Supplementary Material for: A Prospective Investigation of Graves' Disease and Selenium: Thyroid Hormones, Auto-Antibodies and Self-Rated Symptoms

<b><i>Background:</i></b> In Graves' thyrotoxicosis tachycardia, weight loss and mental symptoms are common. Recovery takes time and varies between patients. Treatment with methimazole reduces thyroid hormone levels. According to previous research, this reduction has been faster if selenium (Se) is added. <b><i>Objective:</i></b> The objective was to investigate whether supplementing the pharmacologic treatment with Se could change the immune mechanisms, hormone levels and/or depression and anxiety. <b><i>Methods:</i></b> We prospectively investigated 38 patients with initially untreated thyrotoxicosis by measuring the thyroid-stimulating hormone (TSH), free thyroxine (FT₄), free triiodothyronine (FT₃), thyroid receptor antibodies and thyroid peroxidase auto-antibodies before medication and at 6, 18 and 36 weeks after commencing treatment with methimazole and levo-thyroxine, with a randomized blinded oral administration of 200 µg Se/day or placebo. The selenoprotein P concentration was determined in plasma at inclusion and after 36 weeks. The patients were also assessed with questionnaires about depression, anxiety and self-rated symptoms before medication was started and after 36 weeks. <b><i>Results:</i></b> FT₄ decreased more in the Se group at 18 weeks (14 vs. 17 pmol/l compared to the placebo group, p = 0.01) and also at 36 weeks (15 vs. 18 pmol/l, p = 0.01). The TSH increased more in the Se group at 18 weeks (0.05 vs. 0.02 mIU/l, p = 0.04). The depression and anxiety scores were similar in both groups. In the Se group, the depression rates correlated negatively with FT₃ and positively with TSH. This was not seen in the placebo group. <b><i>Conclusions:</i></b> Se supplementation can enhance biochemical restoration of hyperthyroidism, but whether this could shorten clinical symptoms of thyrotoxicosis and reduce mental symptoms must be investigated further.

<b><i>背景：</i></b> 在格雷夫斯甲状腺毒症伴心动过速患者中，体重减轻与精神症状较为常见。病情恢复存在个体差异，且需耗费一定时长。甲巯咪唑（methimazole）治疗可降低甲状腺激素水平，既往研究显示，加用硒（selenium, Se）可加快这一激素水平下降的进程。<b><i>目的：</i></b> 本研究旨在探讨在药物治疗基础上加用硒，是否可对免疫机制、激素水平以及抑郁、焦虑症状产生影响。<b><i>方法：</i></b> 我们前瞻性纳入38例初始未接受治疗的甲状腺毒症患者，在启动甲巯咪唑联合左甲状腺素（levo-thyroxine）治疗前，以及治疗开始后第6、18、36周，分别检测促甲状腺激素（thyroid-stimulating hormone, TSH）、游离甲状腺素（free thyroxine, FT₄）、游离三碘甲状腺原氨酸（free triiodothyronine, FT₃）、甲状腺受体抗体及甲状腺过氧化物酶自身抗体（thyroid peroxidase auto-antibodies）；同时采用随机双盲口服给药方式，为患者每日给予200 μg硒或安慰剂（placebo）。于入组时及治疗36周后，检测患者血浆中的硒蛋白P（selenoprotein P）浓度。在治疗启动前及治疗36周后，采用问卷对患者的抑郁、焦虑及自评症状进行评估。<b><i>结果：</i></b> 治疗18周时，硒组患者的FT₄下降幅度更大（较安慰剂组：14 vs. 17 pmol/L，p=0.01）；治疗36周时该差异依然存在（15 vs. 18 pmol/L，p=0.01）。治疗18周时，硒组患者的TSH升高幅度更显著（0.05 vs. 0.02 mIU/L，p=0.04）。两组患者的抑郁、焦虑评分无显著差异。硒组中，抑郁评分与FT₃呈负相关，与TSH呈正相关；而安慰剂组未观察到该相关性。<b><i>结论：</i></b> 补充硒可加快甲状腺功能亢进症的生化指标恢复，但该干预是否能够缩短甲状腺毒症的临床病程、减轻精神症状，仍需进一步研究验证。