Vasoactive intestinal peptide (VIP) is a neuropeptide with potent immunoregulatory properties. Reduced serum VIP levels and alterations in VIP receptors/signaling on immune cells have been associated with different inflammatory/autoimmune diseases. However, its role in autoimmune thyroid diseases (AITD) remains unknown. This study examined the interrelationship between VIP system, autoimmune background and thyroid hormones in peripheral immune cells in patients with AITD. Only Graves' disease (GD) patients showed significantly lower serum VIP levels when compared to healthy subjects and to Hashimoto's thyroiditis patients. Serum VIP levels were lower at the onset of GD, showing a significant negative correlation with thyroid hormone levels. The expression of VIP receptors, VPAC1 and VPAC2, was significantly upregulated in peripheral blood mononuclear cells (PBMC) from GD patients. There was an impairment of VIP signalling in these patients, probably attributable to a dysfunction of VPAC1 with preservation of VPAC2. The correlation between VPAC1 and thyroid hormone receptor expression in PBMC from healthy subjects was lost in GD patients. In summary, the VIP system is altered in peripheral immune cells of GD patients and this finding is associated with different thyroid hormone receptor patterns, showing a dynamic inter-regulation and a prominent role of VIP in this setting. Experimental data and clinical observations in animal models and humans point to an important role of interactions between neuroendocrine and immune systems for the maintenance of the overall homeostasis 1,2. This bidirectional network is functionally supported by the presence of shared signalling molecules, including hormones, neuropeptides, cytokines, and their respective receptors. Thus, neuropeptides and hormones are able to modulate immune functions, and immune mediators are capable of affecting the endocrine system. Therefore, although the immune system itself has mechanisms of self-regulation, the neuroendocrine system is also involved in its control. Accordingly, impairment of mechanisms mediating such regulatory relationships has been linked with the development of autoimmune diseases 3. Thyroid hormones, triiodothyronine (T3) and thyroxine (T4), are implicated in key physiological processes, including development, differentiation, and regulation of metabolism 4. Besides, accumulating evidence proves the impact of thyroid status on immune responses and inflammation, by directly affecting the functional activity of monocytes, macrophages, lymphocytes and natural killer 3. Biological actions of thyroid hormones are mediated by classical signalling mechanisms initiated through binding to their corresponding nuclear receptors, TRα and TRβ, that directly modulate gene transcription 5. In addition, recent investigations have described that they also act at the plasma membrane via integrin αvβ3, triggering signalling cascades that indirectly contribute to the regulation of gene expression 4. Thyroid autoimmune diseases (AITD) include a broad...