There are several different types of thyroid disease, including hyperthyroidism, hypothyroidism, thyroiditis and Hashimoto’s thyroiditis.

1. therapeutic diet

2. Thyroid disease
Mr. Abdilahi Hassan Abdilahi
BSc. CE, BSc. HN, PGD-PM, MSc. PHN
Cellphone: +252-(63)-4407722
Lecturer, Department of Human Nutrition

3. Thyroid Gland
• The thyroid gland is a 2-inch butterfly-shaped organ
located at the front of the neck. Though the thyroid is
small, it’s a major gland in the endocrine system and
affects nearly every organ in the body.
• It regulates fat and carbohydrate metabolism, respiration,
body temperature, brain development, cholesterol levels,
the heart and nervous system, blood calcium levels,
menstrual cycles, skin integrity,
• Your thyroid creates and produces hormones that play a
role in many different systems throughout your body.
• When your thyroid makes either too much or too little of
these important hormones, it’s called a thyroid disease.
• There are several different types of thyroid disease,
including hyperthyroidism, hypothyroidism, thyroiditis
and Hashimoto’s thyroiditis.
Mr. Abdilahi Hassan

4. Thyroid Gland
 Second largest endocrine gland in body
 Thyroid is controlled by the hypothalmus and pituitary.
 The most common thyroid condition is hypothyroidism, or
underactive thyroid. In the United States, hypothyroidism
usually is caused by an autoimmune response known as
Hashimoto’s disease or autoimmune thyroiditis.
 This chronic attack eventually prevents the thyroid from
releasing adequate levels of the hormones T3 and T4, which are
necessary to keep the body functioning properly.
 The lack of these hormones can slow down metabolism and
cause weight gain, fatigue, dry skin and hair, and difficulty
concentrating.
Mr. Abdilahi Hassan

5. Typical Thyroid Hormone Levels
in Thyroid Disease
TSH T₄ T₃
Hypothyroidism High Low Low
Hyperthyroidism Low High High
• Measurement of the total plasma hormone
concentration may not provide an accurate
assessment of thyroid gland activity because total
hormone concentration is affected by changes in
either the amount of thyroxine-binding globulin
(TBG) or the affinity of hormones to TBG in plasma.
Mr. Abdilahi Hassan

6. Thyrotoxicosis
• Thyrotoxicosis - clinical state that results from
inappropriately high thyroid hormone action in tissues
generally due to inappropriately high tissue thyroid
hormone levels.
Mr. Abdilahi Hassan

7. Parathyroid glands
• 4 small glands, positioned on the back of the
thyroid gland
• Different roles from the thyroid gland:
– Glands release PTH (parathyroid hormone – also known
as parathormone)
• PTH controls calcium and phosphate
homeostasis
• PTH has opposite effects to calcitonin:
–PTH causes osteoclasts to break down and
release calcium = increasing blood calcium levels
– Increases gastrointestinal absorption of calcium Mr. Abdilahi Hassan

8. T4 to T3 conversion
• Thyroid produces both T4 and T3
–T4 is produced in significantly greater quantities compared to T3
–Up to 80% of the T4 is converted in the body to T3
–T3 is more biologically active than T4
• Conversion by other organs: liver, kidney, spleen and thyroid
•It is possible to have normal levels of T4 and low levels of
active T3 (with low or high TSH)
• ‘Free’ T4 and T3 have been transported to tissues and
cleaved from their protein carriers
Mr. Abdilahi Hassan

9. Synthesis of T4 and T3 hormones
• T3 and T4 required for thyroid function
• Tyrosine and iodine are required for synthesis of T3 and T4
• Ensure adequate tyrosine and iodine in the diet
Iodin
e
Tyrosin
e
Mr. Abdilahi Hassan

10. Tyrosine
• Amino acid
• Rich food sources – eggs, cheese, turkey
• Can be synthesised in the body from phenylalanine
(food sources - chicken, fish, cheese, beans, etc)
Tyrosine
Mr. Abdilahi Hassan

11. Tyrosine supplements
• To support synthesis of T4 and T3
• Used in the body to produce noradrenalin and dopamine,
anti-stress
• 500 – 1000 mg (3 x per day) 30 mins – 1hr before food
• Do not take if you have manic symptoms or high blood
pressure
• Do not take alongside prescription thyroid medication
•Note: tyrosine supplements can cause digestive discomfort
and migraines in some individuals Mr. Abdilahi Hassan

12. Iodine
• Trace element
• Rich food sources include seaweed, fish, seafood and eggs
• Follicles in the thyroid gland absorb iodine
• Thyroglobulin (Tg) is a protein produced by the thyroid gland
which stores iodine
Iodin
e
Mr. Abdilahi Hassan

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14. Functions
 Stimulates & maintains metabolic
processes
 Produces thyroid hormones T3-
triiodothyronine and T4-thyroxine
– Growth & development
– Metabolism
– Body temperature
– Heart rate
 These hormones regulate metabolism & affect
the growth and function of other systems in the
body
 Parathyroid gland secretes PTH to raise
serum calcium levels Mr. Abdilahi Hassan

15. Testing for Thyroid Disease
• First, your doctor will do a physical exam, looking for signs
such as lumpiness in the gland, hair loss, brittle nails, and
dry skin, then will check your heart rate and probably
perform an electrocardiogram (ECG).
• Additionally, your doctor will draw some blood for
laboratory testing. The most useful test will evaluate your
levels of TSH, the hormone that stimulates thyroid
function.
• Your doctor may also measure your levels of thyroid
hormones, such as T3 (triiodothyronine) and T4
(thyroxine), which will help determine what type of
thyroid disease you have.
• Imaging studies of the thyroid gland may be ordered, and
ultrasound is often used to visualize abnormalities of the
thyroid, such as a Goiter (lump).
Mr. Abdilahi Hassan

16. Causes Thyroid Disease
Conditions that can cause
hypothyroidism include:
• Thyroiditis: This condition is an inflammation
(swelling) of the thyroid gland. Thyroiditis can
lower the amount of hormones your thyroid
produces.
• Hashimoto’s thyroiditis: A painless disease,
Hashimoto’s thyroiditis is an autoimmune
condition where the body’s cells attack and
damage the thyroid. This is an inherited
condition.
• Postpartum thyroiditis: This condition occurs in
5% to 9% of women after childbirth. It’s usually
a temporary condition.
• Iodine deficiency: Iodine is used by the thyroid
to produce hormones. An iodine deficiency is
an issue that affects several million people
around the world..
• A non-functioning thyroid gland: Sometimes,
the thyroid gland doesn’t work correctly from
birth. This affects about 1 in 4,000 newborns. If
left untreated, the child could have both
physical and mental issues in the future. All
newborns are given a screening blood test in
the hospital to check their thyroid function.
Conditions that can cause
hyperthyroidism include:
• Graves’ disease: In this condition the entire
thyroid gland might be overactive and
produce too much hormone. This problem is
also called diffuse toxic goiter (enlarged
thyroid gland).
• Nodules: Hyperthyroidism can be caused by
nodules that are overactive within the
thyroid. A single nodule is called toxic
autonomously functioning thyroid nodule,
while a gland with several nodules is called a
toxic multi-nodular goiter.
• Thyroiditis: This disorder can be either
painful or not felt at all. In thyroiditis, the
thyroid releases hormones that were stored
there. This can last for a few weeks or
months.
• Excessive iodine: When you have too much
iodine (the mineral that is used to make
thyroid hormones) in your body, the thyroid
makes more thyroid hormones than it needs.
Excessive iodine can be found in some
medications (amiodarone, a heart
medication) and cough syrups.
Mr. Abdilahi Hassan

17. A higher risk of developing thyroid
disease if person have diabetes
• If person have diabetes and get a positive thyroid
test, there are a few things to person can do to
help feel the best possible. These tips include:
– Getting enough sleep.
– Exercising regularly.
– Watching his/her diet.
– Taking all of his/her medications as directed.
– Getting tested regularly as directed by his/her
healthcare provider.
Mr. Abdilahi Hassan

18. common symptoms can happen
with thyroid disease
Symptoms of an overactive
thyroid (hyperthyroidism) can
include:
• Experiencing anxiety, irritability
and nervousness.
• Having trouble sleeping.
• Losing weight.
• Having an enlarged thyroid gland
or a goiter.
• Having muscle weakness and
tremors.
• Experiencing irregular menstrual
periods or having your menstrual
cycle stop.
• Feeling sensitive to heat.
• Having vision problems or eye
irritation.
Symptoms of an underactive
thyroid (hypothyroidism) can
include:
• Feeling tired (fatigue).
• Gaining weight.
• Experiencing forgetfulness.
• Having frequent and heavy
menstrual periods.
• Having dry and coarse hair.
• Having a hoarse voice.
• Experiencing an intolerance to
cold temperatures.
Mr. Abdilahi Hassan

19. The specific kinds of thyroid
disorders
There are specific kinds of thyroid disorders
that includes:
1. Hypothyroidism
2. Hyperthyroidism
3. Goiter
4. Thyroid nodules
5. Thyroid cancer
Mr. Abdilahi Hassan

20. Hypothyroidism
• Hypothyroidism results from the thyroid gland producing
an insufficient amount of thyroid hormone. It can develop
from problems within the thyroid gland, pituitary gland, or
hypothalamus.
• Symptoms of hypothyroidism can include:
1. Fatigue
2. Poor concentration or feeling mentally "foggy"
3. Dry skin
4. Constipation
5. Feeling cold
6. Fluid retention
7. Muscle and joint aches
8. Depression
9. Prolonged or excessive menstrual bleeding in women
Mr. Abdilahi Hassan

21. Hyperthyroidism
• Hyperthyroidism describes excessive production of thyroid
hormone, a less common condition than hypothyroidism.
Symptoms of hypothyroidism usually relate to increased
metabolism. In mild cases, there may not be apparent
symptoms.
• Symptoms and signs of hyperthyroidism can include:
1. Tremor
2. Nervousness
3. Fast heart rate
4. Fatigue
5. Intolerance for heat
6. Increase in bowel movements
7. Increased sweating
8. Concentration problems
9. Unintentional weight loss
Mr. Abdilahi Hassan

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23. Micronutrients
• Selenium
– Helps to regulate T4 to T3 conversion
– May reduce inflammation
• Zinc
– Deficiency associated with hypothyroidism
• Iron
– Consider malabsorption
– Required for T4 and T3 production
– Possible toxicity
• Copper
– Required for hypothalamus
– To be balanced with zinc
Mr. Abdilahi Hassan

24. Antioxidants
• Antioxidants to reduce oxidative stress
• Reduce thyroid cell damage
• Selenium
• Vitamin E
Mr. Abdilahi Hassan

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27. IODINE NUTRITION DURING PREGNANCY
1. Women of childbearing age ; average iodine intake 150 g/d.
• pregnancy and breastfeeding women should increase intake to 250 g
2. Iodine intake during pregnancy and breastfeeding should not exceed
twice the daily recommended nutritional intake for iodine,
• i.e. 500 g iodine per day
3. To assess the adequacy of the iodine intake during pregnancy in a
population, urinary iodine concentration should be measured in a cohort
of the population.
a) Urinary iodine concentration should ideally range between 150 and
250 g/liter.
4. To reach the daily recommended nutrient intake for iodine, multiple
means must be considered, tailored to the iodine intake level in a
given population.
I. countries with iodine sufficiency and/or with a well established
universal salt iodization (USI) program,
II. countries without a USI program or an established USI program where
the coverage is known to be only partial, and finally
III. remote areas with no accessible USI program and difficult
socioeconomic conditions. Mr. Abdilahi Hassan

28. Maternal Risks
• Heart failure
• Thyroid storm
• Miscarriages
• Growth restriction
• Preterm labour
• Placental abruption
• PIH, preclampsia
• Infection
• Increased risk of congenital anomalies
Mr. Abdilahi Hassan

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31. Key Nutrients
• Many nutritional factors play a role in
optimizing thyroid function. However, both
nutrient deficiencies and excesses can trigger
or exacerbate symptoms.
• Working in collaboration with a physician is
ideal to determine nutritional status for
optimal thyroid health.
• Iodine, Vitamin D, Selenium, Vitamin B12, and
Goitrogens.
Mr. Abdilahi Hassan

32. Iodine
• Iodine is a vital nutrient in the body and essential
to thyroid function; thyroid hormones are
comprised of iodine. While autoimmune disease
is the primary cause of thyroid dysfunction in the
United States, iodine deficiency is the main cause
worldwide.
• Iodine deficiency has been considered rare in the
United States since the 1920s, largely due to the
widespread use of iodized salt. This, along with
fish, dairy, and grains, is a major source of iodine
in the standard American diet.
Mr. Abdilahi Hassan

33. Vitamin D
• Vitamin D deficiency is linked to Hashimoto’s, according to
one study showing that more than 90% of patients studied
were deficient. However, it’s unclear whether the low
vitamin D levels were the direct cause of Hashimoto’s or
the result of the disease process itself.
• Foods that contain some vitamin D include fatty fish, milk,
dairy, eggs, and mushrooms. Sunlight also is a potential
source, but the amount of vitamin production depends on
the season and latitude.
• If clients have low vitamin D levels, supplemental D3 may
be necessary, and the client’s physician should monitor
progress to ensure the individual’s levels stay within an
appropriate range.
Mr. Abdilahi Hassan

34. Selenium
• The highest concentration of selenium is found in the
thyroid gland, and it’s been shown to be a necessary
component of enzymes integral to thyroid function.
• Selenium is an essential trace mineral and has been shown
to have a profound effect on the immune system,
cognitive function, fertility in both men and women, and
mortality rate.
• Conversely, an excessive intake of selenium can cause
gastrointestinal distress or even raise the risk of type 2
diabetes and cancer. So clients will benefit from having
their selenium levels tested and incorporating healthful,
selenium-rich foods in to their diets, such as Brazil nuts,
tuna, crab, and lobster.
Mr. Abdilahi Hassan

35. Vitamin B12
• Studies have shown that about 30% of people with
ATD experience a vitamin B12 deficiency.
• Food sources of B12 include mollusks, sardines,
salmon, organ meats such as liver, muscle meat, and
dairy.
• Vegan sources include fortified cereals and
nutritional yeast.
• Severe B12 deficiency can be irreversible, so it’s
important for dietitians to suggest clients with
thyroid disease have their levels tested.
Mr. Abdilahi Hassan

36. Goitrogens
• Cruciferous vegetables such as broccoli, cauliflower, and
cabbage naturally release a compound called goitrin when
they’re hydrolyzed, or broken down.
• Goitrin can interfere with the synthesis of thyroid
hormones. However, this is usually a concern only when
coupled with an iodine deficiency. Heating cruciferous
vegetables denatures much or all of this potential
goitrogenic effect.
• The potential exception is millet, a nutritious gluten-free
grain, which may suppress thyroid function even in people
with adequate iodine intake.
• If a dietary recall indicates frequent millet consumption in
patients with hypothyroidism, it may be wise to suggest
they choose a different grain.
Mr. Abdilahi Hassan

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40. Foods, Supplements, and Medication
Interactions
• When it comes to thyroid medications, it’s important for
RDs to know the medications can interact with common
nutritional supplements.
• Calcium supplements have the potential to interfere with
proper absorption of thyroid medications, so patients
must consider the timing when taking both.
• Studies recommend spacing calcium supplements and
thyroid medications by at least four hours.
• Coffee and fiber supplements lower the absorption of
thyroid medication, so patients should take them one hour
apart.
• Dietitians should confirm whether clients have received
and are adhering to these guidelines for optimal health.
Mr. Abdilahi Hassan

41. Lifestyle for thyroid health
• Moderate exercise is key
• Too much intense exercise can
compromise function of thyroid gland,
making weight loss very difficult
• Recovery and rest required
• Stress relief
• Adequate sleep supports recovery
Mr. Abdilahi Hassan

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