Influence of selenium supplements on the post-traumatic alterations of the thyroid axis: a placebo-controlled trial
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M M Berger1, M J Reymond, A Shenkin
1Soins Intensifs de Chirurgie, CHUV, Lausanne, Switzerland. Mette.Berger@chuv.hospvd.ch
Insights
Early selenium supplementation normalized plasma selenium levels in critically ill trauma patients. This intervention showed modest improvements in thyroid hormone metabolism, with faster normalization of T4 and reverse T3.
Area of Science:
- Critical Care Medicine
- Nutritional Biochemistry
- Endocrinology
Background:
- Post-traumatic period is characterized by low plasma selenium and negative selenium balance.
- Thyroid hormone metabolism is significantly altered in critically ill trauma patients.
- Early nutritional support may influence recovery and metabolic derangements.
Purpose of the Study:
- To investigate the effect of early selenium supplementation on post-traumatic thyroid hormone metabolism.
- To determine if selenium levels influence thyroid hormone normalization after severe injury.
- To assess the impact of combined alpha-tocopherol and zinc with selenium.
Main Methods:
- Prospective, placebo-controlled randomized supplementation trial in a surgical ICU.
- Critically ill trauma patients (n=31) with severe multiple injuries received selenium or placebo for 5 days.
- Measurements included plasma selenium, alpha-tocopherol, zinc, and thyroid hormones (T4, T3, reverse T3) over 20 days.
Main Results:
- Selenium supplementation normalized plasma selenium levels by day 1.
- Patients receiving selenium showed faster and greater increases in total T4 and T3 post-injury.
- A significant reduction in reverse T3 levels was observed between day 0 and day 2 in the selenium group.
Conclusions:
- Early selenium supplementation effectively increased circulating selenium levels in trauma patients.
- Selenium supplementation was associated with modest, beneficial changes in thyroid hormone profiles.
- Co-administration of alpha-tocopherol and zinc did not provide additional benefits to thyroid hormone normalization.
Objective:
To investigate whether early selenium (Se) supplementation can modify the post-traumatic alterations of thyroid hormone metabolism, since the first week after trauma is characterised by low plasma Se and negative Se balances.
Design:
Prospective, placebo-controlled randomised supplementation trial.
Setting:
Surgical ICU in a tertiary university hospital.
Patients:
Thirty-one critically ill trauma patients aged 42 +/- 16 years (mean +/- SD), with severe multiple injury (Injury Severity Score 30 +/- 7).
Intervention:
Supplementation during the first 5 days after injury with either Se or placebo. The selenium group was further randomised to receive daily 500 microg Se, with or without 150 mg alpha-tocopherol (AT) and 13 mg zinc supplements. The placebo group received the vehicle. Circulating Se, AT, zinc, and thyroid hormones were determined on D0 (= day 0, admission), D1, D2, D5, D10, and D20.
Results:
Plasma Se, low on D0, normalised from D1 in the selenium group; total T4 and T3 increased more and faster after D2 (P = 0.04 and 0.08), reverse T3 rising less between D0 and D2 (P = 0.05).
Conclusions:
Selenium supplements increased the circulating Se levels. Supplementation was associated with modest changes in thyroid hormones, with an earlier normalisation of T4 and reverse T3 plasma levels. The addition of AT and zinc did not produce any additional change.
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