Efficacy of Vitamin-D Supplement on Thyroid Profile in Children with Graves’ Disease

Winra Pratita; Karina Sugih Arto; Nindia Sugih Arto

doi:10.3889/oamjms.2020.4790

Authors

Winra Pratita Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Medan 20136, North Sumatera, Indonesia
Karina Sugih Arto Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Medan 20136, North Sumatera, Indonesia
Nindia Sugih Arto Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan 20136, North Sumatera, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.4790

Keywords:

Efficacy, Graves’ disease, Vitamin-D

Abstract

BACKGROUND: Many studies have shown low Vitamin-D level as a risk factor for autoimmune diseases, especially multiple sclerosis and thyroid disease. Graves’ disease (GD) is an autoimmune disease caused by autoantibodies that stimulate thyroid-stimulating hormone (TSH) receptors by increasing thyroid hormone synthesis and secretion. Several studies report that many patients with autoimmune thyroid disease including GD have low Vitamin-D status.

AIM: The objective of the study was to evaluate the effect of Vitamin-D supplement on GD patients on improvement in thyroid hormone levels.

METHODS: Open random clinical trial was conducted in GD patients to determine changes in thyroid hormone to achieving normal levels between those receiving methimazole plus Vitamin-D supplementation compared with those who only received methimazole. Patients were checked for TSH receptor antibody, thyroid profile and Vitamin-D level before treatment and rechecked for thyroid profile and Vitamin-D level 3 months after treatment. t-test used to compare the drug efficacy (p < 0.05) in two groups.

RESULTS: From 25 children with GD accompanied by Vitamin-D deficiency with an average value of Vitamin-D was 16 ng/mL. GD children who receive methimazole with Vitamin-D supplement had elevated TSH levels in the 3^rdmonth of therapy that was significantly different compared to GD children who received methimazole only (p = 0.00), and the increase of TSH was also followed by an increase in Vitamin-D levels.

CONCLUSION: All children with GD had Vitamin D deficiency, and the addition of Vitamin-D supplement to GD therapy would improve TSH faster than children who did not receive Vitamin-D supplement.

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References

Liu J, Fu J, Xu Y, Wang G. Antithyroid drug therapy for graves’ disease and implications for recurrence. Int J Endocrinol. 2017;2017:3813540. PMid:28529524

Sato H, Minagawa M, Sasaki N, Sugihara S, Kazukawa I, Minamitani K, et al. Comparison of methimazole and propylthiouracil in the management of children and adolescents with Graves ’ disease: Efficacy and adverse reactions during initial treatment and long-term outcome. J Pediatr Endocrinol Metab. 2011;24(5-6):257-63. https://doi.org/10.1515/jpem.2011.194 PMid:21823520

Wacker M, Holick FM. Sunlight and Vitamin D: A global perspective for health. Dermatoendocrinology. 2013;5(1):51-108. PMid:24494042

Wang J, Shishi LV, Guo C, Chenlin G, Jianhua H, Haihua Z. Meta-analysis of the association between Vitamin D and autoimmune thyroid disease. Nutrients. 2015;7(4):2485-98. PMid:25854833

Tani TK, Fukawa E, Tanaka H, Abe Y, Makino I. Effect of l alpha-hydroxyvitamin D3 on serum levels of thyroid hormones in hyperthyroid patients with untreated graves’ disease. Metabolism. 1997;46(10):1184-8. https://doi.org/10.1016/ s0026-0495(97)90214-6 PMid:9322804

Deliana M, Hakimi H, Batubara JR. Hipertiroid. In: Batubara JR, Tridjaja B, Pulungan AB, editors. Buku Ajar Endokrinologi Anak. Jakarta: Ikatan Dokter Anak Indonesia; 2018. p. 295-302. https://doi.org/10.14238/sp5.3.2003.111-6

Verstuyf A, Carmeliet G, Bouillon R, Mathieu C. Vitamin D: A pleiotropic hormone. Kidney International. 2010;78(2):140-5. https://doi.org/10.1038/ki.2010.17. PMid:20182414

Sheriba NA, Abeer A, Maram MM, Ahmed MB, Nesma AI, Dina AM. Effect of Vitamin-D3 in treating hyperthyroidism in patients with graves disease. Egypt J Intern Med. 2017;29(2):64-70.

Mirhosseini N, Ludovi B, Giovanna M, Samantha K. Physiological serum 25-hydroxyvitamin-D concentrations are associated with improved thyroid function-observations from a community-based program. Endocrine. 2017;58(3):563-73. https://doi.org/10.1007/s12020-017-1450-y PMid:29067607

D’Aurizio F, Villalta D, Metus P, Doretto P, Tozzoli R. Vitamin D is a player or not in the pathophysiology of autoimmune thyroid diseases? Autoimmun Rev. 2014;19:1-7. https://doi. org/10.1016/j.autrev.2014.10.008

Simsek Y, Cakir I, Yetmis M, Dizdar OS, Baspinar O, Gokay F. Effects of Vitamin D treatment on thyroid autoimmunity. J Res Med Sci. 2016;21:92 https://doi.org/10.4103/1735-1995.192501 PMid:28163731

Kivity S, Nancy AL, Michael Z, Yinon S, Endre VN, Katalin D. Vitamin-D and autoimmune thyroid diseases. Cell Mol Immunol. 2011;8(3):243-7. PMid:21278761

Camurdan OM, Döğer E, Bideci A, Celik N, Cinaz P. Vitamin D status in children with Hashimoto thyroiditis. J Pediatr Endocrinol Metab. 2012;25(5-6):467-70. https://doi.org/10.1515/ jpem-2012-0021 PMid:22876540

Veenendaal NR, Scott AR. Treatment of pediatric graves disease is associated with excessive weight gain. J Clin Endocrinol Metab. 2011;96(10):3257-63. PMid:21849528

Faizi M. Penatalaksanaan Hipertiroid Pada Anak. Surabaya: Opernurika Creative Multimedia and Presentations and Divisions; 2006.

Berg JP, Sandvik JA, Ree AH, Sornes G, Bjoro T, Torjesen PA, et al. 1,25-dihydroxyvitamin D3 attenuates adenylyl cyclase activity in rat thyroid cells: Reduction of thyrotropin receptor number and increase in guanine nucleotide binding protein Gi_2a. Endocrinology. 1994;135:595-602.