Selenium status, thyroid volume, and multiple nodule formation
in an area with mild iodine deficiency
Lone Banke Rasmussen, Lutz Schomburg1, Josef Ko ¨hrle1, IngeBu ¨lowPedersen2, Birgit Hollenbach1, Antonia Ho ¨g1,
Lars Ovesen3, Hans Perrild4and Peter Laurberg2
Division of Nutrition, Department of Nutrition, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860 Søborg,
Denmark,1Institute for Experimental Endocrinology, Charite ´-Universita ¨tsmedizin Berlin, Augustenburger Platz 1, CVK, D-13353 Berlin, Germany,
2Department of Endocrinology, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18–22, DK-9000 Aalborg, Denmark,3Department of
Gastroenterology, Slagelse Hospital, Ingemannsvej 18, DK-4200 Slagelse, Denmark and4Department of Endocrinology and Gastroenterology, Bispebjerg
University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
(Correspondence should be addressed to L B Rasmussen; Email: firstname.lastname@example.org)
Objective: The objective was to study the associations between serum selenium concentration and
thyroid volume, as well as the association between serum selenium concentration and risk for an
enlarged thyroid gland in an area with mild iodine deficiency before and after iodine fortification was
introduced. Another objective was to examine the association between serum selenium concentration
and prevalence of thyroid nodules.
Design: Cross-sectional study.
Methods: We studied participants of two similar cross-sectional studies carried out before (1997–1998,
nZ405) and after (2004–2005, nZ400) introduction of iodine fortification. Serum selenium
concentration and urinary iodine were measured, and the thyroid gland was examined by
ultrasonography in the same subjects. Associations between serum selenium concentration and
thyroid parameters were examined in multiple linear regression models or logistic regression models.
Results: Serum selenium concentration was found to be significantly, negatively associated with
thyroid volume (PZ0.006), and a low selenium status significantly increased the risk for thyroid
enlargement (PZ0.007). Furthermore, low serum selenium status had a tendency to increase the risk
for development of multiple nodules (PZ0.087).
Conclusions: Low serum selenium concentration was associated with a larger thyroid volume and a
higher prevalence of thyroid enlargement.
European Journal of Endocrinology 164 585–590
Both iodine and selenium play an important role in the
function of the thyroid gland (1). Iodine is a main
constituent of the thyroid hormones thyroxine (T4) and
triiodothyronine (T3). Selenium is found in high
concentration in the thyroid gland, thus suggesting an
important contribution of selenoproteins to integrity
and function of the gland (2–4). Selenium is incorpor-
ated as selenocysteine into a number of antioxidant
selenoproteins and contributes to the antioxidant
defense by protecting the thyrocytes from any excess
hydrogen peroxide, which is produced during thyroid
hormone biosynthesis (5, 6). In addition, selenium
constitutes an essential part of the iodothyronine
deiodinase enzymes, which catalyze thyroid hormone
by activation and inactivation (4, 5). Thus, selenium
deficiency may result in a decreased conversion of T4to
the active hormone T3.
Myxedematous endemic cretinism is prevalent in
goiter-endemic countries with low selenium and
glutathione peroxidase concentrations in serum (7).
However, selenium may also be important for optimal
thyroid functioning and regular thyroid hormone
action in areas without cretinism, given the fact that
a negative correlation between serum selenium and
thyroid volume was reported for children living in an
endemic goiter area (8). Results of other studies have
not been consequent; both an inverse association (9)
and no association have been found (10) between
urinary selenium and thyroid volume. Likewise, both
an inverse (11) and no association (9) have been
found between serum selenium concentration and
In the present study, the association between
serum selenium concentration and thyroid volume
was investigated both before and after iodine
European Journal of Endocrinology (2011) 164 585–590ISSN 0804-4643
q 2011 European Society of EndocrinologyDOI: 10.1530/EJE-10-1026
Online version via www.eje-online.org
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Received 14 January 2011
Accepted 17 January 2011
L B Rasmussen and others
EUROPEAN JOURNAL OF ENDOCRINOLOGY (2011) 164