Thyroid Health: At the Intersection of Stress, Immunity and Cardiovascular Function

Far from being an isolated system, thyroid function is intimately involved in overall wellness, and impairments impact stress resilience, immune response and cardiovascular health. Thyroid disorders range from thyrotoxicosis to thyroid cancer, with the most common being hypothyroidism. Subclinical hypothyroidism is prevalent, affects 3 to 15 percent of adults, mainly women. Symptoms of hypothyroidism are varied and non-specific, with no one symptom definitively predicting the disorder. Because weight gain, fatigue, poor concentration, depression, diffuse muscle pain, menstrual irregularities and constipation are associated with a number of conditions, thyroid dysfunction may be missed by primary care physicians. Additionally, subclinical hypothyroidism is largely asymptomatic and frequently undiagnosed and, left untreated, can progress to overt hypothyroidism.^{1, 2, 3, 4, 5}

The traditional approach to thyroid assessment, generally aimed at diagnosing clinical thyroid disease, is lacking and limited. Standard TSH tests fail to evaluate other markers indicative of thyroid dysfunction, and emerging research suggests conventional reference ranges are outdated and excessively broad, potentially overlooking patients suffering from subclinical hypothyroidism—with troubling consequences. Untreated or inadequately treated, hypothyroidism is linked with infertility, cardiovascular disease, stroke, dyslipidemia, neurological and musculoskeletal problems and increased mortality.^{6, 7, 8, 9, 10}

Furthermore, thyroid health is maintained by the complex interplay of multiple bodily systems. Thyroid activity is intertwined with immune response, stress resilience and cardiovascular integrity, and dysregulation in any of these systems can negatively impact thyroid status. Conversely, thyroid issues significantly affect immunity, stress perception and heart health. The intricate nature of this relationship emphasizes the importance of a personalized, integrative approach, and a growing body of research points to evidence-based botanicals and nutrients for whole-person support.^{11, 12, 13, 14}

The HPT Axis, Stress and Thyroid Fitness.

The hypothalamic-pituitary-thyroid (HPT) axis is a crucial neuroendocrine system regulating thyroid hormone production and release, metabolic functions and various physiological processes. This feedback loop between the hypothalamus, pituitary gland and thyroid gland exists in a delicate balance, and disturbances trigger thyroid disorders and impair other systems. Chronic stress and persistently elevated cortisol levels disrupt the HPT axis, interfering with thyroid hormone synthesis and suppressing the pituitary gland’s release of TSH and potentially exacerbating autoimmune thyroid diseases, worsening symptoms and driving disease progression.^{15, 16, 17, 18}

Adaptogens are known to influence the HPT axis and cortisol, protecting against stress-related thyroid disruption. Holy basil (Ocimum tenuiflorum) in particular is rich in bioactive compounds shown to modulate HPT axis activity, regulate cortisol production and secretion, and minimize perceived stress. In studies, holy basil supplementation was associated with lower salivary cortisol concentrations, reduced blood pressure, decreased ratings of subjective stress and improved sleep scores. In other research, holy basil significantly lessened stress-induced elevations of cortisol and alleviate symptoms in patients with generalized anxiety disorder. Holy basil also has powerful antioxidant and anti-inflammatory properties, mitigating the damaging effects of stress at a cellular level and further contributing to its benefits.^{19, 20, 21, 22, 23, 24}

Selenium and Myo-Inositol: Nutrient Synergy for Thyroid Support.

Selenium is critical for the function of iodothyronine deiodinases, enzymes involved in regulating thyroid hormone availability and activity. Inadequate levels of selenium can impair deiodinase activity, leading to abnormal thyroid hormone metabolism and affecting T3 and other thyroid hormone metabolites, and evidence links selenium deficiency with higher rates of autoimmune thyroid disease and increased risk of mortality. Several studies have investigated the effect of selenium on thyroid disorders, with research suggesting selenium supplementation may improve thyroid hormone measures, lower antibodies and enhance quality of life for autoimmune thyroiditis patients.^{25, 26, 27, 28, 29, 30, 31, 32, 33}

Along with selenium, myo-inositol is vital for thyroid function, regulating hydrogen peroxide (H2O2) generation, essential for iodine organification and thyroid hormone biosynthesis. Myo-inositol has been shown to improve TSH receptor sensitivity, TSH levels and thyroid antibody levels, exerting immunomodulatory activities and alleviating  inflammation associated with autoimmune thyroiditis. The synergistic effect of selenium and myo-inositol is even more powerful, especially for subclinical hypothyroidism: in studies, a combination of both myo-inositol and selenium significantly decreased TSH in patients with subclinical hypothyroidism, as well as reducing TgAb better than selenium alone.^{34, 35, 36, 37, 38, 39}

Thyroid-Immune Crosstalk and Thyroid Resilience.

The thyroid and immune systems are interconnected and bidirectional, with the immune system influencing thyroid function and thyroid hormones impacting immune responses.  In the context of thyroid-immune crosstalk, NK cells, T-regulatory cells (Tregs), and immune checkpoints like ICAM-1 and VCAM-1 play crucial roles in modulating immunity and maintaining thyroid homeostasis—particularly important for autoimmune thyroid diseases. NK cells are implicated in the pathogenesis of thyroid disorders, and dysfunctional Tregs and impaired ICAM-1 and VCAM-1 interactions have been shown to contribute to the development and progression of autoimmune thyroiditis.^{40, 41, 42, 43, 44, 45, 46}

Research suggests certain botanicals affect thyroid-immune crosstalk, immunity and thyroid health. Two of note:

• Shiitake mushrooms are a concentrated source of beta-glucans shown to directly enhance the activity of NK cells, modulate immune responses and maintain immunological tolerance. Additionally, beta-glucans have a significant effect on latent infections, known to trigger autoimmune diseases in susceptible patients.  Studies report a high prevalence of common human viruses in thyroid tissue, and several viruses, including Epstein-Barr virus and cytomegalovirus, are linked with autoimmune thyroid disease.^{47, 48, 49, 50, 51, 52, 53}
• Black cumin seed (Nigella sativa) has powerful immunomodulatory and anti-inflammatory effects and shows promise in managing Hashimoto’s and related thyroid conditions. Bioactive compounds in black cumin seed, especially thymoquinone, regulate immune response and inflammation, a key factor in Hashimoto’s, and thymoquinone’s antioxidant properties protect endocrine tissue against free radical species and contribute to hormonal rebalance. Research on patients with thyroid disorder and Hashimoto’s shows black cumin seed improves T3 and T4 levels, lowers TSH and reduces TPOAb, and animal models confirm the role of black cumin seed in reversing hypothyroidism and mitigating oxidative stress and thyroid cell damage.^{54, 55, 56, 57, 58, 59, 60}

Vitamin D3: The Immune-Endocrine Bridge.

The immune and endocrine systems are intricately linked, engaging in bidirectional communication that impacts thyroid function and immune health. Endocrine hormones affect immune cells and cytokines, and cytokines likewise influence hormone production and HPT axis activity. This crosstalk is crucial for regulating metabolism, immunity and overall homeostasis, and vitamin D plays a prominent part in both systems. Vitamin D is known to modulate innate and adaptive immune responses, and deficiencies are associated with increased autoimmunity, impaired thyroid status and greater risk and severity of thyroid conditions. In research, low serum vitamin D levels are correlated with higher incidence of hypothyroidism, autoimmune thyroid diseases and Hashimoto’s thyroiditis compared to healthy subjects, and studies suggest vitamin D supplementation may improve thyroid function, reduce antibody levels and suppress autoimmune reactions in patients with autoimmune thyroid disorders, including Hashimoto’s and Graves’ disease.^{61, 62, 63, 64, 65, 66, 67, 68, 69}

Thyroid Hormones and the Heart: Nutrients for Thyroid–Cardiovascular Benefits.

Thyroid hormones are engaged in a complex relationship with the cardiovascular system, influencing heart rate, vascular tone, LDL metabolism and blood pressure regulation. Research shows thyroid hormones have direct and serious effects on cardiovascular risk factors, and imbalances are implicated in heart failure, coronary artery disease, stroke and sudden cardiac death. Even mild imbalances negatively impact heart function, potentially heightening the risk of atrial fibrillation and cardiovascular mortality.^{70, 71, 72, 73, 74, 75, 76}

Certain botanicals and nutrients are known to support cardiovascular fitness by various mechanisms. Olive leaf extract, rich in oleuropein, has positive effects on endothelial health, enhancing nitric oxide production and preventing the oxidation of LDL cholesterol, central in the development of atherosclerosis. In trials of hypertension, olive leaf extract significantly reduced both systolic and diastolic blood pressure, with some research indicating it was as effective as Captopril in patients with hypertension.^{77, 78, 79, 80, 81, 82}

In addition to contributing to thyroid hormone production, selenium offers a dual benefit for cardiovascular health, primarily through its antioxidant properties and its incorporation into selenoproteins, essential for heart function. Research confirms selenium’s ability to protect cells from oxidative damage, influence lipid metabolism and modulate inflammation, and deficiencies are associated with higher risk of Keshan disease, atherosclerosis, myocardial infarction and heart failure.^{83, 84, 85, 86, 87, 88, 89}

Autophagy, Cellular Health and Resilience.

As a cellular quality control mechanism, autophagy plays a vital role in both thyroid function and immune homeostasis. In thyroid follicular cells, the process of autophagy maintains cell survival and optimizes cellular performance, while in the immune system, autophagy regulates T-cell development and overall immune response. In addition to other effects, research validates the ability of specific nutrients and botanicals to inform autophagic pathways and promote cellular resilience. Black cumin seed, selenium and oleuropeins in olive leaf extract have all shown potential for influencing autophagy through various pathways including AMPK/mTOR, SIRT1 activation and other mechanisms.^{90, 91, 92, 93, 94, 95, 96, 97, 98}

The key takeaway: the interconnectedness of stress, immune, cardiovascular and thyroid health requires a comprehensive, systems-level approach. A strategic combination of evidence-based nutrients and botanicals designed to address these systems and processes can promote thyroid resilience, restore balance and enhance whole-body wellness.

References:

1. Gaitonde DY et al. Hypothyroidism: an update. Am Fam Physician. 2012 Aug 1;86(3):244-51.
2. Canaris GJ et al. Thyroid disease awareness is associated with high rates of identifying subjects with previously undiagnosed thyroid dysfunction. BMC Public Health. 2013 Apr 16;13:351.
3. Canaris GJ et al. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000 Feb 28;160(4):526-34.
4. Okosieme O et al. Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee. Clin Endocrinol (Oxf). 2016 Jun;84(6):799-808.
5. Gosi SKY, Kaur J, Garla VV. Subclinical Hypothyroidism. 2024 Feb 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
6. Biondi B. The normal TSH reference range: what has changed in the last decade? J Clin Endocrinol Metab. 2013 Sep;98(9):3584-7.
7. Chaker L et al. Hypothyroidism. Lancet. 2017 Sep 23;390(10101):1550-1562.
8. Bauer BS et al. The impact of the management strategies for patients with subclinical hypothyroidism on long-term clinical outcomes: An umbrella review. PLoS One. 2022 May 19;17(5):e0268070.
9. Urgatz B, Razvi S. Subclinical hypothyroidism, outcomes and management guidelines: a narrative review and update of recent literature. Curr Med Res Opin. 2023 Mar;39(3):351-365.
10. Chiovato L et al. Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Adv Ther. 2019 Sep;36(Suppl 2):47-58.
11. Toloza FJK et al. Practice Variation in the Care of Subclinical Hypothyroidism During Pregnancy: A National Survey of Physicians in the United States, Journal of the Endocrine Society. 2019; 3:10, 1892–1906.
12. Eram F. Effective management of subclinical hypothyroidism using herbal medicines and lifestyle modifications: A case report. European Journal of Integrative Medicine. 2025; Volume 76: 102486.
13. Matlock CL et al. Comparison Between Levothyroxine and Lifestyle Intervention on Subclinical Hypothyroidism in Women: A Review. Cureus. 2023 Apr 29;15(4):e38309.
14. Larsen D et al. Thyroid, Diet, and Alternative Approaches. J Clin Endocrinol Metab. 2022 Nov 23;107(11):2973-2981.
15. Feldt-Rasmussen U et al. The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions. Mol Cell Endocrinol. 2021 Apr 5;525:111173.
16. Soundarrajan M, Kopp PA. Thyroid Hormone Biosynthesis and Physiology. In: Thyroid Disease and Reproduction. Cham: Springer, 2019.
17. Kim DS, Park S. Interactions between Polygenetic Variants and Lifestyle Factors in Hypothyroidism: A Hospital-Based Cohort Study. Nutrients. 2023 Sep 3;15(17):3850.
18. Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
19. Singh E, Chaudhuri PK. A review on phytochemical and pharmacological properties of Holy basil (Ocimum sanctum L.). Industrial Crops and Products. 2018; 118: 367-382.
20. Cohen MM. Tulsi – Ocimum sanctum: A herb for all reasons. J Ayurveda Integr Med. 2014 Oct-Dec;5(4):251-9.
21. Jamshidi N, Cohen MM. The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evid Based Complement Alternat Med. 2017;2017:9217567.
22. Lopresti AL et al. A randomized, double-blind, placebo-controlled trial investigating the effects of an Ocimum tenuiflorum (Holy Basil) extract (HolixerTM) on stress, mood, and sleep in adults experiencing stress. Front Nutr. 2022 Sep 2;9:965130.
23. Bhattacharyya D et al. Controlled programmed trial of Ocimum sanctum leaf on generalized anxiety disorders. Nepal Med Coll J. 2008 Sep;10(3):176-9.
24. Saxena RC et al. Efficacy of an Extract of Ocimum tenuiflorum (OciBest) in the Management of General Stress: A Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med. 2012;2012:894509.
25. Bates JM et al. Effects of selenium deficiency on tissue selenium content, deiodinase activity, and thyroid hormone economy in the rat during development. Endocrinology. 2000 Jul;141(7):2490-500.
26. Sabatino L et al. Deiodinases and the Three Types of Thyroid Hormone Deiodination Reactions. Endocrinol Metab (Seoul). 2021 Oct;36(5):952-964.
27. Köhrle J. Selenium and the control of thyroid hormone metabolism. Thyroid. 2005 Aug;15(8):841-53.
28. Ventura M et al. Selenium and Thyroid Disease: From Pathophysiology to Treatment. Int J Endocrinol. 2017;2017:1297658.
29. Wang F et al. Selenium and thyroid diseases. Front Endocrinol (Lausanne). 2023 Mar 24;14:1133000.
30. Duntas LH. The role of selenium in thyroid autoimmunity and cancer. Thyroid. 2006 May;16(5):455-60.
31. Mantovani G et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine. 2019 Dec;66(3):542-550.
32. Bano I et al. A Comprehensive Review of Selenium as a Key Regulator in Thyroid Health. Biol Trace Elem Res. 2025 May 13.
33. Bartalena L, Gallo D, Tanda ML. Autoimmune Thyroid Diseases. In: The Rose and Mackay Textbook of Autoimmune Diseases. Academic Press, Elsevier, 2024.
34. Barbaro D et al. Iodine and Myo-Inositol: A Novel Promising Combination for Iodine Deficiency. Front Endocrinol (Lausanne). 2019 Jul 16;10:457.
35. Paparo SR et al. Myoinositol in Autoimmune Thyroiditis. Front Endocrinol (Lausanne). 2022 Jun 28;13:930756.
36. Benvenga S et al. The Role of Inositol in Thyroid Physiology and in Subclinical Hypothyroidism Management. Front Endocrinol (Lausanne). 2021 May 10;12:662582.
37. Fallahi P et al. Myo-inositol in autoimmune thyroiditis, and hypothyroidism. Rev Endocr Metab Disord. 2018 Dec;19(4):349-354.
38. Yavari M et al. Investigating the effect of combined use of selenium and Myo-inositol supplements on thyroid function and autoimmune characteristics in thyroid disorders: a systematic review and meta-analysis. Expert Rev Endocrinol Metab. 2024 May;19(3):269-277.
39. Zuhair V et al. Role of Supplementation with Selenium and Myo-Inositol Versus Selenium Alone in Patients of Autoimmune Thyroiditis: A Systematic Review and Meta-Analysis. Clin Med Insights Endocrinol Diabetes. 2024 Dec 6;17:11795514241300998.
40. Lee EK, Sunwoo JB. Natural Killer Cells and Thyroid Diseases. Endocrinol Metab (Seoul). 2019 Jun;34(2):132-137.
41. Fang J et al. Exploring the crosstalk between endothelial cells, immune cells, and immune checkpoints in the tumor microenvironment: new insights and therapeutic implications.
42. Pallmer K, Oxenius A. Recognition and Regulation of T Cells by NK Cells. Front Immunol. 2016 Jun 24;7:251.
43. Lünemann A et al. Regulatory NK-cell functions in inflammation and autoimmunity. Mol Med. 2009 Sep-Oct;15(9-10):352-8.
44. Pedroza-Pacheco I et al. Interaction between natural killer cells and regulatory T cells: perspectives for immunotherapy. Cell Mol Immunol. 2013 May;10(3):222-9.
45. Glick AB et al. Impairment of regulatory T-cell function in autoimmune thyroid disease. Thyroid. 2013 Jul;23(7):871-8.
46. Singh V et al. ICAM-1 and VCAM-1: Gatekeepers in various inflammatory and cardiovascular disorders. Clin Chim Acta. 2023 Aug 1;548:117487.
47. Zhong X et al. Immunomodulatory Effect and Biological Significance of β-Glucans. Pharmaceutics. 2023 May 29;15(6):1615.
48. Akramiene D et al. Effects of beta-glucans on the immune system. Medicina (Kaunas). 2007;43(8):597-606.
49. Mirończuk-Chodakowska I et al. Beta-Glucans from Fungi: Biological and Health-Promoting Potential in the COVID-19 Pandemic Era. Nutrients. 2021 Nov 6;13(11):3960.
50. Sundaresan B et al. The Role of Viral Infections in the Onset of Autoimmune Diseases. Viruses. 2023 Mar 18;15(3):782.
51. Weider T et al. High Prevalence of Common Human Viruses in Thyroid Tissue. Front Endocrinol (Lausanne). 2022 Jul 14;13:938633.
52. Fallahi P et al. Thyroid Autoimmunity and SARS-CoV-2 Infection. J Clin Med. 2023 Oct 5;12(19):6365.
53. Li Y, Li W. Viral infection and thyroid disorders: a narrative review. Front Microbiol. 2025 Jun 13;16:1625179.
54. Hannan MA et al. Black Cumin (Nigella sativa L.): A Comprehensive Review on Phytochemistry, Health Benefits, Molecular Pharmacology, and Safety. Nutrients. 2021 May 24;13(6):1784.
55. Ferizi R et al. Black Seeds (Nigella sativa) Medical Application and Pharmaceutical Perspectives. J Pharm Bioallied Sci. 2023 Apr-Jun;15(2):63-67.
56. Farhangi MA, Tajmiri S. The effects of powdered black cumin seeds on markers of oxidative stress, intracellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 in patients with Hashimoto’s thyroiditis. Clin Nutr ESPEN. 2020 Jun;37:207-212.
57. Avci G et al. The positive effect of black seed (Nigella sativa L.) essential oil on thyroid hormones in rats with hypothyroidism and hyperthyroidism. J Food Biochem. 2022 Apr;46(4):e13801.
58. Farhangi MA et al. The effects of Nigella sativa on thyroid function, serum Vascular Endothelial Growth Factor (VEGF) – 1, Nesfatin-1 and anthropometric features in patients with Hashimoto’s thyroiditis: a randomized controlled trial. BMC Complement Altern Med. 2016 Nov 16;16(1):471.
59. Ghaffari-Saravi F, Jokar A. Herbal remedies for hypothyroidism: A systematic review and meta-analysis. Caspian J Intern Med. 2024 Oct 19;16(1):1-8.
60. Khalawi AA et al. Can Nigella Sativa oil (NSO) reverse hypothyroid status induced by PTU in rat? biochemical and histological studies. Life Sci J. 2013;10:1–5.
61. Stelzer IA, Arck PC. Immunity and the Endocrine System. Encyclopedia of Immunobiology. 2016:73–85.
62. Aranow C. Vitamin D and the immune system. J Investig Med. 2011 Aug;59(6):881-6.
63. Hewison M. Vitamin D and immune function: autocrine, paracrine or endocrine? Scand J Clin Lab Invest Suppl. 2012;243:92-102.
64. Fleet JC. The role of vitamin D in the endocrinology controlling calcium homeostasis. Mol Cell Endocrinol. 2017 Sep 15;453:36-45.
65. Kowalówka M et al. Clinical Significance of Analysis of Vitamin D Status in Various Diseases. Nutrients. 2020 Sep 11;12(9):2788.
66. Babić Leko M et al. Vitamin D and the Thyroid: A Critical Review of the Current Evidence. Int J Mol Sci. 2023 Feb 10;24(4):3586.
67. Vieira IH et al. Vitamin D and Autoimmune Thyroid Disease-Cause, Consequence, or a Vicious Cycle? Nutrients. 2020 Sep 11;12(9):2791.
68. Safari S et al. Effects of vitamin D supplementation on TSH and thyroid hormones: A systematic review of randomized controlled trials. Endocrinol Diabetes Nutr (Engl Ed). 2025 Jan;72(1):37-46.
69. Simsek Y et al. Effects of Vitamin D treatment on thyroid autoimmunity. J Res Med Sci. 2016 Oct 18;21:85.
70. Olanrewaju OA et al. Thyroid and Its Ripple Effect: Impact on Cardiac Structure, Function, and Outcomes. Cureus. 2024 Jan 3;16(1):e51574.
71. Razvi S et al. Thyroid Hormones and Cardiovascular Function and Diseases. J Am Coll Cardiol. 2018 Apr 24;71(16):1781-1796.
72. Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007 Oct 9;116(15):1725-35.
73. Yamakawa H et al. Thyroid Hormone Plays an Important Role in Cardiac Function: From Bench to Bedside. Front Physiol. 2021 Oct 18;12:606931.
74. Soetedjo NNM et al. The impact of thyroid disorder on cardiovascular disease: Unraveling the connection and implications for patient care. Int J Cardiol Heart Vasc. 2024 Oct 23;55:101536.
75. Frankel M et al. Thyroid dysfunction and mortality in cardiovascular hospitalized patients. Cardiovasc Endocrinol Metab. 2024 Jan 5;13(1):e0299.
76. Paschou SA et al. Thyroid disorders and cardiovascular manifestations: an update. Endocrine. 2022 Mar;75(3):672-683.
77. Razmpoosh E et al. The effects of olive leaf extract on cardiovascular risk factors in the general adult population: a systematic review and meta-analysis of randomized controlled trials. Diabetol Metab Syndr. 2022 Oct 21;14(1):151.
78. Burja B et al. Olive Leaf Extract Attenuates Inflammatory Activation and DNA Damage in Human Arterial Endothelial Cells. Front Cardiovasc Med. 2019 May 16;6:56.
79. Summerhill V et al. Vasculoprotective Role of Olive Oil Compounds via Modulation of Oxidative Stress in Atherosclerosis. Front Cardiovasc Med. 2018 Dec 21;5:188.
80. Leenen R et al. Supplementation of plasma with olive oil phenols and extracts: influence on LDL oxidation. J Agric Food Chem. 2002 Feb 27;50(5):1290-7.
81. Susalit E et al. Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: comparison with Captopril. Phytomedicine. 2011 Feb 15;18(4):251-8.
82. Lockyer S et al. Impact of phenolic-rich olive leaf extract on blood pressure, plasma lipids and inflammatory markers: a randomised controlled trial. Eur J Nutr. 2017 Jun;56(4):1421-1432.
83. Shimada BK et al. The Impact of Selenium Deficiency on Cardiovascular Function. Int J Mol Sci. 2021 Oct 2;22(19):10713.
84. Benstoem C et al. Selenium and its supplementation in cardiovascular disease–what do we know? Nutrients. 2015 Apr 27;7(5):3094-118.
85. Flores-Mateo G et al. Selenium and coronary heart disease: a meta-analysis. Am J Clin Nutr. 2006 Oct;84(4):762-73.
86. Tinggi U. Selenium: its role as antioxidant in human health. Environ Health Prev Med. 2008 Mar;13(2):102-8.
87. Steinbrenner H et al. Involvement of selenoprotein P in protection of human astrocytes from oxidative damage. Free Radic Biol Med. 2006 May 1;40(9):1513-23.
88. Tapiero H et al. The antioxidant role of selenium and seleno-compounds. Biomed Pharmacother. 2003 May-Jun;57(3-4):134-44.
89. Pei J et al. Research progress of glutathione peroxidase family (GPX) in redoxidation. Front Pharmacol. 2023 Mar 2;14:1147414.
90. Zhang Y et al. Thymoquinone inhibits the metastasis of renal cell cancer cells by inducing autophagy via AMPK/mTOR signaling pathway. Cancer Sci. 2018 Dec;109(12):3865-3873.
91. Chu SC et al. Thymoquinone induces cell death in human squamous carcinoma cells via caspase activation-dependent apoptosis and LC3-II activation-dependent autophagy. PLoS One. 2014 Jul 7;9(7):e101579.
92. Islam MN et al. Revisiting pharmacological potentials of Nigella sativa seed: A promising option for COVID-19 prevention and cure. Phytother Res. 2021 Mar;35(3):1329-1344.
93. Chen D et al. Trends and recent progresses of selenium nanoparticles as novel autophagy regulators for therapeutic development. Front Nutr. 2023 Feb 2;10:1116051.
94. Ma L et al. Selenium triggers AMPK-mTOR pathway to modulate autophagy related to oxidative stress of sheep Leydig cells. Reprod Biol. 2025 Mar;25(1):100973.
95. Zang H et al. The effect of selenium on the autophagy of macrophage infected by Staphylococcus aureus. Int Immunopharmacol. 2020 Jun;83:106406.
96. Leri M et al. EVOO Polyphenols Relieve Synergistically Autophagy Dysregulation in a Cellular Model of Alzheimer’s Disease. Int J Mol Sci. 2021 Jul 5;22(13):7225.
97. Rigacci S et al. Oleuropein aglycone induces autophagy via the AMPK/mTOR signalling pathway: a mechanistic insight. Oncotarget. 2015 Nov 3;6(34):35344-57.
98. Blanco-Benítez M et al. Biological effects of olive oil phenolic compounds on mitochondria. Mol Cell Oncol. 2022 Mar 20;9(1):2044263.