TIM SKWIAT, Pn2

2
 14 FOODS THAT
BOOST YOUR
THYROID
The thyroid gland is often referred to as the body’s “master controller,” as it is responsible
for regulating nearly every major metabolic function in the body. It controls metabolic rate,
the building of new proteins, sensitivity to other hormones, and much more.

The thyroid gland produces hormones that are responsible for a wide range of functions
and have connections with virtually every other system and organ in the body. In fact,
every cell in the body has receptors for thyroid hormone.

Perhaps the most important function of the thyroid is its responsibility to set the body’s
metabolic rate. It dictates how many calories you burn for every physiologic, metabolic,
and physical task. In addition to being one of the master controllers of metabolism and
calorie burning, the thyroid contributes to mental and emotional well being, influences
cognitive function, and even impacts sexual desire and function.

As you can imagine, insufficient thyroid function can have a negative impact on nearly
every aspect of health. Just check out the laundry list of symptoms associated with low
thyroid function:1,2

• Fatigue
• Lethargy
• Depressed mood
• Weight gain
• Difficulty losing weight
• Forgetfulness
• Difficulty with concentration and focus

3
 • Constipation
• Muscle cramping or discomfort
• Joint discomfort
• Feeling cold
• Lightheadedness
• Dry hair and skin
• Hair loss
• And more

Simply put, the thyroid is not a gland to be taken lightly.

Factors Influencing Thyroid Function

From a nutrition standpoint, there are a number of key nutrients essential supporting
optimal thyroid health and function:

• Iodine
• Iron
• Magnesium
• Selenium
• Zinc
• Vitamin A
• Vitamin B12
• Omega-3 fatty acids

For example, iodine is one of two fundamental building blocks of thyroid hormone, and
minerals like iron, zinc, and selenium play key roles in helping the body convert inactive
thyroid hormone (T4) into its active state (T3). A deficiency in any one of these minerals
can result in reduced levels of metabolically active thyroid hormone.

In addition to the key nutrients that support thyroid health, there is also a crucial connection
between gut health and thyroid function. In fact, as early as the 1920s, doctors posited
that gut dysbiosis impaired thyroid function.3 Imagine that; even though it seems probiotics
and gut health have just recently gained the attention they deserve, the notion that the
microbiome impacts thyroid has been around for nearly 100 years!

4
While there are myriad ways that the gut may influence thyroid function, one interesting
fact is that healthy gut bacteria aids in the conversion of the inactive form of thyroid
hormone (T4) into its metabolically active form (T3). In fact, approximately 20% of
the body’s T4 is converted to T3 in the digestive tract via an enzyme called intestinal
sulfatase, which is produced by the healthy bacteria that reside in the gut.4

Another way that gut dysbiosis negatively affects thyroid function is through a
compound called lipopolysaccharide (LPS), which is a component of the cell walls of
the “bad” bacteria that reside in the gut.5 LPS is considered an endotoxin, and there are
a number of potential negative health outcomes associated with excess levels of LPS,
including detrimental effects on thyroid. Specifically, LPS has been shown to reduce
levels of thyroid stimulating hormone (TSH), which communicates to the thyroid gland to
produce thyroid hormone (T4).6,7

What’s more, LPS has been shown to reduce the activity of the enzymes responsible
for converting T4 to T3, decreasing the amount of active thyroid hormone.8 But that’s
not all. LPS also acts on receptor sites for thyroid hormone, reducing the activity of
receptors and preventing uptake of thyroid hormone into the cells.9

With all of that in mind, gut health and the gut microbiome are of tremendous
importance for optimal thyroid function. Gut dysbiosis, which refers to an unhealthy
imbalance of bacteria in the gut flora characterized by excessive levels of “bad” bacteria
and inadequate amounts of “good” bacteria, means you’ll have fewer healthy bacteria
(which help with conversion) and excessive levels of the endotoxin LPS.

Food for Thought

The good news is that there are a number of foods that can help boost thyroid function,
but before delving into them, it’s worth pointing out a handful of dietary and lifestyle
factors that can negatively impact thyroid function.

While it still masquerades as a “health food,” soy has been linked to a number of health
concerns, including thyroid dysfunction. Soy contains estrogenic anti-thyroid compounds
called isoflavones—which are natural pesticides that cause insects to become sterile—
that can have a goitrogenic effect, disrupting the production of thyroid hormone by

5
inhibiting thyroid uptake of iodine and reducing activity of the enzyme involved in thyroid
hormone formation.10,11

While gluten may not be the devil that some make it out to be, several studies have
found a strong connection to thyroid dysfunction and gluten intolerance, fortifying
the connection to gut health.12–14 In one study published in the American Journal of
Gastroenterology, researchers found that gluten intolerant participants who followed
a gluten-free diet for one year improved thyroid function.15 That’s right, avoidance of
gluten may single-handedly boost thyroid function in some folks.

The research from Dr. Alessio Fasano, one of the world’s leading researchers and experts
in the area of gluten sensitivity, has also shown that gluten contributes to intestinal
permeability, more commonly known as “leaky gut”; in fact, Dr. Fasano’s work has shown
that, after gluten exposure, intestinal permeability increases in all individuals—not just
those with gluten sensitivity.16 Gluten is one of the most potent stimuli that can trigger the
body to release a protein called zonulin, which “loosens” the normally “tight” junctions of
the cells that line the intestinal tract.17 This increase in intestinal permeability can lead to
undigested proteins entering the blood stream, triggering an immune response from the
body that may be associated with thyroid dysfunction.18

Again, this is not to say that everyone has to avoid gluten-containing foods or other
plant-based foods with similar hard-to-digest proteins (e.g., prolamins, glycoproteins).
However, this is something to consider for folks who may be having difficulty optimizing
thyroid function.

While soy and gluten may be two common offenders, the fact of the matter is that any
food sensitivity could potentially contribute to thyroid dysfunction through activation of
the immune system and unhealthy levels of inflammation. While not everyone has food
sensitivities, there are some probable suspects, including grains (e.g., wheat), soy, dairy,
shellfish, FODMAP-containing foods, nightshades, and histamine-containing foods.

As mentioned above, this does not mean that everyone needs to avoid these foods.
Rather, this is simply meant to raise awareness that a variety of foods—even foods that
are frequently viewed as healthy—may be an issue for some folks. While consuming
a diet of whole, minimally-processed foods is a huge step in the right direction, a more

6
personalized approach may be necessary for some people, and that involves identifying
and eliminating suspect foods.

When it comes to artificial sweeteners, what good news have you heard about them
recently? At a recent meeting of the American Association of Clinical Endocrinologists,
researchers recommended that folks avoid artificial sweeteners to support thyroid
health. They found that a group of individuals who regularly consumed the equivalent of
3 ½ packets of artificial sweeteners per day showed signs of impaired thyroid function.19
It may sound counter to your weight loss goals, but one surefire way to run your thyroid
into the ground is by going on a crash diet, which includes very-low-calorie diets as
well as certain “detoxes” and “cleanses.” These “quick fix” approaches, which involve
dramatic calorie restriction, can reduce thyroid hormone levels by a whopping 66%.20

Additionally, stress can have a negative impact on thyroid health in a number of
different ways. For example, stress hormones suppress thyroid function and prevent
the release of thyroid stimulating hormone (TSH), which provides the signal to the
thyroid gland to produce thyroid hormones.21 What’s more, stress hormones may also
prevent the conversion of the inactive form of thyroid hormone (T4) to its metabolically
active form (T3).22

Finally, before delving into a list of foods that can help support thyroid health and
function, it’s important to remind you that if you are at risk for or being treated for a
thyroid condition, please talk to your doctor before making any changes to your diet.

Sea Vegetables
Iodine is a fundamental building block in
the production of thyroid hormone, and if
you don’t have enough in your diet, thyroid
function will be compromised. Iodine
deficiency is one of the leading causes of
thyroid dysfunction.23 Approximately 40%
of the world’s population is at risk for iodine
deficiency.

7
In fact, once researchers recognized this, health authorities began adding iodine to table
salt (i.e., iodized salt). However, you don’t have to rely on fortified foods like iodized salt
to support optimal levels of iodine. Sea vegetables, like kelp, nori, kombu, wakame, are
the richest sources of iodine.

With that being said, it’s important to be careful when it comes to iodine consumption;
just as a deficiency can have negative consequences, too much can as well. Iodine
can reduce the activity of an enzyme called thyroid peroxidase (TPO), which is required
for proper thyroid production.24 What’s interesting to note is that excess iodine intake
only seems to be problematic when it’s accompanied by too little selenium, another key
micronutrient for thyroid health and function. Speaking of selenium…

Brazil Nuts
As mentioned above, selenium is another
key nutrient that plays a protective role
in supporting thyroid function. Selenium
concentration in the thyroid gland is
higher than in any other organ in the
body, and like iodine, selenium has
important functions in thyroid hormone
synthesis and metabolism.

Selenium is essential for the conversion of the inactive form of thyroid hormone (T4) to
the active form (T3), and research has shown a linear correlation between the T3/T4 ratio
and selenium status.25 In other words, folks with lower concentrations of selenium have
relatively lower levels of metabolically active thyroid hormone, and researchers have
concluded that reduced conversion (of T4 to T3) is related to impaired selenium levels.

In addition to offsetting potential negative consequences of excess iodine intake, studies

also show that selenium reduces anti-thyroid antibodies.24,26,27 The presence of elevated
levels of anti-thyroid antibodies often suggests thyroid dysfunction.

Brazil nuts are a particularly rich source of selenium, and research has shown that
Brazil nuts are more effective than supplements at raising blood levels of selenium.28

8
But Brazil nuts aren’t a one-trick pony, as they are also a good source of magnesium
and copper, two additional thyroid support nutrients.

That being said, it’s important to not go “nuts” on Brazil nuts. According to the Institute
of Medicine, the tolerable upper intake level (UL) (i.e., the highest level of intake that is
known to avoid toxicity) for selenium is 400µcg per day.29 On average, Brazil nuts have
544 mcg selenium per ounce, but studies indicate that the selenium content may vary
widely depending on country of origin, cultivation methods, etc. With that in mind, a
good starting point for most folks would be to consume 2 – 3 Brazil nuts per day.

Wild Salmon
Vitamin D deficiency is a pandemic, and it’s
estimated that over a billion people worldwide
are vitamin D deficient or insufficient.30 This has
TREMENDOUS health consequences, as the
role and benefits of vitamin D far surpass healthy
bones, which has traditionally been cited as the
primary function of the “sunshine vitamin.”

The active form of vitamin D actually functions as a hormone, and along those lines,
vitamin D is much more than an essential vitamin: it’s a prohormone.31 Nearly every
tissue in the body has a vitamin D receptor, including cells of the pancreas, immune
system, skin, stomach, colon, and you guessed it, the thyroid gland.32,33 With that in
mind, it shouldn’t come as much of a surprise that inadequate levels of vitamin D have
been linked to insufficient thyroid function.34

The body naturally produces vitamin D in the skin when it’s exposed to ultraviolet B
(UVB) radiation from sunlight. This is why it’s so important to get plenty of sunshine.
Unfortunately, most people don’t get nearly enough sunshine (with their bare skin
exposed), and what’s more, there are a number of factors that can dramatically reduce
the amount of the sun’s UVB rays that enter the earth’s atmosphere, including:

• Earlier and later times of the day

• During most of the day during the winter

9
 • Higher latitudes (i.e., the further you are from the equator)

With that in mind, it’s crucial to ensure adequate vitamin D consumption through
dietary and supplemental sources. The best dietary sources of vitamin D are fatty fish,
especially wild salmon, which also happens to be a good source of iodine. What’s
more, wild salmon contains omega-3 fats, which help support optimal thyroid function
both directly (e.g., enhancement of thyroid action) and indirectly (e.g., promoting a
healthy inflammatory response and enhancing immunity).35,36

Eggs
Just like wild salmon, eggs are one of the few good
dietary sources of vitamin D, but that’s not all. Eggs
are a very good source of two more important nutrients
for optimal thyroid function: selenium and iodine. Just
three eggs provide 84% of recommended daily values
for selenium, 54% for iodine, and 33% for vitamin D.

What’s more, when you choose pasture-raised eggs (which are laid by hens that get to
spend their days outside on fresh pastures—not cooped up in small cages or huddled
by the thousands in cage-free barns), you’ll get the added benefit of eggs higher in the
same omega-3 fats found in wild salmon, which both directly and indirectly support
thyroid function.

Research from Mother Earth News demonstrated that eggs from pasture-raised hens
provide a significantly improved nutrition profile compared to standard store-bought
eggs, including 2 TIMES more omega-3 fatty acids.37 In the same series of studies, the
researchers found that pasture-raised eggs contained SIX times more vitamin D than
traditional eggs.

Even more, while all eggs are a good source of vitamin A, pasture-raised eggs contain
over 67% more compared to conventional eggs. Vitamin A has been shown to regulate
thyroid hormone metabolism and promote healthy levels of thyroid-stimulating hormone
(TSH), which, when produced in excess, can be a sign of thyroid dysfunction.

10
In a randomized, double-blind, placebo-controlled study published in The Journal of the
American College of Nutrition, researchers from Iran found that supplementation with
vitamin A for 4 months normalized TSH levels and significantly increased T3 (the active
thyroid hormone) in healthy normal weight and obese women.38

There’s still more, as eggs are a very good source of B12, and research has shown a strong
link between B12 deficiency and inadequate thyroid function. In one study, researchers
found that 58% of B12 deficient participants who were given B12 shots monthly noticed
significant improvements in symptoms associated with thyroid dysfunction.39

You may have heard of eggs garnering the title of “the perfect food,” and there are a
number of reasons why, including their potential to support optimal thyroid function.

Sesame Seeds
Sesame seeds are packed with essential nutrients
that support healthy thyroid function. They are an
excellent source of copper and a good source of iron,
and inadequate levels of both copper and iron have
been linked to low concentrations of active thyroid
hormone, T3.40,41

In one study published in The Journal of Nutrition

and Biochemistry, researchers found that copper
deficiency resulted in reduced T3, lower body temperatures, and elevated TSH in rats,
suggesting that copper deficiency interferes with thyroid hormone metabolism.42

Iron also plays an intricate role in thyroid function, and deficiencies in iron impair the
body’s ability to make thyroid hormone by reducing the activity of TPO (remember, that’s
one of the enzymes required for optimal thyroid production).43 Randomized control trials
have shown that providing iodine plus iron results in greater improvements in thyroid
function than iodine alone, demonstrating the significance of adequate iron intake for
optimal thyroid health.44

Sesame seeds are also a good source of zinc, which plays an important role in the

11
conversion of the inactive form of thyroid hormone (T4) to T3, the metabolically active
form. Just like selenium, deficiencies in zinc can slow down the body’s conversion. In
fact, research has shown that zinc deficiency can decrease activity of the enzymes that
convert T4 to T3 by as much as 67%.45 That could mean running on only one-third of
your thyroid potential!

Pumpkin Seeds
Like sesame seeds, pumpkin seeds are a rich
source of micronutrients that play a key role in
thyroid health and thyroid hormone conversion.
Pumpkin seeds are a very good source of
copper, providing 48% of the recommended daily
intake in just a half-cup serving. What’s more,
pumpkin seeds are also a good source of both
zinc and iron, providing 23% and 16% of the daily
recommended intake, respectively, per half-cup.

Pumpkin seeds are also a very good source of magnesium, providing 48% of the
recommended daily intake in a half-cup serving. Magnesium, which is involved in over 300
enzymatic reactions in the body, joins minerals like copper and zinc in the conversion of
the inactive form of thyroid hormone (T4) into its metabolically active form (T3). Research
has shown that the conversion of T4 to T3 is inhibited by low levels of magnesium.46 What’s
more, experimental studies have shown that diets deficient in magnesium are associated
with “leaky gut” and gut dysbiosis.47 Are you starting to see a trend yet?

Grass-Fed Beef
Beef from pasture-raised cattle is packed with nutrients
that help support healthy thyroid function. In fact,
grass-fed beef is a very good source of:
• Vitamin B12
• Omega-3 fatty acids
• Selenium
• Zinc

12
What’s more, a 3-ounce serving of beef is also a good source of iron, providing 16% of
the recommended daily value. While many foods in the diet contain iron, it is not always
easily absorbed depending on the source. For instance, iron from plant-based foods
(i.e., non-heme iron) is not well absorbed. On the other hand, heme iron, which is found
in beef and other animal-based foods, is much more readily absorbed. Not only that,
combining sources of heme iron with non-heme iron (e.g., beef plus veggies) increases
the amount of non-heme iron absorbed.48 This is often referred to as the “meat factor” of
iron absorption.

Your best bet is to invest in the best beef that you are able to fit into your budget. In a
recent systemic review and meta-analysis published in the British Journal of Nutrition,
a group of researchers critically analyzed data from 67 different studies comparing
the composition of organic (i.e., grass-fed, pasture-raised) and non-organic (i.e.,
conventional) meat products. They found that the beef from pasture-raised animals
contained 47% more omega-3 fatty acids than conventional meat products.49

In addition to a much healthier omega-3 fatty acid profile, research also shows that
grass-fed beef is one of the best dietary sources of conjugated linoleic acid (CLA), as it
contains an average of 2 to 3 times more CLA than conventional beef.50 CLA possesses
antioxidant activity, and research has shown it to reduce body fat, increase lean body
mass, and improve body composition.51

This is a good reminder that you are what you eat ate.

Spinach
It seems like the word “superfood” gets thrown around a lot,
leading you to believe that there are single foods that can
make or break your health and fitness goals. The truth is that
there is no “magic bullet,” and deep health is the by-product
of choosing high-quality, nutritious foods in appropriate
amounts, creating a positive food environment, engaging
in regular physical activity, practicing stress management,
optimizing sleep hygiene and quality, adequately hydrating,
and building and maintaining healthy relationships.

13
Indeed, there are a number of “Big Rocks” that go into the jar of getting (and staying)
lean and healthy, and certainly one of those is regularly and consistently eating
wholesome and nutritious foods. So while the promise of superfoods may be a little
far-fetched, the guidance to eat more nutrient dense foods is not, and when it comes to
foods with a high nutrient density, spinach has got to be near the top of the list.

Just a single cup of cooked spinach is an excellent source of the following nutrients
that have all been shown to support thyroid health and function (percentage of daily
recommended intake):

• Vitamin A (105%)
• Magnesium (39%)
• Iron (36%)
• Copper (34%)
• Zinc (12%)

As mentioned above, combining iron from animal sources (i.e., heme iron) with that
from plant-based sources (i.e., non-heme iron) can increase the amount of non-heme
iron that the body absorbs. In addition, vitamin C has also been shown to facilitate the
absorption of non-heme iron by the body when the two are combined.52 Guess what?
Spinach is also an excellent source of vitamin C, providing 24% of the recommended
daily intake in just a single cup of cooked spinach.

It is worth noting that spinach contains goitrogens, which are naturally-occurring

substances found in a variety of foods (including broccoli, cauliflower, kale, and other
cruciferous vegetables) that may affect thyroid function by blocking the uptake of iodine
by the thyroid gland or by interfering with the activity of TPO. Thus, excessive intake of
goitrogens may potentially be problematic, particularly in folks who are iodine deficient.

For otherwise healthy folks, however, this does not seem to pose an issue. When
nutrient-dense foods like spinach are consumed in moderate quantities, they indeed
support thyroid function, as spinach is such a dense source of so many nutrients that
promote thyroid health. It may also be worth mentioning that goitrogenic substances are
heat-sensitive, and they are inactivated by cooking.

14
Scallops & Shrimp
These two foods from the sea are excellent sources of a number of key nutrients
involved in thyroid health and function. For example, a 4-ounce serving of shrimp packs
the following (percentage of daily recommended intake):

• Selenium (102%)
• Vitamin B12 (78%)
• Copper (32%)
• Iodine (31%)
• Zinc (17%)
• Vitamin A (11%)

What’s more, shrimp are also a good source of omega-3 fats, which, as previously
mentioned, have both a direct and indirect impact on thyroid function. Shrimp cocktail,
anyone? Yes, please!

Besides sea vegetables, scallops are the next richest whole food source of iodine,
providing 90% of the recommended daily intake in a 4-ounce serving. What’s more,
scallops also contain a number of other nutrients involved in optimizing thyroid function:

• Vitamin B12 (102%)

• Selenium (45%)
• Zinc (16%)
• Magnesium (10%)

If you needed any additional

reasons to include these
delicious foods in your diet,
you can add thyroid support
to the list!

15
Cashews
Besides sesame seeds,
cashews are the next best whole
food source of copper, providing
98% of the recommended
intake in a quarter cup serving.
Cashews are also a good
source of both magnesium and
zinc, providing 29% and 21% of
the recommended daily intake,
respectively, per quarter cup
serving.

Fermented Foods: Kombucha, Greek Yogurt &

Sauerkraut

Last on the list, but certainly not least, are fermented foods.
As mentioned in the introduction, gut health and the gut
microbiome can play a tremendous role in thyroid health,
and gut dysbiosis (i.e., a lack of healthy bacteria) can have
wide-ranging negative effects on thyroid function. This is why
it’s very important to support gut and thyroid health by eating
plenty of probiotic-rich foods, and three of the top options are
kombucha tea, sauerkraut (and other fermented vegetables),
and Greek yogurt (and other fermented dairy, like kefir).

In one study published in the Journal of Obesity & Weight

Loss Therapy, researchers from Massachusetts Institute
of Technology (MIT) and Harvard found that administering
probiotics from the Lactobacillus family to mice significantly
improved thyroid function. In fact, based on the data they
collected, the researchers concluded that “beneficial bacteria
stimulate youthful thyroid gland activity.”53

16
Kombucha tea is a great source of lactic acid bacteria (i.e., Lactobacillus probiotics),
and so too are both Greek yogurt and sauerkraut. In addition, kombucha is a good
source of vitamin B12, and research has shown that it has antibacterial and antioxidant
activity, and it may also help support the immune system.54–56

In addition to being a great source of probiotics, Greek yogurt is also a very good source
of two more thyroid support nutrients: iodine and vitamin B12. Greek yogurt also
contains a unique protein called lactoferrin, which has immunity optimizing properties
and anti-microbial activity.57 In one randomized double-blind, placebo-controlled trial,
researchers found that athletes consuming lactoferrin-rich colostrum (i.e., milk) for two
weeks significantly reduced intestinal permeability.58

When choosing Greek yogurt (and other dairy), it’s a good idea to opt for organic. In a
recent systemic review and meta-analysis published in the British Journal of Nutrition,
researchers reviewed the results of 170 published studies comparing the nutrient
composition of organic (i.e., grass-fed, pasture-raised) to conventional (i.e., grain/
commodity-fed) dairy.59 Compared to conventional dairy, the researchers found that
dairy from pasture-raised cows was 56% higher in omega-3 fats (EPA, DHA, DPA),
which help promote a healthy inflammatory response and support thyroid health and
function. What’s more, organic dairy contained 69% more conjugated linoleic acid,
which, as previously mentioned, has been shown to preferentially modulate body
composition, enhance immunity, and promote a healthy inflammatory response.60

In addition, fermented foods like these that provide beneficial bacteria (i.e., probiotics)
support both gut and thyroid health by defending against gut dysbiosis and restoring
the symbiosis (“mutually beneficial relationship between two different organisms living
in close approximation”) between humans and gut microbes. In other words, humans
have evolved intimate symbiotic relationships with gut microbes. In fact, human beings
can be considered “superorganisms” as a result of their close symbiotic associations
with the gut microbiota. Optimal human health and homeostasis revolves heavily on this
symbiotic relationship, which entails maintaining a healthy balance of bacteria in the gut.

Remember that compound LPS that was discussed in the introduction? As a brief
refresher, LPS is an endotoxin released by the “bad” bacteria that reside in the gut, and
it has been shown to reduce levels of thyroid stimulating hormone (TSH), reduce the

17
activity of the enzymes responsible for converting T4 to T3, and reduce the activity of
thyroid hormone receptors, preventing uptake of thyroid hormone into the cells.

The good news is that a number of studies, including randomized control trials, have
shown that probiotics significantly decrease LPS concentrations in the gut.61,62 There’s
more good news. Research has also shown that probiotics, from both the Lactobacillus
and Bifidobacterium families, help prevent intestinal permeability (i.e., “leaky gut”).62
Healthy gut bacteria also support thyroid function through the production of compounds
called short-chain fatty acids (SFCA), which are produced when healthy microbes
ferment indigestible fibers (i.e., prebiotic fibers). SFCA not only serve as fuel for the
immune cells lining the gut, they also increase the expression of thyroid receptors.63,64

Remember, if you are at risk for or being treated for a thyroid condition, it’s important
that you talk to your doctor before making any changes to your diet.

18
 References:
1. Khandelwal D, Tandon N. Overt and subclinical hypothyroidism: who to treat and
how. Drugs. 2012;72(1):17-33. doi:10.2165/11598070-000000000-00000.
2. Roberts CGP, Ladenson PW. Hypothyroidism. Lancet Lond Engl.
2004;363(9411):793-803. doi:10.1016/S0140-6736(04)15696-1.
3. Harries DJ. THE INFLUENCE OF INTESTINAL BACTERIA UPON THE THYROID
GLAND. Br Med J. 1923;1(3248):553-555.
4. de Herder WW, Hazenberg MP, Pennock-Schröder AM, Oosterlaken AC, Rutgers
M, Visser TJ. On the enterohepatic cycle of triiodothyronine in rats; importance
of the intestinal microflora. Life Sci. 1989;45(9):849-856. doi:10.1016/0024-
3205(89)90179-3.
5. Hurley JC. Endotoxemia: methods of detection and clinical correlates. Clin
Microbiol Rev. 1995;8(2):268-292.
6. Iaglova NV, Berezov TT. [Regulation of thyroid and pituitary functions by
lipopolysaccharide]. Biomedit︠ s︡ inskai︠ a︡ Khimii︠ a︡ . 2010;56(2):179-186.
7. Kondo K, Harbuz MS, Levy A, Lightman SL. Inhibition of the hypothalamic-
pituitary-thyroid axis in response to lipopolysaccharide is independent of changes
in circulating corticosteroids. Neuroimmunomodulation. 1997;4(4):188-194.
8. Yu J. Regulation of Hepatocyte Thyroxine 5’-Deiodinase by T3 and Nuclear
Receptor Coactivators as a Model of the Sick Euthyroid Syndrome. J Biol Chem.
2000;275(49):38296-38301. doi:10.1074/jbc.M004866200.
9. Beigneux AP, Moser AH, Shigenaga JK, Grunfeld C, Feingold KR. Sick euthyroid
syndrome is associated with decreased TR expression and DNA binding in mouse
liver. Am J Physiol - Endocrinol Metab. 2003;284(1):E228-E236. doi:10.1152/
ajpendo.00155.2002.
10. Divi RL, Chang HC, Doerge DR. Anti-thyroid isoflavones from soybean:
isolation, characterization, and mechanisms of action. Biochem Pharmacol.
1997;54(10):1087-1096.
11. Doerge DR, Sheehan DM. Goitrogenic and estrogenic activity of soy isoflavones.
Environ Health Perspect. 2002;110 Suppl 3:349-353.
12. Akçay MN, Akçay G. The presence of the antigliadin antibodies in autoimmune

19
 thyroid diseases. Hepatogastroenterology. 2003;50 Suppl 2:cclxxix - cclxxx.
13. Sategna-Guidetti C, Bruno M, Mazza E, et al. Autoimmune thyroid diseases and
coeliac disease. Eur J Gastroenterol Hepatol. 1998;10(11):927-931.
14. Hakanen M, Luotola K, Salmi J, Laippala P, Kaukinen K, Collin P. Clinical and
subclinical autoimmune thyroid disease in adult celiac disease. Dig Dis Sci.
2001;46(12):2631-2635.
15. Sategna-Guidetti C, Volta U, Ciacci C, et al. Prevalence of thyroid disorders in
untreated adult celiac disease patients and effect of gluten withdrawal: an Italian
multicenter study. Am J Gastroenterol. 2001;96(3):751-757. doi:10.1111/j.1572-
0241.2001.03617.x.
16. Hollon J, Puppa E, Greenwald B, Goldberg E, Guerrerio A, Fasano A. Effect of
Gliadin on Permeability of Intestinal Biopsy Explants from Celiac Disease Patients
and Patients with Non-Celiac Gluten Sensitivity. Nutrients. 2015;7(3):1565-1576.
doi:10.3390/nu7031565.
17. Fasano A. Zonulin, regulation of tight junctions, and autoimmune diseases:
Zonulin, regulation of tight junctions. Ann N Y Acad Sci. 2012;1258(1):25-33.
doi:10.1111/j.1749-6632.2012.06538.x.
18. Arrieta MC. Alterations in intestinal permeability. Gut. 2006;55(10):1512-1520.
doi:10.1136/gut.2005.085373.
19. Otto A. AACE: Artificial sweeteners tentatively linked to Hashimoto’s thyroiditis. Clin
Endocrinol News. May 2015. http://www.clinicalendocrinologynews.com/specialty-
focus/pituitary-thyroid-adrenal-disorders/single-article-page/aace-artificial-
sweeteners-tentatively-linked-to-hashimotos-thyroiditis/94dfc3288e204a4cadc5856
dd1861095.html.
20. Wadden TA, Mason G, Foster GD, Stunkard AJ, Prange AJ. Effects of a very low
calorie diet on weight, thyroid hormones and mood. Int J Obes. 1990;14(3):249-
258.
21. Samuels MH. Effects of variations in physiological cortisol levels on thyrotropin
secretion in subjects with adrenal insufficiency: a clinical research center study. J
Clin Endocrinol Metab. 2000;85(4):1388-1393. doi:10.1210/jcem.85.4.6540.
22. Van der Geyten S. Developmentally defined regulation of thyroid hormone
metabolism by glucocorticoids in the rat. J Endocrinol. 2005;185(2):327-336.
doi:10.1677/joe.1.05974.
23. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160
sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the

20
 Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2163-2196.
doi:10.1016/S0140-6736(12)61729-2.
24. Xu J, Liu X-L, Yang X-F, Guo H-L, Zhao L-N, Sun X-F. Supplemental selenium
alleviates the toxic effects of excessive iodine on thyroid. Biol Trace Elem Res.
2011;141(1-3):110-118. doi:10.1007/s12011-010-8728-8.
25. Olivieri O, Girelli D, Stanzial AM, Rossi L, Bassi A, Corrocher R. Selenium, zinc,
and thyroid hormones in healthy subjects: low T3/T4 ratio in the elderly is related
to impaired selenium status. Biol Trace Elem Res. 1996;51(1):31-41. doi:10.1007/
BF02790145.
26. Xue H, Wang W, Li Y, et al. Selenium upregulates CD4(+)CD25(+) regulatory T
cells in iodine-induced autoimmune thyroiditis model of NOD.H-2(h4) mice. Endocr
J. 2010;57(7):595-601.
27. Drutel A, Archambeaud F, Caron P. Selenium and the thyroid gland: more good
news for clinicians. Clin Endocrinol (Oxf). 2013;78(2):155-164. doi:10.1111/
cen.12066.
28. Thomson CD, Chisholm A, McLachlan SK, Campbell JM. Brazil nuts: an effective
way to improve selenium status. Am J Clin Nutr. 2008;87(2):379-384.
29. Institute of Medicine (U.S.), ed. Dietary Reference Intakes for Vitamin C, Vitamin
E, Selenium, and Carotenoids: A Report of the Panel on Dietary Antioxidants and
Related Compounds, Subcommittees on Upper Reference Levels of Nutrients
and of Interpretation and Use of Dietary Reference Intakes, and the Standing
Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and
Nutrition Board, Institute of Medicine. Washington, D.C: National Academy Press;
2000.
30. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health
consequences. Am J Clin Nutr. 2008;87(4):1080S - 6S.
31. Thacher TD, Clarke BL. Vitamin D Insufficiency. Mayo Clin Proc. 2011;86(1):50-60.
doi:10.4065/mcp.2010.0567.
32. DeLuca HF. Overview of general physiologic features and functions of vitamin D.
Am J Clin Nutr. 2004;80(6 Suppl):1689S - 96S.
33. Holick MF, ed. Vitamin D: Physiology, Molecular Biology, and Clinical Applications.
Second edition. New York: Humana Press; 2013.
34. Mackawy AMH, Al-Ayed BM, Al-Rashidi BM. Vitamin d deficiency and its
association with thyroid disease. Int J Health Sci. 2013;7(3):267-275.
35. Souza LL, Nunes MO, Paula GSM, et al. Effects of dietary fish oil on thyroid

21
 hormone signaling in the liver. J Nutr Biochem. 2010;21(10):935-940. doi:10.1016/j.
jnutbio.2009.07.008.
36. Kidd P. Th1/Th2 balance: the hypothesis, its limitations, and implications for health
and disease. Altern Med Rev J Clin Ther. 2003;8(3):223-246.
37. Long C, Alterman T. Meet Real Free-Range Eggs. Mother Earth News. November
2007. http://www.motherearthnews.com/real-food/free-range-eggs-zmaz07onzgoe.
aspx.
38. Farhangi MA, Keshavarz SA, Eshraghian M, Ostadrahimi A, Saboor-Yaraghi AA.
The effect of vitamin A supplementation on thyroid function in premenopausal
women. J Am Coll Nutr. 2012;31(4):268-274.
39. Jabbar A, Yawar A, Waseem S, et al. Vitamin B12 deficiency common in primary
hypothyroidism. JPMA J Pak Med Assoc. 2008;58(5):258-261.
40. Olin KL, Walter RM, Keen CL. Copper deficiency affects selenoglutathione
peroxidase and selenodeiodinase activities and antioxidant defense in weanling
rats. Am J Clin Nutr. 1994;59(3):654-658.
41. Beard JL, Brigham DE, Kelley SK, Green MH. Plasma thyroid hormone kinetics are
altered in iron-deficient rats. J Nutr. 1998;128(8):1401-1408.
42. Lukaski HC, Hall CB, Marchello MJ. Body temperature and thyroid hormone
metabolism of copper-deficient rats. J Nutr Biochem. 1995;6(8):445-451.
doi:10.1016/0955-2863(95)00062-5.
43. Zimmermann MB, Köhrle J. The impact of iron and selenium deficiencies on iodine
and thyroid metabolism: biochemistry and relevance to public health. Thyroid Off J
Am Thyroid Assoc. 2002;12(10):867-878. doi:10.1089/105072502761016494.
44. Hess SY. The impact of common micronutrient deficiencies on iodine and thyroid
metabolism: the evidence from human studies. Best Pract Res Clin Endocrinol
Metab. 2010;24(1):117-132. doi:10.1016/j.beem.2009.08.012.
45. Kralik A, Eder K, Kirchgessner M. Influence of zinc and selenium deficiency
on parameters relating to thyroid hormone metabolism. Horm Metab Res
Horm Stoffwechselforschung Horm Métabolisme. 1996;28(5):223-226.
doi:10.1055/s-2007-979169.
46. Kobayashi S, Gao Y, Pittman CS. The substrate specificity, tissue specificity and
regulation of the 5’ deiodination systems in rat liver and kidney tissues. Endocrinol
Jpn. 1985;32(6):781-792.
47. Pachikian BD, Neyrinck AM, Deldicque L, et al. Changes in intestinal bifidobacteria
levels are associated with the inflammatory response in magnesium-deficient mice.

22
 J Nutr. 2010;140(3):509-514. doi:10.3945/jn.109.117374.
48. Hurrell RF, Reddy MB, Juillerat M, Cook JD. Meat protein fractions enhance
nonheme iron absorption in humans. J Nutr. 2006;136(11):2808-2812.
49. Średnicka-Tober D, Barański M, Seal C, et al. Composition differences between
organic and conventional meat: a systematic literature review and meta-analysis.
Br J Nutr. 2016;115(06):994-1011. doi:10.1017/S0007114515005073.
50. Daley CA, Abbott A, Doyle PS, Nader GA, Larson S. A review of fatty acid profiles
and antioxidant content in grass-fed and grain-fed beef. Nutr J. 2010;9(1):10.
doi:10.1186/1475-2891-9-10.
51. Whigham LD, Watras AC, Schoeller DA. Efficacy of conjugated linoleic acid for
reducing fat mass: a meta-analysis in humans. Am J Clin Nutr. 2007;85(5):1203-
1211.
52. Cook JD, Reddy MB. Effect of ascorbic acid intake on nonheme-iron absorption
from a complete diet. Am J Clin Nutr. 2001;73(1):93-98.
53. Poutahidis T. Beneficial Bacteria Stimulate Youthful Thyroid Gland Activity. J Obes
Weight Loss Ther. 2014;04(02). doi:10.4172/2165-7904.1000220.
54. Bauer-Petrovska B, Petrushevska-Tozi L. Mineral and water soluble vitamin
content in the Kombucha drink. Int J Food Sci Technol. 2000;35(2):201-205.
doi:10.1046/j.1365-2621.2000.00342.x.
55. Vīna I, Semjonovs P, Linde R, Deniņa I. Current evidence on physiological activity
and expected health effects of kombucha fermented beverage. J Med Food.
2014;17(2):179-188. doi:10.1089/jmf.2013.0031.
56. Battikh H, Bakhrouf A, Ammar E. Antimicrobial effect of Kombucha analogues.
LWT - Food Sci Technol. 2012;47(1):71-77. doi:10.1016/j.lwt.2011.12.033.
57. Krissansen GW. Emerging health properties of whey proteins and their clinical
implications. J Am Coll Nutr. 2007;26(6):713S - 23S.
58. Marchbank T, Davison G, Oakes JR, et al. The nutriceutical bovine colostrum
truncates the increase in gut permeability caused by heavy exercise in athletes.
Am J Physiol Gastrointest Liver Physiol. 2011;300(3):G477-G484. doi:10.1152/
ajpgi.00281.2010.
59. Średnicka-Tober D, Barański M, Seal CJ, et al. Higher PUFA and n-3 PUFA,
conjugated linoleic acid, α-tocopherol and iron, but lower iodine and selenium
concentrations in organic milk: a systematic literature review and meta- and
redundancy analyses. Br J Nutr. 2016;115(06):1043-1060. doi:10.1017/
S0007114516000349.

23
60. Pariza MW. Perspective on the safety and effectiveness of conjugated linoleic acid.
Am J Clin Nutr. 2004;79(6 Suppl):1132S - 1136S.
61. Rodes L, Khan A, Paul A, et al. Effect of probiotics Lactobacillus and
Bifidobacterium on gut-derived lipopolysaccharides and inflammatory cytokines:
an in vitro study using a human colonic microbiota model. J Microbiol Biotechnol.
2013;23(4):518-526.
62. Bested AC, Logan AC, Selhub EM. Intestinal microbiota, probiotics and mental
health: from Metchnikoff to modern advances: Part II – contemporary contextual
research. Gut Pathog. 2013;5(1):3. doi:10.1186/1757-4749-5-3.
63. Ortiz-Caro J, Montiel F, Pascual A, Aranda A. Modulation of thyroid hormone
nuclear receptors by short-chain fatty acids in glial C6 cells. Role of histone
acetylation. J Biol Chem. 1986;261(30):13997-14004.
64. Jansen MS, Nagel SC, Miranda PJ, Lobenhofer EK, Afshari CA, McDonnell DP.
Short-chain fatty acids enhance nuclear receptor activity through mitogen-activated
protein kinase activation and histone deacetylase inhibition. Proc Natl Acad Sci.
2004;101(18):7199-7204. doi:10.1073/pnas.0402014101.

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