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Endocrine. 2017 Feb;55(2):376-385. doi: 10.1007/s12020-016-1098-z. Epub 2016 Sep 28.

Insufficient documentation for clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis, based on a systematic review and meta-analysis.

Author information

1
Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark. kristian.winther@rsyd.dk.
2
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark. kristian.winther@rsyd.dk.
3
Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark.
4
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark.

Abstract

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.

KEYWORDS:

Chronic autoimmune thyroiditis; Hashimoto’s thyroiditis; Meta-analysis; Quality of life; Selenium supplementation; Systematic review; Thyroid hormones; Thyroid ultrasound

PMID:
27683225
PMCID:
PMC5272877
DOI:
10.1007/s12020-016-1098-z
[Indexed for MEDLINE]
Free PMC Article

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