Selenium and the Course of Mild Graves' Orbitopathy

• Published in: The New England journal of medicine Vol. 364; no. 20; pp. 1920 - 1931
• Main Authors: Marcocci, Claudio, Kahaly, George J, Krassas, Gerasimos E, Bartalena, Luigi, Prummel, Mark, Stahl, Matthias, Altea, Maria Antonietta, Nardi, Marco, Pitz, Susanne, Boboridis, Kostas, Sivelli, Paolo, von Arx, George, Mourits, Maarten P, Baldeschi, Lelio, Bencivelli, Walter, Wiersinga, Wilmar
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 19.05.2011
• Subjects: Adult; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - therapeutic use; Antioxidants - therapeutic use; Biological and medical sciences; Disease Progression; Double-Blind Method; Endocrinopathies; Female; Free radicals; General aspects; Graves Ophthalmopathy - drug therapy; Humans; Male; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pentoxifylline - adverse effects; Pentoxifylline - therapeutic use; Quality of Life; Selenium; Selenium - therapeutic use; Thyroid. Thyroid axis (diseases); Endocrinopathy; Micronutrient; Medicine; Immunopathology; Hyperthyroidism; Thyroid diseases; Graves disease; Autoimmune disease; Selenium
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1012985

This trial compared oral selenium, an antioxidant agent, or oral pentoxifylline, an antiinflammatory agent, with placebo in mild Graves' orbitopathy. Selenium significantly improved quality of life and eye involvement and slowed disease progression. Approximately half the patients with Graves' disease have ocular involvement (Graves' orbitopathy). 1 Moderately severe and active forms of Graves' orbitopathy can be effectively treated with glucocorticoids, orbital irradiation, or both, 1 , 2 whereas milder forms may improve spontaneously and generally require only local measures to control symptoms (i.e., artificial tears, ointments, and prisms). A wait-and-see strategy in which patients are monitored until symptoms worsen can be challenged. First, many patients with even mild Graves' orbitopathy have a substantial decrease in their quality of life, as assessed either by general health–related quality-of-life questionnaires 3 or by a Graves' orbitopathy–specific quality-of-life questionnaire (GO-QOL). 4 Second, . . .