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Selenium Supplementation in Patients with Hashimoto Thyroiditis: A Systematic Review and Meta-Analysis of Randomized
Valentina V Huwiler1,2, Stephanie Maissen-Abgottspon1, Zeno Stanga1
1Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Thyroid : Official Journal of the American Thyroid Association
|January 20, 2024
Summary
Selenium supplementation effectively lowers thyroid stimulating hormone (TSH) and thyroid peroxidase antibodies (TPOAb) in individuals with Hashimoto thyroiditis (HT). This trace element is safe and may aid in managing HT, particularly in those not on thyroid hormone replacement therapy.
Area of Science:
- Endocrinology
- Nutritional Science
- Autoimmune Diseases
Background:
- Hashimoto thyroiditis (HT) is the leading cause of hypothyroidism in iodine-sufficient regions.
- Selenium, an essential trace element, plays a role in thyroid hormone synthesis and possesses antioxidant properties, suggesting its potential therapeutic value in HT management.
Purpose of the Study:
- To systematically review and perform a meta-analysis of randomized controlled trials (RCTs).
- To evaluate the impact of selenium supplementation on thyroid function, thyroid antibodies, ultrasound findings, immune markers, patient-reported outcomes, and adverse events in patients with HT.
Main Methods:
- Systematic literature search across multiple databases (MEDLINE, Embase, CINHAL, Web of Science, Google Scholar, Cochrane CENTRAL) from inception to January 2023.
- Inclusion of 35 unique randomized controlled trials (RCTs) involving meta-analysis.
- Primary outcome: TSH in patients without thyroid hormone replacement therapy (THRT). Secondary outcomes included thyroid antibodies (TPOAb, TGAb, TRAb), thyroid hormones, ultrasound findings, immune markers, and adverse events.
- Risk of bias assessed using the Cochrane RoB 2 tool, and evidence certainty rated using the GRADE approach.
Main Results:
- Selenium supplementation significantly decreased TSH levels in patients without THRT (SMD -0.21, p<0.05).
- TPOAb (SMD -0.96, p<0.001) and malondialdehyde (MDA) (SMD -1.16, p<0.05) levels were significantly reduced in patients with and without THRT.
- Adverse events were comparable between selenium and control groups (OR 0.89). No significant changes were observed in other thyroid hormones, TGAb, thyroid volume, or specific interleukins (IL-2, IL-10).
- The overall certainty of evidence was rated as moderate.
Conclusions:
- Selenium supplementation is effective and safe for lowering TSH, TPOAb, and MDA levels in individuals with HT, particularly those not on THRT.
- The beneficial effect of selenium in reducing TPOAb levels was observed independently of THRT status.
- Selenium represents a promising adjunctive therapy for managing Hashimoto thyroiditis.
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