SERUM SELENYUM SEVİYESİ DÜŞÜK SUBKLİNİK HİPOTİROİDİLİ HASTALARDA ORAL SELENYUM REPLASMAN TEDAVİSİNİN TSH ÜZERİNE ETKİLERİ

Yıl 2022, , 295 - 299, 18.07.2022

Gökhan Yılmaz , Ece Yiğit , Miraç Pala Tuba Mert

https://doi.org/10.18229/kocatepetip.841436

Öz

AMAÇ: Selenyum insan vücudunun önemli metabolik yolaklarının vazgeçilmez bir bileşenidir. Aktif bölgesine selenosistein şeklinde selenyum katılmış proteinler, selenoproteinler olarak tanımlanmaktadır ve bu proteinlerin fonksiyonlarını yerine getirmeleri için selenyuma gereksinimleri vardır. Selenyum elementi, Glutatyonperoksidaz (GPXs), Tioredoksinredüktaz (TRs) ve iyodotironindeiyodinaz (İD) gibi selenoproteinlerin yapısında bulunmaktadır. Selenoproteinler, tiroid hormon biyosentezine ve metabolizmasına, antioksidan savunma sisteminin kontrolüne katkı sağlamaktadır. Çalışmamızda subklinik hipotiroidisi olan otoimmün tiroidit hastalarına selenyum düşüklüğünün ne sıklıkla eşlik ettiğini ve selenyumu düşük olan hastalarda oral selenyum replasmanının tiroit stimülan hormon (TSH) üzerine etkilerini ortaya koymayı hedefledik.
GEREÇ VE YÖNTEM: Çalışmamızda Aralık 2019 ile Temmuz 2020 aralığında 18 yaşından büyük olup polikliniğimize başvurmuş olan, asemptomatik subklinik hipotiroidisi olan 69 hastayı değerlendirdik. Serum selenyum düzeyi 80 μg/L’den düşük olan hastalara 3 ay süre ile yumuşak bir jel kapsül içinde oral yolla günde 83 mcg selenometiyonin verildi. Başka bir tedavi uygulanmadı. Üçüncü ayın sonunda tüm hastalarda serum tiroid hormon profiline ve selenyum seviyelerine bakıldı. Subklinik hipotiroidisi olan otoimmün tiroiditli hastaların, yüzdelik dilimler kullanılarak, oral selenyum replasmanı sonrası TSH seviyelerindeki değişiklikler gözlemlendi.
BULGULAR: Çalışmamızda Aralık 2019 ile Temmuz 2020 arasında polikliniğimizde tespit edilen 69 asemptomatik subklinik hipotiroidisi olan hasta değerlendirildi. Çalışma kriterlerine uyumlu 43 hastanın 12 tanesinde (%28) serum selenyum düzeyi normal, 31 (%72) tanesinde serum selenyum düzeyi düşük (<80 μg/L) olarak tespit edildi. Üç ay boyunca günlük 83 mcg selenometiyonin oral selenyum replasman tedavisi verilen hastaların 19 (%61)’unda TSH değerinin normal sınırlar içerisine gerilediği görüldü (0,5mIU/L10.00 mIU/L) tespit edilirken, 9 (%29) hastada ise TSH değerinin halen 4.26 mIU/L- 10.00 mIU/L aralığında olduğu görülerek bu hastlara levotiroksin tedavisi başlandı.
SONUÇ: Çalışmamızda selenyum eksikliği bulunan asemptomatik otoimmün subklinik hipotiroidi hastalarına oral selenyum replasmanı yaparak, serum TSH değerleri üzerindeki kısa dönem etkilerini değerlendirdik ve hastaların %61 inin 3 ay içerisinde ötiroid olduğunu gözlemledik. Selenyum eksikliğinin replase edilmesinin, teorik anlamda otoimmün tiroidit başta olmak üzere tüm otoimmün hastalıkların inflamatuar ve oksidatif hasar sürecine olan olumlu etkileri mevcuttur. Ancak bu konuda deneysel ve klinik prospektif planlanmış ve alt grupların detaylandırıldığı kapsamlı çalışmaların yapılması gerektiğini düşünüyoruz.

Anahtar Kelimeler

Selenyum, Subklinik hipotiroidi, TSH.

EFFECTS OF ORAL SELENIUM REPLACEMENT ON TSH IN PATIENTS WITH SUBCLINIC HIPOTIROIDISM WITH LOW SERUM SELENIUM LEVELS

Öz

OBJECTIVE: Selenium is an essential component of important metabolic pathways of the human body. Proteins in which selenium is added to the active site in the form of selenocysteine are defined as selenoproteins and they require selenium to fulfill their functions. Glutathioneperoxidase (GPXs) is found in such selenoproteins as Thioredoxinreductase (TRs) and Iodothyroninedeiodinase (ID). Selenoproteins contribute to thyroid hormone biosynthesis and metabolism and the control of the antioxidant defence system. In our study, we aimed to reveal how often patients with subclinical hypothyroidism and autoimmune thyroiditis are accompanied by low serum selenium level and the effects of oral selenium replacement on Tiroit Stimulating Hormone (TSH) in patients with low selenium.
MATERIAL AND METHODS: In our study, we evaluated 69 patients who were with asymptomatic subclinical hypothyroidism and aged older than 18 and who applied admitted to our outpatient/out-patient clinic between December 2019 and July 2020. Patients with serum selenium levels lower than 80 μg / L were given 83 mcg of selenomethionine in a soft gel capsule for 3 months. No other treatment was applied. At the end of the third month, serum thyroid hormone profile and selenium levels were measured in all patients. Changes in TSH levels were observed in patients with autoimmune thyroiditis with subclinical hypothyroidism after oral selenium replacement by using percentiles.
RESULTS: In our study, 69 patients with asymptomatic subclinical hypothyroidism diagnosed in our outpatient clinic between December 2019 and July 2020 were evaluated. Serum selenium level was identified as normal in 12 (28%) of 43 patients, and serum selenium level was identified as low (<80 μg / L) in 31 (72%) patients. TSH values were found as regressed within normal limits (0,5mIU/L 10.00 mIU / L) in 3 (10%) patients, the TSH value was identified as still in the range of 4.26 mIU / L-10.00 mIU / L in 9 (29%) patients and levothyroxine treatment was started in these patients.
CONCLUSIONS: In our study, we evaluated the short-term effects of oral selenium replacement in asymptomatic autoimmune subclinical hypothyroid patients with selenium deficiency, on serum TSH values and we observed that 61% of patients were euthyroid within 3 months. Replacing selenium deficiency has positive effects on the inflammatory and oxidative damage processes of all autoimmune diseases, especially autoimmune thyroiditis. However, we think that experimental and clinical comprehensive studies, which are detailed in sub-groups, should be conducted on this subject.

Anahtar Kelimeler

Selenium, Subclinical hypothyroidism, TSH.

Kaynakça

• 1. Agency for Toxic Substances and Disease Registry (ATSDR) Toxicological Profile for Selenium https://wwwn.cdc.gov/TSP/ToxProfiles/ToxProfiles.aspx?id=153&tid=28 (Erişim tarihi:26.03.2014).
• 2. Beckett GJ, Arthur JR. Selenium and endocrinesystems. J Endocrinol. 2005; 184(3): 455-65.
• 3. Rayman MP. The importance of selenium to human health. Lancet. 2000;15:233-41.
• 4. Contempre B, Dumont JE, Ngo B, et al. Effect of selenium supplementation in hypothyroid hypothyroid subjects of an iodine and selenium deficient area: the possible danger of in discriminate supplementation of iodinedeficient subjects with selenium. J Clin Endocrinol Metab. 1991;1:213-5.
• 5. Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA guideline: management of subclinicalhypothy-roidism. Eur Thyroid J. 2013;4:215-28.
• 6. Köhrle J, Gärtner R. Selenium and thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6): 815-27.
• 7. Toulis KA, Anastasilakis AD, Tzellos TG, et al. Selenium supplementation in the treatment of Hashimoto's thyroiditis: a systematic review and a meta-analysis. Thyroid. 2010;20(10): 1163-73.
• 8. Reid SM, Middleton P, Cossich MC, et al. Interventions for clinical and subclinical hypothyroidism in pregnancy. Cochrane Database Syst Rev. 2010;(7):CD007752.
• 9. Duntas LH, Benvenga S. Selenium: An element for life. Endocrine. 2015;48(3):756-75.
• 10. Wu Q, Rayman MP, Lv H, et al. Low population selenium status is associated with increased prevalence of thyroid disease. J Clin Endocrinol Metab. 2015;100(11):4037-47.
• 11. Sahebari M, Rezaieyazdi Z, Khodashahi M. SeleniumandAutoimmuneDiseases: A ReviewArticle. Curr Rheumatol Rev. 2019;15(2):123-34.
• 12. Mahmoodianfard S, Vafa M, Golgiri F, et al. Effects of zinc and selenium supplementation on thyroid function in over weight and obese hypothyroid female patients: a randomized double-blind controlled trial. J Am Coll Nutr. 2015;34: 391-99.
• 13. Arthur JR, Nicol F, Beckett GJ, et al. The role of selenium in thyroid hormone metabolism and effects of selenium deficiency on thyroid hormone and iodine metabolism. Biol Trace Elem Res. 1992;33:37-42.
• 14. Nazifi S, Saeb M, Abangah E, et al. Studies on the relationship between thyroid hormones and some trace elements in the blood serum of Iran ianfat-tailedsheep. Vet Arh. 2008;78:159.
• 15. Rostami, R, Aghasi M, Mohammadi A, et al. Enhanced oxidative stress in Hashimoto’s thyroiditis: inter-relationships to biomarkers of thyroid function. Clin Biochem. 2013;46:308-12.
• 16. VanZuuren EJ, Albusta AY, Fedorowicz Z, et al. Selenium supplementation for Hashimoto’s thyroiditis: summary of a Cochrane Systematic Review. Eur Thyroid J. 2014;3:25- 31.
• 17. Dellal FD, Niyazoglu M, Ademoglu E, et al. Evaluation of serum trace elements and vitamin levels in Hashimoto’s Thyroiditis: Single centre Experience from Turkey. Open J Endocrin Metabc Dis. 2013;3:236.
• 18. Stehle P, Stoffel-Wagner B, et al. Parenteral trace element provision: recent clinical research and practical conclusions. Eur J Clin Nutr. 2016;70:886.
• 19. Erdal M, Sahin M, Hasimi A, et al. Trace element levels in Hashimoto thyroiditis patients with subclinical hypothyroidism. Biol Trace Elem Res. 2008;123:1.
• 20. Atmaca H. Hypothyroidism. J Experimental and Clinical Medicine. 2012;29:301-8.
• 21. Díez JJ, Iglesias P. Spontaneous subclinica lhypothyroidism in patients older than 55 years: an analysis of natural course and risk factors for the development of over thyroid failure. J Clin Endocrinol Metab. 2004;89(10):4890.
• 22. Huber G, Staub JJ, Meier C, et al. Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab. 2002;87:3221.
• 23. Meyerovitch J, Rotman-Pikielny P, Sherf M, et al. Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. Arch Intern Med. 2007;167:1533.