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Thyroid dysfunction due to trace element deficiency-not only selenium but also zinc.

Kohei Nagano1, Yuma Motomura1,2, Hironori Bando3,4

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Total parenteral nutrition (TPN) can deplete selenium (Se) and zinc (Zn), leading to thyroid dysfunction. Supplementation with both Se and Zn corrected thyroid hormone levels and normalized thyroid function in a patient with TPN-induced deficiency.

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Area of Science:

  • Endocrinology
  • Nutritional Science
  • Clinical Medicine

Background:

  • Serum selenium (Se) and zinc (Zn) levels decline during total parenteral nutrition (TPN) without trace element supplementation.
  • Se and Zn are crucial for thyroid hormone metabolism; deficiencies can cause thyroid dysfunction.
  • Clinical presentations of TPN-induced trace element deficiency and subsequent thyroid dysfunction are infrequently reported.

Observation:

  • A 50-year-old male patient on TPN for one and a half months without trace element supplementation presented with thyroid dysfunction.
  • Blood tests showed elevated thyroid-stimulating hormone (TSH) and free thyroxine (FT4) with low free triiodothyronine (FT3).
  • Initial Se supplementation improved FT3 and FT4 but TSH remained elevated, suggesting a concurrent deficiency.

Findings:

  • Selenium supplementation normalized FT3 and FT4 levels but resulted in transient TSH elevation.
  • Zinc supplementation was initiated due to persistent subclinical hypothyroidism.
  • Combined Se and Zn supplementation led to the normalization of overall thyroid function.

Implications:

  • Elevated TSH and FT4 warrant consideration of Se and Zn deficiencies in patients receiving TPN.
  • Transient TSH elevation can occur during Se repletion therapy.
  • This case highlights the importance of monitoring and supplementing Se and Zn in patients on long-term TPN to prevent thyroid dysfunction.