Add-On Effect of Selenium and Vitamin D Combined Supplementation in Early Control of Graves’ Disease Hyperthyroidism During Methimazole Treatment

Frontiers in Endocrinology

Michele Marinò¹  Giulia Lanzolla¹  Paola Moretto²  Luigi Bartalena³  Maria Laura Tanda³  Eliana Piantanida³  Daniela Gallo³  Simona AM Cattaneo⁴  Lorenzo Mortara⁵  Matteo Gallazzi⁵  Antonino Bruno⁶  Alberto Passi⁷  Maria Antonietta Lavizzari⁷  Andrea Pini⁷  Andrea Nauti⁷  Angelo Genoni⁸  Carlo Peruzzo⁹  Giovanni Veronesi^1,10  Paolo Lasalvia^1,10 

[1] 0Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Pisa, Italy;Department of Medicine and Surgery, University of Insubria, Varese, Italy;Endocrine Unit, Department of Medicine and Surgery, University of Insubria, Azienda Socio Sanitaria Territoriale (ASST) dei Sette Laghi, Varese, Italy;Immuno-hematology and Transfusion Medicine, ASST dei Sette Laghi, Varese, Italy;Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy;Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy;Laboratory of Clinical Chemical Analysis, ASST dei Sette Laghi, Varese, Italy;Laboratory of Microbiology, Department of Biotechnology and Life Science, University of Insubria, Varese, Italy;Occupational, Preventive and Toxicology Unit, ASST Sette Laghi, Varese, Italy;Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy;

关键词: Graves’ disease;    hyperthyroidism treatment;    vitamin D;    selenium;    quality of life;   

DOI  :  10.3389/fendo.2022.886451

来源: DOAJ

【 摘 要 】

Prompt and stable control of hyperthyroidism is fundamental to avoid the detrimental effects of thyroid hormone excess, and antithyroid drugs, mainly methimazole (MMI), represent the first-line treatment for Graves’ disease (GD) hyperthyroidism. Decreased serum concentrations of selenium (Se) and calcifediol (25(OH)D, VitD) have been reported in newly diagnosed GD patients in observational studies. Low Se levels might exacerbate oxidative stress by compromising the antioxidant machinery’s response to reactive oxygen species, and low VitD levels might hamper the anti-inflammatory immune response. We performed a randomized controlled clinical trial (EudraCT 2017-00505011) to investigate whether Se and cholecalciferol (VitD) addition to MMI is associated with a prompter control of hyperthyroidism. Forty-two consecutive patients with newly-onset GD and marginal/insufficient Se and VitD levels were randomly assigned to treatment with either MMI monotherapy or MMI combined with Se and VitD. Se treatment was withdrawn after 180 days, while the other treatments were continued. Combination therapy resulted in a significantly greater reduction in serum FT4 concentration at 45 days (-37.9 pg/ml, CI 95%, -43.7 to -32.2 pg/ml) and 180 days (-36.5 pg/ml, CI 95%, -42 to -30.9 pg/ml) compared to MMI monotherapy (respectively: -25.7 pg/ml, CI 95%, -31.6 to -19.7 pg/ml and -22.9 pg/ml, CI 95%, -28 to -17.3 pg/ml, p 0.002). Data at 270 days confirmed this trend (-37.8 pg/ml, CI 95%, -43.6 to -32.1 pg/ml vs -24.4 pg/ml, CI 95%, -30.3 to -18.4 pg/ml). The quality of life (QoL) score was investigated by the validated “Thyroid-related Patient-Reported Outcome” questionnaire (ThyPRO). ThyPRO composite score showed a greater improvement in the intervention group at 45 days (-14.6, CI 95%, -18.8 to -10.4), 180 (-9, CI 95%, -13.9 to -4.2) and 270 days (-14.3, CI 95%, -19.5 to -9.1) compared to MMI group (respectively, -5.2, CI 95%, -9.5 to -1; -5.4, CI 95%, -10.6 to -0.2 and -3.5, CI 95%, -9 to -2.1, p 0-6 months and 6-9 months <0.05). Our results suggest that reaching optimal Se and VitD levels increases the early efficacy of MMI treatment when Se and VitD levels are suboptimal.

【 授权许可】

Unknown