The human body is composed of organ systems that work together to maintain balance and

keep optimal conditions in check for its survival and growth. One of the most intriguing organ
systems that perform one of the most crucial functions in the body is the endocrine system– the
organ system responsible for producing hormones that instruct other organs to perform their
functions. This discussion would be too much for a mere five-page journal entry. Thus, we will
focus solely on the thyroid gland and the pathophysiologic disease that is the main subject of
this entry.

The thyroid gland is an endocrine gland that is located inferior, at the anterior part of the human
neck and is responsible for releasing thyroid hormones into the circulation as well as iodine
homeostasis in the body (Armstrong et al., 2022). Shahid et al. (2022) describe the physiologic
function and process that the thyroid gland performs in their article entitled Physiology, Thyroid
hormone. In their description, the thyroid gland itself is stimulated by a hormone that is
produced by another gland called the pituitary gland. The signaling cascade, however, does not
simply originate from this transaction. This is because the pituitary gland is first signaled to
release this hormone by the hypothalamus. The hypothalamus releases a hormone called
thyrotropin-releasing hormone (TRH) to the anterior pituitary gland stimulating it to release the
hormone called the thyroid-stimulating hormone (TSH) which will eventually find its way to the
thyroid gland via the circulatory system. TSH will then bind to the thyroid-releasing hormone
receptor (TSH-R) on the basolateral aspect of the thyroid follicular cell. Once bound, protein
kinases of thyrocytes are activated and begin to modify some specific proteins into their final
forms as thyroid hormones. The five steps of thyroid synthesis are 1) Thyroglobulin synthesis, 2)
Iodide uptake, 3) Iodination of thyroglobulin, 4) Storage, and 5) Release.

Hypothyroidism is a known thyroid hormone deficiency that is usually easily treated but can be
fatal in worse cases (Chaker et al., 2017). There are three types of hypothyroidism according to
Shahid et al. (2022). These are primary, secondary, and tertiary hypothyroidism. Primary
hypothyroidism is characterized by increased levels of TSH as compensation for the lack of
thyroid hormones being produced. Secondary hypothyroidism is quite the opposite of this as it is
caused by pituitary disorders which itself causes the decrease of TSH in the bloodstream and
eventually the decrease of thyroid hormone production. Finally, tertiary hypothyroidism is
caused by hypothalamic disorders which cause a decrease in TRH production and further of
TSH and thyroid hormones. The overall insufficient levels of thyroid hormones that serve as a
consequence of this disease are highly detrimental to the person. Fortunately, advances in
science and research have pushed through some treatments that help patients suffering from
this disease.

One known treatment is Levothyroxine monotherapy in solid formulation, taken on an empty

stomach for maximum absorption (Chaker et al., 2017). This treatment is usually prescribed for
patients of all the aforementioned types of hypothyroidism. Levothyroxine is a synthetic version
of one of the thyroid hormones that the thyroid gland fails to produce due to hypothyroidism
(Eghtedari & Correa, 2022). Although it has been FDA-approved and shown to be effective in
treating those with this disease, Eghtedari & Correa were still able to list down some adverse
effects that are associated with this treatment. Some of these include various cardiovascular
adverse drug reactions (i.e. arrhythmia, myocardial infarction, and atrial fibrillation),
Neuropsychiatric adverse drug reactions (i.e. insomnia and anxiety), gastrointestinal adverse
drug reactions (e.g. diarrhea, weight loss, and emesis), endocrine adverse drug reactions (i.e.
goiter, menstrual irregularities, and decreased bone mineral density as a result of TSH
suppression), and the like. The demographics that are among those who are at high risk of
experiencing these effects are the elders. As an acknowledgment of the risks that
hypothyroidism treatments carry, the health community has always been actively emphasizing
the importance of diet in dealing with a disease such as hypothyroidism. The basics simply start
with the foods that these people should eat and avoid.

An article by Shannon Johnson of Medical News Today touched on this topic just last week
detailing the sorts of food items that help manage the condition. The author was also very clear
about the diet not being a cure for hypothyroidism which should be understood well by the
community, too. This diet consists of foods that are rich in certain nutrients such as iodine,
selenium, and zinc which can help maintain healthy thyroid function. In addition to the good sort
of foods for hypothyroidism patients, Johnson also listed some foods that people with this
condition might want to avoid. These include cruciferous vegetables, gluten (from oats, whole
grains, etc.), and soy. Although Johnson stated that the claims about the effects of soy and
products that contain soy on thyroid function are still lacking and in need of further research.
The debate regarding the effects of soy on thyroid function is also discussed by KC Wright
(2020) in the article entitled Soyfoods and thyroid health where she laid out some findings from
studies that were concerned with this debate. Ultimately, the studies have concluded that
overall, soy supplementation has no effects on thyroid hormone. What this tells us now is not
that following a diet to manage hypothyroidism is a myth, it tells us that we need more research
to be done in this field. A great example would be the 2000 research conducted by Carvalho et
al.

Carvalho et al. (2000) found out in their research that certain compounds or substances have
direct inhibiting activity towards an enzyme known as thyroid peroxidase or TPO. TPO is the
enzyme that is responsible for the third step of thyroid hormone synthesis (iodination of
thyroglobulin). The general steps of this procedure are as follows (Shahid et al., 2022). First,
TPO uses hydrogen peroxide to oxidize iodide (I-) to iodine (𝐼2). Then, TPO links the tyrosine
residues of thyroglobulin proteins with I2 generating monoiodotyrosine (MIT) and diiodotyrosine
(DIT) in the process. Lastly, TPO combines iodinated tyrosine residues to make triiodothyronine
(T3) and tetraiodothyronine (T4). MIT and DIT join to form T3, and two DIT molecules form T4.
T3 and T4 are the thyroid hormones that are necessary for normal human body function. These
hormones are bound to thyroglobulin in the follicular lumen. When needed, T3 and T4 are
released into the fenestrated capillary network and into the bloodstream with iodine being
recycled in the process. Carvalho et al. (2000) have acknowledged some previous studies that
have suggested that endogenous sulfhydryl-containing compounds such as glutathione were
responsible, at least in part, for iodination inhibition. Ascorbic acid, cysteine, epinephrine,
norepinephrine, serotonin, NADH, and NADPH were also shown to inhibit tyrosine iodination.
Furthermore, more recent studies have shown that some exogenous substances such as
dietary flavonoids and sulfamethazine may impair TPO activity, at least in vitro. The research
done by Carvalho et al. (2000) supplemented these reports with their findings. Their study found
that amino acids other than cysteine can inhibit the TPO iodide oxidation and iodination
activities (Though cysteine showed the most potency). As they have explained, during the
catalyzing activity of the enzyme TPO, these inhibitory substances might interfere with the
activity of TPO by competing with its normal substrates for their binding sites, binding to the free
substrates, or reducing their oxidized form. As a result of these interventions, amino acids have
effectively inhibited the synthesis of thyroid hormones. Although these results were derived from
in vitro experiments, these findings hold valuable information regarding the role of amino acids
in thyroid gland regulation.

What this study further shows us is the fact that the patient’s diet can indeed affect how their
hypothyroidism is being managed. This is because the above-mentioned substances are often
found on various food items such as those that are listed by Johnson. In fact, in a journal article
by Larsson et al. (2015), whole grains are cysteine-rich foods which might explain why it was
included in Johnson’s list. On the other hand, the nutrient-rich foods that are advised for those
who have hypothyroidism indeed help in managing their condition. Suppose iodine, for example.
Since it is an essential requiremnet during the synthesis of thyroid hormones, it only makes
sense that those who have low thyroid hormone production should have enough iodine in their
body for when the body needs to produce said hormones. Ultimately, this discussion should
simply end with the reminder that what we eat will truly help define anyone’s healing journey.

References
Armstrong, M., Asuka, E., & Fingeret, A. (2022). Physiology, thyroid function. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK537039/
Carvalho, D.P., Ferreira, A.C.F., Coelho, S.M., Moraes, J.M., Camacho, M.A.S., & Rosenthal, D. (2000).
Brazilian Journal of Medical and Biological Research, 33, 355-361. ISSN 0100-879X
Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. Lancet (London,
England), 390(10101), 1550. https://doi.org/10.1016/S0140-6736(17)30703-1
Eghtedari, B., & Correa, R. Levothyroxine. [Updated 2022 Sep 4]. In: StatPearls [Internet].
Johnson, S. (2023, March 6). Hypothyroidism: Foods to eat and avoid. Medical News Today.
https://www.medicalnewstoday.com/articles/324819#role-of-the-dietTreasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK539808/
Shahid, M. A., Ashraf, A. A., & Sharma, A. (2022). Physiology, thyroid hormone. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK500006/
Wright, K.C. (2020). Soy foods and thyroid health. Today's Dietician.
https://www.todaysdietitian.com/newarchives/0420p28.shtml