Selenium in Graves Hyperthyroidism and Orbitopathy

Purpose: To review the in vitro and in vivo studies supporting a role of selenium for the treatment of mild Graves orbitopathy. Methods: Review of the current literature on the role of selenium in the management of Graves orbitopathy. Results: Graves orbitopathy (GO) is a disfiguring and disabling disorder usually observed in patients with Graves hyperthyroidism, and more rarely in patients with hypothyroid autoimmune thyroiditis or in the absence of overt thyroid dysfunction. Noninvasive treatments include intravenous glucocorticoids and orbital radiotherapy and are generally offered to patients with moderately severe GO. In contrast, patients with mild GO are generally treated only with local measures. Thus, the benefits of intravenous glucocorticoids in mild GO are limited and do not justify the risks that the treatment carries. However, a medical treatment for mild GO is heavily wanted, as a relevant proportion of patients have a significant decrease in their quality of life, and GO can progress into more severe forms. Because of the role of oxidative stress in the pathogenesis of GO, an antioxidant approach has been proposed and the antioxidant agent selenium has been shown to be effective for GO. Conclusion: Studies have shown that a 6-month course of sodium selenite can improve the course of mild GO and prevent deterioration when compared with placebo. Accepted for publication March 19, 2018. Claudio Marcocci received research grants from IBSA Italia and is consultant/speaker for Abogen Pharma and SHIRE. All other authors have no conflicts of interest. Address correspondence and reprint requests to Claudio Marcocci, M.D., Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. E-mail: claudio.marcocci@med.unipi.it © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.