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The Health Index

The thyroid is a butterfly-shaped gland located in the neck. Its purpose is to make thyroid hormones, and it is virtually the body’s internal motor, setting the speed at which the body works. Thyroid hormones affect most cells in the human body by regulating the basal metabolic rate as well as heat production. This is why people with underactive thyroid glands often struggle to lose weight, feel the cold, and have low energy – imagine a record player playing a record at a reduced speed.

Image by Deb Kennedy

The most common thyroid condition is hypothyroid – a condition in which the thyroid is under-functioning. It is more common in women than in men.  One hypothyroid condition – Hashimoto’s hypothyroid – is an autoimmune condition. Hyperthyroidism is a condition in which the thyroid is overactive, and there is too much thyroid hormone.


Unlike hypothyroidism, hyperthyroidism has an over-stimulating effect. Sometimes patients experience both hypothyroid as well as hyperthyroid symptoms. In Hashimoto’s, patients can fluctuate between the two.

What are the causes of thyroid disease?

The cause of hypothyroidism may be a disorder of the thyroid gland itself. Hypothyroidism is seldom congenital. It is usually the result of later loss or destruction of intact thyroid tissue, for example through an overactive immune system. Hypothyroidism can also occur if the regulatory centres in the brain that are important for hormone production, the hypothalamus and the pituitary gland, do not work properly. A severe iodine deficiency in the diet can also lead to hypofunction in rare cases - usually combined with an enlargement of the thyroid gland (goitre).


A hypofunction can be congenital, which is the case in about 1 in 4000 new-borns. For the development and survival of the baby it is crucial that the thyroid is checked at birth. In adulthood, chronic thyroiditis is the most common cause of the development of hypothyroidism. This is usually caused by an autoimmune disease called Hashimoto's thyroiditis. If the thyroid gland is overactive (hyperthyhroid) or the patient has a goitre, the medical treatments to combat this can also unintentionally cause hypothyroidism.


These treatments include:

  • Excessive doses of drugs that inhibit the production of thyroid hormones (thyrostatic drugs)

  • Radioiodine therapy

  • Removal of the thyroid gland or parts thereof

  • X-ray of the anterior neck region in cancer

Although the causes for hyperthyroidism are varied, more than 95% of hyperthyroidism is caused by Graves' disease or by a thyroid autonomy. Like Hashimoto’s thyreoditis, this is an autoimmune disease. For reasons as yet unknown, various antibodies are produced against the thyroid gland.


The most important of these (TSH receptor autoantibodies, "TRAK") stimulate the hormone-producing cells, resulting in increased production of thyroid hormones. As this production is no longer adjusted to the body's actual needs, this leads to hyperthyroidism. Hyperthyroidism is usually also associated with an enlargement of the thyroid gland (goitre). Typical of Graves' disease is that the autoimmune condition not only affects the thyroid gland, but also the tissue of the eye sockets (endocrine orbitopathy) and the skin of the lower leg (pretibial myxoedema).

Functional autonomy means that parts of the thyroid gland (individual nodes or “autonomous adenomas”), or all of the thyroid gland tissues, produce hormones on their own. The so-called autonomous areas are thus no longer subject to the control of the pituitary gland. This can lead to hyperactivity if hormone production exceeds the body's requirements. The cause of thyroid autonomy is often a prolonged enlargement of the thyroid gland due to iodine deficiency (iodine deficiency goitre).


As an accompanying symptom, nodules may or may not form. It is typical that autonomic nodules show up very actively during scintigraphy - an imaging procedure that can provide information about the activity of the thyroid gland tissue (so-called “hot nodules”).

Woman Facing Away

What are the symptoms of an under-active thyroid (hypothyroid)?

Common symptoms of hypothyroidism include poor performance, lack of concentration and tiredness. Others include impaired orientation and memory and an increased sensitivity to cold. The reflexes may be slowed down and muscles tend to cramp more often. Externally, hypothyroidism can cause signs such as a swollen face with thickened lips and an enlarged tongue, swelling around the eye sockets, causing a narrow slit in the eyelid.


The skin can be cool, dry, rough and thickened; sometimes yellowish discolouration occurs (storage of the pigment carotene). In addition, an under-active thyroid gland can cause hair loss and make the hair shaggy and dull. A rough, hoarse voice and possibly a goitre (struma) are further possible symptoms - they are caused by pressure from an enlarged thyroid gland on the nerves of the larynx.

Furthermore, an underactive thyroid can cause:

  • Depression

  • Constipation

  • Unexplained weight gain and difficulty to lose weight

  • Slow heartbeat (bradycardia), enlargement of the heart, low blood pressure

  • Circulatory disorders with sensations of pins and needles

  • Menstrual irregularities 

  • Low libido, impaired fertility and erectile dysfunction

Hashimoto's thyroiditis - i.e. acquired hypothyroidism as a result of chronic inflammation of the thyroid gland - can also be accompanied by chronic atrophic gastritis (shrinking of the stomach lining) and other autoimmune diseases.

  • Difficulty swallowing

  • Hoarseness 

  • Problems buttoning the collar button (enlarged thyroid gland)

  • Bulges or swelling in the front of the neck 

  • Nervous symptoms, e.g. nervousness, irritability, restlessness, lack of concentration, shaking, trembling, insomnia

  • Cardiac symptoms, e.g. high blood pressure, strong pulse and racing heart; in extreme cases also life-threatening cardiac arrhythmia

  • Weight loss despite good appetite

  • Skin symptoms, e.g. warm, damp skin, sweating, heat intolerance, hair loss, brittle nails, sometimes dark skin discolouration or white patches (vitiligo)

  • Digestive symptoms, e. g. diarrhoea

  • Muscle weakness, muscle pain

  • Menstrual disorders; reduction of libido and potency

  • Pasty swelling of the lower leg (myxoedema) in Graves' disease

  • Eye symptoms in the context of Graves' disease. These include: lacrimation, foreign body sensation, light aversion, feeling of pressure (sometimes painful), redness of the conjunctiva, swelling of the eyelids, protruding eyes, and visual disturbances (often double vision).


How can a nutrition practitioner help?

Your nutrition practitioner’s approach will differ depending on whether you have hyper- or hypothyroidism, and whether the cause is autoimmune or not. They will ask you about your medical history and perhaps recommend further functional testing to assess your hormone status, even beyond the thyroid. If you have been diagnosed with Hashimoto’s, they may suggest a detailed gluten antibody test.


They will ask questions about your overall health and health history, diet, lifestyle and exercise habits. Your nutrition practitioner will look at your food diary to see where there may be room for improvement. They will then develop a customised diet, supplement and lifestyle plan for you.

Find your Thyroid


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