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Selenium — Selenium may improve symptoms in patients with mild Graves' orbitopathy, particularly patients residing in areas of relative selenium insufficiency. One trial compared selenium (100 mcg twice daily), pentoxifylline (600 mg twice daily), or placebo in 159 patients from a region in which selenium levels are marginally decreased [23]. These patients had at least one sign of mild orbitopathy (chemosis, mild-to-moderate eyelid swelling, exophthalmos ≤22 mm) and disease duration of <18 months. All patients were euthyroid while taking thionamides or, less commonly, after thyroidectomy or radioiodine treatment. After six months of treatment, eyelid aperture (37 versus 12 percent) and soft-tissue signs (43 versus 32 percent) significantly improved in patients taking selenium versus placebo. Compared with placebo, selenium also significantly improved quality of life (both visual functioning and appearance scores), as assessed by the Graves' Orbitopathy Quality of Life Questionnaire (GO-QOL). Evaluation at 12 months confirmed the findings at six months. Neither placebo nor pentoxifylline improved quality-of-life measures.
Although there were no adverse effects of selenium treatment in any of the orbitopathy studies reported to date, it is uncertain if selenium would benefit individuals with mild Graves' orbitopathy who are from selenium-rich regions (eg, most of the United States). Long-term selenium supplementation (200 mcg daily) has been associated with an increased risk of developing type 2 diabetes mellitus. (See "Risk factors for type 2 diabetes mellitus", section on 'Selenium'.)
Selenium is a trace mineral with a role in multiple biologic functions. More than 30 selenoproteins have been identified, of which the best known are the four forms of glutathione peroxidase, which are important in antioxidant defense, and iodothyronine deiodinase 2 (three forms), which serves as a catalyst for production of thyroid hormone. (See "Overview of dietary trace minerals", section on 'Selenium'.)
Selenium supplementation may also decrease inflammatory activity in patients with autoimmune thyroiditis, as evidenced by a fall in thyroid antibody levels, and may also reduce the risk of postpartum thyroiditis in women who are positive for thyroid peroxidase (TPO) antibodies