硒與甲狀腺疾病2019-10硒與甲狀腺疾病1硒的作用1、抗氧化功能2、保護心血管3、抗輻射損傷能力4、解毒及抗癌5、其他功能（未知）硒的作用1、抗氧化功能2硒在體內的存在形式1、低分子量的硒化合物2、硒蛋白的形式：GSH-PxPHG-Px3、硒代半胱氨酸SeC硒在體內的存在形式1、低分子量的硒化合物3硒蛋白第一個發現的硒蛋白：GSH-Px谷胱甘肽過氧化物酶硒是GSH-Px的必需成分補硒可使GSH-Px活性增強GSH-Px分布廣泛，在腎臟中濃度最高GSH-Px可抑制NF-κB的活化硒蛋白第一個發現的硒蛋白：GSH-Px4硒蛋白第二個發現的硒蛋白：PHG-Px磷脂過氧化谷胱甘肽過氧化物酶硒是其的必需成分活性部位與GSH-Px相同硒蛋白第二個發現的硒蛋白：PHG-Px5硒蛋白還有一些硒蛋白雖然全部功能未知，但它們的一些功能已被人們了解，包括細胞內信號的氧化還原調節、氧化還原穩態和甲狀腺激素代謝。在病理上，硒蛋白表達降低與硒蛋白N（SEPN）相關肌病與因甲狀腺激素代謝缺陷（由SBP2遺傳缺陷引起的脫碘酶缺乏）引起的先天性肌病直接相關。硒蛋白還有一些硒蛋白6硒化合物硒代半胱氨酸Sec

Sec與硒蛋白結合，參與到UGA密碼子的解碼。硒化合物硒代半胱氨酸Sec7硒的攝入硒：Se足量攝入：人每日攝取硒180-280μg有明顯的防癌作用過量：人每日攝取硒≥819μg，敏感的人會出現硒中毒癥狀硒的攝入硒：Se8硒與疾病硒化合物和硒蛋白與很多疾病有關：大骨節病克羅恩病（CD）甲狀腺疾病，包括TAO已與預防某些癌癥、阿爾茨海默病、心血管疾病和壽命密切相關。

硒與疾病硒化合物和硒蛋白與很多疾病有關：9硒與甲狀腺疾病1、Seleniumstatusandover-expressionofinterleukin-15inceliacdiseaseandautoimmunethyroiddiseases.2019

甲狀腺對硒缺乏特別敏感，因為含硒蛋白質（含硒代半胱氨酸）在甲狀腺激素的生物合成和活動中起著重要的作用

硒與甲狀腺疾病1、Seleniumstatusando10硒與甲狀腺疾病2、SeleniuminHumanHealthandDisease.2019

seleniumintheenvironment,dietaryintakes,metabolismandstatus,functionsinthebody,thyroidhormonemetabolism,antioxidantdefensesystemsandoxidativemetabolism,andtheimmunesystem.

硒與甲狀腺疾病2、SeleniuminHumanHea11硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

Context:Therecentrecognitionthattheessentialtraceelementseleniumisincorporatedasselenocysteineinallthreedeiodinaseshasdecisivelyconfirmedtheclear-cutlinkbetweenseleniumandthyroidfunction.Ithasadditionallybeenestablishedthatthethyroidcontainsmoreseleniumthananyothertissueandthatseleniumdeficiencyaggravatesthemanifestationofendemicmyxedematouscretinismandautoimmunethyroiddisease.

硒與甲狀腺疾病3、SeleniumandtheThyr12硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

EvidenceAcquisition:

Clinicalreportsaswellasalargenumberofbiochemicalarticleslinkingseleniumtothyroidhavebeenconsidered.Interventional,prospective,randomized,controlledstudies,includinglargeobservationalstudies,supplementingseleniuminautoimmunethyroiddisease,togetherwithreviewarticlespublishedinMedlineandPubmedhaveundergonescrutiny.Themethodologicaldifferencesandvarietyofresultsemergingfromthesetrialshavebeenanalyzed.

硒與甲狀腺疾病3、SeleniumandtheThyr13硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

EvidenceSynthesis:Evidenceinsupportofseleniumsupplementationinthyroidautoimmunediseaseisevaluated,theresultshereinpresenteddemonstratingthepotentialeffectivenessofseleniuminreducingtheantithyroidperoxidasetiterandimprovingtheechostructureintheultrasoundexamination.However,considerablediscordremainsastowhoshouldcomprisetargetgroupsforseleniumtreatment,whowillmostbenefitfromsuchtreatment,thepreciseimpactofthebasalantithyroidperoxidaselevel,andtheeffectofdiseasedurationonthetreatmentoutcome.Clearly,furtherin-depthstudiesandevaluationarerequiredconcerningthemechanismofactionofseleniumaswellasthechoiceofsupplementsordietaryintake.Conclusions:

Maintenanceof"selenostasis"viaoptimalintakenotonlyaidspreservationofgeneralhealthbutalsocontributessubstantiallytothepreventionofthyroiddisease.

硒與甲狀腺疾病3、SeleniumandtheThyr14硒與甲狀腺疾病4、Ontheimportanceofseleniumandiodinemetabolismforthyroidhormonebiosynthesisandhumanhealth.2019

Thetraceelementsiodineandselenium(Se)areessentialforthyroidglandfunctioningandthyroidhormonebiosynthesisandmetabolism.Whileiodineisneededastheeponymousconstituentofthetwomajorthyroidhormonestriiodo-L-thyronine(T3),andtetraiodo-L-thyronine(T4),Seisessentialforthebiosynthesisandfunctionofasmallnumberofselenocysteine(Sec)-containingselenoproteinsimplicatedinthyroidhormonemetabolismandglandfunction.TheSe-dependentiodothyroninedeiodinasescontrolthyroidhormoneturnover,whilebothintracellularandsecretedSe-dependentglutathioneperoxidasesareimplicatedinglandprotection.Recently,anumberofclinicalsupplementationtrialshaveindicatedpositiveeffectsofincreasingtheSestatusoftheparticipantsinavarietyofpathologies.ThesefindingsenforcethenotionthatmanypeoplemightprofitfromimprovingtheirSestatus,bothasameanstoreducetheindividualhealthriskaswellastobalanceaSedeficiencywhichoftendevelopsduringthecourseofillness.Eventhoughtheunderlyingmechanismsarestilllargelyuncharacterised,theeffectsofSeappeartobeexertedviamultipledifferentmechanismsthatimpactmostpronouncedontheendocrineandtheimmunesystems.硒與甲狀腺疾病4、Ontheimportanceof15硒與甲狀腺相關性眼病（TAO）1、Graves'ophthalmopathy,20192、Graves'Orbitopathy，2019在GO的中度至重度活動期疾病階段，行抗炎治療（主要是全身性類固醇的應用，眼眶照射），而且在威脅視力的嚴重階段行眼眶減壓手術。在輕度疾病中，對癥處理和硒補充就可以。在疾病的非活動階段，手術（眼眶減壓，眼外肌手術，眼瞼手術）可以改善外觀和功能。吸煙會增加GO的患病率和嚴重性，并降低治療的效果。甲狀腺功能恢復正常可以改善約60％GO患者的癥狀。

硒與甲狀腺相關性眼病（TAO）1、Graves'ophth16硒與甲狀腺相關性眼病（TAO）3、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

有輕度Graves眼病（GO）的患者中，硒的補充可以起到改善軟組織癥狀的作用。

硒與甲狀腺相關性眼病（TAO）3、Doesselenium17硒與甲狀腺相關性眼病（TAO）4、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

BackgroundOxygenfreeradicalsandcytokinesplayapathogenicroleinGraves'orbitopathy.MethodsWecarriedoutarandomized,double-blind,placebo-controlledtrialtodeterminetheeffectofselenium(anantioxidantagent)orpentoxifylline(anantiinflammatoryagent)in159patientswithmildGraves'orbitopathy.Thepatientsweregivenselenium(100mugtwicedaily),pentoxifylline(600mgtwicedaily),orplacebo(twicedaily)orallyfor6monthsandwerethenfollowedfor6monthsaftertreatmentwaswithdrawn.Primaryoutcomesat6monthswereevaluatedbymeansofanoverallophthalmicassessment,conductedbyanophthalmologistwhowasunawareofthetreatmentassignments,andaGraves'orbitopathy-specificquality-of-lifequestionnaire,completedbythepatient.SecondaryoutcomeswereevaluatedwiththeuseofaClinicalActivityScoreandadiplopiascore.硒與甲狀腺相關性眼病（TAO）4、Doesselenium18硒與甲狀腺相關性眼病（TAO）4、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

Results

Atthe6-monthevaluation,treatmentwithselenium,butnotwithpentoxifylline,wasassociatedwithanimprovedqualityoflife(P<0.001)andlesseyeinvolvement(P=0.01)andslowedtheprogressionofGraves'orbitopathy(P=0.01),ascomparedwithplacebo.TheClinicalActivityScoredecreasedinallgroups,butthechangewassignificantlygreaterintheselenium-treatedpatients.Exploratoryevaluationsat12monthsconfirmedtheresultsseenat6months.Twopatientsassignedtoplaceboandoneassignedtopentoxifyllinerequiredimmunosuppressivetherapyfordeteriorationintheircondition.Noadverseeventswereevidentwithselenium,whereaspentoxifyllinewasassociatedwithfrequentgastrointestinalproblems.硒與甲狀腺相關性眼病（TAO）4、Doesselenium19硒與甲狀腺相關性眼病（TAO）4、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

Conclusions

Seleniumadministrationsignificantlyimprovedqualityoflife,reducedocularinvolvement,andslowedprogressionofthediseaseinpatientswithmildGraves'orbitopathy.

硒與甲狀腺相關性眼病（TAO）4、Doesselenium20硒與甲狀腺疾病課件21討論內容1、國內關于硒與甲狀腺方面的研究還比較少2、能否做甲狀腺和硒關系的相關研究？討論內容1、國內關于硒與甲狀腺方面的研究還比較少22謝謝！謝謝！23硒與甲狀腺疾病課件24硒與甲狀腺疾病2019-10硒與甲狀腺疾病25硒的作用1、抗氧化功能2、保護心血管3、抗輻射損傷能力4、解毒及抗癌5、其他功能（未知）硒的作用1、抗氧化功能26硒在體內的存在形式1、低分子量的硒化合物2、硒蛋白的形式：GSH-PxPHG-Px3、硒代半胱氨酸SeC硒在體內的存在形式1、低分子量的硒化合物27硒蛋白第一個發現的硒蛋白：GSH-Px谷胱甘肽過氧化物酶硒是GSH-Px的必需成分補硒可使GSH-Px活性增強GSH-Px分布廣泛，在腎臟中濃度最高GSH-Px可抑制NF-κB的活化硒蛋白第一個發現的硒蛋白：GSH-Px28硒蛋白第二個發現的硒蛋白：PHG-Px磷脂過氧化谷胱甘肽過氧化物酶硒是其的必需成分活性部位與GSH-Px相同硒蛋白第二個發現的硒蛋白：PHG-Px29硒蛋白還有一些硒蛋白雖然全部功能未知，但它們的一些功能已被人們了解，包括細胞內信號的氧化還原調節、氧化還原穩態和甲狀腺激素代謝。在病理上，硒蛋白表達降低與硒蛋白N（SEPN）相關肌病與因甲狀腺激素代謝缺陷（由SBP2遺傳缺陷引起的脫碘酶缺乏）引起的先天性肌病直接相關。硒蛋白還有一些硒蛋白30硒化合物硒代半胱氨酸Sec

Sec與硒蛋白結合，參與到UGA密碼子的解碼。硒化合物硒代半胱氨酸Sec31硒的攝入硒：Se足量攝入：人每日攝取硒180-280μg有明顯的防癌作用過量：人每日攝取硒≥819μg，敏感的人會出現硒中毒癥狀硒的攝入硒：Se32硒與疾病硒化合物和硒蛋白與很多疾病有關：大骨節病克羅恩病（CD）甲狀腺疾病，包括TAO已與預防某些癌癥、阿爾茨海默病、心血管疾病和壽命密切相關。

硒與疾病硒化合物和硒蛋白與很多疾病有關：33硒與甲狀腺疾病1、Seleniumstatusandover-expressionofinterleukin-15inceliacdiseaseandautoimmunethyroiddiseases.2019

甲狀腺對硒缺乏特別敏感，因為含硒蛋白質（含硒代半胱氨酸）在甲狀腺激素的生物合成和活動中起著重要的作用

硒與甲狀腺疾病1、Seleniumstatusando34硒與甲狀腺疾病2、SeleniuminHumanHealthandDisease.2019

seleniumintheenvironment,dietaryintakes,metabolismandstatus,functionsinthebody,thyroidhormonemetabolism,antioxidantdefensesystemsandoxidativemetabolism,andtheimmunesystem.

硒與甲狀腺疾病2、SeleniuminHumanHea35硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

Context:Therecentrecognitionthattheessentialtraceelementseleniumisincorporatedasselenocysteineinallthreedeiodinaseshasdecisivelyconfirmedtheclear-cutlinkbetweenseleniumandthyroidfunction.Ithasadditionallybeenestablishedthatthethyroidcontainsmoreseleniumthananyothertissueandthatseleniumdeficiencyaggravatesthemanifestationofendemicmyxedematouscretinismandautoimmunethyroiddisease.

硒與甲狀腺疾病3、SeleniumandtheThyr36硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

EvidenceAcquisition:

Clinicalreportsaswellasalargenumberofbiochemicalarticleslinkingseleniumtothyroidhavebeenconsidered.Interventional,prospective,randomized,controlledstudies,includinglargeobservationalstudies,supplementingseleniuminautoimmunethyroiddisease,togetherwithreviewarticlespublishedinMedlineandPubmedhaveundergonescrutiny.Themethodologicaldifferencesandvarietyofresultsemergingfromthesetrialshavebeenanalyzed.

硒與甲狀腺疾病3、SeleniumandtheThyr37硒與甲狀腺疾病3、SeleniumandtheThyroid:AClose-KnitConnection.2019

EvidenceSynthesis:Evidenceinsupportofseleniumsupplementationinthyroidautoimmunediseaseisevaluated,theresultshereinpresenteddemonstratingthepotentialeffectivenessofseleniuminreducingtheantithyroidperoxidasetiterandimprovingtheechostructureintheultrasoundexamination.However,considerablediscordremainsastowhoshouldcomprisetargetgroupsforseleniumtreatment,whowillmostbenefitfromsuchtreatment,thepreciseimpactofthebasalantithyroidperoxidaselevel,andtheeffectofdiseasedurationonthetreatmentoutcome.Clearly,furtherin-depthstudiesandevaluationarerequiredconcerningthemechanismofactionofseleniumaswellasthechoiceofsupplementsordietaryintake.Conclusions:

Maintenanceof"selenostasis"viaoptimalintakenotonlyaidspreservationofgeneralhealthbutalsocontributessubstantiallytothepreventionofthyroiddisease.

硒與甲狀腺疾病3、SeleniumandtheThyr38硒與甲狀腺疾病4、Ontheimportanceofseleniumandiodinemetabolismforthyroidhormonebiosynthesisandhumanhealth.2019

Thetraceelementsiodineandselenium(Se)areessentialforthyroidglandfunctioningandthyroidhormonebiosynthesisandmetabolism.Whileiodineisneededastheeponymousconstituentofthetwomajorthyroidhormonestriiodo-L-thyronine(T3),andtetraiodo-L-thyronine(T4),Seisessentialforthebiosynthesisandfunctionofasmallnumberofselenocysteine(Sec)-containingselenoproteinsimplicatedinthyroidhormonemetabolismandglandfunction.TheSe-dependentiodothyroninedeiodinasescontrolthyroidhormoneturnover,whilebothintracellularandsecretedSe-dependentglutathioneperoxidasesareimplicatedinglandprotection.Recently,anumberofclinicalsupplementationtrialshaveindicatedpositiveeffectsofincreasingtheSestatusoftheparticipantsinavarietyofpathologies.ThesefindingsenforcethenotionthatmanypeoplemightprofitfromimprovingtheirSestatus,bothasameanstoreducetheindividualhealthriskaswellastobalanceaSedeficiencywhichoftendevelopsduringthecourseofillness.Eventhoughtheunderlyingmechanismsarestilllargelyuncharacterised,theeffectsofSeappeartobeexertedviamultipledifferentmechanismsthatimpactmostpronouncedontheendocrineandtheimmunesystems.硒與甲狀腺疾病4、Ontheimportanceof39硒與甲狀腺相關性眼病（TAO）1、Graves'ophthalmopathy,20192、Graves'Orbitopathy，2019在GO的中度至重度活動期疾病階段，行抗炎治療（主要是全身性類固醇的應用，眼眶照射），而且在威脅視力的嚴重階段行眼眶減壓手術。在輕度疾病中，對癥處理和硒補充就可以。在疾病的非活動階段，手術（眼眶減壓，眼外肌手術，眼瞼手術）可以改善外觀和功能。吸煙會增加GO的患病率和嚴重性，并降低治療的效果。甲狀腺功能恢復正常可以改善約60％GO患者的癥狀。

硒與甲狀腺相關性眼病（TAO）1、Graves'ophth40硒與甲狀腺相關性眼病（TAO）3、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

有輕度Graves眼病（GO）的患者中，硒的補充可以起到改善軟組織癥狀的作用。

硒與甲狀腺相關性眼病（TAO）3、Doesselenium41硒與甲狀腺相關性眼病（TAO）4、DoesseleniumsupplementationimproveGravesophthalmopathy?2019

BackgroundOxygenfreeradicalsandcytokinesplayapathogenicroleinGraves'orbitopathy.MethodsWecarriedoutarandomized,double-blind,placebo-controlledtrialtodeterminetheeffectofselenium(anantioxidantagent)orpentoxifylline(anantiinflammatoryagent)in159patientswithmildGraves'orbitopathy.Thepatientsweregivenselenium(100mugtwicedaily),pentoxifylline(600mgtwicedaily),orplacebo(twicedaily)orallyfor6monthsandwerethenfollowedfor6monthsaftertreatmentwaswithdrawn.Primaryoutcomesat6monthswereevaluatedbymeansofanoverallophthalmicassessment,conductedbyanophthalmologistwhowasunawar