Thyroid eye disease, which is also known as Graves’ ophthalmopathy, affects approximately 50% of those people with Graves’ Disease. And while in most cases the condition isn’t severe, this isn’t always the case. Common symptoms include eye swelling, eye bulging (exophthalmos), and sometimes even blurriness and double vision. While steroids such as prednisone are commonly given to help with the inflammation, certain natural approaches can also benefit the patient, without them having the side effects of steroid medications. Research shows that selenium can be very effective in helping with thyroid eye disease, which I’ll discuss in this post.
But why is selenium so effective in helping with thyroid eye disease? In order to better understand why selenium can help it probably is a good idea to briefly talk about the pathophysiology of thyroid eye disease. Research clearly shows that Graves’ ophthalmopathy isn’t due to the hyperthyroidism associated with Graves’ Disease, but instead is due to the autoimmune response (1). The same autoimmune response involved in Graves’ Disease is also responsible for damaging the tissues of the eyes. Some of the more common symptoms include a dry and gritty ocular sensation, sensitive to light, excessive tearing, double vision, and a pressure sensation behind the eyes (2). The most common clinical features of Graves’ ophthalmopathy are upper eyelid retraction, edema, and erythema of the periorbital tissues and conjunctivae, and bulging of the eyes (2).
Just to summarize, in Graves’ Disease it is the immune system which attacks the TSH receptors, which in turn leads to the excess production of thyroid hormone. And in Graves’ ophthalmopathy the immune system also causes damage to the tissues of the eyes, which in turn cause the signs and symptoms associated with Graves’ Disease. And so the obvious goal should be to modulate the immune system and decrease the TSH receptor antibodies. Glucocorticoids are commonly prescribed by medical doctors to help reduce the inflammation associated with thyroid eye disease, as well as suppress the immune system, which in turn can lower the TSH receptor antibodies (3). But there are negative health consequences of steroids, such as glucose intolerance, gastritis, hypertension, hepatitis, and depression (3).
How Can Selenium Specifically Help With Thyroid Eye Disease?
Although the focus of this post is on thyroid eye disease, selenium has been shown to be effective in the prevention and/or treatment of many other conditions including cardiovascular disease, osteoarthritis, rheumatoid arthritis, hypothyroidism, stroke, atherosclerosis, cancer susceptibility and treatment, HIV, AIDS, neuronal diseases such as Alzheimer’s disease and amyotrophic lateral sclerosis, pancreatitis, depression, and diabetes (4). Selenium might even be able to decrease the progression of thyroid cancer (5) (6). But how can one mineral have such a dramatic impact on these conditions? Well, selenium has numerous functions, as it is a powerful antioxidant which in turn can help to reduce oxidative stress, it is involved in modulating the immune system, it is an enzymatic cofactor, and it is also involved in gene expression. So it is very likely that a deficiency of this mineral will make someone more susceptible to developing other chronic health conditions.
As for how selenium can specifically help with thyroid eye disease, although the exact mechanism isn’t known, an increase in oxidative stress has been observed in both acute and chronic phases of thyroid disease with raised tissue concentrations of reactive oxygen species (7). Selenium is important for the formation of selenoproteins. These selenoproteins are powerful antioxidants and help to neutralize the effects of oxidative stress by reducing these free radicals (8). Glutathione peroxidase and thioredoxin reductase are the two main seleno-enzyme systems which are responsible for the reduction of free radicals (7) (9). These free radicals lead to an increase in proinflammatory cytokines, which as I have discussed in past articles and blog posts, are associated with autoimmune conditions (10). So essentially what happens is that if someone has a selenium deficiency, this will result in a decrease in selenoproteins, and this in turn will result in the accumulation of hydrogen peroxide, which will cause tissue inflammation (11). In addition, a deficiency of these selenoproteins can cause dysregulation of the immune system (12). All of this can lead to tissue injury.
Remember that it’s the immune system attacking the TSH receptors which is responsible not only for the hyperthyroid symptoms of Graves’ Disease, but the immune system also attacks the fibroblasts of the orbit, which results in the symptoms associated with thyroid eye disease. The TSH receptor antibodies are secreted by activated B cells due to immune system dysregulation. But a sufficient amount of selenium can help to regulate the immune system, as it can help restore both innate and humoral immune functions (13) (14).
How Much Selenium Should You Take?
As for the dosage of selenium, it depends on the individual. A typical dosage to help with these conditions is 200 mcg/day, as this frequently is sufficient enough to result in a therapeutic effect without causing a selenium toxicity. Some people don’t respond unless if higher doses of selenium are taken (i.e. 400 mcg/day). However, too much selenium can be toxic, and so you do want to be cautious. Although you can try to get enough selenium through eating selenium-rich foods such as Brazil nuts, it might be best to take a selenium supplement. The reason for this is because the dosage of selenium will vary in the food depend on the source. For example, a Brazil nut that wasn’t grown in selenium-rich soil will of course have a lower amount of selenium than a Brazil nut that was grown in selenium-rich soil.
It also is a good idea to do other things to modulate the immune system, and not just rely on taking selenium. Other nutrients which can decrease oxidative stress and suppress the autoimmune response include curcumin, resveratrol, fish oils, green tea, and vitamin D. While taking supplements can help, in order to reverse thyroid eye disease one of course will need to remove the autoimmune trigger that is responsible for the elevated TSH receptor antibodies.
In summary, thyroid eye disease is common in Graves’ Disease, and this condition involves the immune system attacking the tissues of the eyes. Selenium is a powerful antioxidant which reduces oxidative stress and can modulate the immune system, and it’s an important cofactor for glutathione production. Essentially what selenium is doing is helping to regulate the immune system, which will decrease the damage caused to the tissues of the eyes. Keep in mind that other nutrients can also help with this process, and it’s also essential to remove the autoimmune trigger.
After reading the article and speaking with my Endo, who is clueless, how do you determine your autoimmune trigger?
I have completely changed my diet to gluten-free, non-GMO and organic. Take my Whole Foods derived vitamins, herbal supplements and essential oils daily. I would like to treat my graves and hyperthyroidism naturally but without a lot of money and not having any holistic doctors in my area I feel a bit lost. Any help with the determining the trigger would be greatly appreciated.
Hi DeAnna,
If the trigger is a food allergen then doing an elimination diet can help to determine the trigger. But if you have other imbalances such as weak adrenals/HPA axis dysregulation, a leaky gut, an infection, etc., then further testing is usually necessary. If you don’t have a lot of money then you can continue eating a healthy diet, improve your stress handling skills, if you have a leaky gut eating fermented foods and bone broth can help, etc. Even if you can’t afford continuous visits with a holistic doctor it might be worth going through one or two consultations so that they can help you identify the cause of your condition. Even though there isn’t a local natural healthcare professional you can always do a remote consultation with someone.
You can get a MRT blood test done. It will show what is causing inflammation in your gut and which foods you show avoid or rotate in your diet
I can tell you that for me, taking selenium definitely helped. Before I was even diagnosed with Graves, I could feel my left eye protruding even though most people couldn’t tell by looking. I could tell by feel and I was greatly concerned. It took a while to get in to see the VA eye doctor after my Graves diagnosis and in the meantime I restarted taking the selenium I had taken in the past. Because of a SNP (flaw) in part of my DNA, I need more selenium than the average person. Even so, I stay at less than 400mcg, the max safe dosage according to what I’ve read. I take 200mcg twice a day, with my morning and evening pills. In the couple of weeks I was taking selenium before seeing the eye doctor, my left eye started going back in the eye socket where it belonged. The eye doctor could detect only a small difference in the eye that was pushing out. I continue to take selenium as part of my Graves Disease protocol. For me, it has helped immensely with my Graves Eye Disease.
Hi Susan,
Thank you for sharing your experience, as I’m glad that taking selenium has helped greatly with your thyroid eye disease!
Is there a test to know if you need more selium than the average person?
Thank you for this article. Like Ms. Heider, I’ve been using selenium supplements for my GED and it helps. I take 200 mcg twice daily as well. Sometimes I get too busy and forget to take them; after four or five days, my eyes are super swollen and people notice. I didn’t know about the other vitamins recommended – curcumin & resveratrol. Fish does help as well, it seems to keep the hair softer and eyes don’t dry out too often. I can definitely tell these two vitamins work on my eyes and would recommend them.
Hi, I’ve just started Selenuim yesterday after seeing my eye Doctor. I had RAI for Graves on 14.3.2016. I’m praying my eyes don’t get worse, I only have mild eye issues, but did get referred straight away to an eye specialist by my Endo. I also have Coeliacs disease and Pernicious Anemia. So a things going on. I’ve also been told that I have vitamin d deficiency? Could you recommend a really good all round vitamin with high concentrates of vitamin d at all?
Any advise would be greatly received.
Kind regards
Your eyes can worsen over time with rai so stay on it! Selenium and omega 3 fish oil help me as i have severe dry eyes and buldging. Stay away from omega 6 fish oil as it is inflammatory. I have gotten some benefit from accupuncture and getting off of gluten has calmed immune system down. Have to take nature throid as i cant process synthroid- ive got wilsons thyroid syndrome. Good luck and do some research
I suffer from eye disease. It began 3 years ago. Although it is not so severe but as I am a girl and the appearance is important for me, it has become the main problem of my whole life and every day I pray and ask God to help me. I read about Selenium now and I decided to buy it and start to try it 200mcg/day. I hope it helps me and bulging will be better. Thank you very much Dr.Eric
Hello,
I too am a young lady that suffers from Thyroid Eye Disease. It seems like it’s the only thing I see when I look in the mirror, my eyes. I too came across this article and hopes that Selenium supplements will help. I will keep you in my prayers. I know how you feel!
Hi. I’m just wondering if the supplements have started to work . I’m also was thinking about using them and have just been diagnosed with TED and one of my eye is protruding and makes me so sad to look in the mirror x
HAS ANYONE SEEN A DIFFERENCE AFTER TAKING THIS SUPPLEMENT IN THE APPEARANCE OF YOUR EYES.. DID IT MAKE A BI DIFFERENCE IN THE EYES AND HOW THE LOOK ?? MY DOCTOR JUST TOLD ME TO START TAKING THIS SUPPLEMENT AFTER SIX YEARS OF DEALING WITH GRAVES I HAVE MILD BULGING IN BOTH MY EYES.JUST WANTED TO KNOW WHAT PEOPLE THOUGHT OF IT BEFORE I TOOK IT ??
I find that serrapetase the enzymes from silk worms helps my swollen and bulging eyes. It also helps with other inflammtions in my body
Thanks for sharing your experience Anna!
Hi! I have hyperthyroidism and graves disease but my thyroid is in normal now, but my graves is still here, I can say that my eyes are not yet normal, last week I go back to my doctor and she give me selenium 200mcg to take everyday and its not a medicine its a vitamins which is good… im looking forward and verry excited, I hope it will work.
Harvey, I also hope that the selenium helps to lower the TSH receptor antibodies, although keep in mind that you might also need to find and remove the underlying triggers.
I have being dealing with Graves for 3 years now. I was put on Metimazole once a day and sometimes twice a day. From big dosages to small dosages nothing seeing to help . Terrifying from my eyes getting worse I started taking every single supplement I read about it including Seliniun . My eyes definitely got better but not all gone. At least my eye lid retraction was better and I didn’t look like a freak. I thought I can do this on my own by doing everything in my power to get better but here I sit today more depressed then ever without answers. My endocrinologist is tired of me . I don’t blame her I am a difficult patient and a very hard head too. She keep telling me that my body has proven to me that I will not get better if I don’t do something such as RAI or the surgery to remove my gland. I am scared to dead because she said that the eyes can get worse but at the same time she told me that I can take steroids prior and after to help. The surgery is scary too because they are so many things that can go wrong. After reading a lot about Graves I realize that doing the surgery may be the answer for me but I don’t believe in my heart it will help with my eyes because i know it is not the gland that is making my eyes swell. My body will continue to make thousands of antibodies if I don’t find out the real cause for the overproduction. My levels for the TSI are in the thousands . I feel all of your pain. This is a horrible disease to deal with. I am so depressed to the point of not seeing any light for me .
Hi Haizel,
I of course can understand not seeing the light at the end of the tunnel, but I would try to hang in there, as you are right about needing to find and address the cause of the problem. I realize it’s not always easy to do this, but as you mentioned, getting thyroid surgery doesn’t do anything for the autoimmune response.
Hi Dr Eric, thank you very much for the information! I have a question which I couldn’t find anything online. My eyes have been protruded since 2011. My thyroid hormones have been normal after taking methimazole for about a year since 2012. Although they were slightly higher postpartum in 2014, they went back to normal after a few months. Regardless, my antibodies have always been high from 1000 to 5400 recently. I have just started taking selenium 200mcg and both pro and prebiotics. I also changed my diet to gluten free try to stick with gut friendly diet. Since my eyes protruded and the tissues behind my eyes were swollen 7 years ago, will taking selenium now still help making my eyes less bulging and less eye pressure? Thank you.
Hi Jenny,
Although taking selenium might help to reduce the bulging and pressure, keep in mind that the longer someone has had thyroid eye disease the less likely they are to reverse it. Once again, this doesn’t mean that you can’t get any positive changes, but if someone has had moderate to severe eye bulging for many years, chances are it won’t completely go back to normal. Also keep in mind that while selenium may help, you might need to do other things to improve the health of your immune system and lower the thyroid antibodies. Keep up the good work with the gluten free diet and taking the pre and probiotics!
I had rai 18 months ago then eye lids were swelled i thought from crying now they are heavy and embarrasing some vision issues but not severe. Can selenuim reverse this eye lid swelling? My diagnostic actually suggested it
Hi Sheila,
It sounds like you have experienced severe eyelid edema due to Graves’ ophthalmopathy, which was exacerbated when you got the RAI. It’s possible that selenium can help to reduce the swelling, although I’d be cautious about taking too high of a dosage, and you might need some additional support. Having healthy vitamin D levels (>50 ng/mL) is important, turmeric/curcumin can also help to reduce inflammation. But you also should consider working with a natural practitioner to detect and remove the autoimmune triggers, as the RAI didn’t do anything to address this, and this can also be a factor in the eyelid swelling.
HI, is it ok to take selenium with goiter/ nodula with near hyperthyroidism , because just read on the site of selenium vitamins , that you must avoid it if you have a goiter ?
/ contre indications/
Thanks for answers and for very interesting blog.
Hi Caroline,
Of course everyone is different, but if someone has a selenium deficiency then it should be fine for them to supplement with selenium, even if they have toxic multinodular goiter.
What other tests do you do to check for underlying causes of autoimmune disorders? Also how are you able to treat patients if they live out of state?
Debra, some of the tests I recommend include testing for adrenals and sex hormones, mineral testing, sometimes stool and organic acids testing. As for working with patients remotely, a lot of doctors practice telemedicine these days. Of course you would need to see a doctor in person to receive an exam, but just about everything else can be accomplished over the phone.
I had Rai in 2003 and my eyes are still bulged this year they’re worse than ever especially the right one due to severe itching of the right eye from allergy and going to start the selenium and anything else I need to help me I hope I will be cured