The brain is always a piece of the Hashimoto’s puzzle

One thing I have learned from my readers is they are largely on their own. Rarely do conventional or alternative practitioners understand the depth of Hashimoto’s, a complex web that involves the neurological, hormone, and immune systems (we call it the neuroendocrine-immune axis). If you have Hashimoto’s you must think outside of the “thyroid box.” I am in the process of updating the tremendous amount of information I have learned about the thyroid since publishing Why Do I Still Have Thyroid Symptoms? in 2009. I am also writing other books that supply additional pieces to the Hashimoto’s puzzle.

My recent book Why Isn’t My Brain Working? discusses a big puzzle piece—the brain is always a part of the Hashimoto’s puzzle. My primary goal with the thyroid book was to let readers know most cases of hypothyroidism are autoimmune and to offer some basic solutions. My goal with the new brain book is to educate Hashimoto’s patients that their persistent fatigue, depression, and poor digestion may be brain-based as Hashimoto’s devastates brain health. If you have Hashimoto’s I encourage you to read the following chapters in the brain book:

Chapter 8: Gluten Sensitivity and Beyond

Chapter 9: Brain-Gut Axis

Chapter 10: Brain Inflammation

Chapter 11: What is Neurological Autoimmunity

Chapter 17: Hormone-Brain Connection

Thyroid education for the patient

I appreciate the amazing support from my readers and now understand the only way to raise the bar for thyroid care is to create accurate and referenced information not just health care providers but for patients. I like to think my first thyroid book helped evolve thyroid care beyond iodine supplements and natural thyroid hormones to a more complex but well rounded approach. I admit at times it is hard to see others repackage my years of hard work into their own blog articles and thyroid books with no acknowledgement, but at the end of the day what matters most is the information gets to people who are suffering. I will continue to work very hard the next few years to update and share directly with patients new pieces to the thyroid puzzle.

In this newsletter, however, I would like to clarify the concept of goiter and goitrogens.

thyroid enlargement

Goiter and goitrogens: Another tale in thyroid misunderstanding

Many people assume any enlargement of the thyroid gland is a goiter and indicates an iodine deficiency. Nothing is further from the truth and I would like to clarify the information. I also want to address the outdated concept of the food goitrogens still embraced by many doctors and patients despite lack of clinical evidence. But first let’s start with thyroid gland enlargement.

Thyroid enlargement from thyroiditis

Enlargement of the thyroid gland is classified as diffuse if the entire thyroid gland is enlarged or solitary if only a small section of the thyroid is enlarged. The most common causes of solitary enlargements are benign cysts and nodules. However, a nodule should always be evaluated to make sure it is not a malignant growth found with thyroid cancer.

Now let’s talk about diffuse enlargement. This means the entire gland has become enlarged. The two main causes of diffuse enlargement are goiter or swelling from thyroiditis (inflammation of thyroid gland). Diffuse enlargements are rarely found with thyroid cancer

One of the key ways to differentiate thyroiditis from goiter is to look at whether the size of the thyroid changes. With thyroiditis, the thyroid gland constantly changes size as it goes through various stages of inflammation and swelling. Painless thyroiditis (the thyroid gland is not sensitive to touch) is the hallmark of autoimmune thyroiditis. Painful thyroiditis, on the other hand, is usually associated with viral infection in the thyroid gland and accompanied by fever and signs of infection (bacterial infections are rare due to the thyroid gland’s iodine-rich, anti-bacterial environment).

If you have Hashimoto’s and have noticed painless swelling of your thyroid gland you do not have goiter but instead painless thyroiditis. Factors that may trigger swelling and autoimmunity include iodine, gluten, stress or anything else that activates the immune system. Unfortunately, many people with Hashimoto’s are misdiagnosed with goiter when in fact they have swelling from autoimmune thyroiditis. Remember, the key to diagnosing autoimmune thyroidits (inflammation of the thyroid gland) is painless swelling of thyroid that comes and goes.

Thyroid enlargement from goiter

Now let’s talk about goiter. Goiter is not swelling but instead thick tissue growth of the thyroid that does not change size. The most common cause of goiter in the United States is not iodine deficiency or overconsumption of goitrogenic foods. I know this is widely believed in the natural medicine community, but anyone who tells you this does not know how to read the scientific literature or perform a proper thyroid clinical work-up. The single most common cause of goiter in the United States is from chronically undiagnosed autoimmune Hashimoto’s completely unrelated to iodine deficiency.

Let’s talk about what actually causes a goiter. Goiter is excessive tissue growth of the thyroid and occurs when the thyroid gland has been exposed to too much thyroid-stimulating hormone (TSH) or human chorionic gonadotropin (HCG). And yes, HCG shots for weight loss can cause goiter, but it typically occurs due to pregnancy. Please understand thyroid tissue does not magically grow in the absence of sufficient iodine. It grows when thyroid cells are stimulated by chronic or aggressive thyroid-stimulating hormone (TSH) exposure. This may occur from iodine deficiency, but more often results from chronic undiagnosed Hashimoto’s or pregnancy. Goiter due to iodine deficiency is rare in the United States. Unfortunately, however, many naïve and unskilled educators, doctors, thyroid book authors, and health care practitioners still make the claim.

What do you do if you have goiter?

So what do you do if you have goiter? First you objectively confirm the diagnosis with a thyroid ultrasound. Second, you must find out if you still have an ongoing goiter mechanism as evidenced by an elevated TSH or HCG level. If those are not elevated, chances are you developed the goiter in the past and it is no longer being stimulated to grow. Most people don’t even know they have a goiter until a doctor examines them, at which point TSH needs to be checked to see if it’s still an ongoing mechanism. If TSH is elevated, the possibilities are Hashimoto’s (most common and confirmed with elevated thyroid antibodies), iodine deficiency, or a goitrogenic compound that blocks iodine uptake of the thyroid gland. If it’s iodine-based then taking iodine supplements should immediately correct all thyroid symptoms and normalize TSH.

If that doesn’t happen then it’s due to either a goitrogen or Hashimoto’s. You can identify Hashimoto’s through elevated serum thyroid peroxidase (TPO) or thyroglobulin (TGB) antibodies. You need to check both. Also, sometimes the test will come back negative despite having Hashimoto’s, so if that happens it’s important to repeat the test.

Goitrogens in foods, drugs, and chemicals

Although the most common cause of goiter is Hashimoto’s, let’s talk about goitrogens.

Goitrogens are substances (whether in drugs, chemicals, or foods) that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid gland. This triggers the pituitary to release TSH, which then promotes the growth of thyroid tissue, eventually leading to goiter. Although iodine is important for thyroid function, it only takes a pinhead of iodine a day and a teaspoon of iodine over a lifetime to avoid thyroid goiter.

Let’s shatter another myth about the thyroid. Normal consumption of goitrogenic foods do NOT cause goiter (consuming large amounts of juiced goitrogens, such as cabbage juice, would not be considered normal consumption). Examples of goitrogenic foods include broccoli, cabbage, kale, cauliflower, Brussels sprouts, soy, and a variety of other fruits and vegetables. The fear of goitrogenic foods is another example of how people have taken in vitro (test tube) studies using unbelievably excessive amounts of a dietary goitrogens and concluded eating any small amount of these foods can cause a goiter. For those who don’t believe me, please go on a goitrogen diet loaded with strawberries, kale, peaches, broccoli, cauliflower, and spinach and see if you develop a goiter. I promise you will not. As a matter of fact, these phytochemical-rich foods are essential for health when you have autoimmunity, except for soy, which is immune reactive for many Hashimoto’s patients. I have seen several patients develop thyroiditis swelling with soy and conclude the soy caused a goiter. In those cases the thyroid swelling reduced when they removed the soy from their diet, confirming that the swelling was due to an inflammatory response and not goiter.

Although dietary goitrogens are not clinically relevant there is not doubt that environmental compounds and medications may cause goiter. Listed below is list of commonly known goitrogens.

Medications that may promote goiter

  • Anti-thyroid medications (methimasole, Tapazol, propylthiouracil): used for hyperthyroid patients
  • Sulfonamides: used to prevent the growth of bacteria in the body
  • Amiodarone (cardarone): used as an anti-arrhythmic agent
  • Ethionamide (Trecator): used as an antibiotic for the treatment of tuberculosis
  • Aminosalicylate Sodium (Tubasal): used an anti-infective for the treatment of tuberculosis
  • Lithium: used for bipolar disorders, depression, anxiety , cluster headaches and migraines
  • Aminoglutethimide: used for the treatment of Cushing’s syndrome and other endocrine disorders that produce excess hormones (glucocorticoids, mineralcorticoids, estrogen, androgens)
  • Salofalk: used for the treatment of ulcerative colitis

Environmental compounds that may promote goiter

  • Mercury, Arsenic and potentially other heavy metals
  • Nitrates
  • Pesticide compounds

Unfortunately, the only accurate and objective way to know whether a goitrogenic compound is causing goiter is to do a radioactive uptake test. Unfortunately, this test can trigger a flare-up in those who suffer from autoimmunity. However, if a person with a goiter is being exposed to any of the known goitrogenic compounds, removing exposure to those compounds is vital.

I hope this information helps clarify the issue for you. I know many of you who have Hashimoto’s have had your painless thyroiditis swelling misdiagnosed as goiter or have had your goiter incorrectly blamed on iodine deficiency.

Points to consider when you have an enlarged thyroid gland

I encourage thyroid patients with an enlarged thyroid gland to consider the following points:

  1. If you have been diagnosed with goiter make sure you ask for an ultrasound. Many doctors misdiagnose painless autoimmune thyroiditis as goiter. A thyroid ultrasound delivers a clear and proper diagnosis.
  2. If you have an actual goiter, please test your TSH test to see whether the goitrogenic mechanism is still active. If TSH is elevated please test TPO and TGB thyroid antibodies to rule out Hashimoto’s, the most common cause of goiter. If your TSH is normal, then something in the past caused your goiter.
  3. Be cautious of health care providers who immediately assume iodine deficiency when you have a goiter. They will place you on iodine and be shocked to see your goiter size not change. Remember, goiter tissue is permanent tissue enlargement. It can only be reduced with excess thyroid hormones to induce atrophy or surgery, not iodine.
  4. If you have painless autoimmune thyroiditis, pay careful attention to any mechanisms that cause it to swell, which can indicate exacerbation of autoimmunity. The most common triggers are food intolerances, stress, overtraining, overworking, and lack of sleep. You can use topical glutathione cream directly into your thyroid gland and see if it reduces your swelling.

Body Ecology radio interview with Donna Gates648_large

Please check out my recent radio interview with the Donna Gates, the author of the body ecology diet at


  • Susan S. May 2, 2014 at 6:22 pm

    Dear Guri Dr. K,

    Hearing about you on Mark Ryan’s website got me to immeditely stop gluten and improve so thank you both. <3

    I'm almost done reading your awesome book, "Why do I still have…" and it as well as everything I've read here never addresses the odd one like me who is suppose to have Hashimoto's but NEVER had one hypo symptom. I'm super hyper and since childhood diagnosed with ADHD and today have classic Hyperactive symptoms (not graves, no palpatating, just fast metabolism and energetic) and heard always "slightly overactive thyroid". Now I have a disease that usually affects Hyperthyroidistic patients ! ? ! ?

    From what I've learned from you, I suppose I caused my own Hashi's by years of abusing sugar and overeating then ignoring my gut issues..until I yanked Gluten from the diet. Luckly I've stayed somewhat slim and now even slimmer but I am definitaly NOT a hypo patient like everybody keeps mentioning. How unusal is it for a hyper human to get Hashi's??

    I'm told I have a thyroid (cold) nodule which oddly started to grow once I was put on thyroid meds..could it be the wrong drug messing with my TSH levels and stimulating this? NOBODY has tested my nodule only given me 2 Thyroid Uptake tests here in Germany which do not indicate status of a cold nodule.. BOY am I in the dark and getting ripped off.

    Wish I could fly to SanDiego and see you.

    Thanks for your passion and work you are doing to help us.

    • Susan S. May 2, 2014 at 6:25 pm

      Dr. K,

      In my salutation above, I meant to write “Dear Guru Dr. K.”

      I hope you realize what I meant.
      All the best, Susan

    • Thyroid Book May 5, 2014 at 8:27 pm

      This is complicated and requires a practitioner to weigh in. If it’s possible, you may want to work with a practitioner in the US via email or Skype, some of them do that and can better guide you.

    • Jane October 19, 2017 at 9:48 pm

      Hi Susan,

      I am the same as you by the sound of it. I have found out about my problem only 2 weeks ago so any comment on your findings would be fab to speed up the starting process of getting better/under control!

      Thank you!


      • Susan (admin) October 19, 2017 at 10:15 pm


        Susan’s comment was two years ago, so I don’t know if she will see your question and respond. I wanted to mention that there are plenty of Hashimoto’s (ie: hypothyroid) patients who are thin and have an energetic or ungrounded nature. I am one of them. Traditionally trained doctors will look at a thin person and say, “You don’t look hypothyroid,” but that’s about as accurate as looking at someone and saying, “You don’t look religious.” Every patient is unique.

        Also, some Hashi’s patients swing back and forth from hypo to hyper thyroid activity; it’s one of the bewildering facets of Hashi’s because it can throw people into thinking they don’t have a hypothyroid disorder. To further complicate the picture, not every Hashi’s patient shows high (or any) antibodies on lab tests (sometimes the immune system is so tired it can’t produce enough antibodies to measure). More on that here:
        and here:

  • Susan May 12, 2014 at 10:45 am

    Thank you so much for your answer..I needed to hear just that.
    I’m going to call Dr.Noseworthy in Florida…also found a link to him from Marc Ryan’s
    website; it’s meant to be!

    Honored to hear from you… Thank you again Dr. K for getting me off gluten & on my way!!

    • Joanna June 20, 2016 at 7:08 pm

      How did things go with Dr. Noseworthy? I am thinking about contacting him.

  • Genine September 28, 2014 at 7:04 pm

    Hi Doctor K thank you for the information on thyroid health I was diagnosed with hyper-/with a goiter the treatment I choose was radioactive iodine treatment. I am am hypo-with a goiter w nodules do have any suggestions

    • jurgita lizdenyte January 31, 2018 at 6:23 pm

      how are you now and how was the treatment ?

  • Jason September 30, 2014 at 7:09 pm

    Is it alright to juice 1 glass of cabbage juice a day?

    • Thyroid Book October 5, 2014 at 10:30 pm

      He does not recommend juicing goitrogenic vegetables, just eating them normally.

  • dolly October 18, 2014 at 12:23 pm

    can I do something to get off my medication levothyroxcin, everybody sas we have to be on it for life.

  • Trevor January 12, 2015 at 1:05 pm

    I have heard of people coming off Levo after finding other therapies.
    There are so many factors involved it’s impossible to be specific unless you see a integrative medicine practitioner and get all relevant tests done. There are many side channels to this- gluten intolerance,diet uptake of vits and mins [esp.] and lifestyle [esp. Stress].
    I took Levo last year and never felt good one day on it and stopped it. My TSH has been over 5 and is now under 4. Adrenals are a big link to successfully treating thyroid by any method.
    This may mean reassessing meds [Diuretics?] and adding the demon Salt back into diet!!
    I veer away from all synthetics now- even ascorbic Acid [this seems only useful short term during illness] and otherwise actually depletes our own good C level by using up co-factor bioflavinoids. No one ever seems to much know these essentials much even in alternative areas- luckily a few strands are seeping through.
    Avoid Iodine- until you have a good advisor or have researched this expensively as it can make things worse, easily.
    The other thingI have striven to do is get a Reverse T3 reading at your next blood-I had to go private in the UK 7 was near top of the range showing thyroid resistance for whatever reason I’ve yet to learn.
    My next move will be Hair tissue mineral analysis and an assay on my Copper regulation- this is a vital component for many other enzyme reactions and iron usage , vital in thyroid hormone conversion.
    If you can’t get new advice and stuck with allopathic- at least ask for addition of T3 to your meds- but start VERY slowly at split dose. [CT3M from Paul]
    This guy has done a lot of work on this:
    Hope all this helps- you’ve waited a long time for a reply 🙂

  • J.D. Staton January 30, 2015 at 4:25 am

    I’m a very confused retired RN, BSN, MSW who has received care from three different endocrinologists who have provided superficial, vague, and conflicting diagnostic positions, in my case. I’m very impressed by the clarity of the research and pathophysiological focus of your books and website interviews. I’m 53, morbidly obese, with Stage 3 CKD & truncal paralysis, as well as, formally diagnosed as “hypothyroid” with 4 clinically significant nodules, 7 years ago, (though I believe I’ve been symptomatic for decades, despite MD indifference). I was started on generic levothyroxine at that time, then added prescription Vit D a year later for severe osteopenia and bone/joint pain. I got a levothyroxine dose increase (to 225mcg) one year ago, due to worsening hypothyroid signs/symptoms. My goiter has continued to steadily grow, remain painless, adding a fifth node of clinical significance, one year ago. Most recent two endocrinologists insist I have Hashimoto’s, though they never tested anything more than my TSH levels, except once when I begged my second endo to test for antibodies. In May 2013 Thyroid Peroxidase Antibody level came back a normal 27 IU/ml.

    Nine months ago, my gynecologist instructed me to permanently halt taking the Premarin I’ve been on since age 28 (due to complete hysterectomy for severe endometriosis). All of my endocrinologists and PCPs have adamantly refused, for years, to prove guidance regarding reducing and/or eliminating my long-term Premarin use, stating that’s a matter for gynecologists alone. Approximately six months ago, I developed a whole range of thyrotoxic signs/symptoms, though never imagined that could happen to someone with “hypothyroidism”.

    My TSH level was found to be 0.1. As there was a 3 month wait to access an appointment with my endocrinologist, I halted taking any further levothyroxine, then underwent a thyroid ultrasound and guided FNA biopsy of my largest nodule, while awaiting that appointment. Results came back as a “benign lesion” and “Some of the epithelial groups show flame-cell changes, suggestive of active secretion”.

    I, then, paid twice (Nov. 2014 and Dec. 2014) for out-of-pocket extensive bloodwork to test for wide range of hormonal, digestive, and immune function issues. Most recent TSH was 10.740 uIU/mL (High), T3 Uptake 20% (Low), Reverse T3, Serum 27.7 ng/dL (High), while all remaining thyroid-related tests (including serum selenium and iodine levels), were within normal limits [Thyroxine (T4) 8.6 ug/dL, Free Thyroxine Index 1.7, T4 – Free(Direct) 0.98 ng/dL, Thyroglobulin, Antibody <1.0 IU/mL, Thyroid Stim Immunoglobulin 38%, Thyroxine Binding Globulin 29 ug/mL, Thyroid Peroxidase (TPO) Ab 18 IU/mL, Triiodothyronine – Free,Serum 2.9 pg/mL]. Similar thyroid lab results were obtained one month earlier, so I doubt there are any false positives or negatives in this batch. Also, I was completely off all thyroid replacement medications when both sets of recent labs were drawn.

    The other labs I had done during the same two recent months demonstrated no signs of celiac disease, diabetes (HgA1C 5.0%, fasting glucose 84 mg/dl), CBC with diff irregularities, ferritin problems, altered sed rate/ANA levels/C-Reactive Protein/RA levels, or CMP irregularities – apart from my usual elevated creatinine level/reduced eGFR (Creatinine, Serum 1.70 mg/dL and eGFR If NonAfricn Am 34 mL/min/1.73), mildly elevated lipid levels (all levels, including HDL), elevated uric acid levels (the bane of my life, having formed more than a dozen renal stones, resulting in a botched ureteroscopy/complete nephrectomy with severe denervation injuries/paralysis and severe chronic nerve pain treated with Fentanyl/Vicodan). Additional findings include (unusual for me) mild elevations in these three liver enzymes only, AST, ALT, and GGT alone (which probably correlate with the right upper quadrant pain & digestive signs/symptoms I've been having). A dozen years ago, I had a lap cholycystectomy performed for severe RUQ pain, chronic cholecystitis, extensive mucosal ulceration, and a 3 cm gallstone.

    Having spent the past few months reading well over 150 different medical journal articles, trying to sort out this complex scenario I find myself living with, I've learned a few things. Firstly, it's clear that this recent thyroid "crisis" was triggered by halting my chronic Premarin use. Secondly, my chronic opioid use (which I will be on for life) is impacting my body's utilization of thyroid hormone (free T3). Thirdly, my current liver/digestive disorder(s) are probably impeding my body's formation/use of various thyroid-related chemical transactions. Fourthly, there is no thyroid antibody evidence that I have Hashimoto's Disease, though I have a consistently enlarging goiter that is symptomatic. Fifthly, that reportedly 10% of those with Hashimoto's Disease never develop antibodies (this academic fact causes me to question how their condition was accurately determined via evidenced-based clinical measures).

    While my current endocrinologist is open-minded enough to permit me to take levothyroxine, T3 replacement, and/or Armour, he has left the matter entirely up to me to research and suggest the medication(s) and dose(s) I am willing to try. I am stumped in this quest, first by the lack of clarity surrounding my true thyroid disorder status. Treating a failing thyroid gland that's created true "hypothyroidism" is an entirely different matter than treating a thyroid-focused, auto-immune disorder. I have no idea what diagnostic testing to pursue to clarify this. Sometimes, I believe the diagnosis of "Thyroid Sick Syndrome" (often found among hospitalized patients) is the most accurate one, due to the excessive amounts of bio-psycho-social stress I have been under since becoming severely and permanently disabled, nine years ago (thanks to my unethical and incompetent urologist). However, having an ever-enlarging goiter makes that unlikely.

    Looking at the patterns created by my full thyroid blood panels suggests that the chemistry surrounding Reverse T3 creation is leading or connected to the low T3 Uptake level. My hypothalamic-pituitary-thyroid (HPT) axis appears to be functioning appropriately (except, perhaps it's inability to sense normal serum levels of T4), as does my goiter (as both free and bound T3 and T4 levels are within normal ranges). Pro-inflammatory cytokines, like Interleukin-6 (IL-6) are positively correlated with reverse T3. I'm not sure what to make of the very low T3 Uptake results.

    I have been following a low protein, low sodium, low oxylate, vegetarian diet, since losing my kidney and being (initially) plunged into Stage 4 CKD, nine years ago. That strategy has been highly successful in keeping me from forming any additional kidney stones (though my uric acid level remains somewhat elevated), while improving my early eGFR's from 25 up to the mid – upper 30's (moving me from Stage 4 to Stage 3 CKD). While I have sporadically taken both fish and flax seed oils, it would probably be wise for me to take them more consistently, to help reduce inflammation. A wide variety of whole grains, seeds, nuts, fruits, veggies, dairy, and eggs are the basis of my eating (everything having to be simple to prepare, as I cannot stand longer than 15 minutes, nor sit upright longer than 2 hours, lift more than 10 lbs, or walk far without my walker. Thus, organic soups, salads, sandwiches, hot cereals, stir-fries, and "one-pot dishes" are all I'm able to physically manage making, these days.

    I don't know what medication regimen would be best for me to pursue, at this point, nor if there are any additional alterations to my diet/fluid intake that I should make. My body is irreversibly inflamed from my CKD, extensive family history on both sides of gout combined with my tendency to form both uric acid and calcium oxylate stones, and two separate major falls onto hard surfaces – the result of my weak left leg abruptly buckling from fatigue/lack of functional left truncal musculature from my "flank bulge" surgical deformity (resulting in concussions, whiplash, broken glasses, and severely torn left rotator cuff/shoulder joint tear, and bilateral knee injuries). I have set up an appointment next month with a GI specialist to follow-up on my liver/digestive issues, to address that source of inflammation and potential thyroid disease exacerbation, as soon as possible.

    No doubt my long-term opioid use induces my glial cells to release proinflammatory cytokines, creating a significant factor adding to my cellular hypothyroidism. Halting Fentanyl therapy is not an option for me, nor is the use of NSAIDS, instead. My "flank bulge" denervation paralysis and pain are irreparable and my CKD makes NSAIDS unusable.

    If you have any suggestions as to how I might more effectively manage my thyroid disease and goiter issues, despite the overall palliative state of my health, I would be very grateful for them. It appears clear from my research that most of the "experts" on the topic of thyroid diseases are baffled by the inconsistencies in laboratory and diagnostic imaging standards and criteria, clinical diagnostic approaches, lack of effective and well-researched prevention and treatment options, along with near-absence of basic research on the chain-reactions that are involved in the thyroid signaling-release-absorption and the many barriers that must be overcome to relieve cellular hypo or hyperthyroidism signs and symptoms. With so many diagnostic and treatment barriers to overcome, it's not surprising that nearly every person I've ever known who's had thyroid disease has found getting useful treatment guidance to be just as challenging as coping with the signs and symptoms of the disease they have, itself.

    Despite thyroid disease having been "discovered" many generations ago, the level of present-day medical ignorance on this topic is appalling. I believe it has everything to do with the fact that it is primarily a set of diseases that women experience. Tragically, this is true for most auto-immune disorders, which no doubt explains why health care providers have ignored and/or misdiagnosed them millions of times, all while practicing "modern, science-based medicine". It's so very much easier to tell a woman "it's all in your head" than to say that same phrase to a man, or to conduct the basic research and diagnostic studies to determine the correct underlying pathophysiology and treatment(s). There's better knowledge and treatments available for HIV/AIDs, than for thyroid disease – a disease that was just developing when I was in RN School.

    I apologize for the excessive length of this e-mail. My situation is just so complex, I don't feel I can leave out many details, as they are all so interconnected. My best wishes to you as you juggle the complicated life of an author, speaker, researcher, and clinician, all rolled into one. Please take good care of your adrenals, in the process.


    J.D. Staton

    • Mona Kathy Mistriel January 22, 2017 at 8:11 pm

      Electro-dermal screening is a good diagnostic tool for food allergies and other specific nutritional imbalances. Perhaps you are allergic or intolerant to casein in dairy products. There are also many other plants that can effect antibodies such as night shades, some nuts, corn and coconuts. A lot of “Gluten-free” food has corn starch in it and most of it is genetically modified which also effects the hormones.
      Also try some vitamin k2 therapy to control the calcification as in oxalate stones.
      Next, look into chinese herbs and chinese medicine to help balance and regulate your systems so your body can open up to all the new holistic therapies you can explore.

  • lace;y February 3, 2015 at 3:27 am

    I have suffered with symptoms of thyroid issues and my tests came back negative. i have been prescribed antidepressant after antidepressant and nothing works and i now have what looks like a goiter. i have every symptom of an under active thyroid. i feel like i am losing my mind. should i just ask my primary physician to refer me to a specialist? i am going to the doctor tomorrow. please help. I am on a budget and I can afford to just go to a specialist without a referral.

  • Jacqueline Davison April 19, 2015 at 4:54 am

    After I had my daughter I was diagnosed with hypothyroidism, goiter and autoimmune. I completely changed my lifestyle and my goiter shrunk dramatically. Can goiter do that? Also, I never had issues before I got pregnant but now I am a mess and still breastfeeding. My mother had Hashimotos and hypothyroidism too. Any thoughts? Thank you

  • Joanna June 23, 2015 at 1:24 am

    Im 26 years old and for several years have had a goiter and inflammation. I have a small neck so the goiter and inflammation was really pronounced. After finally reading this article i decided to try the gluten free diet and notice the very first day the inflammation disappear. But i still have a goiter. Now i am pregnant after being gluten free for three weeks and im concerned about my baby. Im concerned i have unresolved issues that keep my goiter large and it may hurt my baby. Id appreciate any advise on the issue

  • Sonia November 23, 2015 at 6:39 pm


    I am 6-weeks post thyroidectomy. I had two large suspicious nodules (4cm and 3cm in length) which were growing visibly over 3-4 months, with compressive symptoms of swallowing difficulties and voice changes. So the thyroid and nodules were removed and thankfully were benign. I’ve started Levo and I’m feeling much better. But – and here’s my question – would you recommend a gluten-free diet and/or any other dietary adjustments? I am otherwise fit and healthy, a little overweight (10 pounds) but working on losing it gradually.Thank you.

    • Susan (moderator) November 23, 2015 at 10:50 pm

      Sonia; Have you been tested for antibodies to thyroid? Dr. Kharrazian does recommend a gluten free diet for those with thyroid issues. In his thyroid and brain books he details the gut-healing anti-inflammatory diet that he recommends. It’s also mentioned on his website at On that link you can also link out to the books.

  • Jen June 22, 2016 at 10:30 am

    Hello, I have normal T3/T4 and low (.57) TSH. I have an enlarged thyroid on the left side (“:The left side of the thyroid is larger than the right side but nothing in there to make it enlarged not abnormal so no further testing needed “–which, by the way–several years ago had several nodules on it, and now it only “enlarged”)), and also have severe fatigue, anxiety, severely painful small fiber neuropathy, severe anemia (iron deficient –possibly due to very heavy periods), chronic diarrhea, weight loss (I was obese to begin with /199 at 5′ 4″), and memory problems (using wrong words and forgetting names). But they say I’m fine. No need for treatment other than for the extremely painful neuropathy (2400 mg Gabapentin/day (neuropathy pain) + 1gr Pramipexole (severe restless legs), and Cymbalta 120/day (neuropathy pain). Do you have any suggestions for me?

    • Jen June 22, 2016 at 10:32 am

      By the way, the TSH keeps getting lower and lower over the years.

    • Susan (admin) June 27, 2016 at 10:23 pm

      Jen; I speak only for myself here when I say the first thing you need to do is find a new healthcare practitioner. With that symptom cocktail, you are clearly in need of a practitioner who can attend to your health by looking for the root causes behind your issues. Can you seek a practitioner trained in the protocols Dr. Kharrazian practices? On his practitioner locator page is a list of practitioners who are highly trained, and lecture for him (read: they are in the loop with current research and protocols)

      One of the most frustrating issues patients see today is that practitioners of various disciplines practice in a specialty vacuum, and won’t see health issue from a wider perspective. I can’t make specific suggestions here regarding your symptoms; it sounds like you really need to find a functional medicine (google that term) practitioner who can do the right labs, look at your big picture and help you get to the root of things. They are out there, so keep looking until you find one who you feel is right for you.

  • Nervaana Lee August 16, 2016 at 2:04 am

    Congratulations to all those who have healthy thyroid and healthy thyroid function.

  • Karen November 22, 2016 at 8:51 pm

    Hi I have had an enlarged goiter for 10+yrs. My doctor has tested my thyroid and test have been normal. I believe she tested TSH, T3 and T4. Recently had an MRI that showed fullness of the thyroid and a high T2focus within left thyroid measuring 6mm. Ultrasound was suggested but my doctor tested my thyroglobulin and peroxidase antibodies, they too were in normal range. The only symptom I believe I am having is feeling as if something is stuck in my throat. Can my thyroid be shrunk and if so what kind of meds or should surgery be an option.Look forward to hearing back as I am frustrated

  • Brad Miller February 10, 2017 at 3:51 am

    I can relate to this article because I dreamed about overcoming my hypothyroidism for years.
    I tried just about everything I could think of but nothing seemed to work.

    Then I did something different and I took back control of my life in a few short weeks. Now I’m happy and don’t think about hypothyroidism anymore.

    If anyone’s interested, here’s a website that helped me a lot:

    Best of luck!

  • Krystyn Andrews May 1, 2017 at 1:31 am

    Thank you for this article! I finally was told I had an enlarged thyroid and goiters, and that they were due to Hypothyroidism, but have never been told they were linked to hashimotos! Simce starting armour almost a year ago i feel way better!! I was working out for a few months it noticed my neck by my wind pipe was enlarged and about 3 weeks ago stopped, much to my surprise after adding an extra armour for a total of 3 a day and not exercising it is almost completely normal. I haven’t been able to lose weight however and am going to do research on hashimotos as a potential for me. I have multiple goiters on both sides of my neck. I can feel them grow with caffeine alcohole and sugar consumption. Again Thank you for this article I feel like no one has answers for me!

    • Susan (admin) May 8, 2017 at 8:46 pm


      We’re glad you found the article helpful. Since you seem to be experiencing some fast changes in your thyroid, I hope you can find a Functional Medicine practitioner who understands Hashimoto’s, and can do an ultrasound to check on whether you have any nodules.

      And good for you for being so observant of how foods affect your body – it’s a great tool to have. Good luck, and keep us posted.

  • Asonchij August 31, 2017 at 9:52 am

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  • Sammy October 16, 2017 at 9:45 am

    Hello – my thyroid enlarges every day after I take my thyroxine dose. I have hashimotos and I feel awful but have euthyroid test results which I am told are ‘perfect’. What could be causing this? From reading your article it would suggest that taking my thyroxine causes my antibodies to increase… could this be possible? I understand my thyroid is nonfunctioning. Thanks.

  • Liana Khumaryan November 6, 2017 at 3:21 pm

    Dear Doctor Kharrazian,

    I have been suffering from Helicobacter pylori, and finally got diagnosed and received treatment for that. I had been having fever accompanying it which the doctors here in Armenia couldn’t know why. Fortunately it went down to normal. Right now I have chest pain and sometimes it is hard for me to breath. They checked my heart and there is no problem with that. I gave thyroid hormone tests and my Anti TPO came high as 41 (the highest range in that lab was 34). TSH was 2.16(normal is 0.32-4.9), T3 was 1.05 (normal is 0.8-2), T4 was 9.73 (normal is 5-14), FT4 was 18. 31 (normal is 12-22).
    I am really concerned now and worried if it will worsen and create more health issues. Does this high Anti TPO mean I have Hashi desease or is it just associated with my stomach and intestines and may go back to normal? I am currently taking vitamin D3, and fish oil. My D3 was slightly low.

    • Liana Khumaryan November 6, 2017 at 3:36 pm

      Also, forgot to mention that my thyroid is slightly bigger in size and there were 2 tissues on it.
      Plus to that doctors say I have no heart issue but my heart rate goes to 100 when I walk, but it is back to 60-70 while I am seating.
      I am a little confused where to go and what to test.

    • Susan (admin) November 7, 2017 at 1:35 am


      I’m sorry, but Dr. Kharrazian can’t diagnose via the blog or email. With so many factors involved, it’s impossible to tell you exactly what is going on or what you need to do without a consultation and proper lab tests.

      As for the TPO, one doesn’t have to have high antibodies to have Hashimoto’s. Because of this, many Functional Medicine practitioners go largely with what the symptoms indicate. Here are two articles that talk about the high/low antibodies:

      On Dr. Kharrazian’s practitioner-locator page are some who are willing to treat remotely; I don’t know if they are able to treat patients outside the US (within the US they can do some treatment options via Skype and knowing your lab results), but it would be worth contacting them to ask. Here is that link:

  • Connie Kirkpatrick November 25, 2017 at 6:56 pm

    I know I have Hashi’s. What I don’t get is the temporary inflammation of my thyroid. Not a lot but enough I can feel it, physically and my mood swings, fatigue. One minute I feel great, the next it feels like I have a lump in my throat and my mood deteriorates and all I want to do is sleep. Tired of the cycle, happens most after eating. Off gluten, soy, unfermented dairy, etc. Some foods cause me lead weight and fatigue in my arms and legs. Am lost. Do not see these symptoms anywhere. Oh, and no gallbladder. See my doc Monday a.m.

    • Susan (admin) November 29, 2017 at 6:10 pm


      It’s common in Hashimoto’s for the thyroid to swing from a hypo to hyper state. This can bring about swings in energy, mood, fatigue, and more. Once you get your thyroid function balance (and the autoimmune reactions quelled), this should change.

      It sounds like you are also experiencing acute food reactions. Testing for that, as well as a full elimination/reintroduction diet might be in order, to determine what is going on. You may have lost some oral tolerance (the body’s ability to determine what is food, what is pathogen), and this can be remedied over time.

      We can’t give you medical advice here. I will say that it would take a complete medical history and exam to begin to lay out a path for you. I encourage you to seek a practitioner who can do this with you; one who will really listen to you, and have conversations with you where you work together toward improving your health. Sadly, many of us thyroid patients are faced with doctors who won’t discuss anything.

      Is your doctor trained in functional medicine? If not, and they take you to just continue on your current trajectory, it may be worth looking for a new practitioner. Dr. Kharrazian has a referral list here:

  • Celeste February 6, 2019 at 2:40 am

    I would love recommendations for what to do for Grave’s disease? (for me, pregnancy induced and due to hyperthyroidism lost the fetus) Or reputable resources that you suggest? thank you!

    • Susan (admin) April 8, 2019 at 5:48 pm

      Hi Celeste;

      I’m sorry, but Dr. Kharrzian doesn’t give advice for Graves’ disease unless you are his in-person patient. This is because Graves’ can be more severe medically than Hashimoto’s and it takes close monitoring by your doctor. I hope you have found a doctor trained in functional medicine who understands autoimmunity, who can help you along.

      With that said: Hashimoto’s can manifest with severe hypo *and hyper* symptoms, and sometimes people are misdiagnosed with Graves when they have Hashi’s, and the treatment protocols are a bit different. In your shoes I’d get a second opinion on the Graves antibodies, and test for Hashi’s as well. That way you know you are moving in the right direction with long-term treatment, and possibly with outcomes for future pregnancies.

      Sorry, but we really don’t have good referral sources for Graves.

      All the best to you and yours.

  • Jaye February 20, 2019 at 4:46 pm

    This was so informative.

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