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[7] Clinicians should exercise extreme caution in advanced chronic kidney disease or sarcoidosis, tuberculosis, and other granulomatous disorders where extrarenal 1-hydroxylase activity can generate excess calcitriol and precipitate hypercalcaemia even at modest serum 25-hydroxyvitamin D concentrations

Rarely, individuals may experience dizziness or mild itching

The senior study author proposed this scenario would cause, hypothyroidism in muscle, with poor activation of the mitochondria and consequently low ATP levels (explaining fatigue and PEM). Further study is needed, but the authors suggested that selenium supplements plus pure T3 could be helpful

This BtrG/GCT fold distinguishes these enzymes from others exhibiting cyclotransferase-like activity (Oakley et al., 2008)