Thyroid carcinoma is the most common endocrine cancer representing 1-1.5% of all cancers diagnosed annually. Differentiated thyroid carcinoma (DTC) with the 2 main subtypes, papillary (PTC) and follicular (FTC), is the most common. DTC incidence has increased significantly in recent years, mainly due to increased and early use of imaging techniques (thyroid ultrasonography) and fine needle biopsy of thyroid nodules. Although after radical treatment, DTC is considered to be curable, histologic and clinical presentation is very diverse, the recurrence rate being 10-30%, while 5% of patients are resistant to conventional therapy, and some are even incurable. In recent years, there has been progress in terms of describing genetic changes in thyroid carcinoma, genetic testing providing important information that may influence therapeutic decision. The practical importance of these genetic mutations (for example, BRAF V600E, RAS, etc.) and their roles in tumorigenesis, the clinical features, treatment and prognosis of thyroid carcinoma is still controversial and incompletely elucidated.The increase knowledge of molecular pathogenesis and tumorigenesis in thyroid cancer lead to the emergence of new therapies with targeted antitumor effect and minimal toxicity. Patient selection should be made taking into account the risk stratification and tangible benefits, molecular tests being expensive and inaccessible.
Vitamin D is a fat soluble vitamin and a steroid hormone with endocrine, paracrine and autocrine actions. The two major forms are vitamin D2 (ergocalcifeol) and vitamin D3 (cholecalciferol), the active hormone being calcitriol. The importance of vitamin D and its metabolites lies in the key role in calcium homeostasis and bone metabolism but vitamin D also has extraskeletal effects, still incompletely understood. Vitamin D receptor (VDR) is ubiquitous in the body, the presence of VDR in multiple tissues suggesting a more general role of calcitriol. Vitamin D can regulate many cellular functions such as cell proliferation, differentiation, and apoptosis. Calcitriol exerts immunomodulating and antiproliferative effects and plays a potential role in the prevention and therapy of various cancers (breast, colorectal, prostate, thyroid), autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis and type 1 diabetes, thyroid autoimmunity), obesity and also in cardiovascular, renal, maternal-fetal pathologies. Conclusions. The current studies bring increasingly more evidence about the benefits of vitamin D supplementation in extraskeletal pathology although there is no agreed protocol in this regard. However, these patients should be considered for adequate intake of vitamin D for the prevention, improving the evolution and the prognosis of their disease.
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Vitamin D is a fat-soluble vitamin and a presteroid hormone synthesized in the dermis under UVB rays. In terms of its endocrine functions, it has an important role in mineral homeostasis. Besides these effects, recent studies have found a series of non-calciotropic actions of vitamin D: modulation of autoimmune processes, promoting secretion and insulin action, pulmonary development, inhibition of malignant cells proliferation in various cancers, implications in maternal-fetal pathology. Recent studies have identified the association of vitamin D deficiency in pregnancy with a series of maternal complications (preeclampsia, bacterial vaginosis, gestational diabetes, increased risk of cesarean delivery) and fetal complications (affecting skeletal development and tooth enamel, impaired fetal growth). Also, newborns from mothers with vitamin D deficiency have an increased risk of tetany, hypocalcemia, with or without seizures and an increased susceptibility to respiratory diseases (asthma, bronchiolitis RSV). Conclusions: There is no current consensus on routine screening of vitamin D deficiency in pregnancy, nor the required dosage for vitamin D supplementation in pregnant women. All pregnant women should have a balanced diet and get vitamin D as part of prenatal vitamins. Their purpose is to increase the availability of calcidiol to the fetus and newborn with a beneficial role over the classic effects of vitamin D and possibly over the non-calciotropic ones.
Vitamin D deficiency is a global health problem, its role as an immune modulator being recently emphasized. Recent studies are increasingly suggesting that vitamin D plays a significant role in reducing the incidence and progression of autoimmune diseases. Furthermore, it was reported that patients with Hashimoto’s thyroiditis, an autoimmune thyroid disease had lower vitamin D levels [1]. We initiated a prospective study, for a period of 6 months with a study group represented by 160 patients admitted to the National Institute of Endocrinology “CI Parhon” in the period 2013 -2014. Patients were divided into 3 groups: 121 patients without thyroid pathology, 22 patients diagnosed with chronic autoimmune thyroiditis, who received 2000 IU cholecalciferol daily, 17 patients diagnosed with chronic autoimmune thyroiditis, which did not receive cholecalciferol. We found that patients with chronic thyroiditis have a poor vitamin D status with ATPO values negatively correlating with 25 (OH) vitamin D levels. Treatment with cholecalciferol not only improves vitamin D status but also lowers antithyroid antibodies titres. Keywords: vitamin D deficiency, chronic
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