Certainly this is NOT the last word on the subject. The conclusion is "not enough evidence".
It is, of course, important that this is not taken as evidence against!
Selenium supplementation for Hashimoto's thyroiditis
Hashimoto's thyroiditis is a common disease in which a form of chronic inflammation of the thyroid gland results in reduced function of the gland. It is an auto-immune disorder, which means that a person's own immune system attacks the thyroid gland, so that it no longer makes adequate quantities of thyroid hormones (hypothyroidism). Common clinical manifestations include feeling cold, depressive mood, dry skin, puffy eyes, constipation, weight gain, slowed heart rate, joint and muscle pain and fatigue. Some but not all people with Hashimoto's thyroiditis have an enlarged gland, also called a goitre. Hashimoto's thyroiditis is more common in women than in men and tends to run in families. Other auto-immune diseases often occur simultaneously, such as vitiligo, rheumatoid arthritis and diabetes type 1. The disease does not always require treatment, but when it does, it is treated with synthetic thyroid hormone replacement (sometimes desiccated thyroid hormone is used, which is not synthetic). Selenium is an essential trace element that is required in small amounts for correct functioning of the immune system and the thyroid gland.
Four studies at unclear to high risk of bias comprising 463 participants were included. The mean study duration was 7.5 months (range 3 to 18 months). None of the studies addressed our key primary outcome-'health-related quality of life'. Two of our secondary outcomes-'change from baseline in levothyroxine (i.e. thyroid hormone) replacement dosage at end of the study' and 'economic costs'-were not assessed either. One study at high risk of bias showed a statistically significant improvement in subjective well-being with sodium selenite 200 µg plus levothyroxine compared with placebo plus levothyroxine (14/18 compared with 3/18, respectively). Selenomethionine 200 µg and sodium selenite 200 µg reduced the serum levels of anti-thyroid peroxidase antibodies in three studies, and although the changes from baseline were statistically significant, their clinical relevance is unclear. Adverse events were reported in two studies, and selenium supplementation did not lead to more adverse events than were seen with placebo. One adverse event was reported in both studies in the selenomethionine 200 µg plus LT4 arm versus none in the control arm.
In conclusion, the results of these four studies do not provide enough evidence to support the use of selenium in the treatment of Hashimoto's thyroiditis.
Hmmmm....Selenium has been like a mircacle cure for me. I had a multinodular goitre, and total thyroidectomy 18 months ago. Since then, I felt like crap on Levothyroxine only until I discovered Selenium. Now my joint and muscle aches have diminished and I can sleep all night!!
I have seen a recent report/comment that Sodium Selenite does not have the same self regulatory effects [protection] on Iodine over supplementation that natural selenium does.
[Sorry, no link right now, but I suspect a Naturopathic source anyway.]
No reason to think that this factlet may not be implicated in under acheivement on the UAT front, as Iodine is involved in Thyroid performance in any case, other than total failure- under Hashis.
No surprise that Brazil Nuts do not figure highly in hard medical testing trials- very hard to scale their input for Se- though, from anecdotal evidence, Se can help some as above post.
"Iodothyronine deiodinases are unusual in that these enzymes contain selenium, in the form of an otherwise rare amino acid selenocysteine" (en.wikipedia.org/wiki/Iodot...
So the requirement for selenium is vital for the proper functioning of the T4, T3, T2, T1 processing.
"Abstract
Selenium is of fundamental importance to human health. It is an essential component of several major metabolic pathways, including thyroid hormone metabolism, antioxidant defence systems, and immune function. The decline in blood selenium concentration in the UK and other European Union countries has therefore several potential public health implications, particularly in relation to the chronic disease prevalence of the Western world such as cancer and cardiovascular disease." (ncbi.nlm.nih.gov/pubmed/116... .
While taking selenium is unlikely to be a cure for hypoT having it around, in very small adequate amounts, is essential to any medication used to fix HypoT such as T4 or T3 to be effective. So why not take a supplement or a few Brazil nuts daily?
I was recommended to take a selenium supplement alongside my 125mcg levothyroxine, which I have done for the past year and feel basically back to normal. I ran out recently and have been off it for about a month and am beginning to feel quite tired and slightly achy joints again - I'm going to go straight back on the selenium and see if I pick up again.
Thanks for that Rod, although I'm past it being useful having lost my thyroid.
This as usual is a little long, but is written to paint a picture which hopefully may be useful to some.
I'm no expert, and there may be a discussion on the role of selenium that involves other considerations - but it may be too that its effective use requirescareful choice of patient situation, and a rather more holistic approach to treatment than is the norm.
i.e. it may not be a magic bullet, it may not be the solution in many cases, but it may (as you take care to suggest) be very important if used correctly and in the right circumstances.
If we take it that (as is commonly held) thyroid problems and subsequent autoimmune issues often entail gut problems - then it may be that catching the problem very early on is necessary if selenium or other minerals (copper etc) are to deliver a result.
The rationale might be as follows. Stress, hereditary tendencies, dietary deficiences and the like can lead to poor absobtiion of key minerals the thyroid needs for proper function like copper and selenium.
The thyroid may as a result reduce its output and/or the body its ability to use hormone - meaning hypothyroidism sets in and gut function and condition worsens.
The gut after a time starts to leak, and its immune moderation and other thyroid related functions like conversion reduce too.
It's pretty incredible (and in another way not - what else is the gut about if not energy production) just how fundamental gut function is to so many aspects of metabolic health: chriskresser.com/the-thyroi...
This leads to the possibility of thyroid (and maybe other) auto immune disease setting in.
The point is that while low selenium may well have been a significant initial trigger in the situation, once gut problems and auto immune issues are well establised it can be a long and multi faceted road back to restoring homeostasis. (correct balance)
It may be too that if the AI situation has progressed far enough that damage to the thyroid, the gut and other organs may make recovery even more difficult if not near to impossible by normal medical means. Secondary conditions (which typically reinforce the original problem) may by now require treatments that seem to bear little relationship to the original cause.
i.e. seleium is likely still necessary, but by now is likely not going to achieve a lot on its own.
I guess as ever it points to the importance of promt and effect treatment of early hypo symptoms and the like. The real damage gets done in this period - one during which medicine tends not to take complaints of fatigue and the like seriously.
I'm reasonably sure for example that this window (where relatively simple treatments might well have restored normal gut and thyroid function) lasted for of the order of four years in my own case. I saw several doctors during this period, but never got past the platitudes. 'We all get a bit depressed at times'.
The whole edifice came tumbling down in 1993 (my health and energy collapsed, i spent two years off work, and i lost my career in management) - it took another 12 years of struggle to decline to the point where I become overtly and seriously ill. Which led to the finding of a thyroid cancer and the confirmation of advanced thyroid auto immune disease.
Despite extensive testing neither hypothyroidism nor auto immune disease were ever diagnosed....
Well, I like the two statements "statistically significant" and "reduced serum antibodies" with nominal adverse events. Maybe for the "unbiased" it doesn't prove enough but for the "sick" it might be worth a try.
Thank you for your thoughtful and interesting comments.
Humans seem to have around 25 seleno-proteins (current estimates/evidence). Of these, we have the three deiodinases (D1, D2 and D3) which are clearly of direct and huge relevance to thyroid folk. Which leaves another 22 or so to ponder.
I suspect that anyone who is low in selenium would be likely to benefit from modest supplementation. But, like so many other things, finding out where you are is not easy. And it is not at all clear from the summary text that the underlying reports took sufficient account of that.
We also have the issues about which sort of selenium is best which was also not exactly clear.
The usual Gov't advice on supplements is that enough nutrients and vitamins are in a normal healthy diet [Fine-if you get one!].
Due to the problems of dosing [and outcomes] therapeutic vitamins are not promoted generally by the medical profession, but I believe they can help -and are safest in dietary form.
I still fall back to tableted Magnesium[Citrate] and Zinc [inc.copper], B12 etc.
2 Brazil nuts are enough -but 6 a day on a regular basis would be far too much Selenium.
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Hashimoto's thyroiditis
