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Overall, adequate vitamin D levels are crucial for optimal immune function and may play a preventive role in various autoimmune conditions and infections ( Figure 1 1.3 The relationship between vitamin D status and thyroid function 1.3.1 The impact of vitamin D deficiency on thyroid hormone synthesis Vitamin D deficiency has been increasingly recognized as a significant factor influencing thyroid hormone synthesis, particularly in autoimmune thyroid diseases such as HT

54 Proximal tubular hypertrophy, a compensatory response to chronic hyperglycemia, triggers metabolic reprogramming, hypoxia, adenosine triphosphate (ATP) depletion, immune cell recruitment, and cytokine release