The Effects of Selenium Supplementation in the Treatment of Autoimmune Thyroiditis: An Overview of Systematic Reviews

Abstract

Objective: The available evidence on selenium supplementation in the treatment of autoimmune thyroiditis (AIT) was inconclusive. This research serves to assess the effects of selenium supplementation in the treatment of AIT.

Methods: Online databases including PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to 10 June 2022. The AMSTAR-2 tool was used to assess the methodological quality of included studies. The information on the randomized controlled trials of the included studies was extracted and synthesized. The GRADE system was used to assess the certainty of evidence.

Results: A total of 6 systematic reviews with 75 RCTs were included. Only one study was rated as high quality. The meta-analysis showed that in the levothyroxine (LT4)-treated population, thyroid peroxidase antibody (TPO-Ab) levels decreased significantly in the selenium group at 3 months (SMD = -0.53, 95% CI: [-0.89, -0.17], p < 0.05, very low certainty) and 6 months (SMD = -1.95, 95% CI: [-3.17, -0.74], p < 0.05, very low certainty) and that thyroglobulin antibody (Tg-Ab) levels were not decreased. In the non-LT4-treated population, TPO-Ab levels decreased significantly in the selenium group at 3 and 6 months and did not decrease at 12 months. Tg-Ab levels decreased significantly in the selenium group at 3 and 6 months and did not decrease at 12 months. The adverse effects reported in the selenium group were not significantly different from those in the control group, and the certainty of evidence was low.

Conclusion: Although selenium supplementation might reduce TPO-Ab levels at 3 and 6 months and Tg-Ab levels at 3 and 6 months in the non-LT4-treated population, this was based on a low certainty of evidence.

Keywords: autoimmune thyroiditis; meta-analysis; overview; selenium; thyroid.

Figure 1

Literature screening process.

Figure 2

Compliance of the AMSTAR-2 items (* critical item).

Figure 3

The risk of bias for RCTs.

Figure 4

Difference of TPO-Ab levels between the selenium group and control group in the LT4 (a) and non-LT4 treatment groups (b). The black block represents the effect sizes of individual studies, red dashed line represents combined effect sizes, blue diamond block represents the 95%CI of combined effect sizes [24,26,27,28,29,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46].

Figure 5

Difference in Tg-Ab levels between the selenium group and control group in LT4 (a) and non-LT4 treatment groups (b). The black block represents the effect sizes of individual studies, red dashed line represents combined effect sizes, blue diamond block represents the 95%CI of combined effect sizes [24,26,27,28,32,34,35,36,38,39,40,44,45].

Figure 6

Difference of adverse effects between the selenium group and control group. The black block represents the effect sizes of individual studies, red dashed line represents combined effect sizes, blue diamond block represents the 95%CI of combined effect sizes [25,26,27,30,31,35,41].