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Effect of vitamin D3 in treating hyperthyroidism in patients with graves’ disease

The Egyptian Journal of Internal Medicine volume 29, pages 64–70 (2017)Cite this article

Abstract

Background

Graves’ disease (GD) is an autoimmune disease characterized by hyperthyroidism secondary to circulating autoantibodies. Multiple factors contributed to its etiology, including genetic and environmental factors. The role of vitamin D is well-known in calcium metabolism and skeletal homeostasis. Vitamin D was shown to be a modulator in both innate and adaptive immunity. There is a link between vitamin D deficiency and various autoimmune diseases. The prevalence of vitamin D deficiency was reported to be common in patients with GD. Interestingly, vitamin D deficiency is found to be associated with higher thyroid volume in patients with newly-onset GD. However, vitamin D deficiency relationship with GD remains a controversial issue.

Objective

The objective of this study was to evaluate the effect of vitamin D supplementation in GD with and without ophthalmopathy.

Patients and methods

A randomized prospective study was conducted on 60 adult patients with GD aged 20–40 years. Group 1 comprised 20 patients with GD receiving a daily dose of 30 mg of methimazole alone. Group 2 comprised 40 patients with GD receiving the same dose of methimazole, supplemented with intramuscular injection of vitamin D3 200 000 IU/month for 3 months. Patients were followed up over a 3-month duration.

Results

There was hypovitaminosis D in all participants with a percentage of vitamin D deficiency (vitamin D level: <20 ng/ml) of 73.9% in male and 54.1% in female and a vitamin D insufficiency (vitamin D level: 20–29 ng/ml) of 26.1% in male and 45.9% in female. Vitamin D was significantly correlated with thyroid volume and degree of exophthalmos. On vitamin D supplementation, group 2 had significantly lower thyroid volume and better effect on the degree of exophthalmos.

Conclusion

Vitamin D supplementation for GD has a favorable effect on thyroid volume and on the degree of exophthalmos.

References

  1. Adams JS, Hewison M. Unexpected actions of vitamin D: new perspectives on the regulation ofinnate and adaptive immunity. Nat Clin Pract Endocrinol Metab 2008; 4:80–90.

    Article  CAS  Google Scholar 

  2. Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol 2010; 10: 482–496.

    Article  CAS  Google Scholar 

  3. Menconi F, Marcocci C, Marino M. Diagnosis and classification of Graves’ disease. Autoimmun Rev 2014; 13:398–402.

    Article  Google Scholar 

  4. Jyotsna VP, Sahoo A, Ksh SA, Sreenivas V., Gupta N. Bone mineral density in patients of Graves’ disease pre- & post-treatment in a predominantly vitamin D deficient population. Indian J Med Res 2012; 135:36–41.

    Article  CAS  Google Scholar 

  5. Li Y-B, Xue X-H, Liu S-W, XiG-X, Zhao L-X, Zhang X-L. Clinical research of serum vitamin D in early Graves’ disease. Chin Rem Clin 2014; 14: 242–243.

    CAS  Google Scholar 

  6. Liu X-H. Correlation between serum level of 25-(OH)D3 and humoral immunity in patients with autoimmune thyroid diseases [Master’s thesis]. Zhengzhou, China: Zhengzhou University; 2012.

  7. Miao W, Ma J, Guo R, Wang Y-J, Wang G, Guan H-X. Research about the correlation between serum 25(OH)D with Graves’ disease. Chin J Pract Intern Med 2013; 33:394–395.

    CAS  Google Scholar 

  8. Wang Y-C. Analysis of the relationship between 25(OH)D, IGF-1 and bone metabolism in patients with Graves’ Disease [Master’s thesis]. Hefei, China: Anhui Medical University; 2014.

  9. Wang Z-S, Song Q-H, Wu Y-P, Chen H, Tan L-L, Sun S-H. Changes of biochemical markers of bone turnover in patients with Graves’ disease. Tianjin Med J 2014; 42:683–686.

    CAS  Google Scholar 

  10. Xuan L-Y. The study on the relation between vitamin D and sFas in patients with autoimmune thyroid diseases [Master’s thesis]. Nanchang, China: Nanchang University; 2014.

  11. Yasuda T, Okamoto Y, Hamada N, Miyashita K, Takahara M, Sakamoto F, et al. Serum vitamin D levels are decreased in patients without remission of Graves’ disease. Endocrine 2013; 43:230–232.

    Article  CAS  Google Scholar 

  12. Zhang H, Liang L, Xie Z. Low vitamin D status is associated with increased thyrotropin-receptor antibody titer in Graves’ disease. Endocr Pract 2015; 21:258–263.

    Article  Google Scholar 

  13. Kang D-H, Wang Y, Cao W, Wang P, Zhang H-M. Higher prevalence of vitamin D deficiency in female patients with Graves’ disease. Acta Nutr Sin 2013; 25:299–301.

    Google Scholar 

  14. Kivity S, Agmon-Levin N, Zisappl M, Shapira Y, Nagy EV, Danko K, et al. Vitamin D and autoimmune thyroid diseases. Cell Mol Immunol 2011; 8:243–247.

    Article  CAS  Google Scholar 

  15. Yamashita H, Noguchi S, Takatsu K, Koike E, Murakami T, Watanabe S, et al. High prevalence of vitamin D deficiency in Japanese female patients with Graves’ disease. Endocr J 2001; 58:63–69.

    Article  Google Scholar 

  16. Yasuda T, Okamoto Y, Hamada N, Miyashita K, Takahara M, Sakamoto F, et al. Serum vitamin D levels are decreased and associated with thyroid volume in female patients with newly onset Graves’ disease. Endocrine 2012; 42:739–741.

    Article  CAS  Google Scholar 

  17. Feng M, Li H, Chen SF, Li WF, Zhang FB. Polymorphisms in the vitamin D receptor gene and risk of autoimmune thyroid diseases: a meta-analysis. Endocrine 2013; 43:318–326.

    Article  CAS  Google Scholar 

  18. Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Surks MI, et al. Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. Arch Intern Med 2007; 167:1533–1538.

    Article  CAS  Google Scholar 

  19. Yue B, Rockwood AL, Sandrock T, et al. Free thyroid hormones in serum by equilibrium dialysis and online solid-phase extraction-liquid chromatography/ tandem mass spectrometry. Clin Chem 2008; 54:642–651.

    Article  CAS  Google Scholar 

  20. Scharla SH. Prevalence of subclinical vitamin D deficiency in different European countries. Osteoporos Int 1998; 8(Suppl 2):S7–S12.

  21. Sadat-Ali M, AlElq A, Al-Turki H, Al-Mulhim F, Al-Ali A. Vitamin D level in healthy men in eastern Saudi Arabia. Ann Saudi Med 2009; 29:378–382.

    Article  Google Scholar 

  22. Chaudhary V, Bano S. Thyroid ultrasound. Indian J Endocrinol Metab 2013; 17:219–227.

    Article  Google Scholar 

  23. Sheriba N, Abu Shady MM, Abdelsalam MM, Eliwa TF. Vitamin D levels in Graves’ disease with and without exophthalmos: a case control study. Endocr Abstr 2016; 41:EP1004.

  24. Goswami R, Marwaha RK, Gupta N, Tandon N, Sreenivas V, Tomar N, et al. Prevalence of vitamin D deficiency and its relationships with thyroid autoimmunity in Asian Indians: a community-based survey. Br J Nutr 2009; 102:382–386.

    Article  CAS  Google Scholar 

  25. Lahooti H, Wise B, Tjiang H, Champion B, Wall J. Vitamin D deficiency may be a risk factor for ophthalmopathy in patients with Graves’ hyperthyroidism but not Hashimoto’s thyroiditis. Ophthalmol Res 2014; 2:10–17.

    Google Scholar 

  26. Effraimidis G, Badenhoop K, Tijssen JG, Wiersinga WM. Vitamin D deficiency is not associated with early stages of thyroid autoimmunity. Eur J Endocrinol 2012; 167:43–48.

    Article  CAS  Google Scholar 

  27. Arabi A, Baddoura R, El-Rassi R, El-Hajj Fuleihan G. XXXXX. J Bone 2010; 47:408–412.

    Article  CAS  Google Scholar 

  28. Vieth R, Ladak Y, Walsh PG. Age-related changesin the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 2003; 88:185–191.

    Article  CAS  Google Scholar 

  29. Mac Laughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985; 76:1536–1538.

    Article  CAS  Google Scholar 

  30. Nasri H, Baradaran A, Behradmanesh S. Association of body mass index and serum vitamin D level in healthy Iranian adolescents. Endokrynol Pol 2012; 63:29–33.

    PubMed  Google Scholar 

  31. Saneei P, Salehi-Abargouei A, Esmaillzadeh A. Serum 25-hydroxy vitamin D levels in relation to body mass index: a systematic review and meta-analysis. Obes Rev 2013; 14:393–404.

    Article  CAS  Google Scholar 

  32. Abou-Samra A, Valiña-Tóth AL, Lai Z, Yoo W, Gadegbeku CA, Flack JM. Relationship of vitamin D and parathyroid hormone to obesity and body composition in African Americans. Clin Endocrinol (Oxf) 2010; 72:595–603.

    Article  Google Scholar 

  33. Atli T, Gullu S, Uysal AR, Erdogan G. The prevalence of vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population. Arch Gerontol Geriatr 2005; 40:53–60.

    Article  CAS  Google Scholar 

  34. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 2000; 72:694–701.

    Article  CAS  Google Scholar 

  35. Winsa B, Mandahl A, Karlsson FA. Graves’ disease. Endocrine ophthalmopathy and smoking. Acta Endocrinol (Copenh) 1993; 128:156–160.

    CAS  Google Scholar 

  36. Bertelsen JB, Hegedus L. Cigarette smoking and the thyroid. Thyroid 1994; 4:327–331.

    Article  CAS  Google Scholar 

  37. Fukawa E, Kawakami-Tani T, Tanaka H, Abe Y, Makino I. Effect of 1α-hydroxy vitamin D3 on serum levels of thyroid hormones in hyperthyroid patients with untreated Graves’ disease. Metabolism 1997; 46:1184–1188.

    Article  Google Scholar 

  38. Mackawy AM, Al-Ayed BM, Al-Rashidi BM. Vitamin D deficiency and its association with thyroid disease. Int J Health Sci (Qassim) 2013; 7:267–275.

    Article  Google Scholar 

  39. Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B. High vitamin D status in younger individuals is associated with low circulating thyrotropin. Thyroid 2013; 23:25–30.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Ain Shams University, 31 Police Building, Kornish El-Nile, Al Maadi, Cairo, Egypt

    Nermin A. Sheriba, Abeer A. A. Elewa PhD, Maram M. Mahdy, Ahmed M. Bahaa El Din, Nesma A. Ibrahim & Dina A. Marawan

  2. Department of Biochemistry, Ain Shams University, Cairo, Egypt

    Tahany M. Abd El Moneim

Authors
  1. Nermin A. Sheriba
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  2. Abeer A. A. Elewa PhD
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  3. Maram M. Mahdy
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  4. Ahmed M. Bahaa El Din
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Correspondence to Abeer A. A. Elewa PhD.

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Sheriba, N.A., Elewa, A.A.A., Mahdy, M.M. et al. Effect of vitamin D3 in treating hyperthyroidism in patients with graves’ disease. Egypt J Intern Med 29, 64–70 (2017). https://doi.org/10.4103/ejim.ejim_10_17

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