Insufficient documentation for clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis, based on a systematic review and meta-analysis

Endocrine. 2017 Feb;55(2):376-385. doi: 10.1007/s12020-016-1098-z. Epub 2016 Sep 28.


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.

Keywords: Chronic autoimmune thyroiditis; Hashimoto’s thyroiditis; Meta-analysis; Quality of life; Selenium supplementation; Systematic review; Thyroid hormones; Thyroid ultrasound.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Health Status
  • Humans
  • Quality of Life*
  • Selenium / therapeutic use*
  • Thyroiditis, Autoimmune / blood
  • Thyroiditis, Autoimmune / drug therapy*
  • Thyrotropin / blood
  • Thyroxine / therapeutic use*
  • Treatment Outcome


  • Thyrotropin
  • Selenium
  • Thyroxine