Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Bengbu, 233004, Anhui, China.
Department of Endocrinology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China.
J Endocrinol Invest. 2017 Nov;40(11):1243-1250. doi: 10.1007/s40618-017-0693-z. Epub 2017 May 22.
New strategies are needed for prevention and treatment of chronic lymphocytic thyroiditis (CLT). This study aimed to assess whether combination of levothyroxine treatment and selenium (Se) supplementation results in improved therapeutic effects in CLT compared with levothyroxine monotherapy.
An open-label, randomized controlled study was performed in 60 CLT patients assigned to two groups. Levothyroxine group (LT) patients (n = 24) received levothyroxine alone for 3 months; meanwhile, the combination (LTSS) group (n = 36) was administered levothyroxine with selenium yeast capsule. Blood selenium concentrations, anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibody levels, and inflammatory cytokine amounts were compared between both groups before and after treatment.
At baseline, similar values were obtained in both groups for all the parameters assessed (p > 0.05). After treatment, significantly increased blood selenium levels (µg/L) [90.05 (80.69, 107.76) vs. 39.64 (29.42, 51.10), p < 0.001] and decreased anti-TPO antibody (23.63 ± 9.31 vs. 32.00 ± 10.41%, p = 0.002), anti-Tg antibody (35.84 ± 15.21 vs. 45.47 ± 14.24%, p = 0.015) and IL-2 amounts (pg/mL) [159.29 (124.54, 189.70) vs. 226.48 (190.74, 266.56), p < 0.001] were observed in the LTSS group compared with the LT group post-treatment; meanwhile, similar IL-10 concentrations [23.14 (21.65, 28.56) pg/mL vs. 24.68 (21.71, 29.67) pg/mL] were obtained in both groups. Subgroup analysis of patients with hypothyroidism showed the same trend observed in the whole population; in patients with normal thyroid function, only Se and IL-2 amounts differed between the two treatment groups. Correlation analysis of of the indexes: in HT patients, the basal serum selenium concentration was positively correlated with TT (r = 0.294, p < 0.05), significantly negatively correlated with TSH (r = -0.343, p < 0.01), and had no significant correlation with TT3 (p > 0.05).
These findings indicated that levothyroxine and selenium combination results in improved therapeutic effects than the levothyroxine monotherapy in preventing CLT progression.
需要新的策略来预防和治疗慢性淋巴细胞性甲状腺炎（CLT）。本研究旨在评估与单独使用左甲状腺素（LT）治疗相比，左甲状腺素联合硒（Se）补充治疗在 CLT 中的疗效是否更好。
这是一项开放标签、随机对照研究，纳入 60 例 CLT 患者，分为两组。LT 组（n=24）接受 LT 治疗 3 个月；同时，LTSS 组（n=36）接受 LT 联合硒酵母胶囊治疗。比较两组治疗前后的血硒浓度、甲状腺过氧化物酶（TPO）和甲状腺球蛋白（Tg）抗体水平以及炎症细胞因子水平。
基线时，两组所有评估参数均无差异（p>0.05）。治疗后，LTSS 组血硒水平[90.05（80.69，107.76）vs. 39.64（29.42，51.10），p<0.001]显著升高，TPO 抗体[23.63±9.31 vs. 32.00±10.41%，p=0.002]、Tg 抗体[35.84±15.21 vs. 45.47±14.24%，p=0.015]和白细胞介素 2（IL-2）水平[159.29（124.54，189.70）vs. 226.48（190.74，266.56），p<0.001]显著降低，而 LT 组无明显变化。LTSS 组的白细胞介素 10（IL-10）浓度[23.14（21.65，28.56）pg/mL vs. 24.68（21.71，29.67）pg/mL]与 LT 组无差异。亚组分析显示，在甲状腺功能减退患者中，观察到与全人群相同的趋势；在甲状腺功能正常的患者中，两组之间仅硒和 IL-2 水平存在差异。相关性分析：在甲状腺功能减退患者中，基础血清硒浓度与 TT 呈正相关（r=0.294，p<0.05），与 TSH 呈显著负相关（r=-0.343，p<0.01），与 TT3 无明显相关性（p>0.05）。
这些发现表明，左甲状腺素联合硒治疗在预防 CLT 进展方面优于左甲状腺素单药治疗。
