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Published in: Endocrine 3/2019

Open Access 01-12-2019 | Thyroiditis | Original Article

Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial

Authors: G. Mantovani, A. M. Isidori, C. Moretti, C. Di Dato, E. Greco, P. Ciolli, M. Bonomi, L. Petrone, A. Fumarola, G. Campagna, G. Vannucchi, S. Di Sante, C. Pozza, A. Faggiano, A. Lenzi, E. Giannetta

Published in: Endocrine | Issue 3/2019

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Abstract

Purpose

Selenium is frequently in nutraceuticals for pregnancy, given its role on fertility and thyroid metabolism. However, most evidence rise from non-controlled studies. We aimed to evaluate the protective effect of selenium against thyroid autoimmunity during and after pregnancy.

Methods

A multicenter, randomized, double-blind, placebo-controlled trial was performed and promoted by the Young Italian Endocrinologists Group (EnGioI)—Italian Society of Endocrinology. Forty-five women with thyroiditis in pregnancy were enrolled and randomly assigned to L-selenomethionine (L-Se-Met) 83 mcg/day or placebo (PLB) and evaluated at 10 ± 2 (T1), 36 ± 2 weeks of gestation (T2) and 6 months after delivery (postpartum, PP).

Results

We measured a significant reduction of autoantibodies after pregnancy in L-Se-Met group [at PP: TgAb 19.86 (11.59–52.60), p < 0.01; TPOAb 255.00 (79.00–292.00), p < 0.01], and an antibodies titer’s rebound in PLB group (TgAb 151.03 ± 182.9, p < 0.01; TPOAb 441.28 ± 512.18, p < 0.01). A significant increase in selenemia was measured in L-Se-Met group at T2 (91.33 ± 25.49; p < 0.01) and PP (93.55 ± 23.53; p = 0.02). Two miscarriage occurred in PLB. No differences were found in thyroid volume, echogenicity, quality of life, maternal/fetal complications.

Conclusions

SERENA study demonstrated a beneficial effect of L-Se-Met supplementation on autoantibody titer during pregnancy and on postpartum thyroiditis recurrence.
Literature
1.
go back to reference A. Stagnaro-Green, S.H. Roman, R.H. Cobin, E. el-Harazy, M. Alvarez-Marfany, T.F. Davies, Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 264(11), 1422–1425 (1990)CrossRef A. Stagnaro-Green, S.H. Roman, R.H. Cobin, E. el-Harazy, M. Alvarez-Marfany, T.F. Davies, Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 264(11), 1422–1425 (1990)CrossRef
7.
go back to reference Y. Han, L.J. Mao, X. Ge, K. Huang, S.Q. Yan, L.L. Ren, S.Q. Hong, H. Gao, J. Sheng, Y.Y. Xu, W.J. Pan, P. Zhu, J.H. Hao, D.F. Zhu, F.B. Tao, Impact of maternal thyroid autoantibodies positivity on the risk of early term birth: Ma’anshan Birth Cohort Study. Endocrine 60(2), 329–338 (2018). https://doi.org/10.1007/s12020-018-1576-6 CrossRefPubMed Y. Han, L.J. Mao, X. Ge, K. Huang, S.Q. Yan, L.L. Ren, S.Q. Hong, H. Gao, J. Sheng, Y.Y. Xu, W.J. Pan, P. Zhu, J.H. Hao, D.F. Zhu, F.B. Tao, Impact of maternal thyroid autoantibodies positivity on the risk of early term birth: Ma’anshan Birth Cohort Study. Endocrine 60(2), 329–338 (2018). https://​doi.​org/​10.​1007/​s12020-018-1576-6 CrossRefPubMed
12.
go back to reference A.S. Al-Kunani, R. Knight, S.J. Haswell, J.W. Thompson, S.W. Lindow, The selenium status of women with a history of recurrent miscarriage. BJOG 108(10), 1094–1097 (2001)PubMed A.S. Al-Kunani, R. Knight, S.J. Haswell, J.W. Thompson, S.W. Lindow, The selenium status of women with a history of recurrent miscarriage. BJOG 108(10), 1094–1097 (2001)PubMed
13.
go back to reference Q. Wu, M.P. Rayman, H. Lv, L. Schomburg, B. Cui, C. Gao, P. Chen, G. Zhuang, Z. Zhang, X. Peng, H. Li, Y. Zhao, X. He, G. Zeng, F. Qin, P. Hou, B. Shi, Low population selenium status is associated with increased prevalence of thyroid disease. J. Clin. Endocrinol. Metab. 100(11), 4037–4047 (2015). https://doi.org/10.1210/jc.2015-2222 CrossRefPubMed Q. Wu, M.P. Rayman, H. Lv, L. Schomburg, B. Cui, C. Gao, P. Chen, G. Zhuang, Z. Zhang, X. Peng, H. Li, Y. Zhao, X. He, G. Zeng, F. Qin, P. Hou, B. Shi, Low population selenium status is associated with increased prevalence of thyroid disease. J. Clin. Endocrinol. Metab. 100(11), 4037–4047 (2015). https://​doi.​org/​10.​1210/​jc.​2015-2222 CrossRefPubMed
14.
17.
go back to reference A. Stagnaro-Green, M. Abalovich, E. Alexander, F. Azizi, J. Mestman, R. Negro, A. Nixon, E.N. Pearce, O.P. Soldin, S. Sullivan, W. Wiersinga; American Thyroid Association Taskforce on Thyroid Disease During, Pregnancy and Postpartum, Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 21(10), 1081–1125 (2011). https://doi.org/10.1089/thy.2011.0087 CrossRefPubMedPubMedCentral A. Stagnaro-Green, M. Abalovich, E. Alexander, F. Azizi, J. Mestman, R. Negro, A. Nixon, E.N. Pearce, O.P. Soldin, S. Sullivan, W. Wiersinga; American Thyroid Association Taskforce on Thyroid Disease During, Pregnancy and Postpartum, Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 21(10), 1081–1125 (2011). https://​doi.​org/​10.​1089/​thy.​2011.​0087 CrossRefPubMedPubMedCentral
18.
go back to reference G.A. Brent, Maternal thyroid function: interpretation of thyroid function tests in pregnancy. Clin. Obstet. Gynecol. 40(1), 3–15 (1997)CrossRef G.A. Brent, Maternal thyroid function: interpretation of thyroid function tests in pregnancy. Clin. Obstet. Gynecol. 40(1), 3–15 (1997)CrossRef
21.
go back to reference T. Rago, V. Cantisani, F. Ianni, L. Chiovato, R. Garberoglio, C. Durante, A. Frasoldati, S. Spiezia, R. Farina, G. Vallone, A. Pontecorvi, P. Vitti, Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM). J. Endocrinol. Invest. 41(12), 1435–1443 (2018). https://doi.org/10.1007/s40618-018-0935-8 CrossRefPubMed T. Rago, V. Cantisani, F. Ianni, L. Chiovato, R. Garberoglio, C. Durante, A. Frasoldati, S. Spiezia, R. Farina, G. Vallone, A. Pontecorvi, P. Vitti, Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM). J. Endocrinol. Invest. 41(12), 1435–1443 (2018). https://​doi.​org/​10.​1007/​s40618-018-0935-8 CrossRefPubMed
22.
go back to reference A.M. Isidori, V. Cantisani, E. Giannetta, D. Diacinti, E. David, V. Forte, D. Elia, C. De Vito, E. Sbardella, D. Gianfrilli, F. Monteleone, J. Pepe, S. Minisola, G. Ascenti, V. D’Andrea, C. Catalano, F. D’Ambrosio, Multiparametric ultrasonography and ultrasound elastography in the differentiation of parathyroid lesions from ectopic thyroid lesions or lymphadenopathies. Endocrine 57(2), 335–343 (2017). https://doi.org/10.1007/s12020-016-1116-1 CrossRefPubMed A.M. Isidori, V. Cantisani, E. Giannetta, D. Diacinti, E. David, V. Forte, D. Elia, C. De Vito, E. Sbardella, D. Gianfrilli, F. Monteleone, J. Pepe, S. Minisola, G. Ascenti, V. D’Andrea, C. Catalano, F. D’Ambrosio, Multiparametric ultrasonography and ultrasound elastography in the differentiation of parathyroid lesions from ectopic thyroid lesions or lymphadenopathies. Endocrine 57(2), 335–343 (2017). https://​doi.​org/​10.​1007/​s12020-016-1116-1 CrossRefPubMed
24.
go back to reference B. Gandek, J.E. Ware, N.K. Aaronson, G. Apolone, J.B. Bjorner, J.E. Brazier, M. Bullinger, S. Kaasa, A. Leplege, L. Prieto, M. Sullivan, Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J. Clin. Epidemiol. 51(11), 1171–1178 (1998)CrossRef B. Gandek, J.E. Ware, N.K. Aaronson, G. Apolone, J.B. Bjorner, J.E. Brazier, M. Bullinger, S. Kaasa, A. Leplege, L. Prieto, M. Sullivan, Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J. Clin. Epidemiol. 51(11), 1171–1178 (1998)CrossRef
25.
go back to reference C. Jenkinson, R. Layte, D. Jenkinson, K. Lawrence, S. Petersen, C. Paice, J. Stradling, A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J. Public Health Med. 19(2), 179–186 (1997)CrossRef C. Jenkinson, R. Layte, D. Jenkinson, K. Lawrence, S. Petersen, C. Paice, J. Stradling, A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J. Public Health Med. 19(2), 179–186 (1997)CrossRef
33.
go back to reference L.H. Duntas, E. Mantzou, D.A. Koutras, Effects of a six month treatment with selenomethionine in patients with autoimmune thyroiditis. Eur. J. Endocrinol. 148(4), 389–393 (2003)CrossRef L.H. Duntas, E. Mantzou, D.A. Koutras, Effects of a six month treatment with selenomethionine in patients with autoimmune thyroiditis. Eur. J. Endocrinol. 148(4), 389–393 (2003)CrossRef
34.
36.
go back to reference C.D. Thomson, S.K. McLachlan, A.M. Grant, E. Paterson, A.J. Lillico, The effect of selenium on thyroid status in a population with marginal selenium and iodine status. Br. J. Nutr. 94(6), 962–968 (2005)CrossRef C.D. Thomson, S.K. McLachlan, A.M. Grant, E. Paterson, A.J. Lillico, The effect of selenium on thyroid status in a population with marginal selenium and iodine status. Br. J. Nutr. 94(6), 962–968 (2005)CrossRef
37.
go back to reference T. Pilli, S. Cantara, L. Schomburg, V. Cenci, S. Cardinale, E.C. Heid, E.C. Kuhn, G. Cevenini, F. Sestini, C. Fioravanti, G. D’Hauw, F. Pacini, IFNgamma-inducible chemokines decrease upon selenomethionine supplementation in women with euthyroid autoimmune thyroiditis: comparison between two doses of selenomethionine (80 or 160 mug) versus placebo. Eur. Thyroid J. 4(4), 226–233 (2015). https://doi.org/10.1159/000439589 CrossRefPubMedPubMedCentral T. Pilli, S. Cantara, L. Schomburg, V. Cenci, S. Cardinale, E.C. Heid, E.C. Kuhn, G. Cevenini, F. Sestini, C. Fioravanti, G. D’Hauw, F. Pacini, IFNgamma-inducible chemokines decrease upon selenomethionine supplementation in women with euthyroid autoimmune thyroiditis: comparison between two doses of selenomethionine (80 or 160 mug) versus placebo. Eur. Thyroid J. 4(4), 226–233 (2015). https://​doi.​org/​10.​1159/​000439589 CrossRefPubMedPubMedCentral
39.
go back to reference L. De Groot, M. Abalovich, E.K. Alexander, N. Amino, L. Barbour, R.H. Cobin, C.J. Eastman, J.H. Lazarus, D. Luton, S.J. Mandel, J. Mestman, J. Rovet, S. Sullivan, Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 97(8), 2543–2565 (2012). https://doi.org/10.1210/jc.2011-2803 CrossRefPubMed L. De Groot, M. Abalovich, E.K. Alexander, N. Amino, L. Barbour, R.H. Cobin, C.J. Eastman, J.H. Lazarus, D. Luton, S.J. Mandel, J. Mestman, J. Rovet, S. Sullivan, Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 97(8), 2543–2565 (2012). https://​doi.​org/​10.​1210/​jc.​2011-2803 CrossRefPubMed
42.
go back to reference M. Navarro, H. Lopez, V. Perez, M.C. Lopez, Serum selenium levels during normal pregnancy in healthy Spanish women. Sci. Total Environ. 186(3), 237–242 (1996)CrossRef M. Navarro, H. Lopez, V. Perez, M.C. Lopez, Serum selenium levels during normal pregnancy in healthy Spanish women. Sci. Total Environ. 186(3), 237–242 (1996)CrossRef
43.
go back to reference E. Ferrer, A. Alegria, R. Barbera, R. Farre, M.J. Lagarda, J. Monleon, Whole blood selenium content in pregnant women. Sci. Total Environ. 227(2–3), 139–143 (1999)CrossRef E. Ferrer, A. Alegria, R. Barbera, R. Farre, M.J. Lagarda, J. Monleon, Whole blood selenium content in pregnant women. Sci. Total Environ. 227(2–3), 139–143 (1999)CrossRef
44.
go back to reference R. Gartner, B.C. Gasnier, Selenium in the treatment of autoimmune thyroiditis. Biofactors 19(3–4), 165–170 (2003)CrossRef R. Gartner, B.C. Gasnier, Selenium in the treatment of autoimmune thyroiditis. Biofactors 19(3–4), 165–170 (2003)CrossRef
46.
go back to reference C. Marcocci, G.J. Kahaly, G.E. Krassas, L. Bartalena, M. Prummel, M. Stahl, M.A. Altea, M. Nardi, S. Pitz, K. Boboridis, P. Sivelli, G. von Arx, M.P. Mourits, L. Baldeschi, W. Bencivelli, W. Wiersinga,European Group on Graves' Orbitopathy, Selenium and the course of mild Graves’ orbitopathy. N. Engl. J. Med. 364(20), 1920–1931 (2011). https://doi.org/10.1056/NEJMoa1012985 CrossRefPubMed C. Marcocci, G.J. Kahaly, G.E. Krassas, L. Bartalena, M. Prummel, M. Stahl, M.A. Altea, M. Nardi, S. Pitz, K. Boboridis, P. Sivelli, G. von Arx, M.P. Mourits, L. Baldeschi, W. Bencivelli, W. Wiersinga,European Group on Graves' Orbitopathy, Selenium and the course of mild Graves’ orbitopathy. N. Engl. J. Med. 364(20), 1920–1931 (2011). https://​doi.​org/​10.​1056/​NEJMoa1012985 CrossRefPubMed
Metadata
Title
Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial
Authors
G. Mantovani
A. M. Isidori
C. Moretti
C. Di Dato
E. Greco
P. Ciolli
M. Bonomi
L. Petrone
A. Fumarola
G. Campagna
G. Vannucchi
S. Di Sante
C. Pozza
A. Faggiano
A. Lenzi
E. Giannetta
Publication date
01-12-2019
Publisher
Springer US
Keyword
Thyroiditis
Published in
Endocrine / Issue 3/2019
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-019-01958-1

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