Download PDFPDF

Original research
Relative selenium insufficiency is a risk factor for developing severe Graves’ orbitopathy: a case–control study
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests


  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

  • Published on:
    Authors’ response to: Tomoyuki Kawada, regarding the publication: “Relative selenium insufficiency is a risk factor for developing severe Graves’ orbitopathy: a case -control study”
    • Mingkwan Lumyongsatien, Ophthalmologist Metta Pracharak Hospital
    • Other Contributors:
      • Krit Pongpirul, Physician

    Dear Editor,
    We are thankful for the enriching comments on our article on the selenium (Se) insufficiency cut-off point value related to severe Graves’ orbitopathy (GO).

    We concur that the area under the ROC curve revealed an imperfect differentiation between mild and severe GO. Since GO is a multifactorial disease, a single trace element like selenium should be combined with other determinants in clinical practice. Nonetheless, finding from our study built upon the existing evidence on the association between selenium and GO by proposing a possible cut-off-point that should be further validated with a larger and/or different population. Also, future studies that include healthy individuals without orbitopathy will generate more obvious comparative evidence on the effects of Se on the disease course.

    Universal normal ranges of serum selenium (Se) levels have not been set because of the geographical variability in selenium levels. The ‘sufficient’ levels of serum selenium have been relative to clinical parameters, e.g., prevention of Keshan disease at > 21 mcg/l, the optimal activity of IDIs (iodothyronine 5’ deiodinase) at > 65 mcg/l (1). The cut-point identified in our study was compatible with at least three studies (90mcg/l, 95mcg/l, and 89 mcg/l) regarding plasma selenium needed to achieve the full expression of plasma GPx (glutathione peroxidase) (1-3).

    1. Thomson CD. Assessment of requirements for selenium and adequ...

    Show More
    Conflict of Interest:
    None declared.
  • Published on:
    Re: Relative selenium insufficiency is a risk factor for developing severe Graves' orbitopathy

    Lumyongsatien et al. investigated the risk of relative selenium (Se) insufficiency for the development of disease severity in 100 patients with Graves' orbitopathy (GO) (1). Thirty-two patients had mild GO and 68 had severe GO, and the adjusted odds ratio (OR) (95% confidence interval [CI]) of Se level ≤93 µg/L for severe GO development was 8.14 (2.39 to 27.75). Abnormal thyroid status was also a risk factor for severe GO, presenting adjusted OR (95% CI) of 3.24 (1.04 to 10.04). The authors concluded that Se ≤93 µg/L was a risk factor for severe GO development, and I have a comment about their study.

    The authors conducted a receiver operating characteristic curve analysis to determine the cut-off point for detecting severe GO, but the area under the curve was not so large in Figure 1. In addition, 95% CI for the adjusted OR presented a wide range. This means that ability of differentiating severe GO from mild GO by using serum Se may not be high, although there was a statistical significance. In addition, there is a need of study to specify the dose-response relationship between serum Se levels and severity of GO by including Graves' disease without orbitopathy. Anyway, further study is needed to determine the appropriate cut-off point of serum Se for detecting severe GO.

    1. Lumyongsatien M, Bhaktikamala U, Thongtong P, et al. Relative selenium insufficiency is a risk factor for developing severe Graves' orbitopathy: a case-con...

    Show More
    Conflict of Interest:
    None declared.