Long term effect of nutrition on thyroid disease

Mohammed Salah Hussein, Lama Samir Asiri, Sadeem Wadia Asali, Abdulaziz Mohsin Alawlaqi, Gadeer Sameer Sibah, Bader Hadi Alshammari, Saltanh Mohammed Gaban, Alanood Nawaf Almansory, Hind Mousa AlGhamdi, Jinan Hikmat Msallati, Hassan Mohammed Al Dhaif, Ali Salem Al Rayshan


Many forms of thyroid diseases have been classified under autoimmune thyroid disease. These include hyperthyroidism or commonly known as Grave’s disease, and hypothyroidism commonly identified as Hashimoto’s thyroiditis. Many nutritional elements have been linked to the function of the thyroid gland as any disturbance in these elements can lead to the development of relevant thyroid diseases. The most important elements include iodine, iron, selenium, zinc, and soy. In this current manuscript, we aimed to discuss the effect of these nutritional elements on the development of thyroid diseases by reviewing relevant studies in the literature. Although it is widely known that iodine is an essential component for the synthesis and release of these hormones, exaggerated intake of iodine can also lead to the development of hypothyroidism by negative feedback mechanisms. Besides, it can also trigger abnormal autoimmune reactions which can lead to the development of AITD. Selenium is another important factor and evidence shows that it has been associated with Grave’s thyroiditis, however, further evidence is needed as recommended by previous investigations. Clinicians should also take care of iron, zinc, and soy levels during management to obtain a better prognosis.


Thyroid, Autoimmune, Nutrition, Iodine, Iron, Selenium

Full Text:



McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012;42(2):252-65.

Okayasu I, Hara Y, Nakamura K, Rose NR. Racial and age-related differences in incidence and severity of focal autoimmune thyroiditis. Am J Clin Pathol. 1994;101(6):698-702.

Duntas L, Hiromatsu Y, Amino N. Centennial of the Description of hashimoto thyroiditis-two thought-provoking events. Thyroid. 2013;23.

Effraimidis G, Wiersinga WM. Mechanisms in endocrinology: autoimmune thyroid disease: old and new players. Eur J Endocrinol. 2014;170(6):R241-52.

Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014;13(4-5):391-7.

Nacamulli D, Petricca D, Mian C. Selenium and autoimmune thyroiditis. J Endocrinol Investig. 2013;36(10):8-14.

Marcocci C, Kahaly GJ, Krassas GE. Selenium and the course of mild Graves' orbitopathy. N Engl J Med. 2011;364(20):1920-31.

Brent GA. Clinical practice. Graves' disease. N Engl J Med. 2008;358(24):2594-605.

Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc. 2019;78(1):34-44.

Mezzomo TR, Nadal J. Effect of nutrients and dietary substances on thyroid function and hypothyroidism. Demetra: Food, Nutr Health. 2016; 11(2):427.

Koibuchi N. Molecular mechanisms of thyroid hormone synthesis and secretion. Nihon Rinsho. 2012;70(11):1844-8.

Laurberg P, Cerqueira C, Ovesen L, Rasmussen LB, Perrild H, Andersen S, Pedersen IB, Carlé A. Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab. 2010;24(1):13-27.

Pedersen IB, Knudsen N, Jørgensen T, Perrild H, Ovesen L, Laurberg P. Thyroid peroxidase and thyroglobulin autoantibodies in a large survey of populations with mild and moderate iodine deficiency. Clin Endocrinol. 2003;58(1):36-42.

Teng W, Shan Z, Teng X, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006;354(26):2783-93.

Teng X, Shan Z, Chen Y. More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels. Eur J Endocrinol. 2011;164(6):943-50.

Peng NC, Shi LX, Zhang Q. An epidemiological survey of the prevalence of thyroid diseases in mild iodine deficiency city after salt iodization. Zhonghua nei ke za zhi. 2013;52(1):16-20.

Zhang JY, Li SM, Leng JL. Changes of the spectrum on thyroid disease after the ten-year implementation of universal salt iodization in Guangxi Zhuang Autonomous Region. Zhonghua liu xing bing xue za zhi. 2013;34(10):970-4.

Pedersen IB, Knudsen N, Carlé A. A cautious iodization programme bringing iodine intake to a low recommended level is associated with an increase in the prevalence of thyroid autoantibodies in the population. Clin Endocrinol. 2011;75(1):120-6.

Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015; 3(4):286-95.

Burek CL, Talor MV. Environmental triggers of autoimmune thyroiditis. J Autoimmun. 2009;33(3-4):183-9.

Sharma R, Traore K, Trush MA, Rose NR, Burek CL. Intracellular adhesion molecule-1 up-regulation on thyrocytes by iodine of non-obese diabetic.H2(h4) mice is reactive oxygen species-dependent. Clin Exp Immunol. 2008;152(1):13-20.

Duntas LH. The role of iodine and selenium in autoimmune thyroiditis. Horm Metab Res. 2015;47 (10):721-6.

Tan L, Sang Z, Shen J. Prevalence of thyroid dysfunction with adequate and excessive iodine intake in Hebei Province, People's Republic of China. Public health Nutr. 2015;18(9):1692-7.

Sun X, Shan Z, Teng W. Effects of increased iodine intake on thyroid disorders. Endocrinol Metab. 2014; 29(3):240-7.

Chung HR. Iodine and thyroid function. Ann Pediatr Endocrinol Metab. 2014;19(1):8-12.

Du Y, Gao Y, Meng F. Iodine deficiency and excess coexist in china and induce thyroid dysfunction and disease: a cross-sectional study. PLoS One. 2014;9 (11):e111937.

Köhrle J. Selenium and the thyroid. Curr Opin Endocrinol Diabetes Obes. 2013;20(5):441-8.

Schmutzler C, Mentrup B, Schomburg L, Hoang-Vu C, Herzog V, Köhrle J. Selenoproteins of the thyroid gland: expression, localization and possible function of glutathione peroxidase 3. Biol Chem. 2007;388 (10):1053-9.

Derumeaux H, Valeix P, Castetbon K. Association of selenium with thyroid volume and echostructure in 35- to 60-year-old French adults. Eur J Endocrinol. 2003;148(3):309-15.

Wu Q, Rayman MP, Lv H. Low population selenium status is associated with increased prevalence of thyroid disease. J Clin Endocrinol Metab. 2015;100 (11):4037-47.

Rasmussen LB, Schomburg L, Köhrle J. Selenium status, thyroid volume, and multiple nodule formation in an area with mild iodine deficiency. Eur J Endocrinol. 2011;164(4):585-90.

Bülow Pedersen I, Knudsen N, Carlé A. Serum selenium is low in newly diagnosed Graves' disease: a population-based study. Clin Endocrinol. 2013;79 (4):584-90.

Liu Y, Liu S, Mao J. Serum trace elements profile in Graves' disease patients with or without orbitopathy in northeast China. Biomed Res Int. 2018;2018: 3029379.

Khong JJ, Goldstein RF, Sanders KM. Serum selenium status in Graves' disease with and without orbitopathy: a case-control study. Clin Endocrinol. 2014;80(6):905-10.

Hesse-Bähr K, Dreher I, Köhrle J. The influence of the cytokines Il-1beta and INFgamma on the expression of selenoproteins in the human hepatocarcinoma cell line HepG2. BioFactors. 2000; 11(1-2):83-5.

Nichol C, Herdman J, Sattar N. Changes in the concentrations of plasma selenium and selenoproteins after minor elective surgery: further evidence for a negative acute phase response? Clin Chem. 1998;44(8):1764-6.

Wichman J, Winther KH, Bonnema SJ, Hegedüs L. Selenium Supplementation Significantly Reduces Thyroid Autoantibody Levels in Patients with Chronic Autoimmune Thyroiditis: A Systematic Review and Meta-Analysis. Thyroid. 2016;26(12): 1681-92.

Van Zuuren EJ, Albusta AY, Fedorowicz Z, Carter B, Pijl H. Selenium supplementation for Hashimoto's thyroiditis. Cochrane Database Syst Rev. 2013(6): Cd010223.

Dunn JT, Dunn AD. Update on intrathyroidal iodine metabolism. Thyroid. 2001;11(5):407-14.

Hess SY, Zimmermann MB, Arnold M, Langhans W, Hurrell RF. Iron deficiency anemia reduces thyroid peroxidase activity in rats. J Nutr. 2002;132 (7):1951-5.

Fayadat L, Niccoli-Sire P, Lanet J, Franc JL. Role of heme in intracellular trafficking of thyroperoxidase and involvement of H2O2 generated at the apical surface of thyroid cells in autocatalytic covalent heme binding. J Biol Chem. 1999;274(15):10533-8.

Beard JL, Borel MJ, Derr J. Impaired thermoregulation and thyroid function in iron-deficiency anemia. Am J Clin Nutr. 1990;52(5):813-9.

Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MP. 2012 ETA Guidelines: The use of L-T4 + L-T3 in the treatment of hypothyroidism. Eur Thyroid J. 2012;1(2):55-71.

Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N. Chronic anemia and thyroid function. Acta Biomed. 2017;88(1):119-27.

Betsy A, Binitha M, Sarita S. Zinc deficiency associated with hypothyroidism: an overlooked cause of severe alopecia. Int J Trichol. 2013;5(1):40-2.

Kelly GS. Peripheral metabolism of thyroid hormones: a review. Alt Med Rev. 2000;5(4):306-33.

Nishiyama S, Futagoishi-Suginohara Y, Matsukura M. Zinc supplementation alters thyroid hormone metabolism in disabled patients with zinc deficiency. J Am Nutr. 1994;13(1):62-7.

Tran L, Hammuda M, Wood C, Xiao CW. Soy extracts suppressed iodine uptake and stimulated the production of autoimmunogen in rat thyrocytes. Exp Biol Med (Maywood). 2013;238(6):623-30.

Sathyapalan T, Manuchehri AM, Thatcher NJ. The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2011;96(5):1442-9.

Mittal N, Hota D, Dutta P. Evaluation of effect of isoflavone on thyroid economy & autoimmunity in oophorectomised women: a randomised, double-blind, placebo-controlled trial. Indian J Med Res. 2011;133(6):633-40.