Autoimmune Hypothyroidism: Nodules, Nutrition, Fertility, and Pregnancy Hello, I am Dr. Isabel Viña Bas, a physician and Scientific Director of IVB Wellness Lab. The thyroid is a small gland, but its hormones are involved in processes that affect the entire body. When its function is altered, especially when there is autoimmune hypothyroidism involved, questions arise about nodules, medication, antibodies, nutrition, or fertility. The first step is to differentiate structure from function. Having thyroid nodules does not necessarily mean having hypothyroidism or hyperthyroidism, and vice versa: you can have a functional alteration without any nodules present. In consultations, I am asked the same questions over and over: what to do about nodules, why iodine matters so much, what the immune system has to do with it, with thyroid antibodies involved, when it is necessary to start Eutirox, what happens after a thyroidectomy, and how all this intersects with menopause, fertility, or the digestive system. If you have been dwelling on unexplained fatigue for a while, this will be useful to you. Why are thyroid nodules so common? Much more than people think. In an ultrasound, thyroid nodules are found in up to six out of seven people, almost 80% of the population. When palpating the neck, many fewer are detected, because to notice them, they usually need to be at least half a centimeter or a centimeter in size. One of their main causes is a lack of iodine in the diet. The thyroid needs iodine to produce T3 and T4 hormones, and when it does not receive enough, it increases in size in an attempt to compensate. It is important to be clear that nodules speak to the structure of the gland, while hypo- or hyperthyroidism speak to its function. These are two different issues and must be assessed separately. How much iodine the thyroid needs and which sources to choose The recommended amount of iodine is between 150 and 300 micrograms per day. A simple way to get it is to use fine iodized salt in your day-to-day life. Sea salt, flake salt, and Himalayan salt do not serve this purpose; they do not provide the amount of iodine you need. You can also find it in eggs, dairy, and seafood. . Seaweed, on the other hand, is not a recommended source because the amount of iodine they contain varies greatly from one product to another, and it is difficult to know how much you are actually taking. If you have hypothyroidism, you should take iodine, for example with a supplement like IVB TyroEnergy, which combines it with selenium to support thyroid function. It is only contraindicated if there is hyperthyroidism or if you no longer have a thyroid gland due to a thyroidectomy. Additionally, taking between 600 and 800 mg of myo-inositol per day seems to help reduce the size of existing nodules. What is the relationship between autoimmune hypothyroidism and autoimmune gastritis? The autoimmune hypothyroidism can go hand in hand with autoimmune gastritis. This combination is part of what is known as autoimmune polyglandular syndrome type 3. When you have one autoimmune disease, you are more likely to develop another. I say this from personal experience as well: I have autoimmune hepatitis and multiple sclerosis, so I know what I am talking about when I say that these things tend to come in groups. . In autoimmune gastritis, antibodies attack the parietal cells of the stomach. By destroying them, the production of acid, pepsinogen (necessary to digest proteins), and intrinsic factor—essential for absorbing vitamin B12. —decreases. This can translate into poor digestion, because proteins are not digested well, and also into acidity. Often, that acidity is treated with omeprazole, but the real problem is just the opposite, a lack of acid, and the medication can make it worse. A vitamin B12 deficiency can also appear. Its lack can cause reversible loss of mood and dementia, but also a degeneration of the spinal cord that affects stability and the ability to walk, and that part is no longer reversible. To confirm autoimmune gastritis, the doctor must order anti-parietal cell antibodies and anti-intrinsic factor antibodies. Autoimmune hypothyroidism and gluten: do you always have to eliminate it? Having autoimmune hypothyroidism does not force you to eliminate gluten if your celiac antibodies come back negative. The first thing, always, is to rule out the existence of actual celiac disease. with a blood test. If you notice fatigue, abdominal bloating, or diarrhea, you can do an empirical test: remove gluten for two weeks and see if you improve. If after those two weeks you do not notice any change, reintroduce it. A gluten-free diet is hard and expensive, and it also generates quite a bit of social anxiety, as celiac people who have to follow it no matter what know well. There may be a non-celiac gluten sensitivity or wheat sensitivity, in which other antibodies that science does not yet know how to detect attack the intestine in an autoimmune way. That is why, when there is no confirmed celiac disease, the decision depends on your symptoms and how you respond during the test. Can autoimmune hypothyroidism be reversed and Eutirox stopped? When hypothyroidism is already established and the gland is partially destroyed, the damage cannot be reversed. Levothyroxine, which most of us know as Eutirox, provides the hormone that the thyroid can no longer produce on its own. In autoimmune hypothyroidism, antibodies destroy the gland little by little. In some people, that process lasts two years; in others, ten or twenty. The traditional medical approach is usually reactive: wait for the gland to fail completely and then prescribe Eutirox. I prefer to try to slow down the destruction and alleviate symptoms in the meantime, by combining myo-inositol and selenium. The regimen I usually recommend is to take between 600 and 800 mg of myo-inositol along with selenium at midday. How myo-inositol and selenium help thyroid function Myo-inositol reduces antibodies and makes the thyroid more sensitive to the orders it receives from the brain via TSH. I like to say that it gives the gland a finer ear to listen to those signals. Selenium, for its part, helps convert inactive T4 into active T3 inside the cells. This combination can also improve symptoms such as joint pain or brain fog. Antibodies do not just hang around the thyroid; they travel through the body and generate inflammation in other tissues. In short, the idea is to slow down the autoimmune process, lower antibodies, and ensure that thyroid hormones perform their function well inside the cells. Why do thyroid antibodies matter too, and not just TSH? There is a classic approach that says the level of thyroid antibodies does not matter as long as the TSH is within range. I do not agree with that idea, and I say it openly. It is not the same to have 300 antibodies as 4,000. Imagine 300 soldiers slamming doors against a door: they are going to break it much sooner than a single 1.10-meter soldier hitting it. The more antibodies there are, the faster the speed of thyroid destruction, and the inflammation circulating through the rest of the body also increases. That is why TSH is not the only data to look at. The antibody level tells you how intensely the immune system is attacking the gland. What happens after a total thyroidectomy The thyroid can be completely removed due to cancer, a very large goiter, or hyperthyroidism that is not controlled. After the operation, you need to take levothyroxine. . Even so, many patients tell me that they never feel as well again. It is common for them to gain an average of three kilos that stay there, chronic, and are very hard to lose. This happens because Eutirox provides a fixed amount of T4. Before the surgery, the thyroid also produced about 20% of active T3 hormone, and it did so by adjusting it second by second, in an intelligent way. T3 is not administered directly because it has a very short half-life and would have to be taken three times a day. Selenium, myo-inositol, and coenzyme Q10 after a thyroidectomy Selenium and myo-inositol also work in people without a thyroid. Selenium enhances the conversion of T4 from Eutirox into active T3, and myo-inositol helps that T3 stay active longer.After a thyroidectomy for papillary cancer, coenzyme Q10 can also be added. The combination of selenium, myo-inositol, and CoQ10 helps the medication hormone activate and perform its effect well inside the cells.The regimen I usually recommend is to take Eutirox with vitamin C on an empty stomach and wait 45 minutes before eating. The selenium and myo-inositol combo goes at midday, while vitamin D3+K2 and magnesium can be taken with lunch or dinner.How to care for the scar after thyroid surgery A thyroidectomy leaves a scar on the neck, an area that moves every time you swallow. During the first few weeks, silicone gels, such as Kelo-cote or Trofolastín, work well.Afterward, you can switch to healing creams like Cicaplast or Cicalfate for two or three months.Throughout the process, maintain strict sun protection to take care of how the scar evolves.Hyperthyroidism and Graves' disease: can they be cured? Hyperthyroidism can come from an isolated nodule or from Graves' disease. In Graves', antibodies overstimulate the gland and make it produce too much hormone.Those antibodies can also attack the muscles and tissues of the eyes, causing ophthalmopathy: bulging eyes and quite intense itching.When hyperthyroidism comes from an isolated nodule, it can be treated and cured by burning it with radioactive iodine. In Graves' disease, there are three paths: . antithyroid drugs in cycles of up to two years, radioactive iodine, or surgery to remove the thyroid.Radioactive iodine is contraindicated if there is ocular involvement. Surgery is especially indicated when the person is seeking pregnancy or has severe ophthalmopathy.What supplements help with hyperthyroidism In hyperthyroidism, selenium, L-carnitine, quercetin, and N-acetylcysteine are used.These nutrients help reduce symptoms such as tremors, palpitations, and diarrhea, and also slow down the development of the eye disease associated with Graves'.Here, unlike in hypothyroidism, iodine is contraindicated: an overactive thyroid does not need more raw material to manufacture hormones.Menopause and thyroid: why symptoms can coincide Menopause does not directly damage thyroid function. Both are consequences of aging, each on its own.Evolutionarily, the human body was not designed to live more than 40 years. From age 45 on, most hormones begin to drop due to organ fatigue, including the ovaries and the thyroid . Vitamin D and aldosterone also drop.The only hormones that rise with age are cortisol and insulin, which is why more insulin resistance , more fat in the abdomen, more hypertension, and more muscle pain appear.For the thyroid to function well and to avoid symptoms such as fatigue, high cholesterol, or brain fog , you must ensure 150 to 300 micrograms of iodine daily and add selenium, zinc, vitamin C, and myo-inositol.These nutrients make the thyroid more sensitive to the warnings it receives from the pituitary gland and help the hormones activate inside the cells.Perimenopause with hypothyroidism: how to take EutiroxIf you have hypothyroidism, follow the same approach I mentioned for perimenopause and maintain your Eutirox treatment . In this stage, body composition changes and it is normal to gain between three and five kilos. . That might be why it is necessary to increase the hormone dose a little.To absorb it better, take Eutirox with vitamin C on an empty stomach and wait 45 minutes before breakfast.In perimenopause, I also recommend soy isoflavones . They act as estrogen in the skin, hair, and liver, helping to lower cholesterol, and as an anti-estrogen in the breast, so they can even be taken by breast cancer patients who are on tamoxifen.The 5-HTP and saffron extract help control sweet cravings, nervousness, and hot flashes because they raise serotonin. For joint pain, I use chondroitin.Hypothyroidism, fertility, and TSH: why they influence the whole processBoth hypothyroidism and hyperthyroidism can block ovulation and worsen oocyte quality.Hypothyroidism raises prolactin, and that reduces the luteal phase and lowers the progesterone that the embryo needs to implant.Antibodies also fill the follicular fluid with inflammation and oxidative stress, and can cause micro-miscarriages. Instead of a calm environment, like chill-out music, the oocyte finds itself in an aggressive environment, more like constant techno music that makes the entire fertilization process difficult for it.If you are seeking pregnancy, I recommend a prenatal supplement with selenium and increasing myo-inositol up to four grams.The TSH must be below 2.5 . If it is between 2.5 and 4 and there are no antibodies, it is usually not treated with Eutirox. If there are antibodies or the TSH exceeds 4, medication is needed to achieve pregnancy.Elevated thyroid antibodies when seeking pregnancyAbout 15% of women with normal thyroid function have elevated anti-TPO or anti-TG thyroid antibodies , and that increases the rate of spontaneous miscarriages in the first trimester.The antibodies attack the thyroid and throw off the hormonal peaks necessary to ovulate and fertilize. They also circulate in the blood and locally attack the ovaries and fallopian tubes, generating inflammation and free radicals.This is how they destroy that antioxidant bubble that is vital for the development of the embryo . To reduce these antibodies. , I recommend taking myo-inositol and selenium together. The usual dose of myo-inositol is 600 to 800 mg, but when seeking pregnancy, it goes up to four grams to improve the FSH signal. The selenium dose moves between 75 and 100 micrograms.Myo-inositol and selenium act synergistically to reduce both thyroid antibodies and other autoimmune antibodies.Iodine in pregnancy when hypothyroidism existsDuring pregnancy, if you have hypothyroidism, not only can you take iodine, you must: needs almost double , up to about 300 micrograms per day.Until week 12 of gestation, the baby does not yet produce its own thyroid hormone. It depends completely on the mother . From week 12 on, the baby's liver begins to produce thyroglobulin, but it needs the iodine from the maternal diet. to manufacture its own hormones.Without enough iodine, the viability of the pregnancy and the neurodevelopment of the baby are seriously compromised.What diet to follow if you have hypothyroidismThere is no strict and universal diet that everyone with hypothyroidism has to follow. On social media, there is quite a bit of sectarianism around this topic.Gluten only needs to be removed mandatorily if celiac disease exists. If you have autoimmune hypothyroidism and notice bloating or fatigue, you can try removing it for two weeks to see if there is non-celiac sensitivity . If you tolerate it well, continue taking it without fear.Iodine, on the other hand, must be part of your diet if you have hypothyroidism. Asking a slow thyroid to manufacture hormones without giving it iodine is like asking someone for a chocolate cake without giving them chocolate.Iodized salt remains one of the simplest ways to ensure that intake.Foods that should be limited or avoided in hypothyroidismDo not abuse cruciferous vegetables, such as broccoli or cauliflower, because they decrease iodine uptake by the gland.It is also advisable to strictly avoid yuca, cassava, or manioc , because they reduce that iodine uptake and also increase the elimination of thyroid hormones through feces.I also do not recommend fasting or low-carbohydrate diets in hypothyroidism. Both reduce the activation of T4 into T3, lower the basal metabolic rate, and worsen fatigue and brain fog.Subclinical hypothyroidism: when to start medicationThe subclinical hypothyroidism is the phase prior to hypothyroidism. The pituitary gland notices that the thyroid is slowing down and raises the TSH above 4 to insist more, even if thyroid hormones are still within the normal range.In men and women who are not pregnant, medication is usually started when the TSH exceeds 4.2 , especially if there are symptoms or cardiovascular risk factors such as high cholesterol.Between 50 and 60 years of age, if there are no risk factors, you can wait until the TSH reaches 10 before giving levothyroxine.In pregnant women or those seeking pregnancy, medication starts from a TSH of 2.5, especially if antibodies are positive .What is the relationship between hypothyroidism and SIBO?. The hypothyroidism and small intestinal bacterial overgrowth, SIBO, go together more than it seems.T3 is responsible for contracting the muscle of the more than eight meters of the digestive tract. When it is missing, intestinal movement decreases and constipation appears.In addition, hypothyroidism lowers the production of acid in the stomach, and acid is a powerful natural antibacterial. If there is less acid, the intestine moves less (or you also take gastric protectors like omeprazole), and then the bacteria do not die and get stuck in the upper part of the intestine.Those bacteria overgrow and steal nutrients. A vitamin B12 deficiency can appear and, in parallel, an excess of folic acid produced by the bacteria themselves.Symptoms of SIBO and how to repair the intestinal barrier The bacterial overgrowth can cause abdominal bloating, gas, diarrhea, and rosacea. Bacteria produce substances that damage the intestinal barrier and create small holes, which leads to . leaky gut. They also break down enzymes and transporters on the brush border.As a consequence, it is possible to suddenly develop lactose or fructose intolerance. The approach involves using an antibiotic, medical or herbal, and repairing the intestinal barrier with . glutamine, zinc carnosine, quercetin, and probiotics.. Do you have to take Eutirox at the same time every day? It is recommended to take levothyroxine at the same time every day, but it is not strictly necessary if you cannot get up early one day or you forget. Levothyroxine has a very long half-life; it stays in the body for about seven days. That is why, if one day you change the time or skip the dose, nothing serious happens. You can even take the forgotten dose along with the next day's dose. How to understand thyroid health completely Your thyroid health is not reduced to a single TSH value. You have to distinguish nodules from functional alterations, look at antibodies, ensure the nutrients that allow hormones to be manufactured and activated, and adapt the treatment to each stage of your life. Iodine provides the raw material. Selenium helps transform T4 into active T3. Myo-inositol improves the gland's sensitivity to signals from the brain and helps lower antibodies. You also have to understand the relationship of the thyroid with the stomach, the intestine, fertility, pregnancy, and menopause. Thyroid hormones act throughout the entire body, and when they drop or rise in excess, their consequences do not stay just in the neck either. Transforming your health is a matter of applying science with consistency, day by day. You have in your hands the knowledge to better understand your lab results, your symptoms, and the decisions that accompany thyroid care. I hope you like it :)For more information, you know you can find me on my Instagram @isabelvina where I share daily contentMy TikTok @isabelvinabasOn my YouTube channel And the supplements formulated by me https://ivbwellness.com