Thyroid Nodules: Symptoms, Causes, and Support Strategies

Thyroid Nodules: Symptoms, Causes, and Support Strategies

Thyroid nodules are growths or lumps on your thyroid tissues. Thyroid nodules are a common condition that affect up to 65 percent of the population. While in most cases thyroid nodules are benign and harmless, in some cases they can cause compressive symptoms or become cancerous.

In this article, you will learn what thyroid nodules are. You will understand the signs, symptoms, and types of thyroid nodules. I will go over the risk factors for thyroid disease. You will learn about diagnosis and conventional treatment options for thyroid nodules. I will explain the common root cause factors for thyroid nodules. I will recommend some key labs to look at for thyroid nodules. Most importantly, I will share some natural support strategies to improve your health.

What Are Thyroid Nodules

Your thyroid gland is a butterfly-shaped organ found at the base of your neck just below your Adam’s apple. When your thyroid tissues grow abnormally, growths, lumps, or nodules can develop. They are called thyroid nodules. These nodules can be singular or multiples, solid or fluid-filled.

Thyroid nodules are a common condition. According to a 2018 article published in JAMA, they affect about 65 percent of the general population (1). Statistically speaking, there is about a 10 percent lifetime probability that you will develop one. To reduce your risk of becoming part of these statistics and lower your risk of developing thyroid nodules, I will go over some natural supportive strategies later in this article.

Most thyroid nodules are benign, clinically insignificant, and not dangerous. However, in some cases, they can turn serious. According to the same article, about 10 percent of nodules are cancerous, 5 percent result in compressive symptoms, and 5 percent may lead to a functional disease (1).

Signs & Symptoms of Thyroid Nodules

Thyroid nodules often go unnoticed without signs or symptoms. If you have any signs or symptoms, they may include:

• Neck fullness and swelling at the base of your neck
• Dysphagia, or difficulty swallowing if the thyroid nodules affect your esophagus and the passage of food
• Odynophagia, or pain in your mouth, throat, or esophagus swallowing due to the pressure in your neck or throat by the thyroid nodules
• Choking if the thyroid nodules are too large or swollen
• Dyspnea, or difficulty breathing and shortness of breath due to very large thyroid nodules
• Hoarseness or voice change
• Goiter, or enlargement of the thyroid gland

In some cases, thyroid nodules can affect thyroxine production and lead to symptoms of hyperthyroidism, including (2):

• Anxiety
• Nervousness 
• Sleep issues
• Fatigue
• Weight loss
• Excessive sweating
• Muscle weakness
• Enlarged thyroid gland
• Heat sensitivity
• Vision problems or eye irritation
• Increase or decrease in appetite
• Light or missed periods
• Thinning hair
• Skin flushing
• Itching
• Heart palpitations

In some cases, thyroid nodules can also cause low thyroid levels leading to hypothyroidism. Symptoms of hypothyroidism may include:

• Fatigue
• Sleep issues
• Weight gain
• Frequent or heavy periods
• Forgetfulness
• Depression
• Weakness
• Irritability
• Dry, coarse skin and hair
• Hair loss
• Constipation
• Trouble dealing with cold temperatures
• Generalized edema (swelling)

While thyroid nodules are usually benign and do not contribute to an increased risk of thyroid cancer, a 2014 study published in Gland Surgery has found that large thyroid nodules greater than 1.5 centimeters are correlated with compressive symptoms that, in 97 percent of cases, improve after surgery (3). Compressive symptoms of thyroid nodules may include:

• Pain in the neck
• Goiter
• Hoarseness or voice change
• Trouble swallowing or breathing

Types of Thyroid Nodules

There are several different types of thyroid nodules, including:

• Colloid nodules: Colloid nodules are characterized by one or more benign overgrowths of normal thyroid tissues. While they may grow large, they do not spread beyond your thyroid.
• Thyroid cysts: Thyroid cysts can be solid, filled with fluid, or only partially filled with fluid.
• Inflammatory nodules: Inflammatory nodules are caused by chronic inflammation and swelling affecting the thyroid gland. For some people, they may be painful, for others, it is not.
• Multinodular goiter: Multinodular goiters usually benign. They are characterized by a goiter (enlarged thyroid) made up of many nodules.
• Hyperfunctioning thyroid nodules: Hyperfunctioning thyroid nodules are nodules that create thyroid hormones that don’t respond to normal feedback. They can often cause hypothyroidism.
• Thyroid cancer: In some cases, thyroid nodules are or can become cancerous.

Risk Factors for Thyroid Nodules

There are a number of factors that may increase your risk for thyroid nodules, including (4):

• Being female: Women are four times more likely to develop thyroid nodules.
• Age: The frequency of thyroid nodules increases with age (4).
• Hormonal changes and pregnancy: The development of thyroid nodules is commonly related to estrogen and progesterone changes, especially during pregnancy (4).
• Iodine intake and iodine levels: Low iodine intake and iodine deficiency may increase your risk of thyroid nodules, goiters, and enlarged thyroid gland (5).
• Iodine radiation: Iodine radiation can increase the risk of thyroid nodules and thyroid cancer(4).

Certain thyroid conditions may also increase your risk of thyroid nodules, including (6):

• Overgrowth of thyroid tissue: Thyroid adenoma or an overgrowth of normal thyroid tissue can cause thyroid nodules, as well as, an overproduction of thyroid hormones (6).
• Hashimoto’s disease: Hashimoto’s disease is an autoimmune thyroid disease that leads to thyroid inflammation and an enlarged thyroid gland. It is caused by the underproduction of thyroid hormone that causes the gradual destruction of the thyroid gland, which may contribute to thyroid nodules and further thyroid issues (6).
• Thyroid cysts: Thyroid cysts can develop because of abnormal tissue growth and are associated with thyroid nodules (6).
• Thyroid goiters: Thyroid goiters are an abnormal enlargement of your thyroid gland caused by the under or overproduction of thyroid hormones. They may increase your risk of co-occurring with thyroid nodules (6).
• Thyroid cancer: While most thyroid nodules are harmless and benign, they can be cancerous. In some cases, cancer starts elsewhere in the thyroid and cancerous thyroid cells cause cancerous thyroid nodules (6). 
• Iodine deficiency: Iodine deficiency may increase your risk of thyroid nodules, goiters, and enlarged thyroid glands (5).

Diagnosis and Conventional Treatment Options

During a physical exam, your doctor will look for thyroid nodules over a neck exam.  Finding any of the following indicates a concern for malignancy (7, 8):

• Nodules that are larger than 4 centimeters
• Nodules that feel firm when touched
• Nodules that seem fixed to adjacent tissues
• Inflammation of the lymph nodes
• Vocal fold immobility or problems with swallowing or your voice
• Nodules in young children

The most common ways to diagnose thyroid nodules include ultrasounds and fine-needles aspiration biopsy. While larger nodules can be found through a simple neck examination, small nodules can only be identified through an ultrasound. Using ultrasonography, your doctor can take accurate measurements of your thyroid nodule (9).

Fine-needle aspiration biopsy done with the guidance of an ultrasound can determine whether your thyroid nodules are benign or cancerous. If you have a benign thyroid nodule observation is usually the best course of action. Yearly ultrasound exams and fine-needle aspirations if there is a change in size or development are recommended. Malignant thyroid nodules undergo a thyroidectomy.

Many clinicians also like to use a ThyroSeq test which looks for unique genetic alterations in your thyroid nodule to help your doctor determine if your nodule is benign (non-cancerous) or malignant (cancerous). ThyroSeq uses an innovative technology called Next Generation Sequencing to analyze genes important for cancer development.

For enlarged nodules that cause compressive symptoms or for benign nodules the following treatment options may be recommended:

• Thyroid hormone therapy: Thyroid hormone therapy helps to reduce the production of thyroid-stimulating hormone (THS) and may help to decrease the size of a thyroid nodule.
• Surgery: Surgery is recommended for benign thyroid nodules if they cause you difficulty swallowing or breathing.
• Radioactive thyroid treatment: Radioactive iodine (RAI) therapy is used to destroy cells in the thyroid gland and decrease the size of the nodule, however, it is not recommended if you only have a low or moderate risk of cancer (10).
• Laser or radiofrequency ablation treatment: Radiofrequency ablation treatment is used to decrease the size of benign nodules without affecting thyroid function. It is more common in Asian and European countries.

Malignant nodules require surgical removal: 

• Thyroid lobectomy: Thyroid lobectomy is used to remove half of your thyroid gland.
• Total Thyroidectomy: Total thyroidectomy is used to remove the entire thyroid gland.

Root Cause Factors

Now that you understand the risk factors for thyroid nodules, I want to go over its root cause factors. Certain health issues, dietary factors, and lifestyle choices may contribute to the development of thyroid nodules. The root cause factors of thyroid nodules include:

Chronic Inflammation

Acute inflammation is an essential protecting mechanism. It’s a way for your body to protect you from acute infections and injuries, and support recovery. However, when inflammation becomes chronic due to the constant stress of inflammatory foods, poor lifestyle choices, environmental toxicity, and chronic stress, it becomes a serious problem. Chronic inflammation is the root cause of most health issues, including thyroid nodules and other thyroid health issues.

Inflammatory thyroid nodules develop because of chronic inflammation affecting your thyroid gland. A 2020 study published in the International Journal of Endocrinology has found a correlation between chronic inflammation and thyroid nodules (11).

They looked at 2722 patients examining various metabolic parameters, inflammation levels, and thyroid-stimulating hormone levels and found that while chronic inflammation did not promote the development of thyroid nodules directly, it leads to the increase of thyroid-stimulating hormone levels, which increased the risk of developing thyroid nodules.

Insulin Resistance 

Insulin resistance means that your body is unable to respond to insulin well and can’t use blood glucose from your blood for energy properly. Insulin resistance increases the risk and leads to prediabetes and type 2 diabetes. It also increases chronic inflammation and may also lead to thyroid problems.

Looking at 201 patients with thyroid nodules and 308 patients without, a 2017 study published in the International Journal of Endocrinology has found a correlation between thyroid nodules and insulin resistance in those with type 2 diabetes (12). A 6-month, cross-section, cross-populational study published in the Journal of Clinical Endocrinology and Metabolism published in 2015 has found that insulin resistance can contribute to the growth and progression of thyroid nodules (13).

A 2017 study published in the Journal of the Turkish German Gynecological Association has found that insulin resistance may contribute to thyroid nodules in women with polycystic ovary syndrome (PCOS) (14). A 2011 study published in Endocrine Research and a 2020 study published in Endocrine Connections has also found that insulin resistance is associated with thyroid nodules (15, 16). 

Leaky Gut and Dysbiosis 

Your gut affects your entire body. It is not surprising the leaky gut syndrome and gut dysbiosis can both contribute to the development of thyroid nodules. Leaky gut syndrome means that your gut lining has holes on it that can allow undigested food particles, microbes, and toxins to slip into your bloodstream. This causes chronic inflammation and may lead to autoimmune issues, including autoimmune thyroid disease. 

Gut dysbiosis means that your gut microbiome is out of balance and there are too many bad bacteria and too few beneficial bacteria in there. Gut dysbiosis will compromise your immune system and make it more difficult for your body to protect you from pathogens. Gut dysbiosis also leads to chronic inflammation and chronic health issues, including thyroid nodules and thyroid problems.

A 2019 study published in Endocrine has found that there is a correlation between gut microbiome health, gut dysbiosis and thyroid function, thyroid nodules, and thyroid cancer (17). A 2020 study published in Nutrients has also found that gut dysbiosis can affect thyroid health and increase the risk of autoimmune thyroid issues and thyroid nodules (18).

High Toxic Load 

Unfortunately, we are living in a world full of toxins. They are all around us from our air to our drinking water. The problem is that a high toxic load can increase your risk of all kinds of chronic health problems, including thyroid nodules. 

According to a 2015 study published in Carcinogenesis, environmental toxins can increase chronic inflammation and the risk of cancer (19). A 2019 review published in the International Journal of Environmental Research and Public Health has found that environmental toxicity, such as radiation and chemical toxicity can increase the risk of thyroid cancer (20). Mold, pesticides, herbicides, fluoride, radiation, heavy metals, and glyphosate are all toxins that you have to watch out for and avoid as much as possible.

Systemic Infections 

Systemic infections, especially the Epstein Barr Virus (EBV) infection can seriously increase your risk of thyroid nodules. EBV is the virus that causes mononucleosis or mono. Even though many of us don’t remember ever getting sick with mono, 90 percent of the population get infected by EBV by their 30s even if they went through it without any noticeable symptoms or no symptoms at all. 

The problem with EBV is once you get it, it remains dormant in your body. You may go for many years without any noticeable effects of an EBV infection. However, stress or health issues can trigger it to wake up and cause all sorts of problems, including chronic inflammation, chronic symptoms, thyroid issues, and autoimmunity.

A 2015 study published in Endokrinologia Polska has found the EBV virus can lead to the development of autoimmune thyroid disease (21). A 2018 multicenter study published in the Journal of Cell Physiology has found the EBV may increase your risk of thyroid cancer (22). A 2016 study published in the Central European Journal of Immunology has also found a link between EBV and autoimmune thyroid disease and multinodular goiters (23).

Vitamin D Deficiency 

Vitamin D is a fat-soluble vitamin. Your body makes it with the help of sunshine. However, due to our indoor lifestyle and gloomy climates and because vitamin D is only found in a few foods, vitamin D deficiency is extremely common. Vitamin D is critical for your immune health, bones, muscles, teeth, brain function, and hormonal health. Deficiencies in vitamin D can cause all kinds of problems, including thyroid issues and thyroid nodules.

A 2013 study published in the International Journal of Health Sciences (Quassim) has found a correlation between vitamin D deficiency and thyroid disease (24). They found that vitamin D deficiency can lead to hypothyroidism and recommend checking vitamin D levels for thyroid patients. A 2018 case-control study and meta-analysis of 276 participants have found a link between vitamin D deficiency and the risk of thyroid cancer (25).

Iodine Deficiency

Iodine is an essential mineral commonly found in seafood. It is important for thyroid function, metabolism, and cellular repair. As you already learned low iodine intake and iodine deficiency may increase your risk of thyroid nodules, goiters, and enlarged thyroid gland (5). 

A 2014 review published in National Reviews in Endocrinology has found a connection between iodine deficiency and thyroid nodules (26). A 2015 comprehensive review of animal and human studies published in Thyroid Research has found that iodine deficiency can increase the risk for thyroid cancer (27). To check for iodine deficiency, I recommend this Iodine Loading Test.

Selenium Deficiency 

Selenium is an important mineral that plays a role in your immune health, thyroid health, neurological health, and heart health. Even though eating only two Brazil nuts a day can cover all your selenium needs, deficiencies happen, especially if you were not aware of this selenium trick. 

A 2011 study published in the European Journal of Endocrinology has found that selenium deficiency combined with iodine deficiency can lead to the development of thyroid nodules (28). A 2008 study published in BMC Endocrine Disorders has found that low selenium levels can lead to silent thyroiditis and both benign and malignant thyroid issues (29). A 2015 review published in Current Opinions in Endocrinology, Diabetes, and Obesity has also found that selenium deficiency can increase the risk of autoimmune thyroid disease, goiter, and thyroid cancer (30). 

Selenium and other nutrient deficiencies often develop because of a low-nutrient diet. However, it may occur because of poor gut health and poor nutrient absorption. If your body is unable to absorb nutrients from your food well enough, you may develop nutrient deficiencies even while eating a healthier diet. To check for selenium deficiency and other micronutrient deficiencies, I recommend this Micronutrient Test.

Zinc Deficiency 

Zinc is an important mineral. It is essential for your immune system. Zinc deficiency can contribute to poor immune cell function and cell signaling, a weakened immune response, and oxidative stress. It can also contribute to thyroid problems.

A 2010 study published in Hormones (Athens) has found a connection between zinc deficiency and thyroid function (31). Examining 201 subjects, researchers found that zinc deficiency contributed to poor thyroid hormone levels and autoimmune thyroid disease in those who have undergone iodine supplementation already. 

A 2003 study published in Biological Trace Element Research has found that zinc deficiency, a poor zinc-copper ratio, a poor zinc-selenium ratio, or a poor copper-selenium ratio may increase the risk of thyroid cancer (32). 

Key Labs to Analyse

To find out what are your risk factors for thyroid nodules or to look at some root cause factors if you have thyroid nodules, I recommend several key labs to analyze.

HbA1C & Fasting Insulin

Since insulin resistance is a major root cause factor for thyroid nodules, I recommend looking at your HbA1C and fasting insulin levels. Your HbA1C levels measure your average blood sugar over the past 2 to 3 months. Hemoglobin A1C (HbA1c) gives the average amount of glucose in your blood or blood sugar over the past 3 months making it one of the top tests for inflammation and diabetes. The clinical range is between 4.8 and 5.6 while the optimal range is 4.5 – 5.2.

Testing your fasting insulin can recognize elevated blood sugar levels and can detect inflammation, insulin resistance, blood sugar issues, and diabetes. The clinical range for fasting insulin is 2.6  – 24.9 uIU/ml and the optimal range is 1.0 – 5.0 uIU/ml. 

HS-CRP and ESR

Chronic inflammation is a common root cause factor for thyroid nodules. That’s why I recommend an HS-CRP and an ESR test. The C-Reactive Protein or CRP test is a key test I recommend that measures a protein (CRP) produced in your liver that indicates inflammation levels in your body. The clinical range is between 0 and 3 mg/L while the optimal range is 0 to 1 mg/L.  When I see levels over 1 mg/L, I know the individual is having an inflammatory response that could be due to acute trauma or chronic conditions.

The erythrocyte sedimentation rate (ESR) is a common hematology test to look for inflammation It refers to the rate at which your red blood cells in anticoagulated whole blood go down in a standardized tube over a period of one hour. Anything over 20 mm/hr is a sign of significant inflammation and optimal results should be under 10 mm/hr.

Vitamin D Levels

Vitamin D3 is an important vitamin that most of our population is deficient in. Poor levels increase your risk for inflammation and autoimmunity.

Deficiency is also a risk factor for thyroid nodules. Testing your vitamin D levels is, therefore, critical. Normal levels of vitamin D are 50 nmol/L (20 ng/mL) or more, while optimal levels are over 75 nmol/L (30 ng/mL).

Zinc-Copper Ratio

According to a 2003 study published in Biological Trace Element Research, a poor zinc-copper ratio can increase the risk of thyroid cancer (32). Zinc and copper compete against each other as antagonists to regulate physiological pathways.

A proper balance between the two is essential for maintaining good health. I recommend checking your plasma zinc and serum copper levels and their balance. The proper zinc-copper ratio should be 1:8, the normal range for zinc is 150 – 240µg/gram, and the serum copper ratio should be between 1 and 1.2.

Thyroid Labs 

I also recommend a full thyroid analysis. Your thyroid-stimulating hormone (TSH) levels should be ideally under 2.5.

Optimal levels for free T4 are over 1, for free T3 are between 3 and 4, and for rT3 are under 20. Your thyroglobulin (tG) and thyroid peroxide (TPO) antibodies should be low.

Comprehensive Blood Analysis

To check for these health markers, I recommend a Comprehensive Blood Analysis (CBA). This is the most detailed blood test that looks at all of these markers of inflammation. This test is more sophisticated than most conventional doctors are able to order.

It examines all parameters for inflammation, blood sugar levels, thyroid function, zinc and copper ratio, vitamin A and D levels, a complete metabolic panel, complete blood count, liver function, nutrient deficiencies, and more. I recommend getting the Comprehensive Blood Analysis done regularly both as a preventative measure and to monitor your inflammation levels and progress.

Natural Support Strategies

With the help of some natural support strategies, you can decrease chronic inflammation, reduce insulin resistance, correct nutritional deficiencies, support your thyroid health, and improve your health and wellness. Here is what I recommend: 

Anti-Inflammatory Nutrition Plan

We learned from a 2020 study published in the International Journal of Endocrinology that there is a correlation between chronic inflammation and thyroid nodules (11). An inflammatory diet is one of the most common ways people develop chronic inflammation and following an anti-inflammatory nutrition plan is one of the best ways to reduce inflammation in your body.

First and foremost, remove any inflammatory foods from your diet, including refined sugar, refined oils, gluten, conventional dairy, artificial ingredients, additives, food allergens, food sensitivities, junk food, and highly processed foods. A 2016 systematic review and meta-analysis published in PLoS One has found that the risk for thyroid disease is high for people with Celiac disease (33).

If you have Celiac disease, avoiding gluten completely is non-negotiable. However, gluten is a common cause of allergies and food sensitivities in those without Celiac disease as well. Avoiding gluten can be beneficial for most people.

I recommend that you follow an anti-inflammatory nutrition plan. This means whole foods. I recommend eating organic foods to reduce your exposure to pesticides, herbicides, and hormones as much as possible. Eat plenty of healthy fats, greens, vegetables, low glycemic index fruits, herbs, spices, grass-fed beef, pasture-raised poultry and eggs, wild-caught fish and seafood, and wild game.

Consider Getting into Ketosis 

A 2017 study published in the International Journal of Endocrinology and countless other research studies have found a correlation between thyroid nodules and insulin resistance in those with type 2 diabetes (12,13, 14, 15, 16). Reducing insulin resistance and improving insulin sensitivity may help. Since ketosis has a powerful impact on improving insulin resistance, it may be one of the best ways to improve your thyroid health.

In most circumstances, if you are following a diet that’s high or moderate in carbohydrates, your body burns glucose for energy. When your body doesn’t have enough dietary glucose to burn for energy as a result of carbohydrate restriction, caloric restriction, or fasting, it will turn to fat for energy instead and starts to make ketones in the process.

Ketosis may occur because of a low-carb, high-fat ketogenic (keto) diet, fasting, or other reasons of caloric and carbohydrate restriction, like famine. A 2010 study published in Endocrinology has found that getting into ketosis while following a ketogenic diet, can reduce insulin resistance, improve insulin sensitivity, and improve glucose tolerance (33).

To follow the ketogenic diet, keep your carbohydrate levels very low at 5 to 10 percent, your protein levels moderate at 30 to 35 percent, and your fats high at 55 to 60 percent of your calories. I recommend that you follow an anti-inflammatory diet with nutrient-dense whole foods as I explained earlier, instead of only focusing on your macronutrient ratios through fatty junk food.

Most of your diet should be made up of healthy fats, including avocados, coconut oil, coconut butter, coconuts, avocado oil, extra-virgin olive oil, pasture-raised butter and ghee, lard, flax seeds, hemp seeds, chia seeds, pumpkin seeds, other seeds, olives, nuts, and any fats from clean animal foods, such as grass-fed beef, pasture-raised poultry and eggs, wild-caught fish, and wild game.

Intermittent Fasting

Intermittent fasting is another fantastic way to reduce inflammation and insulin resistance, which are both major root cause risk factors for thyroid nodules (11, 12,13, 14, 15, 16). A 2011 study published in Obesity (Silver Spring) has found that fasting offers anti-inflammatory effects (35).

A 2019 systematic review and meta-analysis published in the Journal of Clinical Medicine has found that intermittent fasting can help to improve glucose metabolism, reduce insulin resistance, and lower body mass index (36). 

How to Apply Intermittent Fasting

Intermittent fasting is a form of fasting. It is a way of eating that cycles between periods of fasting and periods of eating within one day. If you are new to intermittent fasting, I recommend that you with the Simple Fast that involves 12 hours of fasting including your overnight sleep. Begin your fast after dinner at 6 or 7 pm) and don’t eat for 12 hours until breakfast (at 6 or 7 am). During your eating window, focus on a nutrient-dense, anti-inflammatory, and ketogenic diet to meet your nutrient and caloric needs. 

Gradually increase your fasting window until you reach your sweet spot. Most people feel their best with a 16-hour fasting window using the 16:8 method, but I recommend that you pay attention to your body and see what works for you. If you are a woman, Crescendo fasting and following your menstrual cycle following a fasting-feasting strategy are maybe the best for you. You can find articles on all these different intermittent fasting strategies by using the search bar on my website.

Reduce Stress & Improve Sleep 

Chronic stress and poor sleep can increase chronic inflammation and gut microbiome imbalance, which are two major root cause factors for thyroid nodules (11, 17, 18). Reducing your stress levels and improving your sleep are important, not only for your thyroid health but your overall well-being.

Try to reduce stress from your life as much as possible. Stop scrolling the news and social media. Avoid situations and people that increase your stress levels as much as possible. Learn to respond to stressful situations better and relax your body and mind through various strategies. I recommend meditation, breathwork, guided relaxation, visualization, gratitude, journaling, positive affirmations, mindset shifts, nature time, and prayer.

Avoid food, sugar, caffeine, alcohol, and stress close to bedtime. Avoid electronics or if you must use one, use blue-light blocking glasses and limit time spent in front of your screen. Engage in activities that help you relax your body and calm your mind.

Board games, crossword puzzles, calm conversation, listening to relaxing music, reading, journaling, coloring, taking a healing bath, meditation, contemplation, and prayer are all great ideas for the evening. Make sure that your mattress, pillows, and bedding are supportive and comfortable. Use black-out curtains or eye covers to block out any light and to help you sleep.

Open up Detoxification Pathways

A 2015 study published in Carcinogenesis and a 2019 review published in the International Journal of Environmental Research and Public Health environmental toxins can increase chronic inflammation and the risk of thyroid cancer (19, 20). Toxins can also increase chronic inflammation and gut dysbiosis that may contribute to thyroid nodules (11, 17, 18).

Opening up your detoxification pathways is very important. Support your digestion, absorption, and elimination pathways through a healthy diet. Support detoxification through the skin by sweating through exercise and infrared sauna use. Visit a biological dentist to remove your mercury fillings.

Support your kidneys and liver. These organs are very important when it comes to the detoxification and elimination of toxins and waste. Your liver is your primary detoxification organ. Your kidneys filter your blood to remove waste and support fluid balance. I recommend that you eat plenty of foods that support your kidneys and liver, including beets, grapefruit, green tea, garlic, spinach, broccoli, turmeric, citrus, avocado, cabbage, berries, and olive oil. Additionally, take a kidney and liver support supplement.

To further support the elimination of toxins, I recommend activated coconut charcoal. It binds to heavy metals and toxins, supports the removal of these toxins, and decreases oxidative stress and inflammation. I also recommend BioActive Carbons derived from multiple sources of humic acid, fulvic acid, and humic acid that support the removal of heavy metals and other toxins and improves detoxification pathways. 

Figuring out what kind of toxins are burdening your body can be difficult. On top of that, chronic, systemic infections also play a key role in developing thyroid nodules (21, 22, 23). I recommend working with a functional health practitioner that can help you with specific supplements that help to address toxins, infections, heavy metals, and other issues that are contributing to your symptoms and health issues.

Heal Leaky Gut & Improve Microbiome

As you know, leaky gut syndrome and gut dysbiosis are major factors that can increase chronic inflammation, thyroid problems, and the development of thyroid nodules (11, 17, 18). Having a healthy gut microbiome supports absorption, digestion, detoxification, and elimination.

While following an anti-inflammatory nutrition plan is critical, it can also be important to support your body with probiotics and eating prebiotic-rich foods. Experiment to find the right amount of prebiotics for your body type.  Some people thrive on a prebiotic rich diet while others get worse and need to minimize prebiotics by following a low-FODMAP diet or even a carnivore diet for a period of time.  Try out a high prebiotic diet and see if you feel better and if not, try a low-FODMAP or carnivore diet and see if that helps you feel better.

Probiotics are healthy bacteria that help to improve your gut microbiome, reduce chronic inflammation, and lower the risk of leaky gut. Prebiotics are fibers found in specific plant foods that help to feed the probiotics. 

Take daily probiotics as well and digestive enzymes to support digestion. Make sure that you are taking high-quality probiotics with many strains of beneficial bacterial and experiment to see what type of probiotics you feel best with.  If you have stubborn gut issues, consider choose soil-based (SBO) probiotics since certain strains of bacteria in other probiotics, while healthy for most, may be triggering for those with persistent issues.

Optimize Stomach Acid Production

Poor stomach acid production can lead to all kinds of gut health issues, including small intestinal bacterial overgrowth (SIBO), gut dysbiosis, and leaky gut syndrome, increasing your risk of developing thyroid nodules (11, 17, 18). 

To improve your stomach acid levels, I recommend the following:

• Use Liquid Nutrition Throughout the Day: If you have serious issues with low stomach acid, GERD, or gastritis, liquid nutrition may help. I recommend that at least half of your meals are in a liquid form such as a protein shake or green smoothie. Protein shakes are pre-metabolized and very easy to digest and do not depend upon HCL production. If you have low HCL it may be helpful to drink one to two protein shakes daily to support amino acid absorption, reduce extra stress on your digestion, and support healthy stomach acid levels
• Use Ginger: Ginger is a great herb for improving digestive juices. I recommend drinking 2 to 3 cups of ginger tea each day, you can put ginger essential oil in water (2 to 3 drops in 8 oz of water),  juice a ½ inch of fresh ginger root in a green juice each day and use ground ginger on your foods. You can also add fermented ginger to your diet which is common in Asian dishes such as kimchi. 
• Super Hydrate Outside of Meal Times: Good hydration can help activate bowel motility and push contents through the digestive system which will reduce microbial fermentation and toxicity in the body. This can help to support your stomach acid levels. Good hydration also supports detoxification and elimination.
• Drink Very Little With Meat Containing Meals: While good hydration is critical, drinking water during mealtime is not always a good idea. When you are eating meat or any sort of heavier foods, avoid drinking water or other liquids at least 30 minutes before the meal, except if you need to take a supplement with 2 ounces of water. Avoiding water during these meals will reduce any potential dilution of the gastric juices and allow for better digestion.
• Hold Off On Water After a Meal: To allow for optimal digestion, I also recommend not drinking water or other liquids until at least 30 minutes after a meal. This allows for proper stomach acid activity, sterilization, and protein metabolism.
• Use Lemon and Apple Cider Vinegar: Squeezing fresh lemon or using lemon juice or apple cider vinegar on your meat and vegetables helps to pre-metabolize the food and support better digestion and nutrient absorption. You can either marinate foods in a lemon or ACV base or just add them as a dressing right before you consume them. Again, make sure that apple cider vinegar is not triggering your silent reflux symptoms and if it is, focus on my other recommendations.
• Eat Protein Foods at the Beginning of the Meal: The stomach will begin churning out its stomach acid when you begin eating, especially when you are consuming protein. While it’s culturally common to a salad before their protein dish, this is not great for your HCL production. It is a much better idea to eat your protein with the salad or vegetables instead of after.
• Use Fermented Veggies: Fermented foods such as sauerkraut, kimchi, pickles, pickled ginger, and other fermented vegetables all contain organic acids, enzymes, and probiotics which help to improve digestive juice secretions, I recommend using one of these with all of your heavier meals and especially any meal with protein.
• Use Fermented Drinks: Fermented drinks such as apple cider vinegar, coconut kefir, and kombucha offer antimicrobial benefits and help to reduce the bacterial load, especially the bacteria in the stomach such as H Pylori. Keeping H Pylori levels down is critical for the body to be able to produce enough stomach acid.
• Eat Your Largest Meal When You Are Most Relaxed: Your body needs to activate the parasympathetic nervous system to produce enough stomach acids. If you are busy and, on the go, you will be in fight or flight sympathetic mode. If you struggle with low stomach acid, this fight or flight state is not going to allow your body to produce anywhere near enough. Relaxing before the meal is important to improve stomach acid production.

Optimize Vitamin D Levels

Vitamin D deficiency is one of the main root cause factors for thyroid nodules (24, 25). I recommend that you spend time outside in the sun daily if possible and eat foods rich in vitamin D, such as fatty fish, liver, and egg yolks. 

Using only vitamin D supplements is not enough, however, you also need vitamin K2 for proper absorption and calcium utilization. This is why, I recommend a daily Vitamin D3/K2 supplement to optimize vitamin D levels.

Typically taking 1,000 IU per 25 lbs. of body weight will help you get your levels into a healthy range.  You want to test your vitamin D levels at least 1-2 times each year and get your levels between 50-100 ng/ml.  It has been hypothesized that a therapeutic level for various health conditions like thyroid nodules is going to be between 70-100 ng/ml.

Optimize Iodine, Zinc & Selenium Levels

Iodine, zinc, and selenium deficiency are common root cause risk factors for thyroid nodules gland (5, 26, 27). Since too much iodine can also become a problem, I recommend this Iodine Loading Test to check your iodine levels.

To optimize your iodine levels, I recommend consuming seaweed, such as kelp, nori, wakame, and kombu, as well as salmon, tuna, cod, other seafood, eggs, and prunes. Supplementation may be necessary, however, testing your iodine levels and consulting with a healthcare practitioner is important before starting a supplement regimen. 

Many people have seen good results using nascent iodine topically over their thyroid and allow the iodine to diffuse transdermally into the blood stream and impact the thyroid tissue.  You can also take this orally as well.  

I recommend that you follow a diet rich in zinc. Food sources of zinc include meat, shellfish, nuts, seeds, and legumes. However, diet alone is not always enough, especially if you are dealing with a deficiency. I recommend a daily intake of a zinc supplement is critical for optimal levels. 

Selenium supplementation is rarely necessary. You can easily meet your daily needs by eating two Brazil nuts a day, a nut that’s incredibly high in selenium. Other foods that are rich in selenium include beef, poultry, eggs, shellfish, yogurt, sunflower seeds, spinach, mushrooms, lentils, cashews, and bananas. In case of a serious deficiency, supplementation may be required, however, make sure that you get tested for deficiencies and consult with a functional medicine doctor first.

Anti-Inflammatory Herbs

Since chronic inflammation plays a big role in the development of thyroid nodules and other thyroid issues, certain anti-inflammatory herbs may help.

Turmeric 

Turmeric is one of the most researched herbs for its anti-inflammatory benefits. Turmeric may also benefit your thyroid health.

A 2013 study published in Food Chemistry has found that curcumin, the active compound in turmeric, may help to inhibit growth and metastasis in thyroid cancer (37). A 2015 study published in the Indian Journal of Endocrinology Metabolism has found that turmeric may help to reduce the risk of goiters in thyroid disease. 

I recommend that you add turmeric to your diet, including to your curries, soups, vegetable dishes, smoothies, green juices, dressings, and salads. I also recommend turmeric supplementation for improved health.

Resveratrol & Quercetin 

Resveratrol is a powerful plant compound and antioxidant found in the skin of grapes, berries, and red wine. Quercetin is a flavonoid with antioxidant and anti-inflammatory benefits found in plants. Resveratrol and quercetin complement each other well and they may benefit your thyroid health.  These compounds activate the Nrf2 antioxidant pathway that helps to protect cells and tissues of the body.  

A 2011 study published in the Journal of Endocrinological Investigation has found that resveratrol may help to improve thyroid function (39). A 2016 study published in the Journal of Thyroid Research has found that quercetin can help to trigger cell death in thyroid cancer (40).

I recommend that you consume plenty of resveratrol-rich foods, such as grapes, blueberries, cranberries, pistachio, and cacao, and quercetin-rich foods, such as herbs, romaine lettuce, red leaf lettuce, raw kale, cabbage, sprouts, raw asparagus, snap peas, raw red onions, peppers, cruciferous vegetables, olive oils, cherries, black currants, chokeberries, blueberries, black plums, cranberries, apples, and grapes.

 I also recommend that you supplement with both resveratrol and quercetin. You may find inflammation defense supplements with resveratrol, quercetin, turmeric, and other anti-inflammatory herbs to support your health.

Essential Oils 

You may benefit from using essential oils as well. Frankincense oil is a particularly great essential oil that offers immune-boosting, anti-inflammatory, and pain-relieving properties. It may be helpful for hyperactive thyroid.

According to a 2015 study published in Science Reports, frankincense essential oil may help to lower inflammation (41). Using essential oils may also help to reduce stress which can trigger chronic inflammation contributing to thyroid nodules. Use frankincense oil with a carrier oil and apply it over your thyroid nodules.

Low-Level Laser Therapy 

Low-level laser therapy (LLLT) is a form of alternative medicine. It uses a low-level, low-power laser, light-emitting diodes (LEDs), or near-infrared light close to your body’s surface to reduce tissue damage, promote cellular healing, decrease inflammation, and lower pain levels. Using photochemical technology, it gets inside your cells to improve your mitochondria and decrease inflammation-causing nitric oxide. It helps to move more oxygen to your cells and improves oxygenation, cell metabolism, and mitochondria function to help tissue repair and cellular health.

Low-level laser therapy is a powerful tool that may help to improve your thyroid health. A 2010 clinical trial has found that low-level laser therapy may benefit chronic autoimmune thyroiditis (42). A 2018 study published in the International Journal of Endocrinology has also found that low-level laser therapy may be safe and effective for treating autoimmune thyroid disease (43).

Final Thoughts

Thyroid nodules are growths or lumps on your thyroid tissues that affect up to 65 percent of the population. While in most cases thyroid nodules are benign, in some cases they can cause compressive symptoms or become cancerous.

I recommend that you and your healthcare professional look into the key labs in this article for thyroid nodules. I recommend that you follow my natural support strategies to improve your health.

If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. On our website, we offer long-distance functional health coaching programs. For further support with your health goals, just reach out—our fantastic coaches are here to support your journey.

Inflammation Crushing Ebundle

The Inflammation Crushing Ebundle is designed to help you improve your brain, liver, immune system and discover the healing strategies, foods and recipes to burn fat, reduce inflammation and Thrive in Life!

As a doctor of natural medicine, I have spent the past 20 years studying the best healing strategies and worked with hundreds of coaching clients, helping them overcome chronic health conditions and optimize their overall health.

In our Inflammation Crushing Ebundle, I have put together my very best strategies to reduce inflammation and optimize your healing potential.  Take a look at what you will get inside these valuable guides below!

Sources in This Article Include:

1. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules: A Review. JAMA. 2018 Mar 6;319(9):914-924. doi: 10.1001/jama.2018.0898. Erratum in: JAMA. 2018 Apr 17;319(15):1622. PMID: 29509871

2. Varadhan L, Varughese GI, Sankaranarayanan S. Hyperthyroidism and Graves’ disease: Is an ultrasound examination needed? Indian J Endocrinol Metab. 2016 Nov-Dec;20(6):866-869. doi: 10.4103/2230-8210.192899. PMID: 27867894

3. Eng OS, Potdevin L, Davidov T, Lu SE, Chen C, Trooskin SZ. Does nodule size predict compressive symptoms in patients with thyroid nodules? Gland Surg. 2014 Nov;3(4):232-6. doi: 10.3978/j.issn.2227-684X.2014.08.03. PMID: 25493254

4. Popoveniuc G, Jonklaas J. Thyroid nodules. Med Clin North Am. 2012 Mar;96(2):329-49. doi: 10.1016/j.mcna.2012.02.002. PMID: 22443979

5. Chung HR. Iodine and thyroid function. Ann Pediatr Endocrinol Metab. 2014 Mar;19(1):8-12. doi: 10.6065/apem.2014.19.1.8. Epub 2014 Mar 31. PMID: 24926457

6. Thyroid nodules. Link Here

7. Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2010 Apr;43(2):229-38, vii. doi: 10.1016/j.otc.2010.01.002. PMID: 20510711

8. Knox MA. Thyroid nodules. Am Fam Physician. 2013 Aug 1;88(3):193-6. PMID: 23939698

9. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules: A Review. JAMA. 2018 Mar 6;319(9):914-924. doi: 10.1001/jama.2018.0898. Erratum in: JAMA. 2018 Apr 17;319(15):1622. PMID: 29509871

10. Sacks W, Fung CH, Chang JT, Waxman A, Braunstein GD. The effectiveness of radioactive iodine for treatment of low-risk thyroid cancer: a systematic analysis of the peer-reviewed literature from 1966 to April 2008. Thyroid. 2010 Nov;20(11):1235-45. doi: 10.1089/thy.2009.0455. PMID: 21062195

11. Li Z. The Effect of Inflammation on the Formation of Thyroid Nodules. International Journal of Endocrinology. Link Here

12. Tang Y, Yan T, Wang G, Chen Y, Zhu Y, Jiang Z, Yang M, Li C, Li Z, Yu P, Wang S, Zhu N, Ren Q, Ni C. Correlation between Insulin Resistance and Thyroid Nodule in Type 2 Diabetes Mellitus. Int J Endocrinol. 2017;2017:1617458. doi: 10.1155/2017/1617458. Epub 2017 Oct 12. PMID: 29158735

13. Wang K, Yang Y, Wu Y, Chen J, Zhang D, Mao X, Wu X, Long X, Liu C. The association between insulin resistance and vascularization of thyroid nodules. J Clin Endocrinol Metab. 2015 Jan;100(1):184-92. doi: 10.1210/jc.2014-2723. PMID: 25368977

14. Karaköse M, Hepsen S, Çakal E, Saykı Arslan M, Tutal E, Akın Ş, Ünsal İ, Özbek M. Frequency of nodular goiter and autoimmune thyroid disease and association of these disorders with insulin resistance in polycystic ovary syndrome. J Turk Ger Gynecol Assoc. 2017 Jun 1;18(2):85-89. doi: 10.4274/jtgga.2016.0217. Epub 2017 Feb 7. PMID: 28400351

15. Yasar HY, Ertuğrul O, Ertuğrul B, Ertuğrul D, Sahin M. Insulin resistance in nodular thyroid disease. Endocr Res. 2011;36(4):167-74. doi: 10.3109/07435800.2011.593011. PMID: 21973236

16. Hu L, Li T, Yin XL, Zou Y. An analysis of the correlation between thyroid nodules and metabolic syndrome. Endocr Connect. 2020 Oct;9(9):933-938. doi: 10.1530/EC-20-0398. PMID: 33006954

17. Zhang J, Zhang F, Zhao C, Xu Q, Liang C, Yang Y, Wang H, Shang Y, Wang Y, Mu X, Zhu D, Zhang C, Yang J, Yao M, Zhang L. Dysbiosis of the gut microbiome is associated with thyroid cancer and thyroid nodules and correlated with clinical index of thyroid function. Endocrine. 2019 Jun;64(3):564-574. doi: 10.1007/s12020-018-1831-x. Epub 2018 Dec 24. PMID: 30584647

18. Knezevic J, Starchl C, Tmava Berisha A, Amrein K. Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function? Nutrients. 2020 Jun 12;12(6):1769. doi: 10.3390/nu12061769. PMID: 32545596

19. Thompson PA, Khatami M, Baglole CJ, Sun J, Harris SA, Moon EY, Al-Mulla F, Al-Temaimi R, Brown DG, Colacci A, Mondello C, Raju J, Ryan EP, Woodrick J, Scovassi AI, Singh N, Vaccari M, Roy R, Forte S, Memeo L, Salem HK, Amedei A, Hamid RA, Lowe L, Guarnieri T, Bisson WH. Environmental immune disruptors, inflammation and cancer risk. Carcinogenesis. 2015 Jun;36 Suppl 1(Suppl 1):S232-53. doi: 10.1093/carcin/bgv038. PMID: 26106141

20. Fiore M, Oliveri Conti G, Caltabiano R, Buffone A, Zuccarello P, Cormaci L, Cannizzaro MA, Ferrante M. Role of Emerging Environmental Risk Factors in Thyroid Cancer: A Brief Review. Int J Environ Res Public Health. 2019 Apr 2;16(7):1185. doi: 10.3390/ijerph16071185. PMID: 30986998

21. Janegova A, Janega P, Rychly B, Kuracinova K, Babal P. The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases. Endokrynol Pol. 2015;66(2):132-6. doi: 10.5603/EP.2015.0020. PMID: 25931043

22. Moghoofei M, Mostafaei S, Nesaei A, Etemadi A, Sadri Nahand J, Mirzaei H, Rashidi B, Babaei F, Khodabandehlou N. Epstein-Barr virus and thyroid cancer: The role of viral expressed proteins. J Cell Physiol. 2019 Apr;234(4):3790-3799. doi: 10.1002/jcp.27144. Epub 2018 Oct 26. PMID: 30362517

23. Dittfeld A, Gwizdek K, Michalski M, Wojnicz R. A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders. Cent Eur J Immunol. 2016;41(3):297-301. doi: 10.5114/ceji.2016.63130. Epub 2016 Oct 25. PMID: 27833448

24.Mackawy AM, Al-Ayed BM, Al-Rashidi BM. Vitamin d deficiency and its association with thyroid disease. Int J Health Sci (Qassim). 2013 Nov;7(3):267-75. doi: 10.12816/0006054. PMID: 24533019

25. Hu MJ, Zhang Q, Liang L, Wang SY, Zheng XC, Zhou MM, Yang YW, Zhong Q, Huang F. Association between vitamin D deficiency and risk of thyroid cancer: a case-control study and a meta-analysis. J Endocrinol Invest. 2018 Oct;41(10):1199-1210. doi: 10.1007/s40618-018-0853-9. Epub 2018 Feb 20. PMID: 29464660

26. Zimmermann MB. Thyroid gland: Iodine deficiency and thyroid nodules. Nat Rev Endocrinol. 2014 Dec;10(12):707-8. doi: 10.1038/nrendo.2014.187. Epub 2014 Oct 21. PMID: 25331285

27. Zimmermann MB, Galetti V. Iodine intake as a risk factor for thyroid cancer: a comprehensive review of animal and human studies. Thyroid Res. 2015 Jun 18;8:8. doi: 10.1186/s13044-015-0020-8. PMID: 26146517

28. Rasmussen LB, Schomburg L, Köhrle J, Pedersen IB, Hollenbach B, Hög A, Ovesen L, Perrild H, Laurberg P. Selenium status, thyroid volume, and multiple nodule formation in an area with mild iodine deficiency. Eur J Endocrinol. 2011 Apr;164(4):585-90. doi: 10.1530/EJE-10-1026. Epub 2011 Jan 17. PMID: 21242171

29. Moncayo R, Kroiss A, Oberwinkler M, Karakolcu F, Starzinger M, Kapelari K, Talasz H, Moncayo H. The role of selenium, vitamin C, and zinc in benign thyroid diseases and of selenium in malignant thyroid diseases: Low selenium levels are found in subacute and silent thyroiditis and in papillary and follicular carcinoma. BMC Endocr Disord. 2008 Jan 25;8:2. doi: 10.1186/1472-6823-8-2. PMID: 18221503

30. Köhrle J. Selenium and the thyroid. Curr Opin Endocrinol Diabetes Obes. 2015 Oct;22(5):392-401. doi: 10.1097/MED.0000000000000190. PMID: 26313901

31. Ertek S, Cicero AF, Caglar O, Erdogan G. Relationship between serum zinc levels, thyroid hormones and thyroid volume following successful iodine supplementation. Hormones (Athens). 2010 Jul-Sep;9(3):263-8. doi: 10.14310/horm.2002.1276. PMID: 20688624

32. Kucharzewski M, Braziewicz J, Majewska U, Gózdz S. Copper, zinc, and selenium in whole blood and thyroid tissue of people with various thyroid diseases. Biol Trace Elem Res. 2003 Summer;93(1-3):9-18. doi: 10.1385/BTER:93:1-3:9. PMID: 12835485

33. Sun X, Lu L, Yang R, Li Y, Shan L, Wang Y. Increased Incidence of Thyroid Disease in Patients with Celiac Disease: A Systematic Review and Meta-Analysis. PLoS One. 2016 Dec 28;11(12):e0168708. doi: 10.1371/journal.pone.0168708. PMID: 28030626

34. Kinzig KP, Honors MA, Hargrave SL. Insulin sensitivity and glucose tolerance are altered by maintenance on a ketogenic diet. Endocrinology. 2010 Jul;151(7):3105-14. doi: 10.1210/en.2010-0175. Epub 2010 Apr 28. PMID: 20427477

35. Lavin DN, Joesting JJ, Chiu GS, Moon ML, Meng J, Dilger RN, Freund GG. Fasting induces an anti-inflammatory effect on the neuroimmune system which a high-fat diet prevents. Obesity (Silver Spring). 2011 Aug;19(8):1586-94. doi: 10.1038/oby.2011.73. Epub 2011 Apr 28. PMID: 21527899 

36. Cho Y, Hong N, Kim KW, Cho SJ, Lee M, Lee YH, Lee YH, Kang ES, Cha BS, Lee BW. The Effectiveness of Intermittent Fasting to Reduce Body Mass Index and Glucose Metabolism: A Systematic Review and Meta-Analysis. J Clin Med. 2019 Oct 9;8(10):1645. doi: 10.3390/jcm8101645. PMID: 31601019

37. Zhang CY, Zhang L, Yu HX, Bao JD, Sun Z, Lu RR. Curcumin inhibits invasion and metastasis in K1 papillary thyroid cancer cells. Food Chem. 2013 Aug 15;139(1-4):1021-8. doi: 10.1016/j.foodchem.2013.02.016. Epub 2013 Feb 16. PMID: 23561205

38. Jawa A, Jawad A, Riaz SH, Assir MZ, Chaudhary AW, Zakria M, Akram J. Turmeric use is associated with reduced goitrogenesis: Thyroid disorder prevalence in Pakistan (THYPAK) study. Indian J Endocrinol Metab. 2015 May-Jun;19(3):347-50. doi: 10.4103/2230-8210.152768. PMID: 25932388

39. Duntas, L.H. Resveratrol and its impact on aging and thyroid function. J Endocrinol Invest 34, 788–792 (2011). Link Here

40. Mutlu Altundağ E, Kasacı T, Yılmaz AM, Karademir B, Koçtürk S, Taga Y, Yalçın AS. Quercetin-Induced Cell Death in Human Papillary Thyroid Cancer (B-CPAP) Cells. J Thyroid Res. 2016;2016:9843675. doi: 10.1155/2016/9843675. Epub 2016 Jan 20. PMID: 27057371

41. Su S, Duan J, Chen T, Huang X, Shang E, Yu L, Wei K, Zhu Y, Guo J, Guo S, Liu P, Qian D, Tang Y. Frankincense and myrrh suppress inflammation via regulation of the metabolic profiling and the MAPK signaling pathway. Sci Rep. 2015 Sep 2;5:13668. doi: 10.1038/srep13668. Erratum in: Sci Rep. 2015;5:15597. PMID: 26329643

42. Höfling DB, Chavantes MC, Juliano AG, Cerri GG, Romão R, Yoshimura EM, Chammas MC. Low-level laser therapy in chronic autoimmune thyroiditis: a pilot study. Lasers Surg Med. 2010 Aug;42(6):589-96. doi: 10.1002/lsm.20941. PMID: 20662037

43. Höfling DB, Chavantes MC, Buchpiguel CA, Cerri GG, Marui S, Carneiro PC, Chammas MC. Safety and Efficacy of Low-Level Laser Therapy in Autoimmune Thyroiditis: Long-Term Follow-Up Study. Int J Endocrinol. 2018 Nov 4;2018:8387530. doi: 10.1155/2018/8387530. PMID: 30532779