Two systematic review s have evaluated controlled trials among patients with autoimmune thyroiditis and report that selenium supplementation decreases circulating thyroid autoantibodies .
The immunomodulatory effects of selenium might involve reducing proinflammatory cytokine release .
In Graves ’ disease , some , but not all , trials indicate that adjuvant selenium supplementation enhances the restoration of biochemical euthyroidism , and might benefit patients with mild Graves ’ orbitopathy .
The available evidence from trials does not support routine selenium supplementation in the st and ard treatment of patients with autoimmune thyroiditis or Graves ’ disease .
However , correction of moderate to severe selenium deficiency may offer benefits in preventing , as well as treating , these disorders .
Purpose of review This review provides an appraisal of recent evidence for or against selenium supplementation in patients with autoimmune thyroid diseases , and discusses possible effect mechanisms .
Recent findings Epidemiological data suggest an increased prevalence of autoimmune thyroid diseases under conditions of low dietary selenium intake .
However , clinical ly relevant effects of selenium supplementation , including improvement in quality of life , are more elusive .
Selenium supplementation for patients with Graves’ hyperthyroidism (the GRASS trial): study protocol for a randomized controlled trial
Background Graves ’ hyperthyroidism is an autoimmune disease causing hyperfunction of the thyroid gl and . The concentration of selenium is high in the thyroid gl and and two important groups of enzymes within the thyroid are selenoproteins , that is , they depend on selenium . Selenium may have beneficial effects on autoimmune hypothyroidism and on Graves ' orbitopathy , but the effects of selenium on Graves ' hyperthyroidism is unknown . We hypothesize that adjuvant selenium may be beneficial in the treatment of Graves ' hyperthyroidism . The objective is to investigate if selenium supplementation plus st and ard treatment with anti-thyroid drugs versus st and ard treatment with anti-thyroid drugs will lead to a decrease in anti-thyroid drug treatment failure ( that is , failure to remain euthyroid , without further treatment , one year after cessation of anti-thyroid drug treatment ) , faster and longer lasting remission ( that is , anti-thyroid drug treatment success ) , and improved quality of life in patients with Graves ’ hyperthyroidism . Methods and design The trial is an investigator-initiated , r and omised , blinded , multicentre clinical trial . Inclusion criteria are : age 18 years or older ; diagnosis of active Graves ' hyperthyroidism within the last two months ; and informed consent . Exclusion criteria are major co-morbidity ; previous radioactive iodine treatment ; ongoing anti-thyroid drug treatment for more than two months ; treatment with immunomodulatory drugs ; known allergy towards the components in the selenium and placebo pills ; pregnancy or breast-feeding ; and intake of selenium supplementation above 70 μg per day . We plan to include 492 participants , r and omised ( 1:1 ) to two tablets of 100 μg selenium once daily for the 24 to 30 months intervention period versus two identical placebo tablets once daily . The primary outcome is the proportion of participants with anti-thyroid drug treatment failure ( see above ) at the end of the intervention period ( 24 to 30 months ) . Secondary outcomes are : thyroid-specific quality of life during the first year after r and omisation ; level of thyroid stimulating hormone-receptor antibodies at 18 months after r and omisation and at the end of the intervention period ( 24 to 30 months ) ; hyperthyroid symptoms during the first year after r and omisation ; eye symptoms during the first year after r and omisation , and at the end of the intervention period ( 24 to 30 months ) ; adverse reactions during the intervention period ; and serious adverse events during the intervention period . Discussion It was of great importance to the initiators of this trial , that the results would be directly applicable to daily clinical practice . Therefore , it was design ed as a pragmatic trial : the patients follow their usual treatment at their usual hospitals . In order to still collect high quality data on the clinical course and quality of life , an elaborate trial management system was design ed to keep track of patient input , need for trial personnel input and action , and to collect data from medical chart systems . Meticulous follow-up on missing responses to the QoL measurements has been incorporated into the system , to minimise missing quality of life data . Monitoring of adverse reactions and events is achieved by thorough instruction of the participants , surveillance of patient-reported outcomes , and integration with national data bases regarding hospitalizations . A very long intervention period was necessary , since patients are not considered in remission until one year after stopping anti-thyroid drugs . Usually , patients are treated for 12 to 18 months with anti-thyroid drugs , yielding a total intervention period of 24 to 30 months . Trial registration Clinical Trials.gov : NCT01611896
Two systematic review s have evaluated controlled trials among patients with autoimmune thyroiditis and report that selenium supplementation decreases circulating thyroid autoantibodies .
The immunomodulatory effects of selenium might involve reducing proinflammatory cytokine release .
In Graves ’ disease , some , but not all , trials indicate that adjuvant selenium supplementation enhances the restoration of biochemical euthyroidism , and might benefit patients with mild Graves ’ orbitopathy .
The available evidence from trials does not support routine selenium supplementation in the st and ard treatment of patients with autoimmune thyroiditis or Graves ’ disease .
However , correction of moderate to severe selenium deficiency may offer benefits in preventing , as well as treating , these disorders .
Purpose of review This review provides an appraisal of recent evidence for or against selenium supplementation in patients with autoimmune thyroid diseases , and discusses possible effect mechanisms .
Recent findings Epidemiological data suggest an increased prevalence of autoimmune thyroid diseases under conditions of low dietary selenium intake .
However , clinical ly relevant effects of selenium supplementation , including improvement in quality of life , are more elusive .