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Selenium beneficial in mild Graves’ orbitopathy
Marcocci C. N Engl J Med. 2011;364:1920-1931.
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Six months of treatment with selenium improved the course of disease and quality of life in patients with mild Graves’ orbitopathy, according to results of a new study.
Compared with placebo, patients with mild Graves’ orbitopathy demonstrated significant improvement in self-reported quality of life measures (P<.001), less eye involvement (P=.001) and a slower progression of Graves’ orbitopathy (P=.001) after receiving selenium treatment for 6 months.
The European Group of Graves’ Orbitopathy reported the results of the multicenter, randomized, double blind, placebo-controlled clinical trial in The New England Journal of Medicine. The study compared twice-daily treatment with the antioxidant agent selenium (100 mcg), the anti-inflammatory agent pentoxifylline (600 mg; Trental, Sanofi-Aventis) and placebo in 159 patients who had mild Graves’ orbitopathy. Treatment lasted 6 months, and patients were followed for 6 months thereafter.
“The beneficial effect of selenium on quality of life was corroborated by a significantly better ophthalmic outcome, as compared with placebo, at the end of the 6-month treatment period,” the researchers wrote in the study.
The clinical activity score decreased in all groups, with the greatest change in the selenium group. The clinical activity score consisted of seven items: swelling of the eyelids; spontaneous retrobulbar pain; conjunctival redness; eyelid redness; pain on attempted eye movements; chemosis; and swelling of the caruncle.
Sixty-one percent of patients in the selenium group experienced improvement in their Graves’ orbitopathy, primarily related to amelioration of soft-tissue changes and a decrease in eyelid aperture, compared with 35% of the pentoxifylline group and 36% of the placebo group. Graves’ orbitopathy worsened in 7% of the selenium group, 10% of the pentoxifylline group and 26% of the placebo group.
“Thus, as compared with placebo, selenium was associated with an increased rate of improvement but also with a decreased rate of worsening,” the researchers wrote. “Except for a transient benefit with respect to soft-tissue changes at 6 months, the outcomes with pentoxifylline did not differ significantly from those seen with placebo.”
In addition, quality-of-life measures did not change significantly in the pentoxifylline or placebo groups.
Evaluation at 12 months confirmed the results observed at 6 months, according to the researchers. Two patients in the placebo group and one in the pentoxifylline group required immunosuppressive therapy for deterioration of their Graves’ orbitopathy.
The researchers observed no drug-related adverse events associated with selenium or placebo. However, skin and gastrointestinal disorders were reported with pentoxifylline.
“We speculate that an intervention aimed at improving the antioxidant-oxidant balance might be helpful in both hyperthyroidism and Graves’ orbitopathy,” the researchers wrote.
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