When I dealt with Graves’ disease in 2008/2009 I had a mild goiter, which is a swelling of the thyroid gland.  In my case it was caused by the hyperthyroidism associated with my condition. But there can be other causes of goiter, and while I’ve written a few different articles on this topic, since I get a lot of questions related to thyroid swelling I figured I’d put together an updated post which includes five things you should know.

1. Any thyroid hormone imbalance can cause a goiter.  In the opening paragraph I mentioned how I had a mild goiter when I dealt with Graves’ disease, and both hyperthyroidism and hypothyroidism can lead to an enlarged thyroid gland.  When this is the case the obvious goal should be to correct the thyroid hormone imbalance.  While you always want to address the underlying cause, while doing this it might be necessary to take something to increase or decrease the thyroid hormone levels.  For example, if someone has hyperthyroidism then they might need to take antithyroid medication (i.e. methimazole) or herbs (i.e. bugleweed), whereas if someone has hypothyroidism they might need to take thyroid hormone replacement.

2. There can be other causes of thyroid swelling.  Here are some of the causes of nontoxic goiter according to a research article (1):

• Physiological goiter (puberty, pregnancy)
• Iodine deficiency
• Goitrogens (broccoli, cabbage, goitrogenic drugs)
• Radiation exposure
• TSH release from the pituitary glands
• Autoimmunity
• Infections
• Granulomatous disease

I’m not going to discuss all of these, but I will talk about a few of them.  Let’s start with cruciferous vegetables, which are considered to be goitrogens, which in turn can potentially inhibit thyroid function, thus leading to a goiter.  While exposure to goitrogens can be a potential cause of a goiter, most people do fine eating cruciferous vegetables.  This includes those with hypothyroidism and hyperthyroidism.  In fact, in the past I’ve intentionally tried using raw cruciferous vegetables to lower thyroid hormone levels in some of my hyperthyroid patients with no success.  Therefore, I encourage most of my patients to eat plenty of cruciferous vegetables.

Next I’d like to talk about iodine, as an iodine deficiency can potentially cause a goiter.  In fact, this is how goitrogens can cause a goiter, as they can inhibit iodine metabolism.  However, most people with Graves’ disease and Hashimoto’s who have a goiter don’t have one as a result of an iodine deficiency. On the other hand, some cases of toxic multinodular goiter can be caused by an iodine deficiency.

Two other potential causes of a goiter not mentioned above include insulin resistance and problems with estrogen metabolism.  These two conditions not only can cause a goiter, but can also lead to the development of thyroid nodules as well.  As a result, it’s important to address these problems.

3. Essential oils such as myrrh and frankincense might help if the cause of the goiter is inflammatory in nature.  The truth is that other natural anti-inflammatory agents can help to reduce a goiter if it’s inflammatory in nature.  But I’m focusing on essential oils here because a lot of people ask whether rubbing essential oils on their thyroid gland can help.  Once again, it depends on the cause of the problem, as there are people who have received great benefits from rubbing essential oils such as myrrh and frankincense on their thyroid gland, but there also have been people who didn’t see any benefits when using these.  I need to remind you that essential oils are very concentrated, and so you only would need to use one or two drops of each essential oil, and you would want to dilute them with a carrier oil (i.e. fractionated coconut oil).  Then you can put the diluted oils in a roller ball and rub it on the thyroid gland.

4. Surgery may be the best option for some people with larger goiters.  I’m not suggesting that everyone with a large goiter should get thyroid surgery, but it’s important to mention that very large goiters are unlikely to decrease to their original size.  This doesn’t mean that they can’t shrink at all, but if the goiter is very large and is causing any type of obstruction then surgery might be necessary.  And I probably don’t have to mention that another situation when surgery probably is necessary is when there is a malignancy.  That being said, if someone has a very large goiter with no obstruction, and cancer isn’t suspected, then they might as well try to address the cause of the goiter.

5. In order to shrink a goiter you need to address the cause of the thyroid swelling.  It’s not always easy to determine the underlying cause.  If someone developed a goiter shortly after being diagnosed with hyperthyroidism or hypothyroidism then it makes sense to first address the cause of the thyroid hormone imbalance and see if the thyroid swelling decreases.  If this doesn’t happen then other causes are likely, and I listed some of the more common ones earlier.

So when someone asks if there is anything they can do to shrink their goiter, in most cases the answer is “yes”, although how much depends on the size of the goiter.  And you need to find and address the cause of the problem.  Below I’ll list what I would focus on in the order of priority for those who have a goiter:

1. Balance your thyroid hormone levels.  Once again, this includes taking antithyroid medication or herbs for those with hyperthyroidism/Graves’ disease, and thyroid hormone replacement for those with hypothyroidism/Hashimoto’s.  Obviously these aren’t permanent fixes, but they might be necessary to take while addressing the underlying cause.

2. Do things to reduce inflammation.  Just as is the case with balancing the thyroid hormone levels, you want to address the cause of the inflammation.  For example, if someone has inflammation due to a gut infection or eating gluten, then taking a turmeric supplement isn’t the solution.  That being said, sometimes supplementation can help, and I’ll add that having healthy vitamin D levels are essential.

3. Determine if insulin resistance and/or estrogen metabolism are problems, and if so, address them.  I won’t get into detail with these here, as I’ve written separate articles on insulin resistance and estrogen metabolism, and you also might want to check out this video on estrogen metabolism.

4. Consider an iodine deficiency. This is especially true if someone has non-autoimmune hypothyroidism or multinodular goiter. If testing for iodine I would recommend urinary iodine testing.

What’s Your Experience With Thyroid Swelling?

Have you dealt with a goiter, or do you currently have one?  And if so, what have you done to try to address the cause of it?  Please feel free to share your experience with everyone in the comments below.  Thank you for sharing!

2020 was a tough year for many people, but many still have a lot to be grateful for, and I wanted to list some of the things I’m grateful for:

• Another year of serving people with thyroid and autoimmune thyroid conditions
• Connecting more with my followers in 2020 through online challenges and Facebook (through my new Facebook group and Facebook lives)
• Myself and my immediate family staying healthy
• Having regular Zoom meetings with my father and sisters

I know we still have over a month to go until the New Year, but I want to let you know that I look forward to continuing to serve you in 2021!

Happy Thanksgiving!!!

I was doing some recent research and came across a journal article entitled “Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?“.  Even before finding this article I realized that there was a relationship between the gut and thyroid health, but it was nice to see a published journal article discussing this.  So I’d like to go ahead and summarize the relationship between the thyroid and the gut based on the information in this recent journal article.

In the introduction the authors mention how an impaired microbiota can lead to the development of autoimmune conditions, including Graves’ disease and Hashimoto’s.  They remind us that thyroid autoimmunity likely develops due to the combination of genetics, immune impairment, and environmental factors such as nutrient deficiencies and the gut microbiota.  They end the introduction by mentioning that patients often report changes in their quality of life and thyroid function in relation to dietary changes.  This of course is true, although as I’ve mentioned in previous blog posts, there can be other factors as well.

Intestinal Influences on the Thyroid

The next section starts off by discussing how the gut microbiota modulates both the innate and adaptive immune system, and how it is fundamental in the development of gut-associated lymphatic tissue (GALT). You might have heard that most of the immune system cells are located in the gut, and this article reinforces this, mentioning that more than 70% of the entire immune system is situated in the GALT. It adds that the GALT plays an important role in the development of tolerance to self-antigens.  For more information on immune tolerance you can check out my article entitled ” Thyroid Autoimmunity and Loss of Self Tolerance “.

What You Need To Know About Butyrate and Thyroid Health

In past articles I’ve discussed the importance of regulatory T cells (Tregs), and how these help to keep autoimmunity in check. As a result, you want to have an abundance of Tregs, and the journal article mentions that there is a positive correlation between butyrate and the number of Tregs.  Butyrate is a short chain fatty acid, and the authors also mention how it can help to strengthen intracellular tight junctions together with thyroid hormones.  In other words, butyrate can increase Tregs AND help to maintain the integrity of the gut barrier. I briefly spoke about butyrate in an article entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and SCFA”.

Next they discussed how an alteration in the composition of intestinal bacteria, an increase in intestinal permeability (leaky gut), and a shift to proinflammatory cells are some of the ways the gut microbiota impacts the thyroid.  They also mentioned another study where the authors found that intestinal dysbiosis (imbalance of the gut flora) and bacterial overgrowth was more common in those with hypothyroidism/Hashimoto’s when compared to a euthyroid group (1). I will say that it’s possible that bacterial overgrowth can be a consequence of hypothyroidism. In other words, while intestinal dysbiosis might be a factor in the development of Hashimoto’s (and Graves’ disease), hypothyroidism can lead to altered GI motility, which in turn can lead to small intestinal bacterial overgrowth (2).

Celiac Disease, NCWS, and Thyroid Autoimmunity

The authors then went on to discuss how there is a higher prevalence of thyroid autoimmunity in both Celiac Disease and Non-Celiac Wheat Sensitivity (NCWS).  As for why this is the case, they brought up different possible mechanisms, including 1) shared cytokines, 2) cross-reaction of antibodies (molecular mimicry), malabsorption of micronutrients essential for thyroid health, and 4) increased intestinal permeability.

Nutrient Deficiencies and Thyroid Health

Next they discussed how the microbiota influences the uptake of minerals that play an important role in thyroid health.  This includes iodine, selenium, zinc, and iron.  They also mention how Lactobacillus and Bifidobacterium species are decreased in those with Hashimoto’s thyroiditis and Graves’ disease, and this can also have an effect on the minerals.  This is yet another reason to eat probiotic-rich foods and perhaps consider taking a probiotic supplement.

Speaking of probiotics, the authors discuss how probiotics can help support thyroid health.  They specifically mentioned a study in mice that showed that supplementing with Lactobacillus reuteri resulted in an increase in free T4, and another animal study which showed that supplementing with probiotics increased T3 and T4 (3).  I’m sure there might be a few people with hyperthyroidism/Graves’ disease who are wondering if they should avoid probiotics, and all I can say is that I’ve worked with many hyperthyroid patients over the years, I commonly recommend probiotic supplements, and I don’t recall anyone’s hyperthyroidism worsening by supplementing with probiotics.

The authors brought up another study looking at the influence of Lactobacilli and Bifidobacterium species on thyroid hormone replacement…specifically levothyroxine.  They found a significantly lower adjustment requirement of T4 in the study compared to the control group, reasoning that microbiota modification increases the availability of levothyroxine and stabilizes thyroid function. They also concluded that probiotics can play a role in lowering serum hormone fluctuations, and mentioned how probiotics seem to be able to accumulate trace elements such as selenium, zinc, and copper, and incorporate them into organic compounds.

Bariatic Surgery and Thyroid Health

The article also discussed how bariatric surgery can potentially affect the thyroid.  Bariatric surgery is considered for some people who are obese, as it can result in substantial weight loss. In this journal article they discussed a meta-analysis that showed a significant decrease in the TSH, free T3 and total T3 in obese patients after receiving bariatric surgery, but it didn’t affect the free T4 or total T4 (4).  They also said that subclinical hypothyroidism was completely resolved in 87% of Roux-en-Y gastric bypass (RYGB) patients one year after surgery.  Other studies observed an improvement in hypothyroidism in around 35% of patients and resolution in about 15% (5).

Thyroid Cancer, Nodules, and the Gut Microbiota

The final section discusses the relationship between the gut microbiota and thyroid cancer.  They start off by mentioning how those people with thyroid cancer and thyroid nodules present with higher microbial richness and distinct composition compared to the healthy control group, which suggests that imbalances in the gut microbiota is correlated with thyroid cancer and nodules. They then mention that in thyroid cancer there are higher levels of Clostridiaceae, Neisseria, and Streptococcus, while in thyroid nodules there are increases in Streptococcus and Neisseria when compared to healthy control groups (6).  So while in past articles and blog posts I’ve discussed the role of insulin resistance and estrogen metabolism in thyroid nodules, a healthy gut can also play a role.

Then they mentioned how Lactobacillus is significantly decreased in those with thyroid cancer and nodules.  They remind the reader how Lactobacillus is important for the utilization of trace elements such as selenium, which plays an important role in thyroid health. While most probiotic supplements include Lactobacillus, unfortunately no specific species or strains of Lactobacillus was mentioned in the study.

So hopefully you understand how a compromised gut can have a negative effect on thyroid health.  In the past I’ve mentioned numerous times how a leaky gut is part of the triad of autoimmunity, but this journal article gave a much more comprehensive overview of how problems with the gut can affect thyroid health.  Here is a summary of some of the key points included in this journal article:

• More than 70% of the entire immune system is located in the gut-associated lymphatic tissue (GALT)
• An impaired microbiota can lead to the development of autoimmune conditions, including Graves’ disease and Hashimoto’s
• Butyrate can increase Tregs AND help to maintain the integrity of the gut barrier
• Intestinal dysbiosis and bacterial overgrowth was more common in those with hypothyroidism/Hashimoto’s
• There is a higher prevalence of thyroid autoimmunity in both Celiac Disease and Non-Celiac Wheat Sensitivity (NCWS).
• The microbiota influences the uptake of minerals that play an important role in thyroid health, including iodine, selenium, zinc, and iron
• Probiotics can support thyroid health
• A meta-analysis that showed a significant decrease in the TSH, free T3 and total T3 in obese patients after receiving bariatric surgery
• Imbalances in the gut microbiota is correlated with thyroid cancer and nodules

If you have Graves’ disease or Hashimoto’s thyroiditis, and if you want to do more than just manage your thyroid symptoms, then you might be interested in joining our 21-Day Overcoming Graves’ Disease and Hashimoto’s Challenge (starts November 2nd!):

The 21-day challenge will include the following…

Component #1: Daily Overcoming Graves’ Disease and Hashimoto’s Video Lesson

During this daily 20-30 minute recorded lesson I will focus on a different topic that is essential to overcoming your autoimmune thyroid condition. There will be one lesson every day for 21 consecutive days (although a few lessons include multiple videos). If you’re interested in the specific topics that will be presented please check out the video where I discuss the 21-day challenge calendar (the website link is below).

Component #2: Daily 30-45 minute live group coaching session

The live group coaching calls will take place on Zoom, which is very easy to use on computers, mobile phones, and tablets. And if you are unable to attend live you’ll have the opportunity to email your questions during the separate Q & A sessions (discussed below). For those who choose to join live, the way it works is that I’ll send you a link to join the call, and if you are using a mobile phone or tablet you’ll need to install the free app. I will record every coaching session and post the recordings in a private membership area for those who are unable to attend live. As for the time of the coaching sessions, I will rotate them to accommodate those in different time zones. Most of the live calls will take place either 1pm or 8:30pm Eastern time (New York time zone).

Component #3: Recording of each coaching call for those who are unable to attend live

I hope most people will be able to attend at least 2 or 3 live sessions per week, although I’ll add that with my last two challenges there were participants who didn’t attend the live calls, but simply watched the recordings and emailed their questions for me to answer during the Q and A sessions (discussed below).

Component #4: Daily priority action step

I want people to take action, but I want the action steps to be attainable, which is why there will be a single priority action step each day, although at times there will be one or two additional action steps that aren’t as urgent.

Component #5: Access to a private members-only group

We want you to build relationships with one another and enjoy this challenge together. One way we accomplished this in previous challenges was through the live coaching calls, but another way was through the private members-only communities we had. Since not everyone wants to be on Facebook we initially hosted the group on a platform called Kajabi, and while we did have a lot of people participate, we realized that there are some limitations to Kajabi. So for second challenge I had two private members-only groups…one in Kajabi, and one in Facebook, and it worked out well. And so you can join either one of these groups, or both if you’d like! In our last challenge we had in June approximately 100 people joined the Facebook group and around 25 people joined the Kajabi group. I’ll pop into these groups every now and then, but I plan on having my nutritional health coaches moderate the groups.

Component #6: Weekly 90 minute live Q & A session

Although I’ll be answering some questions during the daily coaching calls, these will be around 45 minutes, and I will focus on answering live questions. But there will also be three separate live Q & A sessions (one per week) during the 21-day challenge. These will be at least 90 minutes long, although with both of my longer challenges I exceeded two hours with each of the Q & A sessions, as my goal is to answer ALL questions! I’ll once again rotate the day and times to accommodate those in different time zones, and so they will either be at 12pm, 1pm ET or 8pm ET. However, unlike the daily coaching calls, if you are unable to attend any of the Q & A sessions live you can email your questions ahead of time.

You Get All of This For A Single Payment of $49

If you watch the video on top of the registration page (the link is below) you’ll see dozens of people rave about my challenges, and I think it’s safe to say that just about everyone easily got back their investment.  I do want to mention that this past summer I had a 5-day challenge, but the testimonials on the website are from participants of my two longer challenges.

Optional Upgrade: 45-minute one-on-one diet and lifestyle call with a certified nutritional health coach

Both of my nutritional health coaches are excellent, and I thought it was important to include an option for affordable one-on-one support with all of the stress everyone is dealing with, although I’m confident the daily group coaching calls will also help with this. You have the option of doing this over the phone or through Skype/Zoom. If you listen to some of the video testimonials from members of the past challenges you’ll hear some rave reviews about the diet and lifestyle call! And so if it’s in your budget I’d highly recommend taking advantage of it for the discounted rate of $50. But if not you still will receive a ton of value from the rest of the challenge.

For more information on the 21-day challenge visit the link below:

www.ThyroidHealthChallenge.com/Enroll2020

Since 2009 I have had a practice that focuses on thyroid and autoimmune thyroid conditions, and while I do work with people who have non-autoimmune thyroid conditions (i.e. toxic multinodular goiter), most people I work with have Graves’ disease or Hashimoto’s thyroiditis.  Some people have the antibodies for both Graves’ disease and Hashimoto’s.  Every now and then someone will ask what the difference is between these two conditions, and so I figured I’d put together a blog post that discusses the similarities and difference between Graves’ disease and Hashimoto’s.

Let’s first start out by discussing the differences between these two conditions:

What Are The Differences Between Graves’ Disease and Hashimoto’s?

1. They involve different autoantibodies.  Those with Graves’ disease have elevated thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody.  Hashimoto’s thyroiditis is usually diagnosed when someone has an elevated thyroid stimulating hormone (TSH) in the presence of thyroid peroxidase and/or anti-thyroglobulin antibodies.  However, it’s worth mentioning that many people with Graves’ disease also have elevated TPO antibodies, and some people have all three of these thyroid antibodies.

2. Hashimoto’s involves damage to the thyroid gland.  Whereas Graves’ disease involves the thyroid stimulating immunoglobulins binding to the TSH receptors without causing permanent damage, this isn’t the case with Hashimoto’s.  In Hashimoto’s there is damage to the thyroid gland.  And while the thyroid gland can regenerate, it does so slowly, and sometimes the damage is so extensive that the person needs to remain on thyroid hormone replacement.  Keep in mind that it can take many years before there is sufficient damage to the thyroid gland that results in an elevated TSH and thyroid hormones that are out of range.

3. Graves’ disease involves hyperthyroidism, and Hashimoto’s involves hypothyroidism.  The truth is that not everyone with Hashimoto’s experiences overt hypothyroidism, as many times it’s subclinical.  In other words, they might have an elevated TSH with the thyroid hormone levels within the lab reference range.  It’s also important to mention that some people with Hashimoto’s experience hyperthyroidism due to Hashitoxicosis.  On the other hand, most people with Graves’ disease will experience overt hyperthyroidism, although there are exceptions.

4. The symptom management differs.  Because most people with Graves’ disease experience overt hyperthyroidism, most endocrinologists will recommend antithyroid medication (i.e. methimazole, PTU) to their patients.  Of course many will recommend radioactive iodine or thyroid surgery.  With Hashimoto’s, thyroid hormone replacement is commonly recommended.  This is true even if the thyroid hormone levels are looking good, as many medical doctors will go by the TSH alone.

5. Unmanaged hyperthyroidism is arguably a greater risk than unmanaged hypothyroidism.  The truth is that there are risks of both unmanaged hyperthyroidism and hypothyroidism.  But arguably unmanaged hyperthyroidism is a greater risk, as it can lead to heart arrhythmias, decreased bone density, and in rare cases thyroid storm, which is a life threatening situation.  On the other hand, myxedema is a severe form of hypothyroidism that can be life threatening, although it’s very rare.

6. The autoimmune triggers can differ.  While there is an overlap of certain triggers, there can also be different triggers for different autoimmune condition.  For example, while stress can be a factor with both Graves’ disease and Hashimoto’s, in the research it shows that it’s a greater factor with Graves’ disease.  And while there is a case report suggesting that Blastocystis Hominis might be a trigger of Hashimoto’s, nothing in the research suggests that it’s a potential trigger of Graves’ disease.

What Are The Similarities Between Graves’ Disease and Hashimoto’s?

So now that you know some of the differences between Graves’ disease and Hashimoto’s, let’s take a look at some of the differences:

1. They are both autoimmune thyroid conditions.  Both Graves’ disease and Hashimoto’s are autoimmune conditions that affect the thyroid gland.

2. Most medical doctors don’t do anything to address the underlying cause of either condition.  Every medical doctor knows that Graves’ disease and Hashimoto’s are autoimmune conditions, yet they never do anything to address the autoimmune component.  Of course this comes down to their training in medical school, and fortunately some medical doctors are open minded enough to look into underlying causes, although not nearly enough.

3. It’s possible to reverse the autoimmune component.  Although there are genetic factors behind autoimmune conditions, it still is possible to reverse the autoimmune component of both Graves’ disease and Hashimoto’s.  This admittedly isn’t easy to do, as one needs to find and remove the autoimmune triggers, and since a leaky gut is a factor with autoimmunity it is also necessary to heal the gut.