It refers to a bulge in the thyroid, the butterfly-shaped gland located at the base of the neck.
Thyroid nodules are standard forms, frequently discovered in clinical practice during a physical examination and incidentally during various imaging procedures.
They are clinically meaningful primarily due to their malignant potential. For this reason, the initial evaluation should always include a history and physical examination that focuses on features suggestive of malignancy.
Definition, clinical significance, and epidemiology
Thyroid nodules are more common in women and older populations.
Evaluating thyroid nodules is to determine which nodules are malignant or require surgical attention.
Thyroid nodules have been defined by the American Thyroid Association (ATA) as “discrete lesions within the thyroid gland, radiologically distinct from the surrounding thyroid parenchyma.”
They may be discovered by palpation during a general physical examination or with radiographic studies performed for medical evaluations, such as carotid duplex ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), or 18FDG-PET scan.
The latter forms are called “thyroid incidentalomas” and do not correspond to palpable thyroid lesions. Conversely, clinicians can identify noticeable thyroid lesions that do not conform to distinct radiographic forms and would not be defined as thyroid nodules.
Thyroid nodules are common, and their prevalence is highly dependent on the method of identification. The estimated prevalence by palpation alone varies from 4% to 7%.
The estimated annual incidence of thyroid nodules in the United States alone is approximately 0.1% per year, conferring a 10% lifetime chance of developing a thyroid nodule.
Thyroid nodules are four times more common in women than in men, and their frequency increases with age and low iodine intake.
The gender disparity is perhaps explained by the hormonal influences of estrogen and progesterone, as increased nodule size and the development of new nodules be related to pregnancy and multiparity.
Exposure to ionizing radiation, either during childhood or as occupational exposure, will cause a thyroid nodule development rate of 2% per year, reaching a peak incidence in 15 to 25 years.
Thyroid nodules are clinically crucial for several reasons. They can cause thyroid dysfunction and, rarely, compressive symptoms but are primarily significant because they need to exclude thyroid cancer.
The reported prevalence of malignancy in biopsy-assessed thyroid nodules ranges from 4.0% to 6.5% and is mainly independent of nodule size.
Despite this, papillary microcarcinomas (smaller than 1 cm) found incidentally at the surgery are much more common (up to 36%). Still, it is controversial whether there is a survival benefit to diagnosing and treating such modular forms. , given its generally benign course.
Notably, the incidence of thyroid nodules discovered incidentally during 18FDG-PET imaging is small (1% to 2%), but the risk of malignancy can be as high as 27%, so such nodules require immediate evaluation.
Risk factors for thyroid disease and thyroid conditions
The occurrence of thyroid diseases is determined by the interaction between genetic and environmental factors.
The main environmental factor determining the prevalence of goiter is iodine status. Still, other ecological factors have been identified that influence entire populations, such as goitrogens in food and drinking water.
Less attention has been paid to individual environmental factors and the interaction between the elements.
Some of the critical risk factors for thyroid disease include:
- Gender: Women face a higher risk of thyroid disease than men.
- Age: Thyroid disease is more common as we age, especially after 50 (but it can affect people of any age).
- Having a personal or family history of thyroid disease.
- Surgery to remove all or part of the thyroid.
- Radioactive iodine ablation treatment (RAI).
- Being pregnant or in the first year after giving birth.
- Be a current or former smoker.
- Recent exposure to iodine in a medical procedure.
- Take iodine from herbs or supplements.
- Living in an area that is deficient in iodine.
- Various medical treatments and medications.
- Overconsumption of raw foods in the goitrogens family, such as Brussels sprouts, spinach, and soybeans.
- Trauma or surgery to the neck.
- Exposure to radiation, through medical treatments or nuclear accidents.
Changes in thyroid
Thyroid conditions often cause symptoms in the neck area where the thyroid is located.
Some of the neck-related symptoms that may indicate hypothyroidism, Hashimoto’s disease, hyperthyroidism, Graves’ disease, various types of thyroiditis, and thyroid cancer include:
- Swollen neck
- Palpable enlargement of the thyroid gland itself (goiter).
- A visible or detectable lump or lumps on your neck.
- The sensation of a bump in the throat when swallowing.
- Throat pain.
- Pain or tenderness in the neck.
- Your neck or throat feels tender, and ties, scarves, or turtlenecks don’t feel comfortable.
- A stethoscope detected evidence of increased blood flow to the thyroid.
Diagnosis, history, and physical exam
The history and physical examination should focus on detecting features particularly suggestive of malignancy.
The spectrum of disorders associated with thyroid nodules ranges from benign etiologies to malignant conditions that can have an indolent course or highly aggressive behavior.
Therefore, clinical evaluation is best suited to identifying clues suggestive of malignancy.
A careful history and physical examination should include information about previous radiation treatment to the head and neck area:
- Growth of a mass in the neck.
- Size and consistency of the thyroid nodule.
- Cervical lymphadenopathy.
- Associated local symptoms such as pain.
Symptoms of hypothyroidism or hyperthyroidism
A family history of thyroid disorders should always be investigated.
Rare but essential familial thyroid syndromes include familial medullary thyroid cancer (MTC), derived from calcitonin-producing C-cell tumors, and familial non-medullary thyroid cancer, which arises from follicular cells.
A history of papillary thyroid cancer (PTC) in a father or brother increases the patient’s risk of developing PTC three and six times, respectively.
Familial TCM may be a component of multiple endocrine neoplasias (MEN), IIA (pheochromocytoma, TCM, and primary hyperparathyroidism), and IIB (pheochromocytoma, TCM, marfanoid habit, and mucosal and digestive neurofibromatosis), or it may occur as a single component.
Follicular cell-derived familial thyroid cancer has been described in several syndromes, including Cowden’s disease, Carney’s complex, Werner’s syndrome, familial polyposis, and occurring in isolation.
Cowden’s disease is an autosomal dominant condition that results from a mutation in the PTEN gene. It is characterized by hamartomatous neoplasms of the skin, oral mucosa, gastrointestinal tract, central nervous system, and genitourinary system, being breast and thyroid cancers the most common malignancies.
Another autosomal dominant condition, Carney’s complex, is characterized by cardiac and skin myxomas, blotchy skin pigmentation, various endocrinopathies, and endocrine and non-endocrine malignancies.
Less commonly, thyroid cancer can be found in patients with Werner syndrome; the main feature is premature aging and familial polyposis, which is primarily associated with colon cancer.
Personal history of head and neck irradiation, especially in children, early age (<20 years) or advanced age (> 70 years), and male sex are demographic characteristics associated with a higher probability of malignancy in a patient with a thyroid nodule.
It is essential to know that symptoms, such as hoarseness, dysphagia, and cough, are rarely related to thyroid conditions. A comprehensive study should exclude other more common etiologies associated with the gastrointestinal and respiratory tract systems.
A spectrum of diagnostic studies is available to aid in evaluating a thyroid nodule.
These include serum markers, such as:
- Serum thyrotropin (TSH).
Fine needle aspiration (ANF) cytology is the cornerstone of thyroid nodule evaluation.
Genetic markers of thyroid cancer risk, such as the BRAF mutation, can also be determined using cytology specimens. In addition, immunohistochemical markers, such as galectin-3, cyclooxygenase 2, and cyclin D2, may have potential use.
Ultrasound plays a critical role in evaluating thyroid nodules, and elastography can be a valuable addition. Other imaging studies, including MRI, CT, and 18FDG-PET scans, can be helpful in certain circumstances.
The risk of malignancy in thyroid nodules increases as serum TSH increases.
Measurement of TSH should be part of the initial work in every patient with a thyroid nodule and should be used to guide further treatment.
A standard or high TSH level should raise concerns about the possible malignant potential of a nodule, while a low TSH level is an indicator of benignity in most cases.
Therefore, the next step in evaluating a patient with low TSH would be a scintigraphy scan with iodine-123 (123-I) or pertechnetate to explore the possibility of an autonomously functioning nodule.
Hyperfunctioning thyroid nodules are almost always benign and do not require further cytologic investigation. Still, a nonfunctional or “cold” nodule in a patient with low TSH may indicate malignant potential.
Recent studies have investigated the relationship between serum TSH concentration and thyroid cancer. TSH was found to be an independent predictor of malignancy in thyroid nodules.
The risk of malignancy increases in parallel with serum TSH, even within the normal range, and higher levels of TSH was found to be associated with advanced-stage thyroid cancer.
Calcitonin is a sensitive marker for the detection of C-cell hyperplasia and TCM and the surveillance and prognosis of TCM.
Calcitonin levels of more than ten pg/ml were high sensitivity for detecting TCM, with the specificity being increased by stimulation with pentagastrin when calcitonin levels exceed 100 pg/ml.
Although calcitonin screening has proven cost-effective and a valuable tool in the evaluation algorithm for thyroid nodules, it is not widely recognized in the US due to the low prevalence of medullary thyroid cancer and the lack of pentagastrin availability.
Measurement of serum thyroglobulin is neither sensitive nor specific for the diagnosis of thyroid cancer in nodular thyroid disease. It is more influenced by iodine intake and the size of the thyroid gland.
Therefore, routine measurement is not recommended in the initial evaluation of a thyroid nodule.
Thyroid ultrasonography allows the detection of suspicious-appearing nodules for biopsy.
Thyroid ultrasonography is a critical technique widely used to detect and evaluate thyroid nodules.
It is a non-invasive and inexpensive procedure that provides information regarding nodule dimensions, structure, and changes in the thyroid parenchyma.
Today, the use of high frequency and brightness mode transducers in ultrasound can detect lesions as small as 2 to 3 mm, raising the question of which thyroid nodules are clinically relevant for further evaluation.
Previous studies have investigated the ability of thyroid ultrasonography to differentiate between benign and malignant lesions to avoid unnecessary use of invasive procedures.
As a result, several characteristics of ultrasound are indicative of malignant potential.
Microcalcifications, irregular or microlobed margins, hypoechogenicity, shape taller than width, and increased intraocular vascularity were considered independent risk factors for malignancy.
Although these suspicious characteristics are characterized by high specificity, their relatively low sensitivity reduces their positive predictive value.
It is essential to know that none of these ultrasound characteristics is sufficient to differentiate benign tumors from malignant tumors. Still, a combination of at least 2 of them indicates a subset of lesions with a high risk of malignancy.
Researcher Papini and colleagues demonstrated that hypoechoic-looking nodules and one of the other suspicious ultrasound features successfully identify thyroid lesions that should undergo further cytological examination.
For example, a predominantly solid nodule with microcalcifications has a 31.6% probability of malignancy, whereas a predominantly cystic lesion without microcalcifications reduces the likelihood of cancer to 1.0%.
Ultrasound findings such as isoechogenicity and spongiform appearance (defined as aggregations of multiple microcysts in more than 50% of the nodule) suggest benignity.
The number of nodules and their size is not predictive of malignancy since a nodule smaller than 1 cm is as likely as a larger nodule to harbor neoplastic cells in the presence of suspicious features on ultrasound.
Choosing an arbitrary size as the cutoff for the likelihood of cancer or stratifying risk in a multinodular goiter based on the ‘dominant’ nodule has fallen out of favor.
Ultrasound identification of cervical lymph nodes showing microcalcifications, increased vascularity, cystic changes, rounded shape, and coexisting ipsilateral thyroid nodules are also vital clues for malignant etiology.
Extracapsular growth, which can range from invasion of the thyroid capsule to infiltration of the parathyroid muscle and recurrent extension of the laryngeal nerve, is another strong indicator of malignancy.
Detection of thyroid nodules on ultrasound or any other imaging study is not recommended in the general population due to the minimal aggressiveness and indolent course of most thyroid cancers.
Current ATA 1 guidelines recommend that diagnostic thyroid ultrasound be performed only in patients with known or suspected thyroid nodules or in the presence of risk factors.
Other imaging techniques, such as MRI and CT, are not indicated for the routine evaluation of thyroid nodules but may help evaluate nodule size, a substernal extension of nodular goiter, and airway compression. Respiratory.
Elastography is a promising tool for predicting the malignant potential of thyroid nodules.
A recent advance in the diagnosis of thyroid nodules has been achieved through elastography. This dynamic technique assesses tissue hardness as an indicator of malignancy.
This technique was particular (96% –100%) and sensitive (82% –97%) in the diagnostic evaluation of thyroid nodules, regardless of nodule size or location within the thyroid gland.
It was also reliable in the diagnostic evaluation of indeterminate/follicular lesions, but this aspect of its use still needs to be confirmed.
The diagnostic performance of elastography is impaired in nodules with a calcified shell, cystic lesions, and multinodular goiter with coalescing nodules because the margins must be well-demarcated for proper interpretation.
It is unsuitable for diagnosing follicular carcinoma, and its use is restricted to high-end US devices. Although more data is needed from more extensive prospective studies to establish the accuracy of this diagnostic technique, it remains a promising tool in the selection of nodules for FNA.
The thyroid FNA biopsy is the most reliable, safe, and cost-effective diagnostic tool used to evaluate thyroid nodules.
FNA under ultrasound guidance. It is preferable to the palpation-guided approach due to lower false-negative and nondiagnostic cytology rates.
This is particularly true for not palpable nodules, are located deep in the thyroid bed, or have a predominantly cystic component.
Adequate sample-based FNA is 95% accurate in diagnosing thyroid cancer.
Almost 20% of FNA results are nondiagnostic due to sampling error or poor preparation technique.
In such cases, a repeat FNA is recommended to be performed under ultrasound guidance. And, if available, an on-site cytology exam for better cytology adequacy.
Approximately 7% of the nodules will still give unsatisfactory cytological results on repeat biopsies. In this situation, surgery is highly recommended for solid nodules and close observation or surgery for partially cystic lesions, as they may harbor neoplastic potential.
Diagnostic FNA results fall into five categories, according to the recent Bethesda System for Reporting Thyroid Cytopathology:
- Benigno (70%).
- Evil (5%).
- Suspect for neoplasia.
- Follicular or Hurthle cell neoplasm.
- Follicular lesions of undetermined importance or atypia.
The last three cytological diagnoses, representing 25% of all cases, have been previously classified as indeterminate lesions. They have a predicted chance of cancer of 50% to 75%, 20% to 30%, and 5% to 10%, respectively.
The most common benign lesions include colloid nodules, macrofollicular adenoma, and lymphocytic thyroiditis.
The most prevalent malignant lesions are represented by PTC, followed by follicular thyroid cancer (FTC), TCM, anaplastic carcinoma, and high-grade metastatic neoplasms.
Suspicious lesions may represent PTC lacking definitive diagnostic criteria, follicular neoplasms, Hurthle cell neoplasms, lymphoma, or follicular variant PTC.
Surgery with lobectomy or total thyroidectomy is the treatment of choice for malignant and suspicious lesions.
The same is true for follicular lesions unless the nodule is found to be autonomous on a 123-I scan at the low standard TSH setting.
Thyroid nodules larger than 3 cm with mixed cystic/solid components should be considered for diagnostic surgery, as FNA produces a high rate of false-negative results in these lesions.
The cytological findings of some FNA biopsies are in an indeterminate category in which malignancy cannot be reliably excluded.
Genetic mutation panels can serve as markers for patients with cytologically indeterminate nodules to safely avoid surgery.
Current treatment for most patients with indeterminate cytology on FNA biopsy consists of diagnostic surgery to establish a histopathologic diagnosis.
However, only between 10 and 40% of these cases will be malignant, which makes more than 60% of surgeries unnecessary, with their associated risks and costs.
Evaluation of genetic markers associated with thyroid carcinoma (PTC: BRAF, RAS, RET / PTC; FTC: PAX8 / PPARγ1) in the cytology specimen has been shown to improve the preoperative diagnosis of thyroid nodules in extensive prospective studies, mainly when used in combination with cytological features.
For example, in a Korean population, cytology and BRAF mutation status increased the specificity of tests from 36% to 95% compared to FNA cytology alone.
In the form of a genetic mutation panel, the use of molecular markers in patients with indeterminate cytology in FNA samples has been shown to increase the likelihood of cancer from 24% to 89% if any mutation is identified. The lack of any modification reduces the risk to 11%.
Cost-effectiveness analysis using a molecular panel of genetic markers and classical cytological findings to increase the predictive power of diagnostic interpretations shows promising results compared to the surgical approach.
Initial evaluation of individual nodules, nodule function, multinodular glands, and incidental nodules
A patient with a multinodular thyroid has the same risk of malignancy as a patient with a single thyroid nodule.
Regarding TSH values, scintigraphy (123-I or technetium 99mTc pertechnetate) should be performed in patients with thyroid nodules and serological evidence of low or low average TSH concentration for further evaluation nodule functionality.
Nodules interpreted as “hot” on the scan represent hyper-functional nodules and should not be considered for FNA biopsy because they are rarely malignant.
Iso-functioning or nonfunctional nodules also called “cold” nodules, have a cancer risk of between 5% and 15% and therefore should be aspirated for further evaluation.
The ability to assess nodular function with radioisotope scanning is generally limited in lesions smaller than 1 cm.
In addition to providing information about the appearance and size of the nodules, the exam will also document the number of nodules.
It is noteworthy that the prevalence of thyroid cancer in patients with multinodular goiter is the same as in patients with a solitary nodule and is independent of the number of nodules. However, the probability of nodule malignancy decreases as the number of nodules increases.
If there are two or more nodules larger than 1 cm, the selection of nodules for the FNA biopsy should be performed based on the suspicious ultrasound features described above. Otherwise, the larger nodule should be biopsied.
Thyroid incidentalomas discovered by CT or MRI scan should initially undergo ultrasound evaluation.
With additional management based on ultrasound characteristics, as mentioned above. In contrast, incidentalomas detected by 18FDG-PET examination have a high risk of malignancy, and an ultrasound evaluation should be performed, along with an FNA biopsy.
Cystic lesions are generally considered benign, and unless a solid component is present, no further diagnostic investigation is required.
Treatment for benign nodules
Surgical treatment is recommended for nodules that cause compressive symptoms and may be considered for toxic nodular disease and thyroid cysts.
T4 suppressive therapy is controversial. It is associated with the risks of iatrogenic hyperthyroidism, but it can prevent the formation of new nodules.
Most benign thyroid nodules do not require any specific intervention unless there are local compressive symptoms of significant enlargement, in which case a thyroidectomy should be performed.
These compressive symptoms are usually:
- Short of breath.
Other indications for surgery on benign nodules include the presence of a single toxic nodule or a toxic multinodular goiter.
Radioactive iodine (131-I) therapy is another option for treating toxic nodular goiters. Still, they are generally more radio-resistant than toxic diffuse goiter, and radioactive iodine is not the first-line treatment if there are compressive symptoms.
Treatment with 131-I is also not preferred for larger nodules, as such nodules require high doses of 131-I with associated side effects.
Radioactive iodine therapy should be approached with caution in individuals with uncontrolled thyrotoxicosis. However, the only absolute contraindications to 131-I therapy are pregnancy and lactation.
Aspiration is the treatment of choice for thyroid cysts, but recurrence rates are high (60% to 90% of patients), particularly with repeated aspirations and large-volume cysts.
Percutaneous ethanol injection (PEI) has been studied in several extensive randomized controlled studies, with reported success in 82-85% of cases after two sessions, with a volume reduction of more than 85 % of the initial size.
PEI can also be considered for hyperfunctioning nodules, mainly if there is a significant fluid component.
It has a success rate that ranges from 64% to 95%, with an average volume reduction of 66%. Still, recurrences are more common, and the number of sessions required to achieve a good response is more significant (approximately four sessions per patient).
PEI is a safe procedure, and the most common reported adverse effects are local pain, dysphonia, redness, dizziness, and, rarely, recurrent laryngeal nerve damage.
In addition to serving as a suitable option for treating single toxic nodules and toxic multinodular goiter, surgery is also a promising therapy for cystic lesions as an alternative to the procedures mentioned above.
Treatment with levothyroxine (T4) has been proposed for benign thyroid nodules to achieve nodule reduction and prevent the appearance of new nodules through suppression of TSH.
Although several randomized control and meta-analysis trials have demonstrated a reduction in nodules in iodine-deficient patients, a clinically significant decrease in nodule volume is achieved only in a minority of patients with sufficient iodine intake.
Other predictive characteristics of an excellent response to T4 treatment are recent diagnosis, the size of small nodules, and the appearance of colloids in the FNA.
T4 suppressive therapy is not without adverse effects, such as decreased bone density, especially in postmenopausal women, atrial fibrillation, and increased overall morbidity and mortality from cardiovascular diseases.
Current guidelines do not recommend the routine use of T4 suppressive therapy in patients with benign thyroid nodules in areas with sufficient iodine.
However, a recent study conducted in Italy in individuals with non-toxic goiter showed a decrease in goiter growth, less formation of new nodules, and a lower risk of developing PTC in a population receiving T4 than in a population not. Treated.
Therefore, this management technique may have some use.
A 50% increase in the volume of a previously biopsied thyroid nodule is a likely trigger for a repeat FNA.
Benign thyroid nodules require additional long-term follow-up due to the risk of false-negative results after the initial FNA, approximately 5%.
There is no consensus definition for nodule growth and threshold size to repeat an FNA.
However, many researchers propose a cutoff value of 50% for the growth of the volume of the nodules or an increase of more than 20% in at least two dimensions of a solid nodule or the solid portion of a mixed cystic nodule- substantial to be reasonable and safe.
Although nodule growth indicates repeat biopsy, growth is not pathognomonic for malignancy.
A repeat FNA biopsy under ultrasound guidance is recommended as false-negative rates are higher with palpation-guided FNA than ultrasound-guided FNA.
A recent retrospective analysis of the value of repeated FNAs of benign thyroid nodules demonstrated the initial diagnosis’s high accuracy (98%).
If no significant growth of the nodules is seen on repeat ultrasound, a follow-up interval of 3 to 5 years may be reasonable.
Thyroid nodules in pregnancy
If thyroid cancer is diagnosed during pregnancy, surgery can usually be delayed until after delivery.
Surgery during the second trimester is the safest for aggressive or fast-growing thyroid cancer.
The etiology and behavior of thyroid nodules discovered during pregnancy are unknown compared to the general population.
Consequently, the evaluation should be similar to that of nonpregnant patients, except for the contraindication for radionuclide exploration.
Suppose a patient is found to have persistently suppressed serum TSH levels after the first trimester. In that case, the radionuclide scan and possible subsequent FNA can be safely postponed until after delivery and cessation of breastfeeding.
In euthyroid or hypothyroid pregnant women with thyroid nodules, consensus guidelines recommend that an FNA biopsy be performed.
However, an argument can be made for deferring FNA until after delivery unless there are worrisome clinical features that might lead to a recommendation for a thyroidectomy during pregnancy.
If the plan envisaged before the FNA is a diagnosis of malignancy as a result of the FNA, but the postponement of the thyroidectomy until the patient is postpartum, this simply exposes the patient to anxiety regarding a diagnosis about which she does not can take no action.
Previous studies have shown cancer-like behavior in pregnant patients diagnosed with PTC compared to the general population, with no differences in survival or recurrence rates in pregnant women operated on for PTC during or after delivery.
However, complications after thyroid surgery are higher in pregnant women than in their nonpregnant counterparts.
Because additional retrospective data suggest that delaying surgery for less than one year from the time of diagnosis of differentiated thyroid cancer has no impact on patient outcome, postponing surgery until after delivery seems a reasonable approach.
Suppose the more advanced or aggressive disease is present at diagnosis, or a decision is made to perform a thyroidectomy for thyroid cancer discovered early in pregnancy. In that case, the surgery should ideally be performed in the second trimester of pregnancy.
In this stage, early abortion and premature delivery can be decreased.
T4 suppressive therapy to maintain a serum TSH level between 0.1 and 1.0 mU / L is a reasonable approach in pregnant patients diagnosed with thyroid cancer based on FNA and awaiting thyroidectomy.
Thyroid diet: 10 ways to heal your thyroid with food and lifestyle
The thyroid is the most critical gland but the most neglected in our body. The butterfly-shaped gland secretes hormones that manage essential functions in our body, such as:
- Metabolize food.
- Regulate our sleep pattern.
- Weight control.
- Humor changes.
- Depression .
Health professionals only rely on blood tests and prescription hormone therapy’ to treat thyroid-related problems.
Attention to food and nutrients to promote proper gland function is often ignored. The nutrients that the thyroid gland needs are readily available in many foods.
- Check your iodine intake.
Iodine is a trace mineral that plays a critical role in forming the primary thyroid hormone thyroxine.
On the other hand, excess iodine can also cause goiter. Avoid iodine deficiency by eating the correct amounts of foods rich in iodine, such as seaweed, iodized salt, and shellfish.
Seaweed is the number one food for iodine deficiency. They offer the broadest range of nutrients, as they contain virtually all the minerals found in the ocean, which are also essential for the human body.
Seaweed like kelp, nori, and kombu can play an essential role in supporting thyroid function. They also contain pantothenic acid and riboflavin, which are B vitamins that are very helpful for those who suffer from anxiety and depression due to poor thyroid management.
Iodine supplements are also available and can help normalize the production of thyroid hormones when taken in low doses.
But only use iodine supplements under the care of your doctor and make sure you are being monitored for side effects. High doses of iodine can aggravate thyroid disorder symptoms.
- Increase your protein intake
Protein carries thyroid hormone to all tissues and thus helps your thyroid function effectively.
Include in your diet:
Avoid soy and soy products like tofu, soy milk, and soy granules, as soy blocks cell receptors and disrupts full thyroid function.
- Avoid goitrogens
Goitrogens are chemicals that interfere with the body’s absorption of iodine.
So avoid foods like broccoli, cabbage, cauliflower, turnips, peanuts, radishes, soybeans, spinach, and kale, especially in their raw form. However, you can eat them after cooking, as the goitrogenic compounds are inactivated there.
20% of thyroid function depends on an excellent intestinal ecology. So, take probiotics or have homemade Dahi or yogurt regularly. You should also eat a lot of garlic, which kills yeast.
- Eat fat
You may be surprised to learn that fats are of great nutritional importance in helping to produce and regulate hormones.
If you are getting insufficient amounts of fat and cholesterol, you could be exacerbating your hormonal imbalance.
Healthy natural fats include ghee, walnuts, fat cheese, butter, coconut oil/milk, flax seeds, chia seeds, and fatty fish like salmon. So make them part of your diet.
- Control your sugar intake
Studies have shown that repeated spikes in insulin tend to destroy the thyroid gland. Sugar spikes cause our adrenal glands to secrete excess cortisol.
If cortisol is overused (from eating sugar daily), it suppresses pituitary function, affecting thyroid function.
- Eat foods rich in selenium, zinc, and B vitamins.
To improve the symptoms of thyroid disease, be sure to get enough selenium, zinc, and B vitamins in your diet. These nutrients are necessary for proper thyroid function and help balance your thyroid hormone levels.
Did you know that the thyroid is the organ with the highest selenium content? The mineral is necessary for the conversion of hormones T4 and T3.
Some of the best selenium foods that can be added to your diet to improve thyroid function include:
- Brazil nuts.
- Sunflower seeds.
- Pinto beans.
- El halibut.
- Grass-fed beef.
- Wild salmon.
- Organic oats.
Foods rich in zinc and B vitamins (especially vitamin B12) are crucial for thyroid health.
- Grass-fed beef.
- Garbanzo beans.
- Try the Ashwagandha
An adaptogenic herb and traditional medicine in Ayurveda, Ashwagandha is often used for thyroid dysfunctions.
A double-blind, randomized, placebo-controlled trial published in the Journal of Alternative and Complementary Medicine evaluated the efficacy of ashwagandha root extract in patients with hypothyroidism.
When patients took 600 milligrams of ashwagandha extract daily for eight weeks, their T4 levels improved significantly compared to placebo.
Other adaptogenic herbs that can be used to improve the symptoms of thyroid disease, especially hypothyroidism, include:
- Holy basil.
- El ginseng.
- Licorice root.
- Reduce stress levels
Research shows that physical and mental stress can cause changes in your thyroid hormone levels.
To prevent the endocrine glands from becoming overloaded, which can cause damage to the body by suppressing immune function and disrupting the part of the adrenal and thyroid glands, it is essential to control stress levels and get enough rest.
You can do this by trying natural stress relievers, such as exercising, getting 7-9 hours of sleep a night, taking time out of your day to do something fun and relaxing, and joining a faith community or support group.
- Reduce toxic exposures
Exposure to chemical toxins can cause inflammatory reactions that make it difficult for the thyroid to function correctly.
Avoid certain medications, hormonal birth control pills, and commercial beauty or cleaning products.
It’s also worth mentioning that heavy metals like mercury and amalgam fillings can upset your hormonal balance, so seeing a holistic dentist and removing silver fillings can be helpful.
Thyroid diet: sugar spikes cause our adrenal glands to secrete excess cortisol.
Avoid all forms of processed foods, artificial sweeteners, BPA-encapsulated foods, and chemical additives that interfere with thyroid function.