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How to investigate abnormalities in selenium plasma concentrations in humans - Diagnostic algorithms
Jasmine Kamani1, Hyacyntha Celine Hazna Imelda2, Alexa R Shipman2
1Kings College London, UK.
Background:
Selenium is an essential trace element involved in antioxidant defence, thyroid hormone metabolism, immune regulation and cellular homeostasis. Both selenium deficiency and selenium excess are associated with clinically significant disease; however, interpretation of abnormal plasma selenium concentrations is challenging because selenium status is influenced by nutritional, inflammatory, environmental, genetic and systemic factors.
Objective:
To critically synthesise the available evidence on the causes, laboratory assessment and clinical interpretation of abnormal plasma selenium concentrations in humans, and to develop practical diagnostic algorithms for routine clinical use.
Methods:
A focused literature review was performed using PubMed/MEDLINE, Google Scholar, OMIM and reference lists of relevant publications from database inception to August 2026. Original human studies evaluating selenium biomarkers, deficiency, toxicity, laboratory assessment, environmental exposure and clinical management were preferentially included. Evidence was synthesised qualitatively because of heterogeneity in study design and outcomes.
Key Content And Findings:
Plasma selenium remains the most widely available biomarker but reflects recent intake and is influenced by systemic inflammation. Alternative biomarkers, including whole-blood selenium, erythrocyte selenium, glutathione peroxidase activity and selenoprotein P, provide complementary information but have important clinical limitations. Elevated selenium concentrations are most commonly associated with excessive supplementation, selenium-rich foods, occupational and environmental exposure, whereas low concentrations are linked to malnutrition, malabsorption, chronic inflammatory disease, chronic kidney or liver disease, bariatric surgery and alcohol misuse.
Conclusion:
This review proposes practical diagnostic algorithms to support investigation of abnormal plasma selenium concentrations in routine clinical practice. Prospective validation, harmonisation of laboratory methods and reference intervals, and evaluation of emerging biomarkers are required to improve diagnostic accuracy and clinical decision-making.
