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Goitrogens & Goitrogen Clarity

goiter
goiter

Feel like you need a refresher on goiter and goitrogen, or feel like you did not have enough information in the first place? It is so important to know all that you can, to help your thyroid and improve your health. Let’s dive into it right now…

What is a goiter?

A goiter is a diffuse, even enlargement of the thyroid gland. As you might be able to notice from the image above, sometimes goiters can be quite large and noticeable.

A goiter is an enlargement of the thyroid. It is a more diffused enlargement that is causing actual pressure upon the gland and the structures around it. It can effect:

  • Breathing
  • Swallowing
  • Circulation

They can also be quite large, or they can be barely noticeable. Most importantly, a goiter is not the same as a nodule. They are distinct in that they are a different density of tissue and are categorized based on size.

There are three distinct classes of goiter:

  1. One that can be felt with palpation (feeling the neck) or via ultrasound but not noticeable.
  2. Noticeable by palpation and also visible.
  3. Very large and creates pressure behind the thyroid itself. There are often marks that are formed from that and causes changes in swallowing and speaking.

The general idea behind a goiter is that it is formed by some combination of inflammation and an exaggerated growth signal. Inflammation just means that something is irritating the thyroid tissue.

The growth signal in the cycle is that there is thyroid stimulating hormone (TSH) that is made to help the thyroid produce hormone so when the gland has a low point of this activity the body makes more thyroid stimulating hormone, TSH, to stimulate the gland and what that does is causes the cells of the gland to divide. So, the gland actually gets larger.

Goiters have a way of finding themselves in large populations (1), and it really highlights this potential danger of “eating local,” let’s call it. Depending on where you live, your food might lack iodine fortification – this is especially prevalent if you live in a city far away from the ocean. Foods that are rich in iodine do not grow as generously, and they can simply be harder to find.

Take the “Goiter Belt” for instance. This was an area around the Great Lakes where children who were iodine deficient actually had started developing goiters (2). It was all due to the fact that what they were eating did not contain iodine, due to their geographical location and the scarce availability of food that was fortified with iodine.

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What’s the problem with goiters?

A goiter is a large amount of swelling in a vital area of the body, so it makes sense that it’s not only uncomfortable to look at, but it definitely hurts. It can also make it difficult to speak or swallow, as well. Worst of all, they can also hide and contain thyroid cancer.

Bottom Line: Goiters are no fun to have at all! They can hurt, they can make normal tasks uncomfortable, and they could also lead to cancers down the road.

What causes goiters?

The two most common causes of goiters in the modern world is Hashimoto’s disease. In areas that do not have iodine fortification, the main cause is iodine deficiency. Paradoxically, too much iodine is one of the main causes of Hashimoto’s.

We need about 100-300 mcg of iodine per day. If we get well under 50, there are higher rates of goiter. When we get much over 300, we also see more goiters and more Hashimoto’s.

Foods cause goiters because they change iodine absorption. So if the population is lower in iodine and they are lacking it or are on the border anything that impairs its absorption will cause a few more people to become deficient.

In the United States, Hashimoto’s thyroiditis is the most common cause of goiters (3). Also, Graves’ disease and toxic nodular goiter can be a cause, too.

Key Insight: Iodine deficiency is nowadays more of a problem for the developing parts of the world, as it relates to goiters, and is more about Hashimoto’s in the developed parts of the globe.

This is the overall paradox when it comes to thinking about iodine in our systems. In order to cure our iodine deficiency, in the 1920’s, foods were fortified with iodine. The problem is that this led us to uncovering Hashimoto’s – which is now the most common way that we developed the goiters we thought we got rid of by treating our iodine deficiency.

Iodine: too little is bad, and so is too much, and even a responsible change can be dangerous for certain segments of the population. That balance is so delicate, and it is just as important that we keep this in mind moving forward.

So, what is a goitrogen?

A goitrogen, very simply, is anything that can worsen the growth of goiters.

There is some discussion about the concept of anti-goitrogens, but right now they are more theoretical than practical. They might include:

  • Statins – with no overall benefit, it’s best to avoid these (4)
  • Casein – the effects are small, and it might have an adverse effect on those with thyroid disease (5)
  • Vitamin E, C and beta-carotene – a good idea for your diet, and a little bit in multivitamins (6)

Back to goitrogens, though, so what do they do exactly? They can:

  • Block iodine absorption
  • Raise TSH levels
  • Increase thyroid autoimmunity

Generally, goitrogens are worse in areas with a selenium deficiency, as well.

Bottom Line: Goitrogens can trigger and cause goiters to grow. They do this by blocking iodine absorption, raising our TSH levels and increasing our thyroid autoimmunity. Want to avoid goiters? Avoid goitrogens.

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Where can I find goitrogens?

There are various sources where we can find goitrogens, so let’s dive deep and figure out where we can find them:

Chemicals

There are two distinct chemicals where we can find goitrogens:

  • Perchlorate – found in soil and some foods, and
  • Thiocyanates – found in tobacco
dirt
medication

Medications

There are also medications which can be goitrogenic, such as:

  • Amiodarone – a high concentrate of iodine, and a huge host of side effects
  • Lithium – blocks thyroid hormones
  • Phenytoin, Carbamazepine, Rifampin – all shown to have effects acting as goitrogens in the body

What types of foods have goitrogens?

This comes down to one big question that I hear time and time again: can I eat broccoli? That’s something that we will definitely come to, but we have to cover a few more things before we can get there.

Isoflavones

An important term that I want you to know is isoflavones (7). This is something we can find mostly in unfermented soy foods, like:

  • Tofu
  • Soy protein powder
  • Texturized vegetable protein (TVP)
  • Soy milk

Isoflavones work primarily in worsening thyroid autoimmunity. They are not so much dealing with iodine absorption, as they are with this autoimmunity problem. That is especially important when we think about Hashimoto’s disease.

But what else do they do?

Here is where we have to introduce a little wrinkle. It is that soy foods actually can benefit our bodies, overall. Soy foods have shown that they can lower our risk of:

  • Mortality (8)
  • Cancer – specifically breast cancer (9)
  • Heart disease (10)

So, what do you do?

Well, you take action steps! There are three things I want you to focus on when it comes to the potentially dangerous goitrogens in soy products, while balancing out the positive effects that they can have on your body overall:

  1. Avoid at the same time that you are taking thyroid medications
  2. Avoid GMO soy, unfermented soy products and soy supplements
  3. Go with non-GMO, fermented, organic soy – like miso, wheat-free tamari, tempeh and natto (seriously fermented, with serious flavor!)

Isothiocyanates

cabagge leaves

This is going to be the next big category of food-based goitrogens. These are the ones that you might be able to find in broccoli, so if you have been waiting for me to cover this topic, here it comes. Isothiocyanates can actually be found in all cruciferous vegetables and those in the genus brassica.

This covers quite a lot of foods, for example:

  • Arugula
  • Broccoli
  • Broccoli sprouts
  • Broccolini
  • Cabbage
  • Canola
  • Cauliflower
  • Chinese cabbage
  • Collard greens
  • Horseradish
  • Kale
  • Kohlrabi
  • Mustard greens
  • Radishes
  • Rapini
  • Rutabagas
  • Turnips
  • Watercress

We can find it in so many foods, but how does it work? Isothiocyanates do work by slowing down iodine absorption, and they are actually inactivated by cooking.

What else do they do?

They actually have been shown to fight most hormonal cancers – like breast and prostate (11). They are also excellent, overall, for detoxing your body.

So what do you do?

If you have Hashimoto’s disease, and goiters, I would not eat more than a pound of these foods a day raw. Cooked is harmless, in any quantity, so we want to make sure that we are keeping an eye only on the raw types of these foods that we are putting into our bodies. Apart from having an actual goiter, it is not a problem to have any of these raw, either.

Key Insight: 1 pound of these types of vegetables is a lot, but we do not want to push it. Make sure you are always adding some variety into your diet, and embrace the concept of cooking (as opposed to always enjoying things raw).

The broccoli, the cabbage, the strawberries, the kale, the spinach, the cauliflower, collard greens, turnips, radishes – these are such good foods. The exact same parts of those foods that make them healthy make them goitrogenic with iodine deficiency, but they are actually healthy for those with Hashimoto’s. Those are the same compounds that help detoxify.

If you take people with Hashimoto’s they have a gene defect which makes it harder for them to detoxify. They can not get waste out of their body the same as someone else would and they need the support of foods like broccoli and kale and spinach. Cooking does neutralize many of these properties but honestly, you do not have to worry about that even. If someone does have Hashimoto’s and they are on thyroid treatment they are fine to have those foods. They do not need to be restricted from these healthy foods.

Goitrogenic Flavonoids/Flavones

There is not a lot of relevance to foods which have these goitrogenic flavones and flavonoids because we eat them anyways, but this is a comprehensive guide so it is important that we know about them too.

These actually work by blocking the formation of thyroid hormones by inhibiting thyroid peroxidase (TPO). We can find them in foods like:

  • Sweet potatoes
  • Pears
  • Cassava
  • Pine nuts
  • Flax seeds
  • Lima beans
  • Millet
  • Strawberries
  • Spinach
  • Bamboo shoots
sweet potato
seeds

With these foods, they are either infrequent enough (or exotic enough) that we will not find them as often in our diets, or they are processed in a way which no longer makes them threatening, or they are not present enough (in quantity) in our diets for them to pose a real threat to our health.

The only special case we have is millet. The amount is relevant, even in cooked forms, and it can vary wildly from batch to batch. If you have had it before, though, that is really not too much of a problem.

Dealing with Goiters

There was a young man I saw who was in his late teens or early twenties and he became an advocate for a rather extreme raw food diet. Over the course of probably six months, he shifted his diet to contain nothing but raw produce. Not even vegetarian or vegan, raw produce only.

Specifically, he was making smoothies with a couple pounds of broccoli. Now that would not make the best smoothie. He would do that and do it with cabbage and carrots also and that was pretty much how he lived. So he had no iodized salt, no seafood, no dairy foods. Not a lot of other sources of produce but large amounts of goitrogenic vegetables. He did develop a rather subtle stage-one goiter and he also developed early hyperthyroidism.

His father brought him into to see me because his father thought that he was getting lethargic and that he was seeming run down. Perhaps his hair was thinning. His father was just suspecting anemia and I was, as well.

Lo and behold, the boy was anemic and he also was developing hyperthyroidism without a clear autoimmune component. So the radically complicated treatment I encouraged was for him to start eating again – in order to get a bigger variety of foods.

Getting some sources of iodine and over the course of the next month or so allowed his thyroid function to correct itself and go back to normal. It stayed that way and I still watch every year or so and he has remained healthy. That was one case I have seen where goitrogen actually mattered.

When we think about goiters, though, make sure that you are always aware of the structure of your thyroid (12). Personally, I think this is something that is too often neglected in medicine. We need to have a really good understanding of our thyroid, and that comes from examining our thyroid in all sorts of ways.

TSH and Goiters

TSH means Thyroid Stimulating Hormone and it does just that. It stimulates the thyroid by making it grow more cells. Imagine that the goiter in your thyroid is a weed in your garden. TSH is like Miracle Grow.

The lower it is, the less apt goiters are to grow. If it is too low, it causes other problems. Most adults under 65 can be healthy with TSH scores as low as 0.5. The higher it gets over 2, the more likely it is to stimulate the goiter.

If you feel like you have anything that looks, or feels, the least bit unusual. Make sure that you seek help today. Get an ultrasound, and don’t guess – test! A structurally healthy thyroid is often a functionally healthy thyroid, and it can go so far to benefit our overall health. You need to feel good about your thyroid to feel good overall.

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If you are not sure about the state of your thyroid, take the quiz today and find out more about your overall health and what you can do to lead a better life today.

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Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet.

Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, cure diabetes, and regain energy. Learn more about the surprising story that started his quest.

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