Selenium and the thyroid: A close-knit connection

Context: The recent recognition that the essential trace element selenium is incorporated as selenocysteine in all three deiodinases has decisively confirmed the clear-cut link between selenium and thyroid function. It has additionally been established that the thyroid contains more selenium than any other tissue and that selenium deficiency aggravates the manifestation of endemic myxedematous cretinism and autoimmune thyroid disease. Evidence Acquisition: Clinical reports as well as a large number of biochemical articles linking selenium to thyroid have been considered. Interventional, prospective, randomized, controlled studies, including large observational studies, supplementing selenium in autoimmune thyroid disease, together with review articles published in Medline and Pubmed have undergone scrutiny. The methodological differences and variety of results emerging from these trials have been analyzed. Evidence Synthesis: Evidence in support of selenium supplementation in thyroid autoimmune disease is evaluated, the results herein presented demonstrating the potential effectiveness of selenium in reducing the antithyroid peroxidase titer and improving the echostructure in the ultrasound examination. However, considerable discord remains as to who should comprise target groups for selenium treatment, who will most benefit from such treatment, the precise impact of the basal antithyroid peroxidase level, and the effect of disease duration on the treatment outcome. Clearly, further in-depth studies and evaluation are required concerning the mechanism of action of selenium as well as the choice of supplements or dietary intake. Conclusions: Maintenance of "selenostasis" via optimal intake not only aids preservation of general health but also contributes substantially to the prevention of thyroid disease. Copyright © 2010 by The Endocrine Society

Thyroid Function in Aging: A Discerning Approach

Thyroid disease, increasingly common among the general population, is also rising among the elderly, which, given that the global population is aging, constitutes a serious public health issue that needs to be urgently addressed. The most common thyroid disease in younger and older individuals alike is hypothyroidism, including subclinical (SCH) and overt disease. Since TSH tends to increase with age due to intrinsic changes of thyroid metabolism and the gradual resetting of the hypothalamic-pituitary-thyroid axis, the diagnosis of "true" hypothyroidism is challenging, another difficulty being distinguishing disease-specific from aging-associated clinical symptoms. Hypothyroidism in the elderly may cause or exacerbate macrocytic anemia, hypercholesterolemia and kidney dysfunction, therefore careful clinical and biochemical control is necessary. Meanwhile, as an increase of TSH in the old and very old has been associated with longevity, a resetting of the TSH normal range according to age is strongly required before any diagnosis is made and treatment is implemented. Levothyroxine, which remains the treatment of choice, should be initiated in the old at TSH>10 mIU/l, starting with 25 μg/daily followed by cautious upward titration. Recent data (the TRUST study) revealed that treatment of SCH in the elderly does not improve hypothyroid symptoms and the tiredness score when compared with a placebo group. Hyperthyroidism is associated with increased mortality in the aged, this dependent upon type and adequacy of treatment. Treatment should be seriously considered in older patients who have endogenous subclinical hyperthyroidism with a TSH between 0.1 and 0.4 mIU/L, with regular monitoring being strongly advised. © 2018, Mary Ann Liebert, Inc

Oxidants, antioxidants in physical exercise and relation to thyroid function

Intensive muscular exercise promotes the production of reactive oxygen species (ROS) in the working muscles and can impair athletic performance, particularly in conjunction with inadequate recovery. Mammals are protected against oxygen toxicity by a system of ROS scavengers composed of enzymatic and non-enzymatic components. Although antioxidant supplementation has recently been considered as a means to diminish or prevent damage from ROS, the specific antioxidant requirements of athletes are not known. Since thyroid function is essential for athletic performance, thyroid control should be undertaken in cases where there is any sign of thyroid dysfunction "of unknown etiology". Hyperthyroidism and hypothyroidism have been associated with increased production of ROS as well as related inflammatory response and myopathy. There is evidence that antioxidant supplementation combined with antithyroid treatment with methimazole could be useful in decreasing the oxidative stress. © Georg Thieme Verlag KG Stuttgart

The catalytic role of iodine excess in loss of homeostasis in autoimmune thyroiditis

PURPOSE OF REVIEW: To review the latest developments concerning the role of iodine in the pathophysiology of autoimmune thyroiditis. RECENT FINDINGS: Recent studies have provided evidence that in areas with excess iodine intake, increased incidence of autoimmune thyroiditis marked by high titers of thyroid peroxidase and thyroglobulin antibodies has occurred. Investigations in the NOD.H2h4 mouse, a strain prone to AIT, showed that they are better adapted to the Wolff-Chaikoff effect. SUMMARY: To provide an overview of the studies conducted during the last few years implicating iodine in the development and manifestation of autoimmune thyroiditis