Selenium, zinc, and vitamin D supplementation affect the clinical course of COVID-19 infection in Hashimoto’s thyroiditis

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Selenium, zinc, and vitamin D supplementation affect the clinical course of COVID-19 infection in
Hashimoto's thyroiditis
Zelija Velija Asimi1,2, Almira Hadzovic-Dzuvo1,3, Djinan Al-Tawil1
1Outpatient Clinic with a Daily hospital "Dr Al Tawil", Sarajevo, 2Sarajevo Medical School, SSST University, 3Sarajevo University,
Bosnia and Herzegovina
Adequate supply of zinc, selenium, and vitamin D is essential
for resistance to other viral infections, immune function, and
reduced inflammation. Low levels of micronutrients are
associated with adverse clinical outcomes during viral
infections. Vitamin D improves the physical barrier against the
virus and stimulates the production of antimicrobial peptides. It
can prevent cytokine storms by reducing the production of
inflammatory cytokines. Selenium enhances the function of
cytotoxic effector cells. Furthermore, selenium is important for
maintaining T cell maturation and function, as well as for
producing T cell-dependent antibodies.
Our goal was to determine the effects of selenium, zinc, and
vitamin D supplementation on recovery from COVID-19 in
patients with pre-existing Hashimoto’s thyroiditis.
For the treatment of people with Hashimoto’s
thyroiditis who become infected with COVID-19,
the addition of selenium, zinc, and vitamin D3
could be beneficial. Randomized controlled trials
and large population studies should be performed
to evaluate these recommendations.
Reference:
1. Alexander J, Tinkov A, Strand TA, Alehagen U, Skalny A, Aaseth J. Early
Nutritional Interventions with Zinc, Selenium and Vitamin D for Raising Anti-Viral
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10.3390/nu12082358. PMID: 32784601; PMCID: PMC7468884.
2. Bae M, Kim H. Mini-Review on the Roles of Vitamin C, Vitamin D, and
Selenium in the Immune System against COVID-19. Molecules. 2020 Nov
16;25(22):5346. doi: 10.3390/molecules25225346
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patients with COVID-19. Int J Infect Dis. 2020 Nov;100:390-393. doi:
10.1016/j.ijid.2020.08.018. Epub 2020 Aug 11.
4. Heller RA, Sun Q, Hackler J, Seelig J, Seibert L, Cherkezov A, Minich WB,
Seemann P, Diegmann J, Pilz M, Bachmann M, Ranjbar A, Moghaddam A,
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INTRODUCTION
Table 2. The disease severity in COVID-19 patients with
Hashimoto thyroiditis according to Se, Zn and vitamin D
supplementation
Classification of COVID-19 severity was performed as following:
-Mild: fever < 38 °C, cough, weakness, loss of smell and/or taste
-Moderate: fever > 38 °C, RR > 22, dyspnoea in response to physical activity, pneumonia
verified using computer tomography (CT stages 1-2 of lung damage), SpO2 < 95%, CRP >
10 mg/L.
-Severe: RR > 30, SpO2 < 93%, lung damage progression revealed using CT, appearance
of signs of other diseases, altered consciousness, unstable hemodynamic; acute respiratory
insufficiency and requirement in mechanical ventilation, septic shock, multiple organ failure.
(p –Chi-Square test; * Logistic Regression model)
RESULTS
An observational cohort study was conducted. Adult patients
with pre-existing Hashimoto's thyroiditis admitted to the
outpatient clinic with COVID-19 from March 15 to December
31, 2020 were included. Out of the 356 Hashimoto’s patients
who had COVID-19 infection, 270 (75.8%) took supplements
(selenium 100 ug, zinc 20 mg and vitamin D3 2000 IU) and 86
(24.2%) did not.
Table 1. Anthropometric and biochemical parameters of the
COVID-19 and Hashimoto thyroiditis patients with and without
supplementation
Most Hashimoto’s patients (93%) who had COVID-19 were
euthyroid. The study showed that Hashimoto's patients (24.2%)
who did not take selenium, zinc and vitamin D increased their
risk of adverse outcomes from COVID-19 infection. In those
who did not take supplements, 28% required hospitalization.
There were no deaths. After adjusting for age, gender, BMI,
smoking status, we found an association between the absence
of supplements and the risk of hospitalization, and invasive
mechanical ventilation (logistic regression model). Patients with
Hashimoto’s thyroiditis who had COVID-19 infection and who
had previously taken supplements such as selenium, zinc, and
vitamin D had milder clinical outcomes, or no symptoms
compared to those who did not receive supplements and who
had a moderate or severe outcome (p <0.05).
M E T H O D S
CONCLUSION
PEP14.2
Data expressed as mean ±SD (continuous variables) and n(%) for categorical variables;
CRP—C-reactive protein; BMI—body mass index, TSH –thyroid stimulating hormone,
FT4 - free thyroxin.
p<0.001
p<0.001
p<0.001
020 40 60 80 100 120 140
No symptoms
Mild
Moderate
Severe
Hospitalization
Invasive Mechanical ventilation
Graph. 1. The disease severity in COVID-19 patients with
Hashimoto thyroiditis according to Se, Zn and vitamin D
supplementation
With Supplementation Without supplementation
Parameter
With Supplementation
Without supplementation
Age (y)
39,5 +/
- 4,3
42,6 +/
- 6,9
Gender (F/M)
246/24 (91/9 %)
67/19 (78/22 %)
BMI (kg/m2)
26,71 +/
- 2,45
28,49 +/
- 3,56
CRP (mg/l)
6,8 +/
- 2,3
76 +/
-12
TSH (mU/l)
2,85 +/
- 1,24
3,63 +/
- 1,67
FT4 (pmol/l)
15,6 +/
- 2,71
14,8 +/
- 3,11
In total 356 (100%)
270 (75,8%)
86 (24,2%)
Disease severity
With
Supplementation
Without
supplementation
P
No symptoms
112 (41,48%)
3 (3,5%)
<0,001
Mild
120 (44,45%)
12 (14%)
<0,001
Moderate
38 (14,07%)
20 (23.2%)
<
0,001
Severe
0
51 (59,3%)
<0,001*
Hospitalization
0
24 (28%)
<0,001*
Invasive Mechanical
ventilation
0
9 (10,5%)
<0,001*