Clinical relevance of environmental factors in the pathogenesis of autoimmune thyroid disease
Wilmar M. Wiersinga - Endocrinol Metab. 2016 Jun;31(2):213-222. English.
Published online May 13, 2016. http://dx.doi.org/10.3803/EnM.2016.31.2.213
The 5-year risk can be quantified by the so-called Thyroid Events Amsterdam-score, based on serum thyroid-stimulating hormone, thyroid peroxidase (TPO)-antibodies and family history. Subjects at risk may ask what they can do to prevent development of AITD.
This review summarizes what is known about modulation of exposure to environmental factors in terms of AITD prevention:
- To stop smoking decreases the risk on Graves disease but increases the risk on Hashimoto disease.
- Moderate alcohol intake provides some protection against both Graves and Hashimoto disease.
- Low selenium intake is associated with a higher prevalence of thyroid autoimmunity, but evidence that selenium supplementation may lower TPO antibodies and prevent subclinical hypothyroidism remains inconclusive.
- Low serum vitamin D levels are associated with a higher prevalence of TPO antibodies, but intervention studies with extra vitamin D have not been done yet.
- Stress may provoke Graves hyperthyroidism but not Hashimoto thyroiditis.
- Estrogen use have been linked to a lower prevalence of Graves disease.
- The postpartum period is associated with an increased risk of AITD.
Taking together, preventive interventions to diminish the risk of AITD are few, not always feasible, and probably of limited efficacy.
Schildkliertje: THEA-score voorspelt Hashimoto of Graves: Bij het Academisch Medisch Centrum in Amsterdam zijn in 2008 de resultaten bekend geworden van een AITD-Cohort studie naar het risico om een...