Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece.
Thyroid. 2010 Oct;20(10):1163-73. doi: 10.1089/thy.2009.0351.
Evidence suggests that selenium (Se) supplementation could be useful as an adjunctive therapy to levothyroxine (LT₄) in the treatment of Hashimoto's thyroiditis (HT). To summarize evidence regarding its effect on thyroid autoantibodies' titers, demands in LT₄ replacement therapy, ultrasonographic thyroid morphology, and mood in patients with HT under LT₄ treatment, a systematic review and meta-analysis of relevant literature were performed.
Systematic review of prospective studies involving patients with HT under LT₄ treatment and meta-analysis of studies on randomized, placebo-controlled, blinded trials were performed.
Patients with HT assigned to Se supplementation for 3 months demonstrated significantly lower thyroid peroxidase autoantibodies (TPOab) titers (four studies, random effects weighted mean difference: −271.09, 95% confidence interval: −421.98 to −120.19, p< 10⁻⁴) and a significantly higher chance of reporting an improvement in well-being and/or mood (three studies, random effects risk ratio: 2.79, 95% confidence interval: 1.21-6.47, p= 0.016) when compared with controls. Demands in LT₄ replacement therapy and ultrasonographic thyroid morphology were found either unaltered or underreported.
On the basis of the best available evidence, Se supplementation is associated with a significant decrease in TPOab titers at 3 months and with improvement in mood and/or general well-being. Evidence suggests a different pattern of response to Se supplementation in HT relative to baseline TPOab titers, and this, if confirmed, could be used to identify which patients would benefit most from treatment. An improvement in thyroid function and morphology should be demonstrated before Se routine supplementation can be recommended in the treatment of HT.
有证据表明，硒（Se）补充剂可能是左旋甲状腺素（LT₄）治疗桥本甲状腺炎（HT）的辅助治疗方法。为了总结有关其对甲状腺自身抗体滴度、LT₄替代治疗需求、甲状腺超声形态和 HT 患者情绪影响的证据，我们对相关文献进行了系统评价和荟萃分析。
对纳入 LT₄治疗的 HT 患者的前瞻性研究进行系统评价，并对随机、安慰剂对照、盲法试验进行荟萃分析。
接受 Se 补充治疗 3 个月的 HT 患者甲状腺过氧化物酶自身抗体（TPOab）滴度显著降低（四项研究，随机效应加权均数差：-271.09，95%置信区间：-421.98 至 -120.19，p<10⁻⁴），且报告改善健康状况和/或情绪的可能性明显更高（三项研究，随机效应风险比：2.79，95%置信区间：1.21-6.47，p=0.016）。LT₄ 替代治疗需求和超声甲状腺形态无明显改变或报告不足。
根据现有最佳证据，Se 补充治疗 3 个月可显著降低 TPOab 滴度，并改善情绪和/或整体健康状况。证据表明，HT 患者对 Se 补充治疗的反应模式与基线 TPOab 滴度不同，如果得到证实，可用于确定哪些患者最受益于治疗。在推荐将 Se 常规补充用于 HT 治疗之前，应先显示甲状腺功能和形态的改善。
