Saturday, March 25, 2023

Does Selenium Help Thyroid Eye Disease

Selenium Supplementation For Autoimmune Hyperthyroidism

Selenium and The Thyroid- How Selenium Helps Patients with Graves, Hashimotos

Selenium supplementation has also resulted in thyroid improvements in a few studies relating to Graves disease, and appears to also have a beneficial effect on Graves orbitopathy or ophthalmopathy .

In one study, serum selenium levels in patients with remission and relapse of Graves disease were compared. The authors found that the highest serum selenium levels were seen in the remission group, indicating a positive effect of selenium levels on the outcome of Graves disease.

Regarding Graves orbitopathy, one study found that treatment with selenium was associated with less eye involvement, improved quality of life, and delayed progression of Graves orbitopathy at six months.

As of 2018, there have been at least two active studies underway to gain more definitive results, the GRASS and the CATALYST . These trials are focused on obtaining data concerned with the optimal amount of selenium supplementation necessary for patients with Graves hyperthyroidism that will provide the fastest remission and improved quality of life.

Even without this definitive data, however, a recommendation for seleniums use in mild cases was incorporated into the recent guidelines for the European Group On Graves Orbitopathy . This is very significant and suggests that selenium may be recommended for Graves disease-related conditions in the near future.

Oxidative Stress In Gh

Thyrotoxicosis is a hypermetabolic state characterized by high consumption of intracellular ATP and oxygen, and by dysfunction of the mitochondrial respiratory chain, which leads to saturation of the physiological antioxidant systems, resulting in an uncontrolled production of ROS in peripheral tissues as well as in the thyroid . Studies in thyrotoxic rats suggest that the oxidative stress may be involved in the pathogenesis of thyrotoxic myopathy and cardiomyopathy and in vitro studies have shown that exposure of thyroid cell to H2O2, particularly when made selenium-deficient, induces DNA double strand breaks, apoptosis, necrosis and mutagenesis . On this basis, we might speculate that the oxidative stress might exert a dual action in patients with GH. The ROS-induced damage of thyroid epithelial cells could lead to an increased release of autoantigens and production of TSH-R autoantibodies , and the peripheral tissue damage might contribute the clinical manifestations of hyperthyroidism.

Use Of Additional Antioxidants

One of the first studies on patients with GD evaluated the effect of supplementation of a mixture of antioxidants, including vitamins C and E, beta-carotene, and Se in a group of patients treated with ATD . The study was conducted in Croatia, a country with habitual low Se intake. Patients who received the additional supplementation with antioxidants attained a more rapid biochemical and clinical remission than those who received methimazole alone. These results were partially confirmed by a small study using an antioxidant combination of vitamins C and E, beta-carotene, Cu, Zn, Mn, and Se . Thus, the role of additional vitamins and antioxidants apart from Se in ameliorating disease symptoms and supporting remission remains to be established in larger studies, preferentially in combination with close monitoring of the status of these parameters along with Se at time points before, during, and at the end of the intervention.

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Data About The Survey Respondents

A total of 266 ETA members participated in the survey, 244 of whom provided complete personal data . Physicians from 34 countries answered the questionnaire, with Italy and Denmark providing the highest number of responses .

Fig. 1.

Countries of respondents. Absolute numbers and percentages are individually reported only for countries with at least 10 respondents. Other European countries include: Albania, Croatia, Finland, France, Hungary, Ireland, Latvia, Macedonia, Montenegro, Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland, and Turkey. Non-European countries include: Armenia, Bahrain, Brazil, Canada, Georgia, India, Japan, Morocco, the Philippines, South Africa, and the USA.

Thirty-seven respondents were also members of the American Thyroid Association , Latin American Thyroid Society , or Asia and Oceania Thyroid Association .

Figure 2 shows the selection of respondents, with the exclusion of incomplete response , non-European members , basic scientists , and those not answering the questions about GD and GO .

Fig. 2.

Flowchart over survey respondents.

Table 1.

Characteristics of analyzed respondents

Selenium And Thyroid Disease: From Pathophysiology To Treatment

Selenium for Graves Disease and Graves

Miguel Melo


1. Introduction

Selenium is a micronutrient first described in 1817 its name derives from the Greek Selene meaning moon, referring to the bright and grey appearance of this compound when it is melted . Selenium levels in the body are dependent on the populations characteristics and its diet and geographical area . This micronutrient has been studied over the last years, and scientific reports have revealed its crucial role in the maintenance of immune-endocrine function, metabolism, and cellular homeostasis. The thyroid gland is characterized by a high concentration of selenium, which is incorporated into selenoproteins. Some of these selenoproteins have an important antioxidant activity, contributing to the antioxidant defense in the thyroid by removing oxygen free radicals generated during the production of thyroid hormones. Being incorporated into iodothyronine deiodinases, selenium plays also an essential role in the metabolism of thyroid hormones.

1.1. Requirements and Natural Sources of Selenium

The level of selenium in the plasma depends directly on the selenium intake and correlates well with the organic availability of this nutrient.

2. Methods

3. Results and Discussion

3.1. Selenium Homeostasis and the Thyroid Gland
3.2. Selenium in Thyroid Pathology
3.2.1. Autoimmune Thyroiditis
3.2.2. Selenium, Thyroid Volume, and Thyroid Nodules
3.2.3. Selenium and Graves Disease
3.2.4. Selenium and Immune Function

4. Conclusions

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Monitoring Your Thyroid Hormones When Taking Selenium

Whenever you start a lifestyle or complementary intervention to address Hashimotos, I encourage you to work with your doctor to monitor your thyroid symptoms, thyroid hormones, and thyroid antibodies. This is a great idea for any lifestyle intervention, but a must for lifestyle changes that could impact your TSH, like myo-inositol, especially if you are already taking thyroid medications.

Studies have shown that selenium can reduce thyroid antibodies by at least 40 percent over three months. Additionally, myo-inositol can lower TSH by an average of 30 percent within six months.

What this means is that myo-inositol could lower/normalize TSH in some cases, thus potentially reducing your requirement for thyroid meds. So as you move forward with supplementation, please look out for the following symptoms of being overmedicated: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, heat intolerance, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and/or excessive sweating.

I recommend testing thyroid hormone levels every six to 12 weeks while using complementary therapies, including root cause approach-based medicine, diet, or supplements, to ensure your thyroid medication dosage is optimized, or sooner, if you are showing any of the above symptoms. Thyroid medications are goldilocks hormones they need to be used in just the right dose and there are risk factors of being overmedicated.

How Selenium Deficiency Can Trigger Hashimotos

It can be a bit complicated, but its worth spending a few minutes talking about how a deficiency in selenium can be a trigger for Hashimotos. Its also important to understand the iodine piece of this, as high levels of iodine can increase the risk for selenium deficiency.

Adequate levels of both iodine and selenium are required for optimal thyroid hormone metabolism. Thyroxine is produced by the thyroid gland in ample amounts, but is relatively biologically inactive. Therefore, triiodothyronine , the biologically active thyroid hormone, must be produced by a hormone conversion process, converting T4 to T3. This conversion occurs mostly in the liver and is the process that iodine supports.

The antioxidant selenium is required during this conversion process, its role being to neutralize the toxic build-up of hydrogen peroxide which is produced as a by-product of the hormone conversion.

Remember I mentioned that the thyroid contained the highest amount of selenium in the body?

This removal process is important, as hydrogen peroxide is a reactive oxygen species, which causes oxidative damage and inflammation. The build-up of reactive oxygen species in cells can cause damage to DNA or even cell death. Seleniums job of neutralizing the hydrogen peroxide produced during thyroid hormone conversion , becomes even more critical when a person has high iodine levels.

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Selenium Homeostasis And The Thyroid Gland

The vital role of selenium in thyroid function began to be questioned because of a condition described in Zaire , known as myxedematous endemic cretinism, which was characterized by a deficit of iodine and selenium, hypothyroidism, myxedema, developmental problems, and intellectual disability . From that moment, more studies were conducted to investigate the role of this nutrient in the thyroid. In fact, it was found that selenium deficiency decreases the synthesis of thyroid hormones, as it decreases the function of selenoproteins, in particular iodothyronine deiodinases , which are responsible for the conversion of T4 to T3. This decreased production of thyroid hormones leads to the stimulation of the hypothalamic-pituitary axis due to the lack of negative feedback control, increasing TSH production. TSH stimulates the DIOs to convert T4 to T3 , with consequent production of hydrogen peroxide, which is not adequately removed by less active glutathione peroxidases and accumulates itself in the thyroid tissue causing thyrocyte damage with subsequent fibrosis.

Vitamin D And Selenium Analysis

A Deep Dive On Selenium For Your Thyroid

Patient charts were reviewed for patient demographics, serum thyroid stimulating hormone, thyroperoxidase antibody, thyroid stimulating immunoglobulin, 25-hydroxy vitamin D, and selenium levels. All serum samples were collected from patients without vitamin D or selenium supplementation at the time of draw. Reference ranges used for vitamin D and selenium levels are 30150 ng/mL and 70150 ug/L, respectively. Vitamin D and selenium laboratory values were collected within 5 months of the measured thyroid laboratory values and none of the patients were on supplementation.

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What To Do If You Have Low Levels Of Iodine

Many people come to me already in the midst of iodine supplementation . However, most people with Hashimotos are not deficient in iodine. Furthermore, too much iodine can be a bad thing as weve seen, especially if you have not addressed the underlying issues triggering your Hashimotos.

That said, I have heard from a few clients and readers that adding selenium in the presence of low iodine levels has made them feel worse.

If you do have an adverse reaction to selenium , you may find that you have an iodine deficiency. While I dont usually recommend taking iodine supplements until addressing other root causes, you can certainly talk with your practitioner about whether a low-dose iodine supplement might be right for you.

Some potential factors that may lead me to suspect an iodine deficiency include: eating a diet low in seafood, eating a vegan diet, having fibrocystic breasts , or having low reverse T3 levels. You can find out more about iodine in the Advanced Protocols section of my book Hashimotos Protocol.

Differences In The Regimen Of Se Supplementations

In published supplementation trials, both inorganic and organic Se compounds were used as intervention agents. At present, there are few intervention trials comparing different supplements in the same setting in order to determine whether supplementation effects on the expression of selenoproteins differ and whether one Se compound offers a better therapeutic effect or is safer than another. Some authors point out that Se levels in subjects receiving organic Se may show a steady rise during treatment, whereas those supplemented with inorganic Se supplements reach a plateau after several months, suggesting a safer approach during chronic supplementation . On the other hand, selenite appears to be distributed into the organs and body fluids more efficiently and universally than selenomethionine . Theoretically, selenomethionine can be directly inserted into all proteins in response to AUG codons and does not only serve as a Se source for the biosynthesis of selenoproteins thus, unlimited uptake may ensue, eventually reaching toxic concentrations . Selenite, on the other hand, can be directly used for selenoprotein biosynthesis or be excreted, upon surplus intake after hepatic conversion, via the urine . However, in practice, there are no reports of toxicity from selenomethionine, Se yeast, or selenite intakes in subjects with poor Se status when the recommended dosages of 50200 g/day are not surpassed.

Fig. 1

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Can Taking Selenium Help To Reverse Thyroid Eye Disease

Thyroid eye disease, which is also known as Graves ophthalmopathy, affects approximately 50% of those people with Graves Disease. And while in most cases the condition isnt severe, this isnt always the case. Common symptoms include eye swelling, eye bulging , and sometimes even blurriness and double vision. While steroids such as prednisone are commonly given to help with the inflammation, certain natural approaches can also benefit the patient, without them having the side effects of steroid medications. Research shows that selenium can be very effective in helping with thyroid eye disease, which Ill discuss in this post.

But why is selenium so effective in helping with thyroid eye disease? In order to better understand why selenium can help it probably is a good idea to briefly talk about the pathophysiology of thyroid eye disease. Research clearly shows that Graves ophthalmopathy isnt due to the hyperthyroidism associated with Graves Disease, but instead is due to the autoimmune response . The same autoimmune response involved in Graves Disease is also responsible for damaging the tissues of the eyes. Some of the more common symptoms include a dry and gritty ocular sensation, sensitive to light, excessive tearing, double vision, and a pressure sensation behind the eyes . The most common clinical features of Graves ophthalmopathy are upper eyelid retraction, edema, and erythema of the periorbital tissues and conjunctivae, and bulging of the eyes .

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What Is Selenium And What Functions Does It Serve In The Body

Selenium is a mineral that is essential to the health of our bodies. It plays an important role in controlling our metabolism, specifically the thyroid hormone metabolism.4

Selenium also plays a key role in reproduction, protecting us from infection, creating DNA, and guarding against cellular and tissue damage.4

Effects Of Selenium Deficiency On The Thyroid Gland And Thyroid Associated Ophthalmopathy

The two main autoimmune thyroid diseases are Graves’ disease which is the most common cause of thyrotoxicosis, and Hashimoto’s thyroiditis which is the most common cause of hypothyroidism. Ninety percent of patients with TAO have Grave’s disease and 10% suffer from Hashimoto’s thyroiditis and in the latter the eye signs are often mild. These autoimmune thyroid diseases are caused by abnormal immune response to self-thyroid antigens and the key role is played by T lymphocytes when antigen recognition is mediated by receptors on the cell surface . This breaks the tolerance by deficit of suppressor T cells and aberrant expression of DR region of HLA , absent on normal thyroid cells. The contemporary expression of HLA-DR on thyroid follicular cells and auto-antigens triggers the autoimmune reaction by antibody-dependent, complement-mediated, direct or indirect cytotoxicity . Se has a dose-dependent inhibitory effect on the expression of HLA-DR molecules of thyrocytes induced by interferon-γ and this may explain one of the mechanisms of beneficial effect of Se in reducing the severity of autoimmune thyroid disease ,.

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Ask Your Doctor If You Should Try A Selenium Supplement

Selenium is a nutrient thats important for normal thyroid hormone production. When people with mild Graves ophthalmopathy took 100 micrograms of selenium twice a day for 6 months, their disease didnt progress as quickly as in those who took a placebo, according to a study published in the New England Journal of Medicine. They also experienced an improvement in their quality of life.

Ilya Leyngold, MD, an ocular plastic surgeon at Duke Eye Center in Durham, North Carolina, cautions that this particular study was performed in Europe, where the soil is not rich in selenium. Americans generally get enough selenium through their diet already, according to the National Institutes of Health Office of Dietary Supplements, so supplementing may not be helpful. Plus, taking too much selenium can increase the risk of skin rashes, diarrhea, and other symptoms, along with increasing the risk of developing type 2 diabetes.

Selenium Supplementation And Hashimotos

Thyroid Eye Disease

Research suggests that selenium supplementation for people with Hashimotos is associated with a reduction in TPO antibody levels, improved thyroid ultrasound features, and improved quality of life. In fact, thyroid antibodies in people with Hashimotos have been shown to be reduced by 40 percent in three to six months, with therapeutic doses of selenium.

But before digging into the research on this topic, lets remember the importance of reducing thyroid antibodies, even if TSH levels may be telling us that we dont have a thyroid problem.

Ive found antibodies are an early warning system for Hashimotos, with positive antibody levels seen years before someone may see abnormal levels for their TSH. Research suggests that 80 to 90 percent of people with Hashimotos will have elevated TPO or TG antibodies, or both.

A reduction in antibodies can result in people feeling better, and interventions such as nutrient supplementation can have fast results!

Years ago, before I was diagnosed with my own thyroid issues, I had not had my antibodies tested, only my TSH, which was deemed normal . I struggled for almost a decade until finally being tested for TPO antibodies. At that time, my antibodies tested in the 2000 IU/mL range. Once I was diagnosed and started focusing on addressing my root causes, I was able to reduce my antibodies and finally start feeling better.

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