| BackgroundSelenium plays an important role in maintaining normal physiological function of thyroid.Up to now,the results of researches on the effect of selenium supplementation in patients with Graves’disease(GD)were still controversial,which may be due to the different baseline serum selenium levels of the patients.However,most studies did not assess the baseline serum selenium levels of patients before selenium supplementation.Objective1.To analyze the clinical characteristics and serum selenium levels of patients with Graves’disease.2.To explore the effect of selenium supplementation on patients with Graves’ disease.MethodsPart Ⅰ:This part was a cross-sectional study,and patients with Graves’ disease who were treated in Shandong Provincial Qianfoshan Hospital from October 2020 to December 2022 were selected.According to the inclusion and exclusion criteria of part Ⅰ,a total of 206 patients were included and the baseline serum selenium levels were analyzed.SPSS 26.0 software was used for statistical analysis.Kruskal-Wallis rank sum test was used to compare the difference of serum selenium levels in patients of different age groups.Spearman correlation test was used to analyze the correlation between serum selenium levels and ages of patients.Independent sample t test and Mann-Whitney U test were used to compare serum selenium levels in patients according to gender and thyroid function status.P<0.05(bilateral)was considered statistically significant.Part Ⅱ:This part was a prospective study,and patients with Graves’disease who were treated in Shandong Provincial Qianfoshan Hospital from October 2020 to December 2022 were selected.Newly diagnosed patients who met the inclusion and exclusion criteria of part Ⅱ were included in this part.The patients were randomly divided into methimazole+selenium yeast group(selenium supplementation group)and methimazole group(control group).The observation time was 12 weeks,and the therapeutic effect was compared between the two groups.SPSS 26.0 software was used for statistical analysis.Mann-Whitney U test was used to compare the free triiodothyronine(FT3),free thyroxin(FT4),thyroid stimulating hormone(TSH),and thyrotropin receptor antibody(TRAb)before and after treatments between the two groups.Paired sample t test and Wilcoxon rank sum test was used to analyze the differences in serum selenium,FT3,FT4,TSH and TRAb before and after treatments in the two groups.MannWhitney U test was used to compare the the improvment of FT3,FT4,TSH and TRAb after treatments between the two groups.P<0.05(bilateral)was considered statistically significant.ResultsPart Ⅰ:A total of 206 patients with Graves’disease were included in this part,and the serum selenium level was 78.93±15.59 μg/L.One hundred and fifty-seven patients(76.21%)had serum selenium levels below the minimum threshold of 90μg/L required for complete selenoprotein expression,and 49 patients(23.79%)had serum selenium levels≥90μg/L.There was no significant difference in serum selenium level between patients with different genders(P=0.467).There was a weak extremely positive correlation between serum selenium level and age(rs=0.192,P=0.006).There was a weak positive correlation between serum selenium level and age in the young group(<45 years old)(rs=0.334,P<0.001)and the middle-aged group(45-59 years old)(rs=0.308,P=0.025).There was no correlation between serum selenium level and age in the elderly group(≥60 years old)(rs=-0.166,P=0.587).The serum selenium levels of patients with hyperthyroidism were lower than those patients with normal thyroid function status(76.46±14.83 μg/L vs.83.08±16.03 μg/L;P=0.003).Part Ⅱ:1.A total of 97 patients with Graves’ disease were finally included in this part,including 50 cases in methimazole+selenium yeast group(selenium supplementation group),whose serum selenium level was 76.30±12.63 μg/L,and 47 cases in methimazole group(control group),whose serum selenium level was 79.10±14.03 μg/L.There were no significant differences in gender composition,age,baseline serum selenium level,FT3,FT4,TSH,and TRAb between the two groups(P>0.05).2.The serum selenium level in the selenium supplementation group after treatment was higher than that before treatment(104.67±13.71 μg/L vs.76.30±12.63 μg/L;P<0.001).There was no significant difference in serum selenium level before and after treatment in the control group(79.10 ± 14.03 μg/L vs.79.98 ± 14.06 μg/L;P=0.107).The serum selenium level after treatment in the selenium supplementation group was higher than that in the control group(104.67±13.71 μg/L vs.79.10±14.03 μg/L;P<0.001).3.After 12 weeks of treatment,the FT3 and FT4 in the selenium supplement group and the control group were lower than those before treatment,and the TSH was higher than that before treatment(P<0.001).After 12 weeks of treatment,there was no significant difference in FT3,FT4,and TRAb between the selenium supplementation group and the control group(P>0.05).There was no significant difference in the difference of FT3,FT4,and TRAb between the selenium supplementation group and the control group before and after 12 weeks of treatment(P>0.05).4.TRAb in the selenium supplementation group and the control group was lower than that before 12 weeks of treatments(P<0.001).After 12 weeks of treatment,TRAb of the selenium supplementation group was lower than that of the control group(P=0.029).The difference of TRAb before and after 12 weeks of treatments in the selenium supplementation group was larger than that in the control group(P<0.001).Conclusions1.The overall selenium status of patients with Graves’ disease was poor,and the baseline serum selenium levels of most patients were lower than the minimum threshold of serum selenium required for the complete expression of selenoprotein.The serum selenium level of young and middle-aged patients was positively correlated with age.2.Selenium supplementation had an effect on reducing TRAb in patients with Graves’disease.3.Selenium supplementation had no significant effect on FT3,FT4 and TSH in patients with Graves’ disease. |
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