Selenium in the treatment of autoimmune thyroiditis

Journal of Endocrinology, 2006

The aim of this study is to investigate the long-term (9 months) effects of variable doses (200/100 mg/day) of L-selenomethionine on autoimmune thyroiditis (AIT) and the parameters affecting the success rate of this therapy. The present study was designed in three steps: (1) 88 female patients with AIT (mean ageZ40$1G13$3 years) were randomized into two groups according to their initial serum TSH, thyroid peroxidase antibody (TPOAb) concentrations, and age. All the patients were receiving L-thyroxine to keep serum TSH%2 mIU/l. Group S2 (nZ48, mean TPOAbZ803$9G483$8 IU/ml) received 200 mg L-selenomethionine per day, orally for 3 months, and group C (nZ40, mean TPOAbZ770$3G 406$2 IU/ml) received placebo. (2) 40 volunteers of group S2 were randomized into two age-and TPOAb-matched groups. Group S22 (nZ20) went on taking L-selenomethionine 200 mg/day, while others (group S21) lowered the dose to 100 mg/day. (3) 12 patients of group S22 (group S222) went on taking L-selenomethionine 200 mg/day, while 12 patients of group S21 (S212) increased the dose to 200 mg/day. Serum titers of TPOAb decreased significantly in group S2 (26$2%, P!0$001), group S22 (23$7%, P!0$01) and group S212 (30$3%, P!0$01). There were no significant changes in group C and group S222 (PO0$05). TPOAb titers increased significantly in group S21 (38$1%, P!0$01). A significant decrease in thyroglobulin antibody titers was only noted in group S2 (5$2%, P!0$01). L-selenomethionine substitution suppresses serum concentrations of TPOAb in patients with AIT, but suppression requires doses higher than 100 mg/day which is sufficient to maximize glutathione peroxidase activities. The suppression rate decreases with time.

The Scientific World Journal, 2010

In adults, selenium supplementation decreases thyroid peroxidase antibody (TPO Ab) concentrations in patients with autoimmune thyroiditis (AIT). Our aim in this study was to investigate if selenium supplementation decreased TPO Ab and thyroglobulin antibody (Tg Ab) concentrations in children with AIT. Forty-nine patients (33 females) with newly diagnosed AIT and hypothyroidism were randomized to daily oral therapy with levothyroxine alone (group A, n = 18), levothyroxine plus 100 µg sodium-selenite (group B, n = 13), or levothyroxine plus 200 µg sodium-selenite (group C, n = 18). Mean age at diagnosis was 12.2 ± 2.2 years. All 49 patients needed a mean levothyroxine dose of 1.6 ± 0.5 µg/kg body weight to lower TSH to the treatment goal of 1-2 µU/ml, with no significant difference between groups. At study entry and after 12 months, TPO Ab concentrations were comparable in all three groups. Tg Ab concentrations decreased significantly after 12 months in group A and group C (p = 0.03 and p = 0.01), but not in group B (p = 0.06). It is our conclusion that selenium supplementation with sodium-selenite does not decrease TPO Ab concentrations in children and adolescents, neither given in the reduced dose of 100 µg daily nor given in the "adult" supplementation dose of 200 µg daily.

The Journal of Clinical Endocrinology & Metabolism, 2002

In areas with severe selenium deficiency there is a higher incidence of thyroiditis due to a decreased activity of selenium-dependent glutathione peroxidase activity within thyroid cells. Selenium-dependent enzymes also have several modifying effects on the immune system. Therefore, even mild selenium deficiency may contribute to the development and maintenance of autoimmune thyroid diseases. We performed a blinded, placebo-controlled, prospective study in female patients (n ‫؍‬ 70; mean age, 47.5 ؎ 0.7 yr) with autoimmune thyroiditis and thyroid peroxidase antibodies (TPOAb) and/or Tg antibodies (TgAb) above 350 IU/ml. The primary end point of the study was the change in TPOAb concentrations. Secondary end points were changes in TgAb, TSH, and free thyroid hormone levels as well as ultrasound pattern of the thyroid and quality of life estimation. Patients were randomized into 2 age-and antibody (TPOAb)-matched groups; 36 patients received 200 g (2.53 mol) sodium selenite/d, orally, for 3months, and 34 patients received placebo. All patients were substituted with L-T 4 to maintain TSH within the normal range. TPOAb, TgAb, TSH, and free thyroid hormones were determined by commercial assays. The echogenicity of the thyroid was monitored with high resolution ultrasound. The mean TPOAb concentration decreased significantly to 63.6% (P ‫؍‬ 0.013) in the selenium group vs. 88% (P ‫؍‬ 0.95) in the placebo group. A subgroup analysis of those patients with TPOAb greater than 1200 IU/ml revealed a mean 40% reduction in the selenium-treated patients compared with a 10% increase in TPOAb in the placebo group. TgAb concentrations were lower in the placebo group at the beginning of the study and significantly further decreased (P ‫؍‬ 0.018), but were unchanged in the selenium group. Nine patients in the seleniumtreated group had completely normalized antibody concentrations, in contrast to two patients in the placebo group (by 2 test, P ‫؍‬ 0.01). Ultrasound of the thyroid showed normalized echogenicity in these patients. The mean TSH, free T 4 , and free T 3 levels were unchanged in both groups.

Clinical Endocrinology, 2013

Context: Euthyroid TPO-Ab positive subjects are at risk for progression to subclinical and overt autoimmune hypothyroidism. Previous studies have shown a decrease of TPO-Ab and improvement of quality-of-life (QoL) in L-T4 treated hypothyroid patients upon selenium supplementation. Objectives: To evaluate in euthyroid TPO-Ab positive women without thyroid medication whether selenite decreases TPO-Ab and improves QoL. Design: Randomized, placebo-controlled, double-blind study. Patients and Methods: Euthyroid (TSH 0.5-5.0 mU/L, FT4 10-23 pmol/L) women with TPO-Ab ≥100 kU/L were randomized to receive 200 mcg sodium selenite daily (n=30) or placebo (n=31) for 6 months. TSH, FT4, TPO-Ab, selenium (Se), selenoprotein P (SePP) and QoL were measured at baseline, 3, 6 and 9 months. Results: There were no differences in baseline characteristics between the Se group and the placebo group. During selenite supplementation, serum Se and SePP did not change in the placebo group, but increased in the Se group. TPO-Ab and TSH did not change significantly in any group. TPO-Ab in the Se group were 895 (130-6800) at baseline, 1360 (60-7050) kU/l at 6 months, in the placebo group 1090 (120-9200) and 1130 (80-9900) kU/l respectively (median values with range). TSH in the Se group was 2.1 (0.5-4.3) at baseline, 1.7 (0.0-5.3) mU/L at 6 months, in the placebo group 2.4 (0.7-4.4) and 2.5 (0.2-4.3) mU/L respectively. QoL was not different between the groups. Conclusion: Six months selenite supplementation increased markers of selenium status but had no effect on serum TPO-Ab, TSH or quality-of-life in euthyroid TPO-Ab positive women.

Objective: We studied the effects of selenium (Se) treatment on serum anti–thyroid peroxidase (TPO) levels in Greek patients with Hashimoto's thyroiditis (HT). Design: We prospectively studied 80 women with HT, median age 37 (range 24–52) years, for 1 year. All patients received 200 mg Se in the form of L-selenomethionine orally for 6 months. At the end of the 6-month period, 40 patients continued taking 200 mg Se (Group A) and 40 patients stopped (Group B). Serum thyrotropin (TSH), free triiodothyronine (FT 3), free thyroxine (FT 4), anti-TPO, and anti-thyroglobulin (Tg) levels were measured at baseline and at the end of each 3-month period. Main outcome: There was a significant reduction of serum anti-TPO levels during the first 6 months (by 5.6% and 9.9% at 3 and 6 months, respectively). An overall reduction of 21% (p < 0.0001) compared with the basal values was noted in Group A. In Group B, serum anti-TPO levels were increased by 4.8% (p < 0.0001) during the second 6-month period. Conclusions: Our study showed that in HT patients 6 months of Se treatment caused a significant decrease in serum anti-TPO levels, which was more profound in the second trimester. The extension of Se supplementation for 6 more months resulted in an additional 8% decrease, while the cessation caused a 4.8% increase, in the anti-TPO concentrations.

European Thyroid Journal, 2016

About two thirds of the respondents considered Se use in cases of subclinical autoimmune hypothyroidism, and about 40% had suggested Se use for patients with AIT who were planning pregnancy or already pregnant. About one fourth of the respondents had used Se for mild Graves' orbitopathy. Regarding the suggested daily dosage of Se, 60% of the respondents answered 100-200 μg, 20-30% recommended <100 μg, and 10-20% recommended >200 μg. Conclusions: Se use is widely considered in daily clinical practice. Moreover, Se supplementation is often used or suggested for purposes extending beyond those supported by evidencebased medicine. Ongoing studies will better clarify how Se treatment can be properly utilized in thyroid disease management.

Revista de Chimie

To evaluate the effect of Selenium (Se) supplementation on: thyroid stimulating hormone (TSH), antiperoxidase antibodies (TPOAb) and glutathione peroxidise 1 (GPx1) in euthyroid subjects with autoimmune thyroiditis. 100 euthyroid women with autoimmune thyroiditis, from the same region, were randomized to receive daily 100 mg selenomethionine (n=50) or placebo (n=50) for 3 months. Serum concentrations of Se, TPOAb and TSH were performed in all patients at baseline and after 3 months. GPx1 activity was measured only in the interventional group before and after Se supplementation. At 3 months TSH presented a significant increase both in treated (2.49 vs. 2.09 UI/mL; p=0.001) and untreated groups (2.38 vs. 1.91 UI/mL; p=0.008). TPOAb decreased by 15.2% in patients treated with Se (p=0.002) and were not modified in untreated patients. At the end of the study Se and TPOAb were in direct insignificant correlation (r=+0.267, p=0.105). GPx1 did not show significant changes after Se supplemen...

EUROMEDITERRANEAN BIOMEDICAL JOURNAL, 2023

Selenium (Se) is an essential trace element of pivotal importance to human health. Se is incorporated into selenoproteins (SePs) which have pleiotropic effects, including antioxidant and anti-inflammatory effects, and in the production of active thyroid hormone. These findings may explain the relationship between Se deficiency and pathogenesis of various human diseases including thyroid disorder. In line with these observations, the therapeutic effectiveness of Se supplementation has already been reported in patients with various thyroid diseases. However, there are still controversial data about the optimal dose of Se to be administered, as well as the duration and efficacy of treatment and safety of this trace element. It is currently recommended to administer Se supplements following the assessment of any deficiency status of this element and, after that, its association with chronic autoimmune thyroid disease has been proven. Consistent with these observations, several clinical studies have highlighted the fact that Se supplementation in patients with chronic autoimmune thyroid disease was associated with a reduction of thyroid autoantibodies, and with an improvement of the thyroid-associated ophthalmopathy. The beneficial effects of Se supplementation have been reported in subjects with thyroid disease during the hyperthyroid phase. The restoration of euthyroidism is a major goal in the management of thyrotoxicosis of Graves’ disease. In line with these observations, clinical studies have shown that, in patients with Graves' disease and autoimmune thyroiditis, treatment with a combination of antithyroid drugs and Se restore the euthyroid status faster than the administration of anti-thyroid drugs alone. The review shows that the treatment of an autoimmune thyroid disease with Se may bring about beneficial effects.

International journal of endocrinology, 2017

Introduction. Selenium is a micronutrient embedded in several proteins. In adults, the thyroid is the organ with the highest amount of selenium per gram of tissue. Selenium levels in the body depend on the characteristics of the population and its diet, geographic area, and soil composition. In the thyroid, selenium is required for the antioxidant function and for the metabolism of thyroid hormones. Methods. We performed a review of the literature on selenium&#39;s role in thyroid function using PubMed/MEDLINE. Results. Regarding thyroid pathology, selenium intake has been particularly associated with autoimmune disorders. The literature suggests that selenium supplementation of patients with autoimmune thyroiditis is associated with a reduction in antithyroperoxidase antibody levels, improved thyroid ultrasound features, and improved quality of life. Selenium supplementation in Graves&#39; orbitopathy is associated with an improvement of quality of life and eye involvement, as well...

Journal of Endocrinology and Metabolism, 2019

Background: Selenium (Se), a necessary trace mineral for humans, has the highest concentration in the thyroid gland and is known of its anti-oxidant and anti-inflammatory properties. Many studies have reported that Se has a close relationship with auto-immune Hashimoto's thyroiditis (HT), characterized by the presence of anti-thyroid peroxidase (aTPO) auto-antibodies. Methods: Five hundred thyroid patients, males and females, mean age 46 ± 19 years, with diagnosed HT, were included in the study. Euthyroid forms of HT were treated with Se only, while patients with thyroid-stimulating hormone (TSH) > 10 µIU/mL were treated with both substitutional therapy of levothyroxine and Se. Results: In around 37% of the patients treated with Se 3 × 50 µg/ day with aTPO > 1,000 IU/mL, aTPO remained unchanged after 12 months, while 24.16% had aTPO < 500 IU/mL and 38.20% had aTPO between 500 and 1,000 IU/mL. Eighty-three out of 150 (55.33%) patients treated with Se 2 × 50 µg/day with aTPO between 500 and 1,000 IU/mL responded. More than half of the patients (91/172, 52.90%) with aTPO < 500 IU/mL treated with Se 50 µg/day normalized in 1 year. In hypothyroid group of patients, 12 months after treatment with levothyroxine and Se, 47.18% were responders with aTPO > 1,000 IU/mL, while 79.20% with aTPO between 500 and 1,000 IU/mL. In euthyroid group (Se only), the biggest response (30.56%) was seen in patients with the highest titer of aTPO > 1,000 IU/mL. Conclusion: Se treatment is effective in reducing the levels of aTPO in patients with HT, alone or in combination with levothyroxine. This is due to the anti-inflammatory and anti-oxidant effect of Se. Our study promotes the concept of Se treatment in patients with euthyroid or hypothyroid state, with increased titers of aTPO.