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Toxic Multinodular what foods to avoid? Should I take Iodine Tabs?
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Toxic Multinodular what foods to avoid? Should I take Iodine Tabs?

I am a 47 year old male and I have been diagnosed with Toxic Multinodular Goiter. My TSH is low at .20 but my T3 and T4 are normal. The rest of my blood work was normal except for High cholesterol and low calcium and vitamin D. I have most of the typical symptoms of Hyperthyroidism and most annoying to me is confusion and short term memory problems. I am experiencing a bit of pain on the left side of my neck as well.  I am 5 feet 9 inches tall and currently weigh 290lbs.  In my teens and twenties and even into my early ‘30s I was of normal weight and only gradually became obese in my late ‘30s early ‘40s. I have had great difficulty loosing weight on any diet and I do exercise regularly.  I have had a history of low TSH as far back as 2004. I was never treated for this exhaustion, loosing hair, memory problems etc until now when I had an ultrasound done where the cysts were discovered.  Below is the Ultrasound report.  My Doctor wanted to do a thyroid uptake and scan and then either Ablation or surgery, as a last option and temporary she mentioned Methimzole. For now I opted to only take the Methimzole while I study my options.  I really do not understand the implications of the Ultrasound and the doctor did not explain it.

My Questions are:  1) What does the “Toxic” part of this mean 2) Where can I find a diet to loose weight and help this condition, is it possible to reverse this condition with proper diet? How do I know what I should and should not be eating?

- McMillan Nelson
Ultrasound Report

12/2/2009

THYROID SONOGRAM:
Clinical Indication: History of thyroid cyst on a screening exam. Screening is not available for review. No old studies available for review.

Right Lobe: Mildly enlarged, measuring 5.2 cm x 1.9 cm x 2.1 cm. A 0.6 cm x 0.4 cm hypoechoic and I believe predominately cystic nodule is seen inferiorly in the right lobe without coarse or papillary calcification. A 0.3 x 0.3 cm x 0.3 cm predominately hypoechoic nodule containing two echogenic foci which cast reverberation artifacts consistent with colloid seen in the interpolar region. A similar appearing 0.5 cm nodule is also identified in the interpolar region. No evidence suspicious for papillary or coarse calcification is seen in the right lobe.

Isthmus: Mildly enlarged and without evidence of discrete nodule, coarse or papillary calcification.

Left lobe: Enlarged, measuring approximately 5.2 cm x 2.2 cm 2.1 cm. The length may have been underestimated as the inferior pole extends below the clavicle. A 0.4 cm x 0.5 cm x 0.3 cm anechoic and most likely cystic nodule is seen in the superior pole. 0.7 cm x 0.5 cm x 0.7 cm nodule is seen on the interpolar region and it contains a punctuate echo which casts a reverberation artifact consistent with colloid. No coarse or papillary calcification is seen of the left.

Opinion: The thyroid gland is enlarged. Multiple thyroid nodules are present, none of which meets Society of Radiologist’s in Ultrasound criteria for strong consideration to fine needle aspiration biopsy and at least three of which appear to contain colloid.
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15 Comments Post a Comment
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Avatar_f_tn
You NEED to post your FT3 and FT4 levels. Your symptoms sound HYPO, not HYPER, but your TSH is low, common in hyper. Have you had your pituitary checked? This could be a pituitary problem as well.

Also, get the TGab and TPOab tests to determine if Hashimoto's is behind all this.

Remember, TSH is a pituitary hormone. It doesn't tell us EXACTLY what the thyroid is doing. TSH is the message the pituitary sends to the thyroid. If the pituitary is damaged, this could by why you have low TSH and hypo symptoms.

I want to know your free levels. 'Normal' is changing.

Are you on any thyroid hormone pills?

:) Tamra
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Avatar_f_tn
And yes, if the frees are high enough, you can lose weight.
:) Tamra
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1144849_tn?1395458766
Hi Tamara, Thanks for responding.  I suppose something could  be goofy with my pituitary gland also.  Since I have the 6 "Nodules" in the thyroid that is a problem there but I don't know how that affects my T3 or T4.  ( am new at this)  I did fill in my blood work that i had data for from October and November into my Thyroid Tracker thing. Are you able to see that in my profile ?  Otherwise I can re type it all in a post here. The doctor wanted to do Ablation and I said no .. I wanted to see what my options are. so instead she put me on Methimzole 5mg x2 day but I am only taking once a day for now.

I don't know what TGab and TPOab are but I did not see that on any of the two recent blood work I had done.

Thanks! Mac
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Avatar_f_tn
The "toxic" part of your diagnosis means that you have nodules that are functioning separately and independently from your thyroid.  These nodules produce thyroid hormones and dump them into your bloodstream.  Unlike the other parts of your thyroid, they do not need TSH to stimulate hormone production; they just keep cranking out hormones (and make you hyper).

It is very difficult to lose weight when thyroid hormones are out of balance.  True, weight gain is more often associated with hypo than hyper, but it is far from unheard of in hyper.  Attempting weight loss until you get your thyroid hormones under control will probably be an exercise in frustration.

There is no way to control any thyroid dysfunction with diet.  There are about as many dietary suggestions to improve our condition as there are people with thyroid disease.  Some things work for one person, some for another.  The best approach is to eat a sensible diet to maintain overall health and to address any known nutrient deficiencies or confirmed intolerances.

You are taking an excellent approach in taking the methimazole while researching your condition.  Learn all you can about it and also research hypOthyroidism, because after ablation or surgery, you will be hypo for the rest of your life.  However, this is an easier and less dangerous condition to treat than hyper.  But, it does mean that you will be on daily meds for the rest of your life.

TPOab and TGab are two of the thyroid antibodies implicated in autoimmune thyroid disease.  Since your nodules have already been determined to be toxic, I'm not sure how much knowing if it's an autoimmune disease causing the nodules is going to add to your thyroid profile.  Toxic nodules kind of trump anything else in their path.  However, once you have one autoimmune disease, you are more likely than the general population to develop another, so that might make it worthwhile to know.    
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Avatar_f_tn
I don't understand the tracker because it just shows a graph and not actual numbers. I can't tell what the FT4 is. Is that above or below a one? Just post your FT4 numbers. I see the doctor did not test the TPOab, just the TGab. Both tests are needed.

It is important to know if Hashi is behind this. Hashimoto's does more than cause hypothyroidism. It's an auto-immunity and can accompany other auto-immunities - not to mention it's a pain in the rear. For me, at least I have  a name for my suffering.

:)Tamra
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1144849_tn?1395458766
Hi "goolarra" , Thanks for your input!  I Guess I can see now why the doctor is concerned about the "toxic" part of this problem and wants to do an Ablation, but I am still not convinced that is the only solution to this issue.  I really appreciate everyone's feedback this is a wonderful forum.  

Can/should I take Iodine supplements or is that a bad idea ?

Merry Christmas to all :-)

McMillan
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1144849_tn?1395458766
Hi Tamara, Here are my blood work results: There is alot of stuff here. I don't know if what you asked about is here.

Lab: Q-CALCIUM, IONIZED
Name Value Reference Range
CALCIUM, IONIZED 4.95 4.8-5.6
Result:
Assessments: Weight gain Abnormal
Lab: Q-GLUCOSE, FASTING (P)
Name Value Reference Range
GLUCOSE, FASTING (P) 88 65-99
Assessments: Weight gain Abnormal
Lab: Q-INSULIN
Name Value Reference Range
INSULIN 17 <17
Assessments: Pruritic dermatitis NOS
Lab: Q-SPEP-PROTEIN, TOTAL AND PROTEIN ELECTROPHORESIS
Name Value Reference Range
GAMMA GLOBULINS 0.9 0.6-1.6
BETA GLOBULINS 1.1 0.8-1.4
ALPHA-2-GLOBULINS 0.9 0.5-1.0
ALPHA-1-GLOBULINS 0.3 0.1-0.3
ALBUMIN 3.9 3.5-4.7
PROTEIN, TOTAL 7.1 6.2-8.3
ABNORMAL PROTEIN BAND 1
ABNORMAL PROTEIN BAND 2
ABNORMAL PROTEIN BAND 3
INTERPRETATION
==
Assessments: Hyperthyroid, NOS
Lab: Q-T-4, FREE
Name Value Reference Range
T4, FREE 1.2 0.8-1.8
==
Assessments: Hyperthyroid, NOS
Lab: Q-TSH, 3RD GENERATION
Name Value Reference Range
TSH, 3RD GENERATION 0.28 0.40-4.50
==
Assessments: Hyperthyroid, NOS
Lab: Q-THYROID PEROXIDASE$ANTIBODIES
Name Value Reference Range

THYROID PEROXIDASE ANTIBODIES <10 <35
Assessments: Pruritic dermatitis NOS
Lab: Q-PSA, TOTAL
Name Value Reference Range
PSA, TOTAL 1.3 24.0
Assessments: Hyperlipidemia Mixed
Lab: Q-CARDIO CRP
Name Value Reference Range
CARDIO CRP(R) 4.8
==
Assessments: Diarrhea
Lab: Q-SEROTONIN, SERUM
Name Value Reference Range
SEROTONIN, SERUM 61 26-165
==
Assessments: Thyroid cyst
Lab: Q-THYROGLOBULIN PANEL
Name Value Reference Range
THYROGLOBULIN AB <20 <20
THYROGLOBULIN 36.5 2.0-35.0
==
Assessments: Hyperthyroid, NOS
Lab: Q-TSI (THYROID STIMULATING$IMMUNOGLOBULIN)
Name Value Reference Range
TSI 81 <=125
Assessments: Hyperthyroid, NOS
Lab: Q-T3, FREE
Name Value Reference Range
T3, FREE 355 230-420
Assessments: GERD [Gastroesophageal reflux disease]
Lab: Q-H-PYLORI IGA & IGG
Name Value Reference Range
H. PYLORI AB IGG Negative Negative
H. PYLORI AB IGA Negative Negative
==
Assessments: Pruritic dermatitis NOS
Lab: Q-HISTAMINE (PLASMA)
Name Value Reference Range
HISTAMINE, PLASMA <0.1
==
Assessments:
Lab: VITAMIN D, 25-HYDROXY, LC/MS/MS
Name Value Reference Range
VITAMIN D, 25 OH TOTAL 27 20-100
VITAMIN D, 25 OH, D2 12
VITAMIN D, 25 OH, D3 15

Thanks for your help and advice.

Merry Christmas!

McMillan

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Avatar_f_tn
It's a difficult problem to deal with with meds.  But, learn, learn, learn...read everything you can, and you'll be able to make a really informed decision.

BTW, you did have both TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulen antibodies) run.  TPOab was negative, but TGab is positive...just barely positive (36.5 with the upper end of the range at 35).

I think (not a doctor, just a fellow patient) that iodine would not be a good idea.  Iodine is essential for making thyroid hormones...you're nodules are already making too much.  I don't think you want to give them any more ammunition.
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Avatar_f_tn
I would probably hold off on the iodine until the nodules are resolved.

TSH low. Your FT4 is normal, but the FT3 is slightly in the higher end.

Your Tgab is positive, although just barely. Still, with your nodules and other issues, I do think an auto-immunity is at work.

You can be fatigued with hyper symptoms. I know I am exhausted and wired at the same time when my nodules leak.

Something needs to be done about these nodules. In this abalation, do they cut out the nodules or use RAI?

:) Tamra
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1144849_tn?1395458766
Hi, Thanks for responding and advising against the Iodine supplements. it does appear that that would only make things worse!

McMillan
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1144849_tn?1395458766
Hi Tamara, The Ablation would be RAI.  I have been feeling like crap for the last few days .. thinking more like I should just go do that, but I am still researching the down sides of doing that and of course looking for any other natural options that might be out there.

Thanks,

McMillan
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Avatar_f_tn
There is a slightly higher risk of developing stomach cancer 10 years after RAI. See below link or Google stomach cancer and RAI:

http://www.drrathresearch.org/health_news/cancer_060607_excess.html

Here's another article on side-effects:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radioactive_Iodine_Therapy_43.asp?sitearea=

Some members on this forum have had successful RAI treatments, but you should explore all options before any new treatment.  

:) Tamra
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1144849_tn?1395458766
Hi Tamara, Thanks again for your help!  Your suggestions and links were very helpful.

You mentioned that when your nodules "leak" you have problems etc. what sort of treatment did you have for nodules?   Nothing so far seems to be a cure presented without long term risk or problems.  I have not seen much offered in the way of natural treatments. Just curious since you have been through so many Endos.

Thanks!

Mac
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1144849_tn?1395458766
Here is some interesting information that I found regarding my question of whether I should take Iodine or not.  I thought I would share it here.  Anyone can Google to find more information.

-McMillan


November, 2004, Issue

"Fatigue — An underactive thyroid typically causes fatigue. Iodine supplementation can quickly activate the thyroid and relieve fatigue. Dr Abraham reports iodine deficiency may harm pituitary-adrenal function in rodents. Your adrenal is essential for energy and stamina."
...
"Thyroid disease — When there’s not enough iodine to bind with cell membranes, it allows enzymes called peroxidases (which can damage those membranes) to wreak havoc and cause autoimmune disease, such as thyroiditis (Hashimoto’s or Grave’s)."
...
"While iodine will help the thyroid increase the production of hormone where necessary, it also inhibits over-release from the gland by giving thyroid enzymes what they want. These iodine-seeking enzymes that attack thyroid membranes can be normalized when they get the iodine they need. This old information is terrific news for the many people (usually women) who have been told to have their thyroid removed to end hyperthyroidism. These draconian measures ensure the patient will have to rely on prescriptive thyroid hormone for the rest of their life. But iodine can completely solve the problem."

"Poor digestion — many organs need iodine, but can’t absorb it until the blood measurements reach very high levels. The stomach and salivary glands are two such organs, but they can’t uptake iodine in any significant amounts until the blood level reaches 100 times what the thyroid needs. Most people do not produce enough stomach acid as they grow older. I firmly believe low gastric acidity can be caused by iodine deficiency, as iodine promotes stomach acidity!"
...
"Breast, ovarian, and skin cysts — In addition to fixing almost all cases of breast cysts, iodine also has a remarkable healing effect on ovarian cysts, and even on skin cysts. (For the latter, I recommend rubbing in iodine right over the cyst.)"
...
"Dementia and glaucoma — Iodine is found in large amounts in the brain (including the parts of the brain associated with Parkinson’s disease) and the ciliary body of the eye, a possible factor in glaucoma."

Dr. Robert Jay Rowen
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Avatar_m_tn
Did you ever find an answer to what diet to follow for toxic nodule goiter. It seems when you ask a question, too many people ignore the question, and just go on about themselves. If so, what is it? What are you supposed to eat, and what are you supposed to avoid?
The toxic means you have more than one area with nodules.
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