Selenium Supplementation for Hashimoto's Thyroiditis: Summary of a Cochrane Systematic Review

Abstract

Selenium supplementation in people with Hashimoto's thyroiditis might reduce antibody levels and result in a decreased dosage of levothyroxine (LT₄) and may provide other beneficial effects (e.g. on mood and health-related quality of life). The aim of our systematic review was to assess the effects of selenium supplementation on Hashimoto's thyroiditis. We searched The Cochrane Library, MEDLINE, EMBASE and Web of Science for randomized controlled trials. Study selection, data extraction, assessment of risk of bias and analyses were carried out by two independent review authors. We assessed the quality of the evidence of included studies using GRADE. Four studies rated at unclear to high risk of bias comprising 463 participants were included. One study at high risk of bias showed statistically significant improvement in subjective well-being with sodium selenite 200 μg plus titrated LT₄ compared with placebo plus titrated LT₄ (RR 4.67, 95% CI 1.61-13.50). Selenomethionine 200 μg as a single treatment or combined with LT₄ reduced the serum levels of anti-thyroid peroxidase antibodies compared with placebo (or placebo plus LT₄) in three studies (p < 0.001). Although the changes from baseline were statistically significant in these three studies, their clinical relevance is unclear. In conclusion, the results of these four studies, assessed at unclear to high risk of bias, show that evidence to support or refute the efficacy of selenium supplementation in people with Hashimoto's thyroiditis is incomplete and not reliable to help inform clinical decision making.

MECHANISMS IN ENDOCRINOLOGY: Autoimmune thyroid disease: old and new players

“…Finally, it might be possible that individual requirements for selenium differ because of polymorphisms in selenoprotein genes. A Cochrane systematic review concludes that data at present do not allow confident decision making about the use of selenium supplementation for Hashimoto's thyroiditis (64). …”

Does selenium supplementation affect thyroid function? Results from a randomized, controlled, double-blinded trial in a Danish population

“…Furthermore, the iodine fortification program in Denmark was associated with an increase in the TPO-Ab positivity prevalence (38). An attenuating modulation of this effect by selenium is conceivable, due to its potential to decrease thyroid antibodies in autoimmune thyroid disease (39). However, this trial was not designed or powered to investigate the effect of selenium supplementation on TPO-Ab prevalence, and TPO-Ab was measured merely to evaluate potential differences between groups at baseline.…”

“…However, the fact that thyroid function appears to be sensitive to selenium supplementation adds to the incentive for investigating its effects on multifactorially regulated traits, such as thyroid function (19,41), size (42,43), and autoimmunity (44) in autoimmune thyroid diseases, where selenoprotein biosynthesis may be impaired (18). A number of trials in Hashimoto's thyroiditis have thus far not clarified the role of selenium supplementation (39). A single trial reported promising results for a subset of Graves' orbitopathy patients (45), and two Danish randomized trials are currently investigating clinical effects of selenium supplementation in Graves' disease (46) and chronic autoimmune thyroiditis (47).…”

A makro-TSH diagnosztikus és terápiás jelentősége Hashimoto-thyreoiditises betegekben

“…A betegek átlagéletkora 44,8 év (28-64 év) volt (728 nő). A Hashimoto-thyreoiditis diagnózisa a nemzetközileg elfogadott kritériumokon alapult [6]. A betegek L-Thyroxin-(átlagosan 66,5 μg/nap) kezelésben részesültek, 319 beteg kapott szervesszelén-tablettát is (átlagosan 60 μg/nap).…”