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.
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 ,.
Use Of Selenium In Go
Over the last few years, in addition to the most common treatment for the management of moderate-to-severe and active GO, namely high dose oral and intravenous glucocorticoids , orbital irradiation and surgical procedures , other medications have been proven effective to various extents, including rituximab , the recently FDA-approved teprotumumab , mycophenolate , and tocilizumab . Until recently, the treatment of mild GO was typically limited to local measures . In general, major treatments are not recommended for mild GO, unless there is a sufficient impairment in the quality of life, which justifies the risk of GC-related adverse events . In view of the role of oxidative stress in GO, antioxidant supplements have been proposed as a possible therapeutic approach, and basic and clinical studies have investigated the effect of selenium, due to its antioxidant and immunomodulating actions.
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The Effects Of Se Supplementation On Go
The role of Se in GO was studied in only one prospective, randomized, placebo-controlled trial, which recruited patients with mild active eye disease of short duration . One hundred fifty-nine GO patients were randomized to receive Se supplementation , pentoxifylline, or placebo for 6 months and were evaluated over a total time period of 12 months . The overall responses were significantly better in the Se group compared with those in placebo, including a decrease in inflammation and eye-specific symptoms along with a marked improvement in disease-specific QoL . Furthermore, very few patients treated with Se progressed to more severe disease. Unfortunately, the Se status of the study population was not determined and the results have not as yet been confirmed in an independent study. Moreover, the effects of Se supplementation on moderate-to-severe GO and on the emergent condition of sight-threatening GO remain unknown. This lack of verification studies is most unfortunate, as other treatment options in GO are few and the disease burden of affected patients is very high.
Selenium In The Treatment Of Graves Hyperthyroidism And Eye Disease
- Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Pisa, Italy
Based on the role of oxidative stress in the pathogenesis of Graves hyperthyroidism and Graves Orbitopathy , a therapy with the antioxidant agent selenium has been proposed and a number of studies have been performed, both in vitro and in vivo. In GH, reactive oxygen species contribute to the thyroid and peripheral tissues damage. In GO, tissue hypoxia, as well as ROS, are involved in the typical changes that occur in fibroadipose orbital tissue and the perimysium of extraocular muscles. Antioxidants have been proposed to improve the effects of antithyroid drugs in GH patients, as well as the remodeling of orbital tissues in patients with GO. Here, we reviewed the literature on the possible beneficial effects and clinical use of selenium in the management of patients with GH and GO. A randomized clinical trial on the use of selenium in patients with mild GO provided evidence for a beneficial effect no data are available on more severe forms of GO. Although the real effectiveness of selenium in patients with GH remains questionable, its use in the management of mild GO is generally believed to be beneficial, and selenium administration has been included in the clinical practice for the patients with mild eye disease.
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Selenium Supplementation And Hashimotos
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.
How Does Selenium Impact Ted
The thyroid the butterfly-shaped gland that is responsible for making hormones contains more concentrated amounts of selenium than any other organ in the human body. It needs selenium to produce essential hormones to keep the thyroid healthy and functioning.5
If a person is deficient in this essential mineral, it can lead to thyroid problems like TED. Because of this, researchers believe that selenium deficiency may be a risk factor for thyroid eye disease.6
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Causes Of Selenium Deficiency
The Se deficiency is mostly caused by low dietary intake or poor intestinal absorption. Rarely Se and SP deficiency can be genetically inherited. Individuals with inherited defects in selenocysteine insertion sequence binding protein 2 display a syndrome of selenoprotein-related defects including abnormal thyroid hormone metabolism. Selenocysteine incorporation sequence binding protein 2 represents a key trans-acting factor for the co-translational insertion of selenocysteine into SPs . In individuals with SBP2 deficiency due to mutations in the SBP2 gene the dietary Se intake is obviously not the limiting factor in the individuals when regular daily Se intake is provided . The total serum Se concentrations in such individuals with selenoprotein biosynthesis defects respond to selenomethionine supplementation .
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.
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Selenium Supplementation May Slow Disease Progression And Restore Thyroid Function More Research Is Needed To Identify Patients Who May Benefit And To Establish Treatment Guidelines
Reviewed by Sarju Patel, MD, MPH, Msc
Is selenium supplementation useful in patients with mild Graves orbitopathy?
Take Note
- Selenium supplementation is widely used for a broad range of autoimmune thyroid diseases, although it is only recommended for mild Graves orbitopathy.
- One study found that patients treated with selenium had better quality of life and slower progression of their Graves orbitopathy.
- A number of factors, including gender and where a patient lives, may determine how efficacious selenium supplementation is in this population.
Two recent reviews attempted to shed light on this controversial treatment. In Nature Reviews Endocrinology, a team from Denmark and the United Kingdom provided an in-depth overview on the role of selenium in thyroid disorders. In Hormones, investigators from Germany and Poland focused more narrowly on Graves disease, including orbitopathy.1,2
The Nature Reviews team noted that while selenium supplementation is widely used by clinicians for a broad range of autoimmune thyroid diseases its recommended only for mild Graves orbitopathy,1 in the guidelines of the European Thyroid Association/European Group on Graves Orbitopathy .1,3
Rationale for selenium supplementation
In their comprehensive NatureReviews overview, the authors explain the rationale for clinicians interest in selenium in thyroid disorders1:
The impact of a single study
Does it matter where patients live?
Clinical considerations and future research
Blood Collection And Serum Se Determination
Blood samples were collected in clot blood tubes and centrifuged for Se analyses. The serum was separated within 3hours and stored at 80°C for a biochemical analysis. The Se level was measured using graphite furnace atomic absorption spectrophotometry with the SpectrAA 600 system and a specific Se electrode discharge lamp.
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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.
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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Cell Redox State And Evaluation Of Oxidative Stress
The balancing of the cell redox state is a key point in cellular homeostasis. Reactive oxygen species , including hydroxyl radicals , hydrogen peroxide , superoxide anions , and lipid peroxides, are molecules highly reactive because of the presence of unpaired electrons . The increase in ROS production, as well as the decrease in their elimination, can disrupt the balance of the cell redox state, resulting in oxidative stress and breaking of cellular homeostasis . As oxidizing agents, ROS interfere with intracellular functions, being capable of damaging various cellular elements, including cell membranes, proteins, lipids and nucleic acids, and ultimately resulting in mitochondrial dysfunction and loss of enzymatic activity . Under physiological conditions, antioxidant agents, namely glutathione , superoxide dismutase , glutathione peroxidase and catalase, act as ROS antagonists, therefore contributing to the maintenance of the cell redox state .
Se Supplementation In Go
For Graves patients with GO, 76 out of 136 respondents declared that the available evidence supports the use of Se supplementation. Only 6 answered that there is no evidence in favor of this treatment and 44 affirmed that they sometimes prescribed Se even if recognizing the available scientific evidence as insufficient . Accordingly, the vast majority of respondents recommended Se use in GO, namely 53 sometimes , 41 frequently , and 34 always . Se supplementation was recommended by 83 ETA members as an alternative to surveillance alone in patients with mild ocular involvement and by 61 as a supplement to the established treatment modalities in patients with moderate to severe GO . The preferred dose was 200 µg/day for 108 out of 119 clinicians who answered this question, and 102/128 recommended Se treatment for a period of a few weeks to months and a subsequent reassessment of the patient for evaluating the effect of Se supplementation.
Fig. 4.
Distribution of respondents for Se supplementation in GO. a The perceived quality of evidence about the use of Se in this setting. b The reasons supporting Se supplementation . c The declared use of Se supplementation.
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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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What Does Selenium Do
Selenium acts as an antioxidant in our bodies. Antioxidants are molecules that fight free radicals in your body.
Free radicals are compounds that are produced as a result of the chemical reactions that happen all the time in our bodies. Free radicals can cause harm if their levels become too high in our bodies. They have been linked to many illnesses including diabetes, heart disease and cancer. Free radicals also serve important functions essential for health such as fighting infections. Our bodies need to maintain a certain balance of free radicals and antioxidants.
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How Is Selenium Used In Treating Ted
Research shows that when taken regularly for at least 1 year, selenium supplements can improve symptoms and quality of life for people with TED who live in a region where the soil is selenium-deficient.1
However, it is not yet known if selenium supplements would have the same effect for people with TED who live in selenium-rich regions of the world. More research is needed.1
If you have mild thyroid eye disease and treatments are not working for you, talk with your doctor. Selenium supplements might be an option to help ease your TED symptoms. Selenium can interact with some drugs, so be sure to tell your doctor about any medicines you are currently taking before adding a selenium supplement to your diet.