SUN-401 - Efficacy and Safety of Selenium Supplementation Versus Placebo in the Treatment of Graves' Orbitopathy: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials

Background:
Graves’ orbitopathy (GO) is a frequent extrathyroidal manifestation of Graves’ disease, characterized by ocular inflammation, functional impairment, and reduced quality of life (QOL). Selenium supplementation has been proposed as an adjunctive therapy due to its antioxidant and immunomodulatory effects, but randomized evidence remains variable. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of selenium supplementation compared with placebo in patients with GO.

Methods:
A systematic search of major electronic databases was conducted to identify randomized controlled trials comparing selenium with placebo in patients with Graves’ orbitopathy. Outcomes included disease activity measured by the Clinical Activity Score (CAS), visual and psychological functioning QOL, eyelid aperture, proptosis, and GO-specific quality of life (GO-QOL) response at 6 and 12 months. Pooled mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Results:
Six randomized controlled trials comprising 345 patients were included (186 in the selenium group and 159 in the placebo group). Selenium supplementation did not significantly improve CAS (MD −0.34; 95% CI −1.02 to 0.34), visual functioning QOL (MD 1.39; 95% CI −4.87 to 7.65), psychological functioning QOL (MD 1.69; 95% CI −6.33 to 9.70), eyelid aperture (MD −0.60 mm; 95% CI −2.57 to 1.36), or proptosis (MD −0.07 mm; 95% CI −0.98 to 0.85). In contrast, selenium was associated with significantly higher GO-QOL improvement at 6 months (RR 1.85; 95% CI 1.03–3.33) and 12 months (RR 1.93; 95% CI 1.34–2.76), as well as overall GO-QOL response (RR 1.90; 95% CI 1.33–2.72). Selenium was well tolerated, with no major safety concerns reported.

Conclusion:
While selenium supplementation does not significantly improve objective disease activity or ocular parameters in Graves’ orbitopathy, it is associated with meaningful improvements in GO-specific quality of life, particularly with longer follow-up. Selenium may therefore be considered a safe adjunctive therapy to improve patient-reported outcomes in selected patients with GO.

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