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Wojtas, Natalia, Wadolowska, Lidia, & Bandurska-Stankiewicz, Elżbieta. (2019). Evaluation of Qualitative Dietary Protocol (Diet4Hashi) Application in Dietary Counseling in Hashimoto Thyroiditis: Study Protocol of a Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 16(23), 4841.

This study aimed to examine the prevalence of fructose, lactose, and sorbitol malassimilation in patients with Hashimoto thyroiditis (HT) and healthy controls. This is an important study because the researchers collected several parameters from the study’s participants and controls, such as hydrogen breath tests, lactose, sorbitol, and glucose. Additionally, the researchers used a food-frequency questionnaire (FFQ) to compare the average daily intakes of free fructose, lactose and sorbitol between patients and controls.

The study found a significant association between patients with HT and carbohydrate malassimilation. Moreover, the study showed that euthyroid patients with HT suffer significantly more from fructose, lactose, and gastrointestinal symptoms. This can relate to to nutritional sciences because it found a link between HT and the gastrointestinal tract.

The main clinical implication of this study is that healthcare providers who treat patients with HT patients should consider the association between HT and gastrointestinal symptoms. Additionally, physicians have to perform H2-breath tests, especially if patients have gastrointestinal intolerance.

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Mangge, Harald, et al. “Hypothyroidism Exacerbates Thrombophilia in Female Rats Fed with a High Fat Diet.” International Journal of Molecular Sciences, vol. 16, no. 7, 2015, pp. 15776–15784.
Cardiovascular disease is still a high incidence in the United States, and how thyroid hormone regulates factors to influence atherosclerosis. However, thyroid regulation is uncertain, and previous studies observe that high fat intake would increase endogenous thrombin potential. The study is the thyroid dysfunction and cardiovascular disease effect to give the patients' efficacy therapy.

Although this study only has one figure and table, the researchers show that the thyroid plays a role in cardiovascular factors. They design the experiment about how rats are related to diet in biochemistry parameters. The hypothyroid groups increase free fatty acid and endogenous thrombin potential to decline the high risk of atherosclerotic. Cardiovascular patients manage their thyroid-related food.

This study utilizes animal models to understand thyroid and cardiovascular disease correlation. The researchers provide the experiment approach, so they need to confirm that the human subjects are similar to animal models. It improves thyroid mechanisms to treat cardiovascular patients.

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Iodine deficiency and thyroid disease

Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr;3(4):286-95. doi: 10.1016/S2213-8587(14)70225-6. Epub 2015 Jan 13. PMID: 25591468.

An iodine deficiency impairs thyroid hormone production and can have some adverse effects causing an iodine deficiency disorder and ultimately causing cognitive impairment. Thyroid hormones are needed for neuronal migration, glial differentiation, and myelination of the central nervous system. An iodine deficiency primarily affects Africa and South Africa regions. The recommended iodine intake for adults over the age of 12 is 150 ug per day. Iodine status is assessed through urinary iodine concentration, biomarkers of function, goiter, and thyroid function tests. Unless iodized salt is available, the main source of iodine in a typical American diet has been through dairy. Iodine intake from dairy might be decreasing for several many reasons. The government regulations have lead to a restriction in iodine concentration in livestock supplements decreasing the amount in cow’s milk. In the last decade, the decrease in iodine intake from dairy products could be contributed to the re-emergence of iodine deficiency in Australia and the United Kingdom. As far as thyroid disorders and iodine intake, an excessive amount of iodine and a deficiency can lead to impaired thyroid function. If there is a deficiency in dietary iodine, thyroid function is maintained by increasing thyroidal clearance. Thyroid stimulating hormone is triggered by a deficiency in iodine intake increasing the expression of the sodium-iodide symporter to maximize uptake of iodine in thyroid cells. Populations with mild-moderate iodine deficiency have a higher prevalence of hyperthyroidism and lower mean serum TSH concentrations. Whereas populations with severe iodine deficiency have the prevalence of hypothyroidism. As populations shift from severe iodine deficiency to iodine sufficiency, there is a shift from hypothyroidism to hyperthyroidism. This paper illustrates that iodine intake id directly related to thyroid disorders and that the agriculture change has affected the iodine intake.

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Carvalho GA de, Fighera TM. Effect of gastrointestinal disorders in autoimmune thyroid diseases. Translational Gastrointestinal Cancer. 2014;4(1):762-782. Accessed February 17, 2021. https://tgc.amegroups.com/article/view/4364/5767

This aim of this paper is discussion of the gastrointestinal GI) disorders that can have impact on treatment regimens for autoimmune thyroid diseases. Awareness of medication absoption in the presence of concurrent GI disease is impactful in the care and nutrition counselling of thyroid disease.

Key findings:
Patients with disorders impairing acid production (Atrophic gastritis and Helicobactor pylori infection) and patients taking medications to reduce stomach acid will need higher doses of thyroid hormone to treat their hypothyroidism. Any patient presenting with autoimmune thyroid disease should be screened for celiac disease (by historical review of symptoms) and lactose intolerance (by diet elimination and reintroduction) , and encouraged to try gluten free diet or lactose free diet, respectively, to improve absorption of thyroid treatments and quality of life. Bowel resection or other short-bowel syndromes result in malabsorption of nutrients, but also thyroid hormones, necessitating high doses to reach euthyroid status.

It is important to review patients with autoimmune thyroid disorders for gastrointestinal comorbitites that will change treatment escalation and dietary recommendations.

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C Sategna-Guidetti, U Volta, C Ciacci, P Usai, A Carlino, L De Franceschi, A Camera, A Pelli, C Brossa,
Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study, The American Journal of Gastroenterology, Volume 96, Issue 3, 2001, Pages 751-757, ISSN 0002-9270, https://doi.org/10.1016/S0002-9270(00)02410-2.
This study is important because autoimmune diseases are rarely found in isolation; often a patient will have 2-3 throughout their lifetime. This study investigates the association of celiac disease with thyroid impairment.
One key finding of this study was that thyroid disease was 3x higher in patients with celiac disease, and in most patients who adhered to a gluten-free diet for 1 year (and achieved “remission”) had resolution of their thyroid dysfunction.
The clinical implications of this study are that it is important to conduct a full assessment on patients with new autoimmune disease, as symptoms for multiple diseases can be similar, and by treating one you may be able to treat several. I have a friend who had Hashimoto’s thyroiditis, and was not diagnosed with celiac disease until she was in her early 30s and her young daughter was diagnosed. The damage to her GI tract was significant, and once her celiac disease was managed, her dosing of Synthroid greatly decreased, indicating some degree of cross-effect of the gluten free diet.

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Leung, A. M., & Braverman, L. E. (2014). Consequences of excess iodine. Nature reviews. Endocrinology, 10(3), 136–142. https://doi.org/10.1038/nrendo.2013.251

This study is important because it looks at the negative impacts associated with excess iodine. Iodine is a micronutrient that we primarily take in from our diet. Iodine is also required for the production of thyroid hormones. Too much or too little of this nutrient can lead to several negative consequences. 

One key finding of this study is that iodine supplementation is one of the primary concerns for excess exposure. Many patients take iodine supplements for iodine deficiency, but it some cases it is possible to get too much iodine. Patients who have an abnormal iodine exposure level can be at risk for iodine-induced hypothyroidism or iodine-induced hyperthyroidism if they meet the susceptibility criteria. 

The clinical implications of this study is that excess iodine can result in thyroid dysfunction in susceptible patients. Thyroid dysfunction caused by excess iodine would most likely occur in patients who are more susceptible to the negative side effects of this micronutrient. Susceptible patients include those with a pre-existing thyroid disorder (such as Graves’ disease or Hashimoto’s), the elderly, fetuses, and neonates. 

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Citation: Ihnatowicz P, Drywień M, Wątor P, Wojsiat J. The importance of nutritional factors and dietary management of Hashimoto's thyroiditis. Ann Agric Environ Med. 2020 Jun 19;27(2):184-193. doi: 10.26444/aaem/112331. Epub 2019 Oct 2. PMID: 32588591.

This review articles focuses on the importance of nutritional factors for developing and progress of Hashimoto’s (HT) disease. The authors also discuss which of these factors play a significant role in etiopathogenesis, or the causes/development, of HT. It is important because it is a recent compilation of the various factors that can influence HT and nutritional tips to balance diets during HT.

One key topic they discussed was that fluctuations of thyroid hormone levels can affect the intestinal microbiota and patients with HT have an increased risk for bacterial overgrowth. The review lists key recommendations to improve quality of the microbiota such as intake of polyunsaturated fat as opposed to saturated fat, adequate intake of omega-3 acids, and consumption of fiber.

This has clinical implications because dysbiosis can stimulate autoimmune processes. Individuals with Hashimoto’s can talk with their doctor and tailor their diet to change their microbiota to decrease the risk of autoimmune occurrences.

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Umar H, Muallima N, Adam JM, Sanusi H. Hashimoto's thyroiditis following Graves' disease. Acta Med Indones. 2010;42(1):31-35.

Graves’ disease and Hashimoto’s disease are both thyroid autoimmune diseases but sit in the opposite sides: overproduction of thyroid hormones (Hyperthyroidism) and underproduction (Hypothyroidism).  This study is important because it shows four case studies of patients in their 20s to 40s in which each patient with Graves’ disease developed Hashimoto’s thyroiditis 7 to 25 years after their treatment.

This study reports about 15-20% of patients with Graves’ disease who receive thyroidectomy or discontinue anti-thyroid treatment spontaneously develop hypothyroidism from Hashimoto thyroiditis 10-15 years later, and it is often appeared from I treatment.

Although its pathogenesis is still unclear, the clinical implication of this study is that such transition occurs when autoantibodies’ immune response is expanded, and thyroid cells are damaged by lymphocytic infiltration, resulting in hypothyroid.

Unfortunately, this study does not describe a relationship with nutritional sciences, but if we know that medical treatment of Graves’ disease could lead the patients to Hashimoto’s disease decades later, we can advise patients the importance of diet management more seriously so that they may not have to suffer from hypothyroidism later.

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Pradeep Yarra

Citation:  Grove-Laugesen D, Cramon PK, Malmstroem S, et al. Effects of Supplemental Vitamin D on Muscle Performance and Quality of Life in Graves' Disease: A Randomized Clinical Trial. Thyroid. 2020;30(5):661-671. doi:10.1089/thy.2019.0634

Question 1:   Why is this study important?

Several studies have shown low Vitamin D levels in Graves’ disease in both cross sectional and observational designs. Studies then have also correlated low levels of Vitamin D with effect on development and course of Graves’ disease, specifically in relation to muscle weakness or quality of life. Some cross-sectional studies have shown an association of low vitamin D levels with poor muscle strength, thus decreases quality of life. This study is first prospective study to see if vitamin D supplementation improves muscle performance and quality of life and these outcomes were compared to response to anti-thyroid medications.

Identify one key finding of this study and describe how it relates to nutritional sciences.

After 9 months of Vitamin D supplementation, there was a decrease in muscle strength in all measures of muscle function and were statistically significant. These outcomes were significant when compared to placebo and more pronounced with anti-thyroid medications. Quality of life was also affected negatively but was not as significant as muscle strength.

What are the clinical implications of this study?

In the subset of autoimmune diseases, we should be careful about implementing dietary changes as associations can be found between diet and disease course frequently. More specific diet focused research studies should be conducted to assess the effects on disease patterns. Even though Vitamin D, has beneficial effects generally on body metabolism, it should not be used to alleviate muscle weakness among Graves’ disease patients.

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Muscogiuri, G., Tirabassi, G., Bizzaro, G., Orio, F., Paschou, S. A., Vryonidou, A., ... & Colao, A. (2015). Vitamin D and thyroid disease: to D or not to D?. European journal of clinical nutrition, 69(3), 291-296.

Admittedly, the title of this review caught my attention at first as I am very used to dry article titles designed for function - not entertainment. This review looks at vitamin d through the lens of thyroid disease and thyroid cancer in general while also taking a look at how research has approached vitamin d supplementation within its subjects.

One key finding within this review was, for me, a surprising one. Vitamin D has long been understood in its role within the body, and a deficiency has long been tied to thyroid disease, thyroid cancer, and many other autoimmune conditions. Despite the plethora of information showing this relationship, this review found that there was very little research that looked closely at how a supplementation of vitamin d in the diet could help with the conditions discussed. Very few studies have been conducted in animal models and even fewer in humans.

This study is important because it both fully describes the major relationship and potentially causal role that a vitamin d deficiency has in autoimmune conditions - particular thyroid conditions and brings up a huge issue that this relationship has been ignored by research. Even with a huge research potential, adding vitamin d to an individual’s treatment plan has not been tested and can really only be recommended on anecdotal stories and a general understanding of vitamin d and thyroid disease.

This entire review shows how nutrition is ignored within a major research scope despite its potential in drastically improving the lives of individuals living with thyroid disease and thyroid cancer. The review does end on a positive note - with a little research and work, adding vitamin d to one’s nutritional guidelines could potentially improve disease progression and overall health.

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Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc. 2019 Feb;78(1):34-44. doi: 10.1017/S0029665118001192. Epub 2018 Sep 13. PMID: 30208979.

Why is this study important?

This is a review article discussing the importance of iron, iodine and selenium supplementation/intake in patients with autoimmune thyroid disease. It discusses excess and deficiency of iodine as well as iron and selenium deficiencies that are correlated with autoimmune thyroid disease.

Key Finding and Relation to Nutritional Sciences

Both high and low amounts of dietary iodine are associated with an increased prevalence of both HT and GD.  The possible mechanisms of this are that highly iodinated thyroglobulin is immunogenic, as well as increasing the expression of intra-cellular adhesion molecule-1 on thyrocytes which can cause infiltration by mononuclear cells. This is relevant to clinical practice as many supplements that are available, are not necessarily recommended by dieticians, as they can contain megadoses of some vitamins and minerals. Consumers often think the more of a ingredient, the better, but in some causes, this over-supplementation can have deleterious effects.

Clinical Implications

Since all three of the minerals discussed in this paper can be toxic at high doses, it’s important for patients to be educated on the risks of over-supplementation. Also, any time a disease state can be prevented or modified through diet, it’s important to discuss these with patients.

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Citation: Peter N. Taylor, Onyebuchi E. Okosieme, Rhian Murphy, Charlotte Hales, Elisabetta Chiusano, Aldo Maina, Mohamed Joomun, Jonathan P. Bestwick, Peter Smyth, Ruth Paradice, Sue Channon, Lewis E. Braverman, Colin M. Dayan, John H. Lazarus, Elizabeth N. Pearce, Maternal Perchlorate Levels in Women With Borderline Thyroid Function During Pregnancy and the Cognitive Development of Their Offspring: Data From the Controlled Antenatal Thyroid Study, The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 11, 1 November 2014, Pages 4291–4298, https://doi-org.ezproxy.uky.edu/10.1210/jc.2014-1901

This study is important because it shows that women with a borderline functioning thyroid who are exposed to elevated levels of perchlorate are at an increased risk of producing offspring with lower than average IQ. The study investigated the use of levothyroxine therapy and found that it was not sufficient in reducing the effects of perchlorate.

A key topic from this study for me is the fact that genetics does play a role in intelligence and environmental factors can exacerbate the effects of the genetic component. Thus, there is an intricate balance among genetics, the environment, and even society that all play a role in the development of a healthy individual, in this case, specifically looking at neurologic health.
Even though the therapy wasn’t able to attenuate the condition, further research should be warranted to finding a way to treat this condition. Perchlorate is generally introduced in the body through ingesting fruits and vegetables with a high-water content. People living in an area where the use of explosives are common are at a greater risk from perchlorate exposure.

Optimal functioning of the thyroid gland is vital for the healthy cognitive development of the offspring. Monitoring the risk factors for excessive perchlorate exposure and therapy should be made available to pregnant women

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Citation: Vita, Roberto & Saraceno, Giovanna & Trimarchi, Francesco & Benvenga, Salvatore. (2012). A novel formulation of L-thyroxine (L-T4) reduces the problem of L-T4 malabsorption by coffee observed with traditional tablet formulations. Endocrine. 43. 10.1007/s12020-012-9772-2. DOI: 10.1007/s12020-012-9772-2

Why is this study important?

It has been documented and is a common blanket recommendation that patients taking tablet forms of levothyroxine (L- T4) should avoid coffee consumption within 60 minutes of oral administration of L-T4.  L-T4 is a common medication prescribed for hypothyroidism.  This study is important because dietary behaviors can be difficult to change and the authors of this study report that almost 50% of the world’s population consumes coffee.  For coffee lovers or for those whose day must begin with coffee and who are taking the tablet form of L-T4, this study is significant because no change in intake habits/dietary habits revolving the timing of coffee consumption would be necessary!

Identify one key finding of this study and describe how it relates to nutritional science.

A soft gel formulation of L-T4 reduces the L-T4 malabsorption caused by coffee. As mentioned above, dietary behaviors can be difficult to change and poor adherence to medication regimens as prescribed when involving dietary behavior(s) can decrease the adherence to prescribed medication regimens.

What are the clinical implications of this study?

The study was very small and only included 8 patients with coffee-associated L-T4 malabsorption and used Italian coffee.  Although small, this study indicates that the new formulation of the L-T4 reduces malabsorption of L-T4 from coffee.  Patients with hypothyroidism, celiac disease and post-bariatric surgery could benefit from this new formulation of L-T4.

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Citation:  Cellini M, Santaguida MG, Virili C, Capriello S, Brusca N, Gargano L, Centanni M. Hashimoto's Thyroiditis and Autoimmune Gastritis. Front Endocrinol (Lausanne). 2017 Apr 26;8:92. doi: 10.3389/fendo.2017.00092. PMID: 28491051; PMCID: PMC5405068.

Why is this study Important:   This is a review article  demonstrating the prevalence of co-existing Hashimoto thyroid disease and  Autoimmune gastritis and the implications for both making an appropriate diagnosis and  successful treatment.

Key Finding:   Hashimoto's Thyroid disease, the most common autoimmune disease is  associated with gastritis in 10-40% of patients.  The inverse is also true in that  40% of patients with chronic autoimmune gastritis  also present with hashimotos thyroid disease.   This is known as" Thyrogastric Syndrome".  The article points out multiple  embryologic and functional similarities between thyroid and gastric  tissue  (fascinating!).

Importance and Nutritional Implications:
The co-existence of these two disorders is  surprisingly very prevalent.  The gastritis is known to  impair parietal cells in the gut, thus impairing hydrochloric acid and intrinsic factor leading to multiple problems including anemia (iron deficiency and B12), gastric atrophy, malabsorption.  Malabsorption not only applies to  nutrients but also to medications, such as the levothyroxine which is essential to effective treatment of  Hashimoto's.
From a clinical perspective,  it is so important to recognize the  association between these disorders and the diagnosis of one should trigger a specific additional work-up.

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Citation:  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. Exp Clin Endocrinol Diabetes. 2019 Jul;127(7):417-422. doi: 10.1055/a-0653-7108. Epub 2018 Jul 30. PMID: 30060266.

Why this study is important:

This investigated the affects of a gluten free diet on thyroid autoimmunity and function tests in women with Hashimoto’s disease.  The study is important because it is evaluating a causal link between a gluten free diet and Hasimoto’s disease.

Key study findings related to nutritional sciences:

The major finding of this study is that the gluten-free diet reduced thyroid autoimmunity and increased thyroid output in eu-thyroid (normal measurement) women with Hashimoto’s thyroiditis. The authors concluded that this is a specific effect of the gluten-free diet because in 62% of the patients, the decrease in thyroid antibody ti- ters and changes in thyroid function tests were also accompanied by disappearance of anti-tissue transglutaminase antibodies, a celiac indicator.

This being said, the study does not determine what causes the favorable effect of the gluten-free diet on thyroid autoimmunity, but the researchers noted an improvement in vitamin D status and hypothesize that this may be a reason for this effect.

Clinical Implications:

In the study it was noted that the research methodology of this study was weak due it’s non-randomized nature, a limited number of research subjects and a short treatment period.  Still, the overall objective is important as other studies are supportive in similar research and the potential findings warrant continued evaluation.

The clinical implications include looking to utilize a gluten free diet to control Hashimoto’s thyroiditis. It could help the patient to maintain normal measurements and prolong a hypothyroid presentation.  Understanding this possible causal effect could also mean that when treating a patient with celiac or thyroid disease (in this case, Hashimoto’s), it may be important to evaluate whether there is a secondary disease to be treated and balance the requirements of both diseases.  For example, a patient with Hashimoto’s disease may present with constipation, but adding fiber into the diet may need to come from very specific, gluten free sources.

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Citation: Abbott, R. D., Sadowski, A., & Alt, A. G. (2019). Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto's Thyroiditis. Cureus, 11(4), e4556. https://doi.org/10.7759/cureus.4556

Key study question: "Determine the efficacy of a multi-disciplinary diet and lifestyle intervention for improving the quality of life, clinical symptom burden, and thyroid function in a population of middle-aged women with HT."

Key finding: 16 women between the ages of 20-45 with a prior dx of Hashimoto's disease were enrolled in the study. Baseline was evaluated through a health-related quality of life (HRQL) and clinical symptom burden survey. Thyroid labs were also taken. These women underwent a 10 week intervention that focused on a Autoimmune Protocol (AIP) diet, which mimicked a Paleolithic elimination diet. The study found that HRQL was improved, however thyroid labs did not change. The HRQL was speculated to be due to decrease in inflammation related to diet intervention.

Nutritional Implications: This study is important because the quality of life for people with this disease can be poor. If through diet intervention we can elevate symptoms it would be a good clinical recommendation. However, getting people to follow that strict of a diet may be a challenge. I would like to see studies where they try and reintroduce foods back into the diet from the elimination period. This way we may be able to determine if its a person to person situation.

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Grove-Laugesen, D., Grove-Laugesen, A., Cramon, P., Endocrinology, D., Malmstroem, S., Department of Endocrinology and Internal Medicine, . . . Duntas, L. (2020, May 07). Effects of supplemental vitamin d on muscle performance and quality of life in graves' disease: A randomized clinical trial. Retrieved February 12, 2021, from https://www.liebertpub.com/doi/10.1089/thy.2019.0634

Why is this study important?

This study is important because it shows a very valuable way that vitamin D supplementation can impact the muscular impairment for those with Graves Disease. Graves Disease commonly shows symptoms of low vitamin D levels. As with many diseases where low vitamin vitamin D levels are indicated, the correlations are firm yet the exact mechanisms and scope of impact are less well understood. Muscular impairment is commonly seen for those diagnosed with Graves Disease. This study sought to inhibit the impairments, with the hypothesis that vitamin D supplementation will aid in restoration of muscular performance in newly diagnosed and those who have been taking oral medication to combat Graves Disease and the symptoms of hyperthyroidism.

Key Findings

This was a double-blinded clinical trial. Recently diagnosed GD subjects and oral intake medication subjects were randomized between a treatment and control group. They received either a 2800 IU/day or the equivalent placebo. Isometric muscle strength, muscle function tests, postural stability, body and composition were measured using ThyPRO questionnaire at  baseline, 3, and 9 months.  Compared with placebo, vitamin D supplementation tended to reduce gain of lean body mass. In response to vitamin D supplementation, the oral medication intake subject group improved all baseline measurements in the 9 month period.

Clinical Implications

Hyperthyroidism and Graves disease are plagued with a variety of symptoms associated (generally) with increased metabolism. Muscular wasting and impairments have been seen and the mechanism is less well understood. As GD develops, vitamin D levels tend to deteriorate over time. This makes sense, as the response to vitamin D ingestion was much greater in people who have been diagnosed with GD for a while. Supplementation with vitamin D could be suggested in a clinical setting as an additional way to prevent the breakdown of muscle.

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Citation: Asik, M., Gunes, F., Binnetoglu, E. et al. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine 46, 279–284 (2014).

Key study question: to evaluate the prevalence of lactose intolerance (LI) in patients with Hashimoto’s thyroiditis (HT) and the effects of lactose restriction on thyroid function in these patients.

Key finding: Thirty-eight patients with lactose-intolerance (LI) were started on a lactose-restricted diet for 8 weeks. Thirty-eight patients with LI (30 euthyroid and 8 with subclinical hypothyroidism), and 12 patients without LI were included in the final analysis. The level of TSH significantly decreased in the euthyroid and subclinical hypothyroid patients with LI [from 2.06 ± 1.02 to 1.51 ± 1.1 IU/mL and from 5.45 ± 0.74 to 2.25 ± 1.88 IU/mL, respectively (both P < 0.05)]. This indicates a possible relation between thyroid disorders and malabsorption syndromes, and potential benefit from modifying diets accordingly.

Nutritional implications:

Lactose intolerance occurs at a high frequency in hypothyroid patients. Lactose restriction leads to decreased levels of thyroid-stimulating hormone (TSH), and LI should be considered in hypothyroid patients who require increasing LT4 doses, have irregular TSH levels and are resistant to LT4 treatment.

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Abebe Z, Gebeye E, Tariku A. Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia. BMC Public Health. 2017;17(1):44. Published 2017 Jan 7. doi:10.1186/s12889-016-3914-z

Goiter is defined as the abnormal enlargement of the thyroid gland due to an iodine deficiency in the diet. In the United States goiter is not as prevalent because we have iodized salt to help combat thyroid dysfunction leading to goiter. In Ethiopia however, there is a major public health problem documented with goiter and the most affected age group is school children. This is concerning because thyroid disjunction can lead to physical and mental developmental issues in school aged children. This study is important because it highlights the impacts of iodine deficiency as it leads to goiter and developmental issues. In this study, they focused on school age children with goiter and found that they had lower scores in school and suffered from a higher incidence of learning disabilities.  Nutritionally, we know that iodized salt is a way that iodine can be implemented into the diet and help with iodine deficiency. The Ethiopian Government has actually put a priority on funding iodized salt and implementing that. China underwent a similar project and found a drastic decrease in deficiency rates (about a quarter decrease) . Clinically, this study indicates the important of iodized salt and the impact that it has on deceasing the prevalence of iodine deficiency.

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Krysiak, Robert, Szkrobka, Witold, Okopien, Boguslaw. Exp Clin Endocrinol Diabetes 2019; 127(07): 417-422. DOI: 10.1055/a-0653-7108

Autoimmune thyroiditis is the most prevalent coexisting autoimmune disorder in patients with celiac disease. This study focuses on this association between Hashimoto's thyroiditis and celiac disease or an asymptomatic increase in anti-tissue transglutaminase antibodies (anti-TPO). The purpose of this study was to investigate whether a gluten-free diet has an impact on thyroid autoimmunity, hypothalamic-pituitary-thyroid axis activity and thyroid function tests in drug-naive women with Hashimoto's thyroiditis who have positive anti-TPO.

One major finding is that gluten-free diet reduced thyroid autoimmunity and slightly increased thyroid output in euthyroid women with Hashimoto's thyroiditis. This appears that the decrease in thyroid antibody titers and changes in thyroid function tests were accompanied by disappearance of anti-TPO. One of the reason responsible for favorable effect of this diet is improvement in vitamin D status or increased in circulating levels of 25-OH vitD (active form). Another mechanism being improvement in selenium status, thus, reducing in thyroid autoimmunity by inhibiting a secretory function of human T cells.

As inhibitory effect of gluten-free diet may participate in improvement of thyroid secretory capacity. Gluten-free diet may implicate delaying the development of thyroid hypofunction in euthyroid women with Hashimoto's thyroiditis. As such, gluten-free diet may bring clinical benefits to euthyroid women with Hashimoto's thyroiditis.

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Kassa, W., Memon, R., & Munir, K. (2020, March 30). The gluten- grave's connection: Is there one? Retrieved February 11, 2021, from https://www.sciencedirect.com/science/article/pii/S2666396120300029

This is a case report that I found on an individual who had hyperthyroidism secondary to Graves’ disease. This patient was following a gluten free diet which in turn was discovered to resolve the hyperthyroidism. It further researched the role of a gluten free diet with Graves’ disease. Evidence of this diet actually curing or significantly helping these thyroid disorders is rare, however, this case showed an interesting benefit of GFD for this disorder. It is a more frequently thought of phenomenon. It is important also because it connected ideas of Celiac Disease along with Graves’ Disease, finding similarities between autoimmune disorders. It relates to the idea that nutrition is a very critical part of diseases and can benefit the person overall if they change their diet. Nutritional sciences look at the connections between health and diet, which this is a prime example of. Clinical implications could be keeping diets in mind for more diseases and determining if new ways of nutritional changes could benefit a patient. This idea could lead to new through processes and attempts to lessening severities of these diseases.