Patient-reported outcome measures after non-diffractive extended range of field IOL implantation: PureSee versus Vivity.

Autoimmune thyroiditis, commonly referred to as Hashimoto’s disease, is recognized as one of the most prevalent human disorders, the most frequent organ-specific autoimmune condition, and the primary cause of hypothyroidism (excluding regions affected by iodine deficiency) [,]. The disease is characterized by antibody-mediated cytotoxicity and programmed cell death, leading to the gradual destruction of thyroid follicular cells. Consequently, normal thyroid parenchyma is progressively replaced by lymphocytic infiltration and fibrotic tissue deposition []. One of the less well-recognized complications of autoimmune thyroiditis is sexual dysfunction, which is more frequently observed in women, who represent the majority of affected patients. Although more pronounced in the presence of hypothyroidism, sexual dysfunction may already occur in the euthyroid stage [,]. In such cases, it may be associated with increased production of pro-inflammatory mediators, subtle alterations in thyroid function, inadequate micronutrient intake, and/or reduced testosterone levels []. However, the possibility of confounding effects of nonspecific factors, including dysmenorrhea, smoking, stress, and traumatic life experiences, in these studies cannot be completely excluded. Autoimmune thyroiditis development and progression have been linked recently to altered vitamin D (calciferol) homeostasis. Patients with autoimmune thyroid disease exhibit a higher prevalence of vitamin D deficiency than healthy individuals or those with other endocrine disorders [] and display lower mean 25-hydroxyvitamin D (25OHD) levels []. Vitamin D deficiency severity correlates directly with thyroid peroxidase antibody (TPOAb) titers, Hashimoto’s thyroiditis duration, and thyroid gland volume []. Supplementation significantly reduces TPOAb and thyroglobulin antibody (TgAb) titers, an effect that intensifies over time [,]. The beneficial effect of vitamin D is likely mediated by regulated dendritic cell maturation and inhibited antigen presentation, which curtail self-reactive T-cell activation []. Consequently, adequate vitamin D levels promote immune tolerance, directly controlling thyroid autoimmunity []. Vitamin D deficiency appears to be associated with sexual dysfunction, with the risk increasing as the degree of deficiency increases [,]. The beneficial effects of exogenous vitamin D on sexual function in women of reproductive age suggest that this dysfunction may be reversible. Improvements were reported both in women with isolated vitamin D deficiency and in those with vitamin D deficiency coexisting with polyendocrine metabolic ovarian syndrome following administration of high doses of this vitamin (an average of 50,000 IU per week) [,,]. In patients with autoimmune thyroiditis, the beneficial effects of moderate doses of vitamin D (4000 IU daily) were observed regardless of baseline vitamin D status and were more pronounced than those associated with other management options for this condition, namely selenomethionine and myo-inositol []. However, it remains unknown whether these effects are modified by other modifiable lifestyle factors.