Selenium Supplementation for Hashimoto’s Thyroiditis.

Selenium supplementation for Hashimoto’s thyroiditis.

Cochrane Database Syst Rev. 2013 Jun 6; 6: CD010223
van Zuuren EJ, Albusta AY, Fedorowicz Z, Carter B, Pijl H

BACKGROUND: Hashimoto’s thyroiditis is a common auto-immune disorder. The most common presenting symptoms may include anxiety, negative mood, depression, dry skin, cold intolerance, puffy eyes, muscle cramps and fatigue, deep voice, constipation, slow thinking and poor memory. Clinical manifestations of the disease are defined primarily by low levels of thyroid hormones; therefore it is treated by hormone replacement therapy, which usually consists of levothyroxine (LT4). Selenium might reduce antibody levels and result in a decreased dosage of LT4 and may provide other beneficial effects (e.g. on mood and health-related quality of life). OBJECTIVES: To assess the effects of selenium supplementation on Hashimoto’s thyroiditis. SEARCH METHODS: We searched the following databases up to 2 October 2012: CENTRAL in The Cochrane Library (2012, Issue 10), MEDLINE, EMBASE, and Web of Science; we also screened reference lists of included studies and searched several online trial registries for ongoing trials (5 November 2012). SELECTION CRITERIA: Randomised controlled clinical trials that assessed the effects of selenium supplementation for adults diagnosed with Hashimoto’s thyroiditis. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, assessment of risk of bias, and analyses were carried out by two independent review authors. We assessed the quality of the evidence of included studies using GRADE. We were unable to conduct a meta-analysis because clinical heterogeneity between interventions that were investigated is substantial. MAIN RESULTS: Four studies at unclear to high risk of bias comprising 463 participants were included. The mean study duration was 7.5 months (range 3 to 18 months). One of our primary outcomes?’change from baseline in health related quality of life’?and two of our secondary outcomes?’change from baseline in LT4 replacement dosage at end of the study’ and ‘economic costs’?were not assessed in any of the studies. One study at high risk of bias showed statistically significant improvement in subjective well-being with sodium selenite 200 ?g plus titrated LT4 compared with placebo plus titrated LT4 (relative risk (RR) 4.67, 95% confidence interval (CI) 1.61 to 13.50; P = 0.004; 36 participants; number needed to treat (NNT) = 2 (95% CI 2 to 3)). Selenomethionine 200 ?g reduced the serum levels of anti-thyroid peroxidase antibodies compared with placebo in one study (mean difference (MD) -917 U/mL, 95% CI -1056 to -778; P < 0.001; 85 participants) and in another study where it was combined with LT4 (MD -1508 U/mL, 95% CI -1671 to -1345; P < 0.001; 86 participants). In a third study, where LT4 was added to both intervention arms, a reduction in serum levels of anti-thyroid peroxidase antibodies favoured the selenomethionine arm (MD -235 IU/mL, 95% CI -374 to -95; P = 0.001; 88 participants). Although the changes from baseline were statistically significant in these three studies, their clinical relevance is unclear. Sodium selenite 200 ?g was compared with placebo in another study and showed a reduction in antibody levels (MD -345 IU/mL, 95% CI -359 to -331; P < 0.001; 169 participants). Serum antibodies were not statistically significantly affected in the study comparing sodium selenite 200 ?g plus titrated LT4 with placebo plus titrated LT4 (MD -25, 95% CI -181 to 131; P = 0.75; 36 participants).Adverse events were reported in two studies (1 of 85 and 1 of 88 participants, respectively). Selenium supplementation did not appear to have a statistically significant impact on the incidence of adverse events (RR 2.93, 95% CI 0.12 to 70.00; and RR 2.63, 95% CI 0.11 to 62.95). AUTHORS' CONCLUSIONS: Results of these four studies show that evidence to support or refute the efficacy of selenium supplementation in people with Hashimoto's thyroiditis is incomplete. The current level of evidence for the efficacy of selenium supplementation in the management of people with Hashimoto's thyroiditis is based on four randomised controlled trials assessed at unclear to high risk of bias; this does not at present allow confident decision making about the use of selenium supplementation for Hashimoto's thyroiditis. This review highlights the need for randomised placebo-controlled trials to evaluate the effects of selenium in people with Hashimoto's thyroiditis and can ultimately provide reliable evidence to help inform clinical decision making. HubMed – depression


A Longitudinal Study of Somatic Complaints in Urban Adolescents: The Role of Internalizing Psychopathology and Somatic Anxiety.

J Youth Adolesc. 2013 Jun 7;
Ruchkin V, Schwab-Stone M

Despite the frequent association between anxiety and somatization, the role of somatic anxiety-a tendency to experience somatic sensations, when anxious-in relationship to persistent somatic complaints has not been addressed previously. This study assessed the predictive role of internalizing psychopathology (anxiety, posttraumatic stress, depression) and somatic anxiety for somatic complaints over a 1-year period in a community sample of urban youth. The Social and Health Assessment, a self-report survey, was administered to 2,524 (mean age = 12.8, 54 % female) American urban adolescents in two consecutive years. There was significant continuity of somatic complaints over 1 year. Girls reported higher levels of somatic complaints and somatic anxiety than boys. All types of internalizing psychopathology significantly predicted somatic complaints over time. Somatic anxiety was associated with somatic complaints over and above the role of internalizing symptoms. Internalizing psychopathology and somatic anxiety should both be considered in the assessment and treatment of youth with persistent somatic complaints. HubMed – depression


[Mental illness, personality traits and quality of life in epilepsy: control study of patients with juvenile myoclonic epilepsy and other epilepsies].

Rev Neurol. 2013 Jun 16; 56(12): 608-14
Martinez-Dominguez S, Labrada-Abella J, Pedros-Rosello A, Lopez-Gomariz E, Tenias-Burillo JM

INTRODUCTION. The association of epilepsy with mental illness is described for years. Current is trying to relate certain epilepsies, such as juvenile myoclonic epilepsy (JME) with certain personality traits marked by emotional instability. SUBJECTS AND METHODS. We study a group of patients with JME and his mental state, with emphasis on the personality traits, presence of clinical anxiety or depression and quality of life, with other epilepsy patients versus a control group. RESULTS. Patients with epilepsy have more marked personality traits and symptoms of anxiety and depression, making a more negative assessment of their quality of life than the control group. Patients with others epilepsy have a higher other personality disorder and a poorer perception of their quality of life than patients with JME. CONCLUSIONS. Differences are obtained among patients with epilepsy and control groups in all the variables analyzed (personality, anxiety, depression and quality of life). JME patients have better scores on personality and quality of life than those in the other group of epilepsies. HubMed – depression