Dr. Ahmed
Latest Study Affirms a Possible Role of Selenium for Hashimoto’s Disease.
A meta-analysis and systemic review of 687 records revealed a possible role of selenium in thyroid disorders and Hashimoto’s thyroiditis in particular.
Key points of the study:
- Hypothyroidism is a disease primarily caused by Hashimoto thyroiditis, especially in areas where iodine intake is sufficient.
- One of the essential trace elements, selenium is required for the synthesis of thyroid hormone having antioxidant effects, thus it is used in the management of Hashimoto thyroiditis.
- It was evaluated from a systematic review and meta-analysis of randomized controlled trials that the supplementation of selenium has different effects on parameters of Hashimotos Thyroiditis (HT), including TSH, thyroid peroxidase antibodies, thyroglobulin antibodies, ultrasound findings, and adverse effects.
- Among those patients who are not receiving thyroid hormone replacement therapy (THRT), the supplementation of selenium lowers the level of thyrotropin (TSH) and thyroid peroxidase antibodies (TPOAb), as well as it also lowers the level of malondialdehyde (MDA), with similar negative effects observed in the intervention and control groups.
- The results suggest that selenium supplementation is safe and beneficial in decreasing TSH, TPOAb, and MDA levels in persons with HT who are not undergoing THRT, pointing to possible benefits independent of THRT.
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Selenium for Hashimoto’s Thyroiditis
Hypothyroidism is commonly caused by iodine deficiency worldwide. Among 4% to 10% of the general population is affected by hypothyroidism with a further 5% being undiagnosed.
Among them, 99% usually suffer from primary hypothyroidism. In children and infants, two types of hypothyroidism are usually present, one is congenital that present at birth, and the other is acquired, which develops after birth. The acquired hypothyroidism is autoimmune and called Hashimoto thyroiditis.
Hypothyroidism is generally diagnosed by elevated levels of thyroid-stimulating hormone (TSH) with low levels of thyroid hormone.
The thyroid gland is one of the major glands in the human body. It synthesizes its hormones for proper functioning.
The thyroid gland needs different nutrients to synthesize its hormones, out of them selenium is one of the important trace elements.
Selenium is most abundant in the thyroid gland. It is not produced in the human body and low availability of selenium may lead to abnormalities of thyroid metabolism disorders.[ref]
A recent study focused on giving “selenium supplementation” in patients with Hashimoto thyroiditis.
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Selenium for Hashimoto’s Disease Findings:
The systemic review found no direct effects of selenium on Thyroxine, Free T3, and thyroid volume or echogenicity.
However, Selenium supplementation was found to be associated with lower levels of Thyroid autoantibodies (TPOAb) and Thyroid Receptor Antibodies.
It is safe and effectively lowers TGAb (thyroglobulin antibodies) in patients with Hashimoto thyroiditis without THRT (thyroid hormone replacement therapy).
It lowers the TSH (thyroid stimulating hormone), TPOAb (thyroid peroxidase antibodies), and MDA (Malondialdehyde) levels.
However, future investigation is needed to understand the clinical significance of lowering TPOAb as it was found independent of THRT [ref].
Methodology and analysis:
The study followed the principles of the Cochrane Handbook and Prisma 2020 when conducting a systematic review and meta-analysis.
The search approach included both forward and backward citation searches and covered several databases.
Randomized controlled trials including selenium supplementation in individuals with Hashimoto thyroiditis and hypothyroidism, with or without thyroid hormone replacement therapy (THRT), were considered eligible investigations.
Thyroid function, antibodies, ultrasonography results, immunological indicators, patient-reported outcomes, and adverse events were all included in the outcomes.
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Association of obesity or overweight with Hashimoto’s thyroiditis:
According to previous studies obese people are more likely to develop Hashimoto thyroiditis.
Obesity is significantly associated with Hashimoto thyroiditis symptoms and increased levels of TPOAb.
Childhood obesity and overweight also increase the susceptibility to develop hypothyroidism and thyroid autoimmunity in later age.
Research conducted that the increased TPOAb levels are directly linked with triglyceride levels, as their high levels lead towards obesity and are inversely linked with “good cholesterol” or HDL cholesterol.
Independent of thyroid functions, Hashimoto thyroiditis also has some effects on higher lipid levels and abdominal obesity.
In Hashimoto thyroiditis, it is indicative to determine the lipid profiles and anthropometric parameters of all patients, even the euthyroid [ref].
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Important Supplementation in Hashimoto Thyroiditis:
Iodine and Selenium:
Researchers conclude that iodine deficiency may lead to many serious consequences like goitre to cretinism but high iodine supplementation should be discouraged in Hashimoto thyroiditis.
A new treatment for Hashimoto’s thyroiditis is the selenium supplementation in the form of selenomethionine with adequate iodine intake but large quantities of selenium may have adverse effects.[ref].
Vitamin D:
A study from 2015 suggests that the deficiency of vitamin D is somehow related to the pathogenesis of Hashimoto thyroiditis thus its supplementation may contribute to the Hashimoto thyroiditis treatment [ref].
Dietary modification in Hashimoto thyroiditis:
When you are looking for Hashimoto thyroiditis treatment, the following recommendations must be considered:
- Adjusting the daily energy value and low-fat diet is recommended as it may affect the thyroid functioning.
- It is recommended to use plant based oils or fats such as olive oil, rapeseed oil, avocado oil, walnut oil and from animal sources including fish oil and seafood.
- Increase daily intake of fibre and use whole grains to meet the carbohydrate source containing high amounts of dietary fibres.
- It is recommended to increase the daily protein intake from 10-15% to 15-20% and even 25% for some cases.
- Consumption of processed food like bakery items, beverages and simple sugars are not recommended.
- It is recommended to take 4-5 meals/day with the increased nutrients count of vitamin A, D, C, E, group of B vitamins, selenium, iodine, iron, magnesium, and zinc.
- To improve defecation and bowel function, Increase the intake of soluble fibres. Plant based foods, including vegetables and fruits are good sources and support gut microbiota.
- Elimination of lactose is also preferable, as 75.9% of patients with Hashimoto thyroiditis are diagnosed with lactose intolerance. Lactose intolerance hinders the bioavailability of drugs thus it is recommended to eliminate it. [ref]
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