Bioidentical Hormones 101 
The Book, by Jeffrey Dach MD

Chapter 33. Selenium for Hashimoto's Thyroiditis

Chapter 33. Selenium for Hashimoto's Thyroiditis

Susan has Hashimoto's Thyroiditis, an autoimmune thyroid disorder causing fatigue, puffy face and muscle weakness.  For the past year, she had been under the care of other doctors who started her on Synthroid, the most widely used thyroid medication.  Later,  her doctors re-tested the thyroid antibody levels (TPO thyroid peroxidase and thyroglobulin antibodies).  The disturbing thing was that her antibodies kept climbing higher on each follow up lab test.  The doctors had no explanation, so she came to see me, asking if there was anything else that could be done. 

Selenium Can Decrease Antibody Levels

As it turns out, a trace mineral called selenium plays an important role in thyroid.  Selenium deficiency has been implicated in the etiology of Hashimoto's Thyroiditis, and selenium supplementation has been found beneficial.

Three Selenium Studies Show Benefits of Selenium for Hashimoto's Thyroiditis

1912 Photograph of Dr. Hakaru Hashimoto, credited with the discovery of Hashimoto’s Thyroiditis

The first study by Mazokopakis from Crete was published in the 2007 Thyroid Journal.(1)  This study reported a 21 per cent reduction in TPO antibodies after one year of seleno-methionine  supplements (200 mcg per day).   A second study from Germany in the 2002 Journal of Clinical Endocrinology & Metabolism showed a 40 per cent reduction in antibody levels after selenium supplementation with 9 of 36 (25%) patients completely normalizing their antibody levels.(2)  A third study done in Turkey by Omer Turker et al. was published in the 2006 Journal of Endocrinology. (5)  They showed a 30 per cent decrease in anti-thyroid antibodies after three months of L-seleno-methionine supplementation at 200 mcg per day in women with Hashimoto’s Thyroiditis. The starting average Thyroid Peroxidase (TPO) antibodies of 803 and after three months the average was 572. 

Left Image: 1912 Photograph of Dr. Hakaru Hashimoto, credited with the discovery of Hashimoto’s Thyroiditis. Source: reprinted in: Hashimoto K. My Father and his Teachers. Endocr J. 49, 4, 389-91. 2002. Author Unknown. Public domain photo Courtesy of wikimedia commons.

Why is Selenium So Important for Thyroid Function?

Recent advances in research into thyroid cell physiology shows that selenium is very important for thyroid function. (3-4)(11-12)  There are at least 30 selenium dependent proteins, including the glutathione peroxidase enzyme, and the Iodothyronine deiodinases enzyme (this is the one that converts thyroxine (T4) to bioactive  (T3).  These proteins all need selenium as a co-factor in order to function properly.  The selenoprotein, glutathione peroxidase,  protects thyroid cells from damage by hydrogen peroxide (H2O2) produced by the thyroid cell.  H2O2 is needed as a normal step in thyroid hormone production.  However, excess hydrogen peroxide (H202) can damage the thyroid cell.  In the event of selenium deficiency, the glutathione peroxidase enzyme cannot do its job protecting the thyroid cell, and the thyroid cells are damaged by excess H2O2.(11-12)  The current theory is that this damaged cell material is then recognized by the immune system as foreign, leading to Hashimoto's autoimmune disease. 

Back to the Patient

Susan was started on selenomethionine 200 mcg per day.  In addition, her thyroid medication was switched from Synthroid to natural desiccated thyroid.  Three months later Susan returned for follow up labs which showed a decline in her thyroid antibody levels.  Although not all patients will see a dramatic decline in antibody levels, I have found that many patients will benefit from selenium supplementation.

Thyroid Testing and Treatment

A good thyroid testing protocol includes the following lab values, Thyroid Stimulating Hormone (TSH), Free T3 (tri-iodiodothyronine), Free T4, Thyroid Peroxidase (TPO) Antibodies, Thyroglobulin (Tgb) Antibodies, selenium level, and iodine level.  The thyroid panel is usually part of a larger evaluation with additional lab tests tailored to the clinical history and examination. A good thyroid treatment protocol uses natural desiccated thyroid medication such as Nature-Throid from RLC labs.  Dosage for natural desiccated thyroid medication varies, based on residual thyroid function, body weight, starting thyroid labs, and other variables. 

Selenium Safety or Toxicity Depends on Dosage

Although Selenium is an inexpensive mineral supplement available without a prescription at the health food store, I would recommend working closely with your physician if you are considering selenium supplementation.  Although selenium is generally considered safe at standard doses, very high dosage can cause selenium toxicity.  In addition, your physician will determine if you need thyroid medication, the type and dosage of the medication, etc.  By the way, for those looking for a food source for selenium, Brazil Nuts are high in selenium.

Testing and Treatment in Hashimoto's Thyroiditis

Thyroid function in Hashimoto's Thyroiditis can have a variable course, with thyroid function varying, and the thyroid medication dosage may vary as thyroid function changes.  Lab studies at any one time may show low, normal or high thyroid function in patients with elevated antibody levels and Hashimoto's thyroid disease.  Dr. David Brownstein's protocols are excellent recommendations regarding thyroid testing and treatment. See his book, "Overcoming Thyroid Disorders"  2nd Edition which shows how a holistic treatment program can effectively treat Hashimoto’s Disease.  His book, Overcoming Thyroid Disorders provides information on safe and effective natural therapies with over 30 actual case studies. The book contains information on:  Natural Thyroid Hormone, Bioidentical Natural Hormones, Diet, Vitamins and Minerals Important for Thyroid Function.(7)

Web Sites with Reliable Information about Selenium for Hashimoto's

Janie Bowthorpe's book and the Stop the Thyroid Madness Blog is an excellent source of reliable information. Mary Shomon's, Thyroid web site and newsletter is also an excellent source of reliable information.  Beware and avoid anonymous message boards that may give false or incorrect information about selenium.   One question to ask about information on anonymous message boards: Is the information backed up by citations or references in the peer reviewed medical literature? If not, then it may not be reliable information. 

For references see web site:

References for Chapter 33. Selenium for Hashimoto’s Thyroiditis

(1) Thyroid. 2007 Jul;17(7):609-12. Effects of 12 months treatment with L-selenomethionine on serum anti-TPO Levels in Patients with Hashimoto's thyroiditis.  Mazokopakis EE, Papadakis JA, Papadomanolaki MG, Batistakis AG, Giannakopoulos TG, Protopapadakis EE, Ganotakis ES. Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece.

(2) The Journal of Clinical Endocrinology & Metabolism Vol. 87, No. 4 1687-1691, 2002 Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. Gärtner R, Gasnier BC, Dietrich JW, Krebs B, Angstwurm MW. Department of Endocrinology, Medizinische Klinik Innenstadt, University of Munich, D-80336 Munich, Germany.

(3) Thyroid. 2002 Oct;12(10):867-78.The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health.
Zimmermann MB, Köhrle J.Laboratory for Human Nutrition, Swiss Federal Institute of Technology, Zürich, Switzerland.

(4) Hashimoto’s thyroiditis and the role of selenium. Current concepts. by Hellenic in the Journal of Nuclear Medicine January - April 2007 Review Article

(5) Journal of Endocrinology (2006) 190, 151-156 . Selenium treatment in autoimmune thyroiditis: 9-month follow-up with variable doses
Omer Turker et al Thyroidology Unit, Department of Nuclear Medicine, GATA Haydarpasa, Istanbul, Turkey

(6) Endocrine Reviews 26 (7): 944-984, 2005
Selenium, the Thyroid, and the Endocrine System by J. Köhrle, F. Jakob, B. Contempré and J. E. Dumont  Institut für Experimentelle Endokrinologie (J.K.), Charité Universitätsmedizin Berlin, Humboldt Universität, D-10098 Berlin, Germany;

(7)   David Brownstein,M.D.  Overcoming Thyroid Disorders, 2nd Edition, Medical Alternatives Press, Inc.

(8) Selenium Page .  Linus Pauling Institute Micronutrient Research for Optimum Health

(9) Stop the Thyroid Madness Blog Janie Bowthorpe

(10) Mary Shomon Thyroid Web Site

(11) Biologics. 2008 June; 2(2): 265–273. Selenium and thyroid autoimmunity  Roberto Negro

(12) Dietary Iodine and Selenium Interact To Affect Thyroid Hormone Metabolism of Rats by Christine S. Hotz, Dennis W. fitzpatrick,    Keith D. Trick, and Mary R. L'Abbé

Author: Dr Dach

Jeffrey Dach MD

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