of current medical research. In particular, vitamin D deficiency is defined by the US Endocrine Society guideline as 25 (OH)D less than 20 ng/ml (50 nmol/l), vitamin D insufficiency as 25 (OH)D between 21 and 29 ng/ml, and the upper cutoff to minimize the risk of adverse effects as 25(OH)D equal to 100 ng/ml (250 nmol/l).[\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. In our study, it was observed that, the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Vitamin D levels were as low as 16.268\u0026thinsp;\u0026plusmn;\u0026thinsp;10.50\u0026micro;l/ml in hypothyroidism patients as compared to control mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D 32.641\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26. In hyperthyroidism patient the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D of vitamin D was 39.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.50, which is within the normal range and was statistically insignificant. Low levels of vitamin D in hypothyroidism were in consistency with Joseph Yasmeh et al. 2006[\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e] and Mackawy et al.2013.[\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eVitamin D is a lipid soluble vitamin which affects via vitamin D receptor (VDR). Vitamin D receptor is an intracellular receptor which belongs to the steroid/thyroid nuclear receptor family. This receptor is located in many immune cells, such as neutrophils, macrophages, dendritic cells, T and B cells. Vitamin D has potent immunomodulatory effects both on the innate and adaptive immune system. Vitamin D inhibits pro-inflammatory processes by suppressing the over-activity of CD4+, Th1, Th2 and Th17 cells and the production of their related cytokines by the activation of VDR. Finally, 1,25(OH)2D inhibits B cell proliferation and differentiation into plasma cells, immunoglobulin secretion (IgG and IgM), memory B cell generation, and also induces B cell apoptosis. The ability of 1,25(OH)2D to suppress the adaptive immune system promotes immune tolerance and appears to be beneficial for a number of autoimmune disease (\u003cb\u003eBaeke et al. 2010\u003c/b\u003e [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e] \u003cb\u003eand Hewison etal.2012\u003c/b\u003e [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAlthough the biological activities of vitamin D are mainly manifested in the regulation of calcium-phosphorus metabolism, studies in the past 30 years indicate vitamin D may play an important role in the immune system. In the past two decades, vitamin D receptors have been found not only in bone, kidney, and intestine, but also in the immune system (T and B cells, macrophages, and monocytes), reproductive system, endocrine system, muscles, brain, skin, and liver, suggesting that the role of vitamin D is not limited to the skeletal system. Low levels of vitamin D have also been associated with thyroid disease, such as Hashimoto\u0026rsquo;s thyroiditis. Similarly, patients with new-onset Graves\u0026rsquo; disease were found to have decreased 25-hydroxyvitamin D concentrations. (Jiying Wang et al 2015).[\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGraves\u0026rsquo; disease is a multifactorial disease caused by a complex interaction between genetic and environmental factors that lead to the loss of immune tolerance to thyroid antigens, and therefore to the initiation of an immune reaction against the thyroid. In GD, lymphocytic infiltration is mild and involves mainly CD4\u0026thinsp;+\u0026thinsp;type 2 T-helper (Th2) cells, which induce the production of antibodies to bind to the thyroid stimulating hormone (TSH) receptor. This stimulates the growth and function of thyroid follicular cells leading to hyperthyroidism, indicating a humoral immune response. Vitamin D may counteract the onset of GD, as Th1 dominance seems to be involved in the induction of the disease. ( \u003cb\u003eDohee Kim 2017)\u003c/b\u003e [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTSH levels are the most sensitive indicator of thyroid dysfunction but cannot be used in patients with pituitary disease. TSH used alone as a first line test will miss (levels \u0026lsquo;normal\u0026rsquo;) unsuspected cases of secondary hypothyroidism and some laboratories therefore combine TSH and T4 as first line tests.[\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTSH level was significantly high in hypothyroidism patients with the value of mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD 10.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6 as compared in control whose mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD was 3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40. Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD TSH level in hyperthyroidism patient was 0.226\u0026thinsp;\u0026plusmn;\u0026thinsp;0.115.\u003c/p\u003e \u003cp\u003eMeasurements of serum \u003cb\u003e[TSH]\u003c/b\u003e provide the best screening test. A normal result excludes primary thyroid disease. If, at the time the test is performed, the patient is not recovering from a recent non thyroidal illness (NTI), a serum [TSH]\u0026thinsp;\u0026gt;\u0026thinsp;10 mU/L indicates that the patient has hypothyroidism and may require treatment with thyroxine. If the serum [TSH]\u0026thinsp;\u0026lt;\u0026thinsp;0.1 mU/L, serum [FT4] or [total T4] and serum [total T3] or [FT3] should be measured. If the results for either the T4 or T3 measurements are raised, the patient should be referred for specialist advice, as treatment for hyperthyroidism may be required. If, however, the results for the T4 and T3 measurements are normal or low, this suggests that the cause of the serum [TSH] is NTI, subclinical hyperthyroidism, rarely, secondary hypothyroidism.[\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThyroid disorders are commonly separated into two major categories, hyperthyroidism and hypothyroidism, depending on whether serum thyroid hormone levels (T4 and T3) are increased or decreased, respectively. In our study mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of T4 was 1.052\u0026thinsp;\u0026plusmn;\u0026thinsp;0.242 in hypothyroidism patient as compared to control whose mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD was 1.2812\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37. In hyperthyroidism patient mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of T4 was 1.8192\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59. Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D of T3 level was 3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68 in hypothyroidism patient as compared to control whose mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D was 2.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24. In hyperthyroidism patient mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of T3 was 3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66. Free T3 and T4 tests (FT3, FT4) are now more reliable and preferred to total T3 or T4 measurements.\u003c/p\u003e \u003cp\u003eThe normal values for FT4 in adults range from 1.0 to 3.0 ng/dL (13 to 39 pmol/L). A minute amount of thyroid hormone circulates in the blood in a free form, not bound to serum proteins. It is in reversible equilibrium with the bound hormone and represents the diffusible fraction of the hormone capable of traversing cellular membranes to exert its effects on body tissues. Although changes in serum hormone-binding proteins affect both the total hormone concentration and the corresponding fraction circulating free in the euthyroid person, the absolute concentration of free hormone remains constant and correlates with the tissue hormone level and its biologic effect. Serum FT4 may be suppressed in the patients with thyroidal illness and transiently rise in acute thyroidal illness, when\u003c/p\u003e \u003cp\u003e \u003cb\u003eFT3\u003c/b\u003e normal adult reference value is 0.25\u0026ndash;0.65 ng/dL (3.8\u0026ndash;10 nmol/L). It measures the very tiny amount of T3 that circulates unbound. It is useful in looking for hyperthyroidism or thyroxine overplacement in women who are pregnant or taking any effective drugs that varies the TBG like estrogen. More consistently, patients with a variety of non-thyroidal illnesses have low FT3 levels. This decrease is characteristic of all conditions associated with depressed serum TT3 concentrations due to a diminished conversion of T4 to T3 in peripheral tissues. Marked elevations in both FT4 and FT3 concentrations in the absence of hypermetabolism are typical of patients with resistance to thyroid hormone. The FT3 concentration is usually normal or even high in hypothyroid persons living in areas of severe endemic iodine deficiency and their FT4 levels are, however, normal or low.(G. SHIVARAJ 2009).[\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eCONCLUSION AND RECOMMENDATION\u003c/h2\u003e \u003cp\u003eVitamin D has been shown to have a potential beneficial role in the treatment of various autoimmune diseases. In the case of deficiency or insufficiency, supplementation is needed and either vitamin D2 or vitamin D3 can be used. Adults who are vitamin D-deficient should be treated with 50 000 IU of vitamin D2 or vitamin D3 once a week for 8 weeks or its equivalent of 6000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25 (OH)D above 30 ng/ml.\u003c/p\u003e \u003cp\u003eEvidence on this issue deriving from clinical association studies must be taken with great caution. In fact, there are many confounding factors able to influence vitamin D concentration that have not always been properly considered in the relevant works and that can affect the relationship between vitamin D levels and thyroid diseases. Although several findings support the role of vitamin D in the pathogenesis of thyroid diseases, no guidelines are currently available for or against recommending vitamin D supplementation in the prevention or therapy of thyroid disease.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was Self-Funded\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eDepartment of Medical Laboratory Technology, UIAHS, Chandigarh University, Mohali, Punjab India\u003c/li\u003e\n \u003cli\u003eDepartment of Physiotherapy, UIAHS, Chandigarh University, Mohali, Punjab India\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVikas Tiwari: acquired the data, or analysis and interpretation of data, designed and drafted the work and substantively revised it for content\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJaishree Tiwari: revised the manuscript, worked on the English, and made the final version. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Vikas Tiwari at [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe AMCH Institutional Ethical Committee (AMCH-IEC/23-108) provided ethical approval. Before any data was collected, the participants received a thorough explanation of the study's objectives and methodology. The participants' privacy and confidentiality were guaranteed and upheld. At any point during the data collection process, participants were made aware of their right to withdraw from the study or to refuse to participate. Participants were guaranteed of the anonymity of their answers, and no personal information was recorded. Prior to the collection of data, the participants provided written informed consent.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDemers LM, Spencer C The Thyroid: Pathophysiology and Thyroid Function Testing. Teitz Textbook of clinical chemistry and molecular diagnostics. 4th ed\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoeber KA Treatment of hypothyroidism. In: Braverman LE, Utiger RD (eds). Werner and Ingbar\u0026rsquo;s the Thyroid, a Fundamental and Clinical Text, 9th edn. Philadelphia, USA: Lippincott Williams\u0026amp;Wilkins,2005,864\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHollick MF, Chen TC (2008) Vitamin D deficiency a worldwide problem with health consequences. 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(2017) \u003cem\u003e18\u003c/em\u003e(9), 1949; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms18091949\u003c/span\u003e\u003cspan address=\"10.3390/ijms18091949\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJim Stockigt MD FRACP, FRCPA Monash university and Alfred and Epworth Hospital Melbourne, Australia\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLecture Notes on Clinical Biochemistry, Alistaire A, Smith F, Beckett G, Walker SW (1998) Peter Rae Edition 6, Wiley, illustrated ISBN 0632048344, 9780632048342\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHIVARAJ G, DESAI PRAKASH B, SONAL V, SHRUTHI K, VINAYAK H M. AVINASH Department of biochemistry. J N Med Coll Belgaum 590010, Karnataka (India).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Arogyam medical college and hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vitamin D deficiency, Thyroid function, Hyperthyroidism, Hypothyroidism, Hashimoto’s thyroiditis","lastPublishedDoi":"10.21203/rs.3.rs-8992274/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8992274/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVitamin D deficiency is a global health problem. Over a billion people worldwide are vitamin D deficient or insufficient. Recent studies indicate that 1,25(OH)2D, the biologically active form of vitamin D, is a modulator of both the innate and adaptive immune system. Immune cells such as monocytes, macrophages, dendritic cells, T- lymphocytes, and B-lymphocytes are targets for the active vitamin D [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Low vitamin D intake and vitamin D deficiency have been identified as a risk factor for autoimmune thyroid disease including Graves\u0026rsquo; disease and Hashimoto\u0026rsquo;s thyroiditis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a prospective study conducted in Arogyam Medical College and Hospital (AMCH), Roorkee, India. This study was carried out over a period of 4 months extending from March 2023 to July 2023. During which 100 samples were taken. Venous blood was collected and biochemical parameters like Vitamin D, T3, T4 and TSH are analyzed using chemilumenescence assay. Data was analyzed using SPSS version 20.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTotal 100 patients were reported to the Arogyam Medical College and Hospital, Roorkee, India. In these patients, we found the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Vitamin D levels were as low as 16.268\u0026thinsp;\u0026plusmn;\u0026thinsp;10.50 \u0026micro;l/ml in hypothyroidism patients as compared to control mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (32.641\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26). In hyperthyroidism patient the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of Vitamin D was (39.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.50) which is within the normal range and was statistically insignificant. TSH level was significantly high in hypothyroidism patients with the value of mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (10.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6) as compared in control whose Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD was 3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40. Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of TSH level in hyperthyroidism patient was 0.226\u0026thinsp;\u0026plusmn;\u0026thinsp;0.115.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eVitamin D has been shown to have a potential beneficial role in the treatment of various autoimmune diseases. In the case of deficiency or insufficiency, supplementation is needed and either vitamin D2 or vitamin D3 can be used. Evidence on this issue deriving from clinical association studies must be taken with great caution. In fact, there are many confounding factors able to influence vitamin D concentration that have not always been properly considered in the relevant works and that can affect the relationship between vitamin D levels and thyroid diseases. Although several findings support the role of vitamin D in the pathogenesis of thyroid diseases, no guidelines are currently available for or against recommending vitamin D supplementation in the prevention or therapy of thyroid disease.\u003c/p\u003e","manuscriptTitle":"Vitamin D Levels and Thyroid Function in Patients with Hyperthyroidism and Hypothyroidism","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 16:38:11","doi":"10.21203/rs.3.rs-8992274/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3fb73cb4-5e99-4c47-940f-1cba1eac8ec9","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63684430,"name":"Endocrinology \u0026 Metabolism"}],"tags":[],"updatedAt":"2026-03-08T16:38:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 16:38:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8992274","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8992274","identity":"rs-8992274","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}