{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T17:05:00Z","timestamp":1779815100038,"version":"3.53.1"},"reference-count":47,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Hashimoto\u2019s thyroiditis (HT) is a chronic autoimmune disorder characterized not only by thyroid dysfunction but also by metabolic disturbances, micronutrient inadequacies, and low-grade inflammation. Composite indices derived from routine laboratory parameters may therefore help capture the broader systemic profile of the disease. This study explored within-cohort associations of immunonutritional indices including the Prognostic Nutritional Index (PNI), Nutritional Risk Index (NRI), and Controlling Nutritional Status (CONUT), and hemogram-derived inflammatory markers including the Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII), with thyroid function, thyroid autoimmunity, metabolic characteristics, disease duration, and vitamin D status in adults with Hashimoto\u2019s thyroiditis. Methods: This cross-sectional study included 229 adults diagnosed with HT. PNI, NRI, CONUT, and complete blood count-derived inflammatory markers were evaluated in relation to thyroid function, thyroid autoimmunity, disease duration, metabolic characteristics, and vitamin D status. Because most variables were not normally distributed, the main analyses were conducted using non-parametric tests. Correlations were evaluated using Spearman\u2019s rank correlation coefficients. Exploratory regression models were estimated using HC3 heteroscedasticity-consistent robust standard errors, and CRP-based sensitivity analyses were performed by excluding participants with CRP &gt; 10 mg\/L. Results: Vitamin D deficiency was highly prevalent and affected 70.3% of the participants. Among the immunonutritional indices, NRI differed significantly according to BMI category and HOMA-defined insulin resistance (both p &lt; 0.001), indicating a closer relationship with metabolic burden. PNI was associated with disease duration (p = 0.009), whereas the inflammatory indices were largely similar across the clinical groupings examined. In exploratory robust regression models, the explanatory power remained modest (R2 = 0.066\u20130.171). PLR showed the most consistent index-related association with TSH, whereas the CONUT\u2013FT3 association observed in the full-sample robust model was not retained after CRP-based sensitivity analysis. Conclusions: Adults with HT in this study showed frequent vitamin D deficiency together with a substantial burden of excess weight and insulin resistance. Routine immunonutritional and inflammatory indices may provide supportive information on within-cohort biochemical and metabolic heterogeneity, but they should not be interpreted as stand-alone diagnostic or prognostic markers. In particular, NRI appeared to reflect metabolic and adiposity-related burden more than nutritional risk alone, while PLR showed the most internally consistent index-related association with TSH.<\/jats:p>","DOI":"10.3390\/nu18111698","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T16:17:58Z","timestamp":1779812278000},"page":"1698","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunonutritional Indices, Inflammatory Markers, and Thyroid-Related Parameters in Adults with Hashimoto\u2019s Thyroiditis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-2661","authenticated-orcid":false,"given":"Hulya","family":"Yilmaz Onal","sequence":"first","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul 34862, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songul","family":"Aktas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul 34865, Turkey"},{"name":"Knappschafts-Klinik Bad Driburg, 33014 Bad Driburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6580-0207","authenticated-orcid":false,"given":"Aysun","family":"Yuksel","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul 34862, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8742-2625","authenticated-orcid":false,"given":"Tutku","family":"Tuncal\u0131 Yaman","sequence":"additional","affiliation":[{"name":"Department of Management Information Systems, Faculty of Business Administration, Marmara University, Istanbul 34854, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozcan","family":"Keskin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul 34865, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1347-8498","authenticated-orcid":false,"given":"Hafize","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul 34403, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101367","DOI":"10.1016\/j.beem.2019.101367","article-title":"Hashimotos\u2019 thyroiditis: Epidemiology, pathogenesis, clinic and therapy","volume":"33","author":"Ragusa","year":"2019","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.autrev.2014.01.007","article-title":"Hashimoto thyroiditis: Clinical and diagnostic criteria","volume":"13","author":"Caturegli","year":"2014","journal-title":"Autoimmun. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/s12020-012-9703-2","article-title":"The incidence and prevalence of thyroid autoimmunity","volume":"42","author":"McLeod","year":"2012","journal-title":"Endocrine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"bvaf120","DOI":"10.1210\/jendso\/bvaf120","article-title":"Autoimmune Thyroid Disease in the United States: Population Prevalence, Diagnosis Rates, and Trends","volume":"9","author":"Dillon","year":"2025","journal-title":"J. Endocr. Soc."},{"key":"ref_5","first-page":"310","article-title":"Neutrophil and platelet to lymphocyte ratio in patients with hypothyroid Hashimoto\u2019s thyroiditis","volume":"91","year":"2020","journal-title":"Acta Bio Med. Atenei Parm."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5831858","DOI":"10.1155\/2023\/5831858","article-title":"Association Between the Systemic Immune-Inflammation Index and Thyroid Function in US Adults","volume":"2023","author":"Hu","year":"2023","journal-title":"Mediat. Inflamm."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7554085","DOI":"10.1155\/ije\/7554085","article-title":"Association Between Systemic Immune-Inflammation Index and Thyroid Function: A Cross-Sectional Population-Based Study","volume":"2026","author":"Huang","year":"2026","journal-title":"Int. J. Endocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"03000605241280049","DOI":"10.1177\/03000605241280049","article-title":"Evaluation of systemic inflammation markers in patients with Hashimoto\u2019s thyroiditis","volume":"52","author":"Bozdag","year":"2024","journal-title":"J. Int. Med. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1089\/thy.2016.0635","article-title":"Multiple nutritional factors and the risk of Hashimoto\u2019s thyroiditis","volume":"27","author":"Hu","year":"2017","journal-title":"Thyroid"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ihnatowicz, P., W\u0105tor, P., G\u0119bski, J., Fr\u0105ckiewicz, J., and Drywie\u0144, M.E. (2021). Are Nutritional Patterns among Polish Hashimoto Thyroiditis Patients Differentiated Internally and Related to Ailments and Other Diseases?. Nutrients, 13.","DOI":"10.3390\/nu13113675"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"90","DOI":"10.5604\/17322693.1136383","article-title":"Metabolic disorders and nutritional status in autoimmune thyroid diseases","volume":"69","author":"Kawicka","year":"2015","journal-title":"Postep. Hig. Med. Dosw."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102649","DOI":"10.1016\/j.autrev.2020.102649","article-title":"Hashimoto\u2019s thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation","volume":"19","author":"Ralli","year":"2020","journal-title":"Autoimmun. Rev."},{"key":"ref_13","first-page":"38","article-title":"CONUT: A tool for controlling nutritional status. First validation in a hospital population","volume":"20","author":"Mancha","year":"2005","journal-title":"Nutr. Hosp."},{"key":"ref_14","first-page":"1001","article-title":"Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients","volume":"85","author":"Onodera","year":"1984","journal-title":"Nihon Geka Gakkai Zasshi"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_16","unstructured":"World Health Organization (2000). Obesity: Preventing and Managing the Global Epidemic, Report of a WHO Consultation, WHO Technical Report Series 894."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Nishikawa, H., Yoh, K., Enomoto, H., Ishii, N., Iwata, Y., Takata, R., Nishimura, T., Aizawa, N., Sakai, Y., and Ikeda, N. (2018). The relationship between controlling nutritional (CONUT) score and clinical markers among adults with hepatitis C virus related liver cirrhosis. Nutrients, 10.","DOI":"10.3390\/nu10091185"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bo, Y., Wang, K., Liu, Y., You, J., Cui, H., Zhu, Y., Lu, Q., and Yuan, L. (2016). The geriatric nutritional risk index predicts survival in elderly esophageal squamous cell carcinoma patients with radiotherapy. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155903"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and \u03b2-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/nbu.12108","article-title":"Vitamin D: An overview of vitamin D status and intake in Europe","volume":"39","author":"Spiro","year":"2014","journal-title":"Nutr. Bull."},{"key":"ref_21","unstructured":"Van Rossum, G., and Drake, F.L. (2014). The Python Language Reference, Python Software Foundation."},{"key":"ref_22","unstructured":"The Pandas Development Team (2025). pandas-dev\/pandas: Pandas, version 2.3.3. Zenodo."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1038\/s41586-020-2649-2","article-title":"Array programming with NumPy","volume":"585","author":"Harris","year":"2020","journal-title":"Nature"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/biomet\/52.3-4.591","article-title":"An analysis of variance test for normality (complete samples)","volume":"52","author":"Shapiro","year":"1965","journal-title":"Biometrika"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1214\/aoms\/1177730491","article-title":"On a test of whether one of two random variables is stochastically larger than the other","volume":"18","author":"Mann","year":"1947","journal-title":"Ann. Math. Stat."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/01621459.1952.10483441","article-title":"Use of ranks in one-criterion variance analysis","volume":"47","author":"Kruskal","year":"1952","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_27","unstructured":"Zar, J.H. (2010). Biostatistical Analysis, Pearson Prentice-Hall. [5th ed.]."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/00401706.1964.10490181","article-title":"Multiple comparisons using rank sums","volume":"6","author":"Dunn","year":"1964","journal-title":"Technometrics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"72","DOI":"10.2307\/1412159","article-title":"The proof and measurement of association between two things","volume":"15","author":"Spearman","year":"1904","journal-title":"Am. J. Psychol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.21105\/joss.03021","article-title":"Seaborn: Statistical data visualization","volume":"6","author":"Waskom","year":"2021","journal-title":"J. Open Source Softw."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1109\/MCSE.2007.55","article-title":"Matplotlib: A 2D graphics environment","volume":"9","author":"Hunter","year":"2007","journal-title":"Comput. Sci. Eng."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: Fundamental algorithms for scientific computing in Python","volume":"17","author":"Virtanen","year":"2020","journal-title":"Nat. Methods"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"92","DOI":"10.25080\/Majora-92bf1922-011","article-title":"Statsmodels: Econometric and statistical modeling with python","volume":"7","author":"Seabold","year":"2010","journal-title":"Scipy"},{"key":"ref_34","first-page":"16222","article-title":"Hashimoto thyroiditis: An evidence-based guide to etiology, diagnosis and treatment","volume":"132","author":"Wartofsky","year":"2022","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Song, R.-H., Wang, B., Yao, Q.-M., Li, Q., Jia, X., and Zhang, J.-A. (2019). The impact of obesity on thyroid autoimmunity and dysfunction: A systematic review and meta-analysis. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.02349"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s00394-019-01991-w","article-title":"Serum 25-hydoxyvitamin D concentrations in relation to Hashimoto\u2019s thyroiditis: A systematic review, meta-analysis and meta-regression of observational studies","volume":"59","year":"2020","journal-title":"Eur. J. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"479","DOI":"10.4158\/EP12376.OR","article-title":"The association between severity of vitamin D deficiency and Hashimoto\u2019s thyroiditis","volume":"19","author":"Bozkurt","year":"2013","journal-title":"Endocr. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e36759","DOI":"10.1097\/MD.0000000000036759","article-title":"Effects of vitamin D supplementation on autoantibodies and thyroid function in patients with Hashimoto\u2019s thyroiditis: A systematic review and meta-analysis","volume":"102","author":"Tang","year":"2023","journal-title":"Medicine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"03000605211060675","DOI":"10.1177\/03000605211060675","article-title":"Effects of vitamin D on thyroid autoimmunity markers in Hashimoto\u2019s thyroiditis: Systematic review and meta-analysis","volume":"49","author":"Zhang","year":"2021","journal-title":"J. Int. Med. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1111\/jcpt.13605","article-title":"Effects of vitamin D treatment on thyroid function and autoimmunity markers in patients with Hashimoto\u2019s thyroiditis\u2014A meta-analysis of randomized controlled trials","volume":"47","author":"Jiang","year":"2022","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1590\/1806-9282.63.12.1065","article-title":"Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto\u2019s thyroiditis","volume":"63","author":"Aktas","year":"2017","journal-title":"Rev. Assoc. M\u00e9d. Bras."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1055\/a-0723-3441","article-title":"Neutrophil-and platelet-to lymphocyte ratio in patients with euthyroid hashimoto\u2019s thyroiditis","volume":"127","author":"Bilge","year":"2019","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Alijani, S., Ghadir, M., and Gargari, B.P. (2024). The association between dietary inflammatory index and dietary total antioxidant capacity and Hashimoto\u2019s thyroiditis: A case-control study. BMC Endocr. Disord., 24.","DOI":"10.1186\/s12902-024-01708-z"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1089\/thy.2020.0299","article-title":"Influence of dietary habits on oxidative stress markers in Hashimoto\u2019s thyroiditis","volume":"31","author":"Ruggeri","year":"2021","journal-title":"Thyroid"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1139\/apnm-2024-0164","article-title":"The relationship between nutritional status and thyroid function among adults in the USA: NHANES 2007\u20132012","volume":"49","author":"Liu","year":"2024","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Gong, B., Wang, C., Meng, F., Wang, H., Song, B., Yang, Y., and Shan, Z. (2021). Association between gut microbiota and autoimmune thyroid disease: A systematic review and meta-analysis. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.774362"},{"key":"ref_47","first-page":"819","article-title":"Obesity rather than metabolic syndrome is a risk factor for subclinical hypothyroidism and thyroid autoimmunity","volume":"34","author":"Yao","year":"2021","journal-title":"Biomed. Environ. Sci."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/11\/1698\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T16:25:06Z","timestamp":1779812706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/11\/1698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":47,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18111698"],"URL":"https:\/\/doi.org\/10.3390\/nu18111698","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]}}}