We’re guessing the title and picture above attracted a quarter of you and deterred the rest, depending on your stance on New Year’s resolutions and whether you’re a green smoothie devotee or consider it a culinary abomination.  Regardless of how you sway, we encourage you to keep reading because such topics are of critical concern when it comes to your thyroid health.  January marks thyroid awareness month, and according to the American Thyroid Association, it is estimated that 20 million Americans presently suffer from some type of thyroid dysfunction – over half of whom are unaware.¹  Conventional therapies have been demonstrated to be effective at managing the disease’s symptoms, but rarely provide a permanent cure.²  Increasingly, evidence has found food to be strongly implicated in disease progression and regression, ³ and since many individuals designate this season toward eating better, we found it only befitting to post on why altering your diet may be the most effective strategy for optimizing your thyroid health.  Find out more below.

What is the thyroid?
Weighing a modest 20 to 60 grams and measuring 5 cm wide, the thyroid is a butterfly-shaped gland that wraps around the trachea.  It is composed of numerous lobules that store hormones involved in the regulation of every metabolic function, including body temperature, heartrate, brain maturation, energy utilization, and skeletal growth.⁴   

Symptoms and causes of thyroid disease
Symptoms of thyroid disease vary depending on the degree of hormonal activity.  Underactivity, formally recognized as clinical or subclinical hypothyroidism, is the most common type of thyroid disease and symptomized by extreme fatigue, unexplained weight gain (or inability to lose weight), depression, hair loss, enlargement of thyroid gland, low bone density, digestive distress, dyslipidemia, dysglycemia, vascular and arterial plaquing, gallstones and infertility.  Overactivity, known as hyperthyroidism, is usually manifested by irritability, poor concentration, heart palpitations, enlargement of thyroid gland, excessive sweating, brittle hair, and increased appetite and bowel movements.⁵  

Reasons for the aforementioned disorders are not entirely definitive; however, contemporary findings suggest they may be a result of a nutrient deficiency or dietary toxins.  Inadequate intake of iodine has been historically recognized as the most common cause of dysfunction,⁶ though at present, dietary toxins are the primary contenders since most diagnoses are autoimmune in origin (e.g., Hashimoto’s or Graves’).⁷  Autoimmunity is a condition in which a person’s immune system attacks their tissues, typically triggered by the entry of foreign invaders resembling their own proteins.  In this case, multiple studies have identified a connection between Hashimoto’s, Graves’ and gluten intolerance,^8-10 which is not too surprising considering gliadin, the protein portion of gluten, is similar in chemical composition to a resident enzyme of the thyroid gland.¹¹

A word of caution to plant-based and Paleo diet enthusiasts: We know you love your Brassica babies in all of their transmutations (cauliflower crust pizza, kale juice and broccoli tots, anyone?), but they won’t always love you back. Goitrogens, pungent compounds inherent to these vegetables, impede iodine uptake by the thyroid gland.¹²  Be forewarned that If you are consuming copious amounts on a consistent basis, you could be elevating your risk of hypothyroidism. 

Dietary remedies for thyroid disease

Standard care for hyperthyroidism consists of surgery, radioactive iodine or antithyroid medication in order to suppress hormone production, whereas treatments for hypothyroidism generally rely upon hormone replacement medications and isolated doses of iodine or selenium to boost the gland’s activity.^{2, 13-14}  Yet in light of the etiology above, these can’t serve as long-term solutions because they don’t address the underlying immune dysregulation or adequately correct nutrient deficiencies.  Importantly for the latter, supplementation of iodine is only effective at restoring thyroid function when coupled with selenium at a specific ratio, although this is difficult to achieve synthetically and high doses can predispose individuals to health problems in the future.^15-16 

So what gives?

Your bread, cereal, crackers, cookies, cakes and muffins.  Get rid of them. 

And replace these glutenous foods with seaweed, cod, shrimp, tuna, halibut, salmon, scallops, Brazil nuts, cremini mushrooms, chicken, eggs, lamb, and turkey.  Oh, and while you’re in the kitchen, make sure you steam or roast all of your cruciferous vegetables, as heat deactivates the lion’s share of goitrogens.^17-18  Not only will these steps remove the autoimmune triggers, they will help you to safely meet – and maximize – your mineral requirements for hormone synthesis. 

(As a disclaimer: We recognize that each patient is unique, and so these treatments may NOT always be the most effective options for those who do not respond well to natural alternatives).   

Taking the green out of green smoothie?

Did you know Jonathan Edwards, prominent pastor and theologian during the Great Awakening, took resolutions so seriously that he penned 70 to review weekly by age 19?  (Albeit, we doubt this means he would have lost any sleep over whether or not to join team green smoothie, given the existentially more pressing matters of his time).  Truth be told, this number is slightly ambitious even for our standards, and so we vow to recommend no more than 69 when you make an appointment with Dr. Pamela Abrams, MD or any other of our providers at Family Practice Associates in Broomfield, Colorado to discuss optimizing your thyroid function.  (Kidding).  As January inspires people to adopt healthier habits, we hope this article has inspired you to become more proactive about your health – first by resolving to never liquify raw kale again.

by Brenda Burgess, PhD in Nutritional Biochemistry & Physiology (Dr. Pamela Abrams' niece)

References

1. General Information. American Thyroid Association website. https://www.thyroid.org/media-main/press-room/. 2020. Accessed December 15, 2019.
2. Can thyroid disease be cured? American Thyroid Association website. https://www.thyroid.org/media-main/press-room/. 2020. Accessed December 15, 2019.
3. Bajaj JK, Salwan P, Salwan S. Various possible toxicants involved in thyroid dysfunction: A review. Journal of Clinical and Diagnostic Research. 2016; 10(1):FE01–FE03. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740614/. Accessed December 15, 2019.
4. Nussey S, Whitehead S. Chapter 3 – The thyroid gland. In: Endocrinology: An Integrated Approach. Oxford: BIOS Scientific Publishers; 2001. https://www.ncbi.nlm.nih.gov/books/NBK28/. Accessed December 15, 2019.
5. Walker HK, Hall WD, Hurst JW. Chapter 135 – Thyroid disease. In: Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. https://www.ncbi.nlm.nih.gov/books/NBK241/. Accessed December 15, 2019.
6. Iodine Deficiency. American Thyroid Association website. https://www.thyroid.org/iodine-deficiency/. 2020. Accessed December 15, 2019.
7. Amino N. Autoimmunity and hypothyroidism. Baillière's Clinical Endocrinology and Metabolism. 1988; (2)3:591-617. https://www.sciencedirect.com/science/article/abs/pii/S0950351X88800557. Accessed December 15, 2019.
8. Krysiak R, Szkróbka W, Okopień B. The effect of gluten-free diet on thyroid autoimmunity in drug-naïve women with Hashimoto's Thyroiditis: A pilot study. Experimental and Clinical Endocrinology and Diabetes. 2019; 127(7):417-422. https://www.ncbi.nlm.nih.gov/pubmed/30060266. Accessed December 15, 2019.
9. Sategna-Guidetti C, Bruno M, Mazza E, Carlino A, Predebon S, Tagliabue M, Brossa C. Autoimmune thyroid diseases and coeliac disease. European Journal of Gastroenterology and Hepatology. 1998; 10(11):927-931. https://www.ncbi.nlm.nih.gov/pubmed/9872614. Accessed December 15, 2019.
10. Virili C, Bassotti G, Santaguida MG, Iuorio R, Del Duca SC, Mercuri V, Picarelli A, Gargiulo P, Gargano L, Centanni M. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. Journal of Clinical Endocrinology and Metabolism. 2012; 97(3):E419-422. https://www.ncbi.nlm.nih.gov/pubmed/22238404. Accessed December 15, 2019.
11. Wong KV. Gluten and thyroid health. Juniper Online Journal of Public Health. 2017; 1(3);555563. https://juniperpublishers.com/jojph/pdf/JOJPH.MS.ID.555563.pdf. Accessed December 15, 2019.
12. Felker P, Bunch R, Leung AM. Concentrations of thiocyanate and goitrin in human plasma, their precursor concentrations in brassica vegetables, and associated potential risk for hypothyroidism. Nutrient Reviews. 2016; 74(4):248-258.  https://www.ncbi.nlm.nih.gov/pubmed/26946249. Accessed December 15, 2019.
13. Sun X, Shan Z, Teng W. Effects of increased iodine intake on thyroid disorders. Endocrinology and Metabolism (Seoul). 2014; 29(3): 240–247. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192807/. Accessed December 15, 2019.
14. Turker O, Kumanlioglu K, Karapolat I, Dogan I. Selenium treatment in autoimmune thyroiditis: 9-month follow-up with variable doses. The Journal of Endocrinology. 2006; 190(1):151-156. https://www.ncbi.nlm.nih.gov/pubmed/16837619. Accessed December 15, 2019.
15. Triggiani V, Tafaro E, Giagulli VA, Sabbà C, Resta F, Licchelli B, Guastamacchia E. Role of iodine, selenium and other micronutrients in thyroid function and disorders. Endocrine, Metabolic and Immune Disorders Drug Targets. 2009; 9(3):277-294. https://www.ncbi.nlm.nih.gov/pubmed/19594417. Accessed December 15, 2019.
16. Leung AM, Braverman LE. Consequences of excess iodine. Nature Review Endocrinology. 2014; 10(3):136–142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976240/. Accessed December 15, 2019.
17. McMillan M, Spinks EA, Fenwick GR. Preliminary observations on the effect of dietary brussels sprouts on thyroid function. Human Toxicology. 1986; 5(1):15-19. https://www.ncbi.nlm.nih.gov/pubmed/2419242. Accessed December 15, 2019.
18. Rungapamestry V, Duncan AJ, Fuller Z, Ratcliffe B. Effect of cooking brassica vegetables on the subsequent hydrolysis and metabolic fate of glucosinolates. The Proceedings of the Nutrition Society. 2007; 66(1):69-81.https://www.ncbi.nlm.nih.gov/pubmed/17343774. Accessed December 15, 2019.