Insufficient documentation for clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis, based on a systematic review and meta-analysis
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- 作者：Kristian Hillert Winther ; Johanna Eva Märta Wichman ; Steen Joop Bonnema…
- 关键词：Chronic autoimmune thyroiditis ; Hashimoto’s thyroiditis ; Selenium supplementation ; Thyroid hormones ; Systematic review ; Meta ; analysis ; Quality of life ; Thyroid ultrasound
- 刊名：Endocrine
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：55
- 期：2
- 页码：376-385
- 全文大小：645KB
- 刊物主题：Endocrinology; Diabetes; Internal Medicine; Science, Humanities and Social Sciences, multidisciplinary;
- 出版者：Springer US
- ISSN：1559-0100
- 卷排序：55
文摘
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.