A Prospective Investigation of Graves' Disease and Selenium: Thyroid Hormones, Auto-Antibodies and Self-Rated Symptoms

Abstract

Background: In Graves' thyrotoxicosis tachycardia, weight loss and mental symptoms are common. Recovery takes time and varies between patients. Treatment with methimazole reduces thyroid hormone levels. According to previous research, this reduction has been faster if selenium (Se) is added. Objective: The objective was to investigate whether supplementing the pharmacologic treatment with Se could change the immune mechanisms, hormone levels and/or depression and anxiety. Methods: We prospectively investigated 38 patients with initially untreated thyrotoxicosis by measuring the thyroid-stimulating hormone (TSH), free thyroxine (FT₄), free triiodothyronine (FT₃), thyroid receptor antibodies and thyroid peroxidase auto-antibodies before medication and at 6, 18 and 36 weeks after commencing treatment with methimazole and levo-thyroxine, with a randomized blinded oral administration of 200 µg Se/day or placebo. The selenoprotein P concentration was determined in plasma at inclusion and after 36 weeks. The patients were also assessed with questionnaires about depression, anxiety and self-rated symptoms before medication was started and after 36 weeks. Results: FT₄ decreased more in the Se group at 18 weeks (14 vs. 17 pmol/l compared to the placebo group, p = 0.01) and also at 36 weeks (15 vs. 18 pmol/l, p = 0.01). The TSH increased more in the Se group at 18 weeks (0.05 vs. 0.02 mIU/l, p = 0.04). The depression and anxiety scores were similar in both groups. In the Se group, the depression rates correlated negatively with FT₃ and positively with TSH. This was not seen in the placebo group. Conclusions: Se supplementation can enhance biochemical restoration of hyperthyroidism, but whether this could shorten clinical symptoms of thyrotoxicosis and reduce mental symptoms must be investigated further.

The role of selenium in thyroid gland pathophysiology

“…In addition, based on the data from two studies, the beneficial effect of selenium supplementation was confirmed regarding the mood of the patients [126]. Brief characteristics of the most important prospective clinical studies [98,122,[127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143][144] concerning the efficacy of supplementation with selenium in benign thyroid diseases, in particular autoimmune diseases, are presented in Table II.…”

Селен Та автоімунні Захворювання Щитоподібної Залози

“…У численних дослідженнях доведено ефектив-ність застосування селеновмісних засобів у пацієн-тів із цим захворюванням [1,5,12,16,31,32].…”

“…При цьому погіршен-ня перебігу захворювання встановлено тільки в 7 % пацієнтів, які отримували селен, проти 26 % осіб, які приймали плацебо [21]. Аналогічні результати були отримані при проведенні інших досліджень [5,27].…”

Effects of selenium in patients with Graves’ disease treated with antithyroid drugs

“…В 2015 г. в Стокгольме было проведено исследо-вание, целью которого являлась оценка влияния фармакотерапии Se на иммунные механизмы, уро-вень тиреоидных гормонов, депрессии и тревоги у пациентов с БГ [14]. В исследование были включе-ны 38 пациентов с впервые выявленной БГ, которые ранее не получали терапию.…”

“…Противоречивые результаты получены в недавно проведенных исследованиях Se в комплексной тера-пии БГ J. Calissendorff [14] (Швеция) и M. Leo [15] (Италия). В шведском исследовании (9 мес терапии) было отмечено статистически достоверное улучше-ние показателей биохимического контроля тирео-токсикоза у пациентов с впервые выявленной БГ на фоне тиреостатической терапии + Se, в итальянском исследовании (3 мес терапии) статистически значи-мых отличий по показателям биохимического кон-троля тиреотоксикоза между группами метимазола + Se и метимазола не наблюдалось.…”