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Der Nuklearmediziner 2013; 36(04): 241-245
DOI: 10.1055/s-0033-1357118
Schilddrüsenerkrankungen und Stoffwechselstörungen, ­Schwangerschaft und Psyche
© Georg Thieme Verlag KG Stuttgart · New York

Selen bei Autoimmunerkrankungen der Schilddrüse

The Role of Selenium in Autoimmune Thyroid Diseases
R. Gärtner
1   Medizinische Klinik IV, Luwig-Maximilians-Universität München
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Publication History

Publication Date:
09 January 2014 (online)

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Zusammenfassung

Der Bedeutung von Selen für die Aufrechterhaltung der normalen Schilddrüsenfunktion und möglicherweise auch die Verhinderung von Schilddrüsenerkrankungen wurde in den letzten Jahrzehnten zunehmende Aufmerksamkeit gewidmet. Die Schilddrüse ist das Organ mit dem höchsten Selengehalt. Ein kombinierter Selen- und Iodmangel führt zur Destruktion der Schilddrüse und ist die Ursache des myxoedematösen Kretinismus. Selenmangel scheint mit ein Grund für die Auslösung einer Autoimmunthyreoiditis bei genetische disponierten Personen zu sein. Es wurden mehrere kontrollierte Interventions-­studien bei Patienten mit Autoimmunthyreoiditis (AIT) durchgeführt, und bei den meisten konnte gezeigt werden, dass durch eine Selensubstitution die TPO-AK abfallen und sich das Echomuster der Schilddrüse verbessert. Bisher nicht gezeigt werden konnte, dass der Verlauf der AIT durch eine Selensubstitution verzögert werden kann. Hierzu fehlen bisher die ausreichend großen und langfristig angelegten Studien. Jedoch konnte gezeigt werden, dass die postpartale Exazerbation der AIT und die damit einhergehenden Funk­tionsstörungen durch 200 µg Selen in Form von Selenmethionin signifikant reduziert werden können.

Bei Patienten mit Morbus Basedow und milder endokriner Orbitopathie konnte eine signifikante Verbesserung der klinischen Aktivität und der spezifischen Lebensqualität durch eine Selensubstitution mit Natriumselenit belegt werden.

Ein gering erhöhtes Diabetesrisiko unter einer Selensubstitution wurde insbesondere bei hohen Selenspiegeln beschrieben, die aber zumindest in Deutschland mit der marginal niedrigen Selenversorgung über die Nahrung nicht erreicht werden.

Abstract

The important role of selenium for the maintenance of normal thyroid function and probably prevention of thyroid disorders had been a matter of intensive research within the last decades. The thyroid is the organ with the highest selenium content. Since the discovery, that the combined iodine and selenium deficiency is the cause of myxoedematous cretinism because of thyroid destruction and atrophy, research on the role of selenium for thyroid metabolism and inflammation increased. Especially also the role of selenium in autoimmune disorders has been emphasised. In most of the controlled intervention trials it could be shown that the anti-TPO-antibodies decreased and the ultrasound structure improved under a supplementation with 200 µg of selenium. However, until now it could not be demonstrated that the course of AIT disease is influenced by a selenium supplementation, because this would mean large long-term trials, which hardly are to be done. But in one trial with pregnant women and AIT the selenium supplementation not only reduced significantly the postpartal increase of anti-TPO-antibodies but also the hypothyroidism.

In Graves’ disease with mild orbitopathy a significant improvement of the clinical activity score and also specific quality of life could be achieved by selenium.

A minor risk of diabetes has been reported especially in patients with high selenium plasma levels that hardly can be achieved by a supplementation with 200 µg selenium as Germany is a re­gion with low selenium intake with normal food.

Schlüsselwörter

Autoimmunthyreoiditis - Morbus Basedow - endokrine Orbitopathie - Schilddrüsen-Autoantikörper - Selenmethionin - Natriumselenit

Key words

autoimmune thyroiditis - Graves’ orbitopathy - thyroid autoantibodies - selenomethionine - sodium selenite
 

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