A Prospective Investigation of Graves' Disease and Selenium: Thyroid Hormones, Auto-Antibodies and Self-Rated Symptoms
A Prospective Investigation of Graves' Disease and Selenium: Thyroid Hormones, Auto-Antibodies and Self-Rated Symptoms
复制标题
DOI：
10.1159/000381768
复制
发表时间：
2015-01-01
影响因子：
4.7
通讯作者：
Moller, Marika
中科院分区：
文献类型：
--
作者：
Calissendorff, Jan;Mikulski, Emil;Moller, Marika
背景：在Graves‘s甲状腺机能亢进性心动过速中，体重减轻和精神症状是常见的。康复需要时间，不同患者的康复情况各不相同。他巴唑治疗可降低甲状腺激素水平。根据以前的研究，如果添加硒，这种减少会更快。目的：探讨在药物治疗的基础上加用硒是否能改变免疫机制、激素水平和/或抑郁、焦虑。方法：对38例初治甲亢患者在服药前、治疗后6、18、36周测定促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、甲状腺受体抗体和甲状腺过氧化物酶自身抗体。在包涵体时和36周后测定血浆中硒蛋白P的浓度。在服药前和服药36周后，对患者进行抑郁、焦虑和自测症状问卷调查。结果：与安慰剂组相比，补硒18周时FT4下降幅度更大(14比17pmol/L，P=0.0 1)；36周时FT4下降幅度更大(15比18 pmol/L，P=0.0 1)。18周时Se组TSH升高更明显(0.05vs.0.02mIU/L，p=0.04)。两组的抑郁和焦虑得分相似。Se组抑郁发生率与FT3呈负相关，与TSH呈正相关。在安慰剂组中没有发现这一点。结论：补硒可促进甲亢的生化恢复，但能否缩短甲亢的临床症状，减轻精神症状，有待进一步研究。(C)2015年欧洲甲状腺协会，S.Karger AG出版，巴塞尔
Background: In Graves' thyrotoxicosis tachycardia, weight loss and mental symptoms are common. Recovery takes time and varies between patients. Treatment with methimazole reduces thyroid hormone levels. According to previous research, this reduction has been faster if selenium (Se) is added. Objective: The objective was to investigate whether supplementing the pharmacologic treatment with Se could change the immune mechanisms, hormone levels and/or depression and anxiety. Methods: We prospectively investigated 38 patients with initially untreated thyrotoxicosis by measuring the thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid receptor antibodies and thyroid peroxidase auto-antibodies before medication and at 6, 18 and 36 weeks after commencing treatment with methimazole and levo-thyroxine, with a randomized blinded oral administration of 200 mu g Se/day or placebo. The selenoprotein P concentration was determined in plasma at inclusion and after 36 weeks. The patients were also assessed with questionnaires about depression, anxiety and self-rated symptoms before medication was started and after 36 weeks. Results: FT 4 decreased more in the Se group at 18 weeks (14 vs. 17 pmol/l compared to the placebo group, p = 0.01) and also at 36 weeks (15 vs. 18 pmol/l, p = 0.01). The TSH increased more in the Se group at 18 weeks (0.05 vs. 0.02 mIU/l, p = 0.04). The depression and anxiety scores were similar in both groups. In the Se group, the depression rates correlated negatively with FT 3 and positively with TSH. This was not seen in the placebo group. Conclusions: Se supplementation can enhance biochemical restoration of hyperthyroidism, but whether this could shorten clinical symptoms of thyrotoxicosis and reduce mental symptoms must be investigated further. (C) 2015 European Thyroid Association Published by S. Karger AG, Basel