Selenium in the Treatment of Thyroid Diseases: An Element in Search of the Relevant Indications?

Bonnema, Steen Joop; Winther, Kristian Hillert

doi:10.1159/000448002

Cited by 25 publications

(19 citation statements)

References 17 publications

(23 reference statements)

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“…The insight into the role of Se in thyroid diseases has improved in recent years [26-28], and its therapeutic use in mild GO is recommended in current ETA guidelines [29, 30]. An Italian survey, published in 2016, investigated the clinical use of Se supplementation in the index case of a 42-year-old female patient with GD.…”

Section: Introductionmentioning

confidence: 99%

A 2018 European Thyroid Association Survey on the Use of Selenium Supplementation in Graves’ Hyperthyroidism and Graves’ Orbitopathy

Negro¹,

Attanasio²,

Papini³

et al. 2018

Eur Thyroid J

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Objective: Selenium (Se) supplementation has been suggested in the treatment of Graves’ disease (GD). We sought to investigate Se prescription patterns for GD across European countries. Methods: Members of the European Thyroid Association were invited to participate in an online survey investigating the use of Se in GD either without or with orbitopathy (GO). Of 872 invited members, 244 (28%) completed the survey. After exclusion of basic scientists and non-European members, 197 responses were retrieved out of clinical trials (nearly half of clinician members), of whom 61 do not use Se. Thus, 136 respondents remained for further analyses. Results: Among the 136 analyzed respondents, most (64.7%) were not aware of the Se status in their populations, did not assess Se levels (78.7%), nor considered iodine status (74.3%). In GD without GO, 38.2% recommend Se supplementation (“sometimes” [27.2%], “frequently” [5.9%] or “always” [5.1%]). When GO occurs, 94.1% recommend Se supplementation (“sometimes” [39%], “frequently” [30.1%] or “always” [25%]). Of these, 60.1% recommend Se as an alternative to watchful waiting in patients with mild ocular involvement and 44.9% as an adjuvant to the established treatment modalities in patients with moderate to severe ocular involvement. Conclusions: In Graves’ hyperthyroidism without GO, 38.2% of ETA (European Thyroid Association) members recommend Se supplementation. Conversely, Se is recommended by the majority of respondents in GO, both in patients with mild and moderate to severe ocular involvement. This clinical practice is partially in disagreement with current European treatment guidelines that recommend Se as a 6-month treatment in mild GO only.

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Section: Introductionmentioning

confidence: 99%

A 2018 European Thyroid Association Survey on the Use of Selenium Supplementation in Graves’ Hyperthyroidism and Graves’ Orbitopathy

Negro¹,

Attanasio²,

Papini³

et al. 2018

Eur Thyroid J

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“…Both Negro et al [1] and, especially, Hegedüs et al [2] , in the accompanying Editorial [1,2] , underscored the abuse of selenium in thyroid disease.…”

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confidence: 99%

“…One of the points of Hegedüs et al [2] concerning a cautious and more restricted use of selenium in thyroid disease is the fear for side effects or adverse events, possibly linked to selenium overtreatment or to treatment with selenium of subjects that are already selenium sufficient [2,8] . However, in our recent study, as well as in the study from Calissendorff et al [4] and in the EUGOGO study on GO [5,6] , no major side effects or adverse events were recorded for selenium doses not exceeding 200 μg/day.…”

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confidence: 99%

Selenium in the Treatment of Thyroid Diseases

et al. 2017

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“…Selenium supplementation with 60 μg/day as of 12-14 gestational weeks did not change the prevalence of TPOAb, TgAb, or subclinical hypothyroidism in the second and third trimesters (Mao et al 2016). Adequate nutritional supply of selenium that saturates expression of circulating selenoprotein P, together with optimal iodine and iron intake, is required for a healthy thyroid development (Kohrle 2015), but the utility of selenium supplementation to combat thyroid autoimmunity has not yet been established (Hegedus et al 2016). 5.…”

Section: Environmental Factorsmentioning

confidence: 99%

Hashimoto’s Thyroiditis

Wiersinga¹

2016

Endocrinology

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Hashimoto's thyroiditis is best defined as an organ-specific autoimmune disease, characterized by autoimmune-mediated destruction of the thyroid gland. Diagnostic criteria have changed dramatically since the first description in 1912; they now include the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin, hypoechogenicity on thyroid ultrasound, and often but not always hypothyroidism. Distinct pathologic phenotypes are recognized: goitrous and atrophic variants but also an IgG4-related variant, hashitoxicosis, juvenile thyroiditis, and silent or painless thyroiditis. With a prevalence of 10-12% in the general population, it is the most common autoimmune disease. The prevalence is higher in females than in males, increases with advancing age, and is highest in Whites and lowest in Blacks. The incidence of autoimmune hypothyroidism is about 350 cases/100,000/year for women and 60 cases/100,000/year for men in iodine-sufficient regions and 44 (females) and 12 (males) per 100,000 per year in iodine-deficient areas. Breakdown of self-tolerance against thyroid antigens may lead to thyroid autoimmunity. Loss of T reg inhibitory actions and gain of Th17 proinflammatory actions (reflected by a shift to higher values of Th17/Th10 ratio in peripheral blood) play a crucial role in the loss of tolerance against thyroid antigens. Cytotoxic CD8+ T cells directed against TPO and Tg mediate thyroid gland destruction, either by the granule exocytosis pathway or apoptosis (programmed cell death). TPOAb and TgAb may cause antibody-dependent cellmediated cytotoxicity (ADCC) via complement-mediated lysis of thyrocytes. Hashimoto's thyroiditis often runs in families as evident from a high sibling risk ratio of 28. Twin studies suggest genes contribute about 73% of the liability to the development of TPOAb and TgAb; environmental factors would thus

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Selenium in the Treatment of Thyroid Diseases: An Element in Search of the Relevant Indications?

Cited by 25 publications

References 17 publications

A 2018 European Thyroid Association Survey on the Use of Selenium Supplementation in Graves’ Hyperthyroidism and Graves’ Orbitopathy

A 2018 European Thyroid Association Survey on the Use of Selenium Supplementation in Graves’ Hyperthyroidism and Graves’ Orbitopathy

Selenium in the Treatment of Thyroid Diseases

Hashimoto’s Thyroiditis

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