Thyroid Diseases, Living Well With (cont.)

Ultimately, one of the most important things a patient can do is to determine which combinations of options, both nutritional, conventional, alternative and even mind/body (I swear by deep breathing, Pilates and some meditation) will help you personally achieve your best possible outcome despite your thyroid condition.

I have read that excess iodine is a trigger for autoantibodies associated with Graves' yet iodine-rich foods and supplements are often recommended for those with Hashi's. For those with both diseases, couldn't this exasperate the problem?

This is an excellent question, and it brings up several important issues.

First, you can have Hashimoto's disease and Graves' disease or hyperthyroidism at the same time. Sometimes that condition is known as Hashitoxicosis. In Hashitoxicosis, one can swing back and forth between hypo and hyperthyroid conditions. It is often one of the most difficult conditions to diagnose because if a doctor sees you during a hyperthyroid phase, you may be given antithyroid drugs or rushed into radiation treatment, which then deactivates the thyroid and worsens the existing Hashimoto's disease, whereas if you're seen during a hypothyroid phase, you may be given thyroid replacement drugs, which then make you more hyperthyroid. If you have symptoms that change frequently, have your doctor check all antibodies that test for hypo and hyper antibodies at the same time.

The second part of your question related to iodine. That is a very controversial subject for thyroid patients because both too much and too little can be a host for a variety of thyroid problems. If you have autoimmune thyroid tendencies, taking iodine or an iodine-containing supplement such as bladderwrack, may in fact aggravate your autoimmune condition and worsen both Hashimoto's and/or Graves' disease and can make you either more hypo or hyperthyroid. If you are iodine deficient, however, and only 20% of the American public is deficient in this essential nutrient, then you can develop what's known as a goiter or an enlarged thyroid, and the use of iodine or iodine supplements can actually help restore your thyroid to normal functions. Deficiency in iodine is a major problem in the developing world, and areas where salt in foods are not routinely iodized. However, the lack of iodine has not been a common problem in the U.S. since iodized salt. However, in people on low-salt diets and avoiding salty foods, we're seeing an increasing insurgence of iodine deficiency -- but again, it's the minority of the population.

Be careful about the use of iodine. Many holistic practitioners have an almost knee-jerk reaction, and suggest kelp or iodine as a treatment. Unfortunately, the reality is that whether or not you need iodine is a question unique to your own nutritional status, and given where you are located within the U.S. and the world, so be careful and discuss it with your practitioner before changing iodine intake to affect your thyroid condition.

"There is research, however it's considered controversial, that has shown overconsumption of soy may be a trigger to autoimmune thyroid disease in some people."

I have a few questions concerning a hypothyroid condition with a goiter. Is consumption of soy safe? I've read that amounts of isoflavones from soy can be bad for thyroid symptoms. Nutrition -- what kinds of food are beneficial and what kinds of food should I avoid? Treatment -- how to deal with a goiter? What medicine is helpful and are there any side effects?

Goiter refers to an enlargement of the thyroid; sometime it is enlarged enough to be visibly a thickening of the neck area.

There is research, however it's considered controversial, that has shown overconsumption of soy may be a trigger to autoimmune thyroid disease in some people. What we're talking about here is not eating some soy to be healthy. Rather, it's the "soy crazy, if some is good more is better" approach that some people tend to take. What you don't want to be doing are soy smoothies for breakfast, soy powders for snacks, soy nuts, burgers, creams all day long. If you are going to eat soy, eat it in moderation and use it in its natural form like the Asians. That means tempeh or tofu, not pills powders and shakes. Edamame are fine in reasonable quantities as well, for most people.

When it comes to goiter, certain foods eaten in large quantities can actually contribute to a worsening goiter. These are known as goitrogens. Goitrogens include large quantities of raw cabbage, brussel sprouts, many other greens and the aforementioned soy. Broccoli is also one of these. Cooking goitrogens, however, neutralizes most of the thyroid impact, and typically they are not a problem unless you are eating large quantities of them raw everyday.

The treatment for a goiter is typically the use of thyroid hormone drugs which can help shrink the goiter to a manageable size, but if the goiter is extremely large so that it is cosmetically unsightly, if it endangers breathing or swallowing, most doctors will typically recommend partial or complete removal of the thyroid, surgery known as thyroidectomy. However, most goiters don't require such dramatic measures and usually respond to drug treatment.

I am taking prenatal vitamins. Is this giving me a sufficient amount of the vitamins you recommended in your book or should I be taking additional supplements in addition to the prenatal?

Prenatal vitamins characteristically have somewhat higher levels of the B vitamins and calcium and iron than typically found in a regular multivitamin. Whether this is meeting your requirements is not something I can determine. You'd need to talk to your doctor or nutritionist, about whether this is suitable for your health situation.