Insufficient documentation for clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis, based on a systematic review and meta-analysis.
By a systematic review and meta-analysis to investigate clinically relevant effects of selenium supplementation in patients with chronic autoimmune thyroiditis. Controlled trials in adults (≥18 years) with autoimmune thyroiditis, comparing selenium with or without levothyroxine substitution, versus placebo and/or levothyroxine substitution, were eligible for inclusion. Identified outcomes were serum thyrotropin (thyroid stimulating hormone) levels in LT4-untreated patients, thyroid ultrasound and health-related quality of life. Eleven publications, covering nine controlled trials, were included in the systematic review. Random effects model meta-analyses were performed in weighted mean difference for thyroid stimulating hormone, ultrasound and health-related quality of life. Quality of evidence was assessed per outcome, using GRADE. Meta-analyses showed no change in thyroid stimulating hormone, or improvements in health-related quality of life or thyroid echogenicity (ultrasound), between levothyroxine substitution-untreated patients assigned to selenium supplementation or placebo. Three trials found some improvement in wellbeing in patients receiving levothyroxine substitution, but could not be synthesized in a meta-analysis. The quality of evidence ranged from very low to low for thyroid stimulating hormone as well as ultrasound outcomes, and low to moderate for health-related quality of life, and was generally downgraded due to small sample sizes. We found no effect of selenium supplementation on thyroid stimulating hormone, health-related quality of life or thyroid ultrasound, in levothyroxine substitution-untreated individuals, and sporadic evaluation of clinically relevant outcomes in levothyroxine substitution-treated patients. Future well-powered RCTs, evaluating e.g. disease progression or health-related quality of life, are warranted before determining the relevance of selenium supplementation in autoimmune thyroiditis.
Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark. kristian.winther@rsyd.dk.|Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark. kristian.winther@rsyd.dk.
Kristian Hillert
http://orcid.org/0000-0001-5210-4029
KH
Winther
Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark.|Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark.
Johanna Eva Märta
JE
Wichman
Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark.|Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark.
Steen Joop
SJ
Bonnema
Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark.|Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark.
Laszlo
L
Hegedüs
D006304:Health Status; D006801:Humans; D011788:Quality of Life; D012643:Selenium / Q000627:therapeutic use*; D013967:Thyroiditis, Autoimmune / Q000097:blood / Q000188:drug therapy*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000627:therapeutic use*; D016896:Treatment Outcome
D013972:Thyrotropin; D012643:Selenium; D013974:Thyroxine
Chronic autoimmune thyroiditis; Hashimoto’s thyroiditis; Meta-analysis; Quality of life; Selenium supplementation; Systematic review; Thyroid hormones; Thyroid ultrasound
Nat Rev Endocrinol. 2014 Mar;10(3):164-74
24419358
Eur Thyroid J. 2016 Sep;5(3):149-151
27843804
PLoS One. 2016 Jun 03;11(6):e0156925
27257805
J Thyroid Res. 2013;2013:424163
24224112
Thromb Haemost. 2012 Nov;108(5):973-80
22918596
Nat Rev Endocrinol. 2011 Oct 18;8(3):160-71
22009156
Thyroid. 2014 May;24(5):802-8
24383722
J Clin Endocrinol Metab. 2000 Feb;85(2):536-9
10690851
J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2015;33(3):328-68
26074278
J Clin Epidemiol. 2011 Apr;64(4):395-400
21194891
J Endocrinol Invest. 2015 Oct;38(10):1065-74
25894865
Zhonghua Yi Xue Za Zhi. 2012 Aug 28;92(32):2256-60
23158484
Thyroid. 2007 Jul;17(7):609-12
17696828
Endocrine. 2015 Apr;48(3):756-75
25519493
Int J Clin Pract. 2012 Apr;66(4):378-83
22356267
Eur J Nutr. 2016 Feb;55(1):55-61
25524327
J Clin Endocrinol Metab. 2014 Oct;99(10):3708-17
25004246
Clin Endocrinol (Oxf). 2010 Oct;73(4):535-9
20039895
J Endocrinol. 2006 Jul;190(1):151-6
16837619
Med Care. 1992 Jun;30(6):473-83
1593914
PLoS One. 2013 Sep 16;8(9):e75789
24066186
Int J Endocrinol. 2014;2014:904573
25574167
Eur J Endocrinol. 2003 Apr;148(4):389-93
12656658
Clin Endocrinol (Oxf). 2014 Mar;80(3):444-51
23844613
J Clin Endocrinol Metab. 2007 Apr;92(4):1263-8
17284630
Thyroid. 2008 Jan;18(1):7-12
18302514
Biofactors. 2003;19(3-4):165-70
14757967
Br Med Bull. 2011;99:39-51
21893493
Eur J Endocrinol. 2006 Jan;154(1):21-8
16381987
Clin Endocrinol (Oxf). 2012 Apr;76(4):457-64
22168537
J Clin Endocrinol Metab. 2013 Mar;98(3):1069-75
23365121
J Clin Epidemiol. 2016 Oct;78:63-72
27020087
J Clin Endocrinol Metab. 2011 Jul;96(7):2206-15
21508145
J Trace Elem Med Biol. 2015 Oct;32:195-9
26302929
Eur Thyroid J. 2016 Sep;5(3):164-170
27843806
Clin Chem Lab Med. 2006;44(8):991-8
16879067
Eur Thyroid J. 2015 Dec;4(4):226-33
26835425
Cochrane Database Syst Rev. 2013 Jun 06;(6):CD010223
23744563
J Clin Endocrinol Metab. 2002 Apr;87(4):1687-91
11932302
J Clin Epidemiol. 2011 Apr;64(4):401-6
21208779
Thyroid. 2010 Oct;20(10):1163-73
20883174
Clin Endocrinol (Oxf). 1991 Sep;35(3):235-8
1742880
Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S354-5
23565426
J Clin Epidemiol. 2011 Apr;64(4):383-94
21195583
Thyroid. 2015 Oct;25(10):1069-79
26214034
Trials. 2014 Apr 09;15:115
24716668
Orv Hetil. 2008 Jun 29;149(26):1227-32
18565817
J Clin Endocrinol Metab. 2015 Nov;100(11):4037-47
26305620
Cancer Epidemiol Biomarkers Prev. 2006 Apr;15(4):804-10
16614127
Lancet. 2012 Mar 31;379(9822):1256-68
22381456
Biol Trace Elem Res. 2008 Winter;126(1-3):76-82
18679588