August 20, 2015
Thyroid eye disease, which is also known as Graves’ ophthalmopathy, affects approximately 50% of those people with Graves’ Disease. And while in most cases the condition isn’t severe, this isn’t always the case. Common symptoms include eye swelling, eye bulging (exophthalmos), and sometimes even blurriness and double vision. While steroids such as prednisone are commonly given to help with the inflammation, certain natural approaches can also benefit the patient, without them having the side effects of steroid medications. Research shows that selenium can be very effective in helping with thyroid eye disease, which I’ll discuss in this post.
But why is selenium so effective in helping with thyroid eye disease? In order to better understand why selenium can help it probably is a good idea to briefly talk about the pathophysiology of thyroid eye disease. Research clearly shows that Graves’ ophthalmopathy isn’t due to the hyperthyroidism associated with Graves’ Disease, but instead is due to the autoimmune response (1). The same autoimmune response involved in Graves’ Disease is also responsible for damaging the tissues of the eyes. Some of the more common symptoms include a dry and gritty ocular sensation, sensitive to light, excessive tearing, double vision, and a pressure sensation behind the eyes (2). The most common clinical features of Graves’ ophthalmopathy are upper eyelid retraction, edema, and erythema of the periorbital tissues and conjunctivae, and bulging of the eyes (2).
Just to summarize, in Graves’ Disease it is the immune system which attacks the TSH receptors, which in turn leads to the excess production of thyroid hormone. And in Graves’ ophthalmopathy the immune system also causes damage to the tissues of the eyes, which in turn cause the signs and symptoms associated with Graves’ Disease. And so the obvious goal should be to modulate the immune system and decrease the TSH receptor antibodies. Glucocorticoids are commonly prescribed by medical doctors to help reduce the inflammation associated with thyroid eye disease, as well as suppress the immune system, which in turn can lower the TSH receptor antibodies (3). But there are negative health consequences of steroids, such as glucose intolerance, gastritis, hypertension, hepatitis, and depression (3).
How Can Selenium Specifically Help With Thyroid Eye Disease?
Although the focus of this post is on thyroid eye disease, selenium has been shown to be effective in the prevention and/or treatment of many other conditions including cardiovascular disease, osteoarthritis, rheumatoid arthritis, hypothyroidism, stroke, atherosclerosis, cancer susceptibility and treatment, HIV, AIDS, neuronal diseases such as Alzheimer’s disease and amyotrophic lateral sclerosis, pancreatitis, depression, and diabetes (4). Selenium might even be able to decrease the progression of thyroid cancer (5) (6). But how can one mineral have such a dramatic impact on these conditions? Well, selenium has numerous functions, as it is a powerful antioxidant which in turn can help to reduce oxidative stress, it is involved in modulating the immune system, it is an enzymatic cofactor, and it is also involved in gene expression. So it is very likely that a deficiency of this mineral will make someone more susceptible to developing other chronic health conditions.
As for how selenium can specifically help with thyroid eye disease, although the exact mechanism isn’t known, an increase in oxidative stress has been observed in both acute and chronic phases of thyroid disease with raised tissue concentrations of reactive oxygen species(7). Selenium is important for the formation of selenoproteins. These selenoproteins are powerful antioxidants and help to neutralize the effects of oxidative stress by reducing these free radicals (8). Glutathione peroxidase and thioredoxin reductase are the two main seleno-enzyme systems which are responsible for the reduction of free radicals (7) (9). These free radicals lead to an increase in proinflammatory cytokines, which as I have discussed in past articles and blog posts, are associated with autoimmune conditions (10). So essentially what happens is that if someone has a selenium deficiency, this will result in a decrease in selenoproteins, and this in turn will result in the accumulation of hydrogen peroxide, which will cause tissue inflammation (11). In addition, a deficiency of these selenoproteins can cause dysregulation of the immune system (12). All of this can lead to tissue injury.
Remember that it’s the immune system attacking the TSH receptors which is responsible not only for the hyperthyroid symptoms of Graves’ Disease, but the immune system also attacks the fibroblasts of the orbit, which results in the symptoms associated with thyroid eye disease. The TSH receptor antibodies are secreted by activated B cells due to immune system dysregulation. But a sufficient amount of selenium can help to regulate the immune system, as it can help restore both innate and humoral immune functions (13) (14).
How Much Selenium Should You Take?
As for the dosage of selenium, it depends on the individual. A typical dosage to help with these conditions is 200 mcg/day, as this frequently is sufficient enough to result in a therapeutic effect without causing a selenium toxicity. Some people don’t respond unless if higher doses of selenium are taken (i.e. 400 mcg/day). However, too much selenium can be toxic, and so you do want to be cautious. Although you can try to get enough selenium through eating selenium-rich foods such as Brazil nuts, it might be best to take a selenium supplement. The reason for this is because the dosage of selenium will vary in the food depend on the source. For example, a Brazil nut that wasn’t grown in selenium-rich soil will of course have a lower amount of selenium than a Brazil nut that was grown in selenium-rich soil.
It also is a good idea to do other things to modulate the immune system, and not just rely on taking selenium. Other nutrients which can decrease oxidative stress and suppress the autoimmune response include curcumin, resveratrol, fish oils, green tea, and vitamin D. While taking supplements can help, in order to reverse thyroid eye disease one of course will need to remove the autoimmune trigger that is responsible for the elevated TSH receptor antibodies.
In summary, thyroid eye disease is common in Graves’ Disease, and this condition involves the immune system attacking the tissues of the eyes. Selenium is a powerful antioxidant which reduces oxidative stress and can modulate the immune system, and it’s an important cofactor for glutathione production. Essentially what selenium is doing is helping to regulate the immune system, which will decrease the damage caused to the tissues of the eyes. Keep in mind that other nutrients can also help with this process, and it’s also essential to remove the autoimmune trigger.