Effects of Vitamin D Supplementation on Muscle Function in Graves’ Disease Patients: Vitamin D Supplementation in Graves’ Disease

Sadia Kazi; Saif Ur Rehman; Mozna  Talpur; Shuja Anwar  Kazi; Shahid   Shakeel; Shahnaz  Bano

doi:10.36283/ziun-pjmd13-4/017

Authors

Sadia Kazi Isra University, Hyderabad https://orcid.org/0009-0002-0901-3783
Saif Ur Rehman FMDC
Mozna Talpur Isra University, Hyderabad
Shuja Anwar Kazi College of Medicine, King Faisal University
Shahid Shakeel FMDC, Abbottabad
Shahnaz Bano Isra University, Hyderabad

DOI:

https://doi.org/10.36283/ziun-pjmd13-4/017

Keywords:

Graves’ Disease, Muscle Strength, Range of Motion, Vitamin D

Abstract

Background: Lack of vitamin D and Graves' disease are linked to the decrement in quality of life (QoL) and weakening of the muscle groups. The goal of study report was to discover at the possible advantages of vitamin D supplementation for the improvement of thyroid-related QoL and muscle function in GD patients.

Method: A single-blinded randomized controlled trial was conducted at King Abdullah Hospital in Mansehra Hospital in Abbottabad. The trial was carried out from January 1, 2021, to January 1, 2022. This study was carried out on 48 participants recruited via the envelop method of simple random sampling technique who had been diagnosed with Graves' disease. The participants were divided into two groups n=24 in each group. In summation to standard ATD, Groups received either a placebo or received 70 μg (2800 IU) of vitamin D daily. We measured muscular function and isometric strength at baseline, at three, and nine months, whereas QoL was measured at baseline and 9 months. Data was analyzed using SPSS. Paired sample t-test was run for within-group analysis whereas an independent sample t-test was applied for between-group comparison. Statistics were deemed significant when P <0.05.

Results: From baseline to the three- and nine-month follow-ups, both groups showed significant gains in hand grip strength, elbow flexion and extension, and knee flexion and extension at 60° and 90° angles (p=0.001). Comparison between group showed an increased mean difference with p <0.001 from baseline to 9 months. For Quality of Life the results were significantly improved in vitamin D group for Goiter Symptoms (p=0.045), Hypothyroid Symptoms (p=0.027), Tiredness (0.032), Emotional Susceptibility (p=0.011), and Social and Work Impact respectively (p=0.034).

Conclusion: Vitamin D supplementation appears to enhance muscle function and thyroid-related quality of life (QoL) in patients with Graves' disease. It significantly improves muscle strength compared to placebo.

Author Biographies

Sadia Kazi, Isra University, Hyderabad

Pharmacology Department
Saif Ur Rehman , FMDC

Associate Professor of Physiology
Mozna Talpur, Isra University, Hyderabad

Associate Professor, Department of Pharmacology
Shuja Anwar Kazi, College of Medicine, King Faisal University

Assistant Professor ,Department of Biomedical Sciences,
Shahid Shakeel, FMDC, Abbottabad

Assistant Professor Department of Medicine
Shahnaz Bano, Isra University, Hyderabad

Assistant Professor, Department of Pharmacology

References

Meng F, Li E, Yen PM, Leow MK. Hyperthyroidism in the personalized medicine era: The rise of mathematical optimization. Journal of the Royal Society Interface. 2019 Jun 28;16(155):20190083. https://doi.org/10.1098/rsif.2019.0083.

Wisnu W, Alwi I, Nafrialdi N, Harimurti K, Pemayun TG, Jusman SW, Santoso DI, Harahap AR, Suwarto S, Subekti I. The differential effects of propylthiouracil and methimazole as graves’ disease treatment on vascular atherosclerosis markers: a randomized clinical trial. Frontiers in Endocrinology. 2021 Dec 20;12:796194. https://doi.org/10.3389/fendo.2021.796194.

Weetman AP. Graves' disease. New England Journal of Medicine. 2000 Oct 26;343(17):1236-48. DOI: 10.1056/NEJM200010263431707.

Ferrari SM, Ruffilli I, Elia G, Ragusa F, Paparo SR, Patrizio A, Mazzi V, Antonelli A, Fallahi P. Chemokines in hyperthyroidism. Journal of clinical & translational endocrinology. 2019 Jun 1;16:100196. https://doi.org/10.1016/j.jcte.2019.100196.

Davies TF, Andersen S, Latif R, Nagayama Y, Barbesino G, Brito M, Eckstein AK, Stagnaro-Green A, Kahaly GJ. Graves’ disease. Nature reviews Disease primers. 2020 Jul 2;6(1):1-23. https://doi.org/10.1038/s41572-020-0184-y.

Hyperthyroidism. https://www.niddk.nih.gov./health-information/endocrine-diseases/hyperthyroidism.

Azizi F, Amouzegar A, Tohidi M, Hedayati M, Cheraghi L, Mehrabi Y. Systemic thyroid hormone status in treated Graves’ disease. International Journal of Endocrinology and Metabolism. 2019 Oct;17(4). https://doi.org/10.5812%2Fijem.95385.

Bloise FF, Cordeiro A, Ortiga-Carvalho TM. Role of thyroid hormone in skeletal muscle physiology. Journal of Endocrinology. 2018 Jan 1;236(1): R57-68. https://doi.org/10.1530/JOE-16-0611.

Brennan MD, Powell C, Kaufman KR, Sun PC, Bahn RS, Nair KS. The impact of overt and subclinical hyperthyroidism on skeletal muscle. Thyroid. 2006 Apr 1;16(4):375-80. https://doi.org/10.1089/thy.2006.16.375.

Johansson B, Holmberg M, Skau S, Malmgren H, Nyström HF. The relationship between mental fatigue, depression, and cognition in Graves’ disease. European Thyroid Journal. 2023 Jul 12;12(4). https://doi.org/10.1530/ETJ-23-0040.

Saponaro F, Saba A, Zucchi R. An update on vitamin D metabolism. International journal of molecular sciences. 2020 Sep 8;21(18):6573. https://doi.org/10.3390/ijms21186573.

Romeu Montenegro K, Amarante Pufal M, Newsholme P. Vitamin D supplementation and impact on skeletal muscle function in cell and animal models and an aging population: what do we know so Far? Nutrients. 2021 Mar 28;13(4):1110. https://doi.org/10.3390/nu13041110.

Krasniqi E, Boshnjaku A, Ukëhaxhaj A, Wagner KH, Wessner B. Association between vitamin D status, physical performance, sex, and lifestyle factors: a cross-sectional study of community-dwelling Kosovar adults aged 40 years and older. European Journal of Nutrition. 2024 Jan 9:1-4. https://doi.org/10.1007/s00394-023-03303-9.

Grove-Laugesen D, Cramon PK, Malmstroem S, Ebbehoj E, Watt T, Hansen KW, Rejnmark L. Effects of supplemental vitamin D on muscle performance and quality of life in Graves' disease: a randomized clinical trial. Thyroid. 2020 May 1;30(5):661-71. https://doi.org/10.1089/thy.2019.0634.

Alhuzaim ON, Aljohani N. Effect of vitamin d3 on untreated graves' disease with vitamin d deficiency. Clinical Medicine Insights: Case Reports. 2014 Jan;7: CCRep-S13157. https://doi.org/10.4137/CCRep.S13157.

Antonelli A, Ferrari SM, Ragusa F, Elia G, Paparo SR, Ruffilli I, Patrizio A, Giusti C, Gonnella D, Cristaudo A, Foddis R. Graves’ disease: Epidemiology, genetic and environmental risk factors and viruses. Best practice & research Clinical endocrinology & metabolism. 2020 Jan 1;34(1):101387. https://doi.org/10.1016/j.beem.2020.101387.

Fukao A, Takamatsu J, Arishima T, Tanaka M, Kawai T, Okamoto Y, Miyauchi A, Imagawa A. Graves’ disease and mental disorders. Journal of clinical & translational endocrinology. 2020 Mar 1;19:100207. https://doi.org/10.1016/j.jcte.2019.100207.

Kahaly GJ. Management of Graves thyroidal and extrathyroidal disease: an update. The Journal of Clinical Endocrinology & Metabolism. 2020 Dec;105(12):3704-20. https://doi.org/10.1210/clinem/dgaa646.

Setoyama D, Lee HY, Moon JS, Tian J, Kang YE, Lee JH, Shong M, Kang D, Yi HS. Immunometabolic signatures predict recovery from thyrotoxic myopathy in patients with Graves' disease. Journal of cachexia, sarcopenia and muscle. 2022 Feb;13(1):355-67. https://doi.org/10.1002/jcsm.12889.

Hedberg F, Falhammar H, Calissendorff J, Bränström R. Surgical outcome after thyroidectomy due to Graves’ disease and Lugol iodine treatment: a retrospective register-based cohort study. Endocrine. 2024 Feb 2:1-7. https://doi.org/10.1007/s12020-024-03708-4.

Zhang Y, Chen Y, Lin L, Shen X, Zhao F, Yan S. A Beneficial Levels of 25-hydroxyvitamin D for a Decrease in thyrotropin receptor antibody (TRAB) in Patients with Graves' Disease: A Real-World Study. https://doi.org/10.21203/rs.3.rs-3665456/v1.

Ghanam MM, Abouelmagd M, Mesbah A, Shaaban AN, Shaaban NM. Vitamin D Level in Graves’ Disease and Effect of Vitamin D Supplements on Associated Autoimmunity. The Egyptian Journal of Hospital Medicine (January 2024).;94:456-64. DOI: 10.21608/ejhm.2024.338763.

De Oliveira Gomes RG. Major considerations and outcomes of clinical trials of vitamin D in athlete performance: a systematic review. International Journal of Nutrology. 2023 Mar 17;16(2). https://doi.org/10.54448/ijn23202.

Das A, Jawla N, Meena V, Gopinath SD, Arimbasseri GA. Lack of vitamin D signalling shifts skeletal muscles towards oxidative metabolism. Journal of Cachexia, Sarcopenia and Muscle. 2024 Feb;15(1):67-80. https://doi.org/10.1002/jcsm.13378.

Bass JJ, Nakhuda A, Deane CS, Brook MS, Wilkinson DJ, Phillips BE, Philp A, Tarum J, Kadi F, Andersen D, Garcia AM. Overexpression of the vitamin D receptor (VDR) induces skeletal muscle hypertrophy. Molecular metabolism. 2020 Dec 1; 42:101059. https://doi.org/10.1016/j.molmet.2020.101059.