662. Thyroid Nodules and Goiters: When to Watch, When to Act, and What May Help

0:00So, think of a nodule or goiter as a physical response to one or more types of stress or stimulation. And this is where I come back to the whole point of if your thyroid gland is growing something out of it. Maybe pay attention to it, because that particular gland, IE the thyroid, is under stress, and it needs some love and support. I just want to say thank you. The fact that you're here means that you have trusted me with something so valuable these days, your time, and I do not take that lightly at all. So if you're listening because you're exhausted, you're gaining weight for no reason, losing your hair, getting really frustrated, or you've been told that everything looks normal, when you know deep down something isn't right, I want you to know that I see you. I've been where you are, and that's exactly why I created this podcast. My mission is super simple, to give you the information, the hope, and the tools that I wish someone had given me years ago.

1:05So, my goal is you get to stop wondering what's wrong with your body and finally start getting your life back. So if these episodes have helped you add all, would you do me one small favor? Take it just a few seconds to follow the show, the little button in the upper corner, and then leave a review. Every follow and every review helps this podcast reach another person who's lying there awake at night wondering why they don't even recognize themselves anymore when they look in the mirror. Wondering what's happened to this amazing, energized, full-of-life person they used to be? You're helping them, and not only that, when you follow the show, you'll be notified about the hottest episodes everyone is listening to in everyone's downloading, along with any bonus episodes I drop throughout the month. Think of it as your insider pass. So thank you for letting me be part of your journey, and thank you for your time. Now let's get into today's episode.

2:06If you're over 40, which many of you are, and managing a thyroid or hormone issue, you know this feeling. You're doing everything right, but your energy is low, your strength might be slipping at the gym. The scale definitely won't move, and you hit just this wall, you just can't push through. So that was me. And what finally changed wasn't another energy drink. It was starting essential amino acids. So here's the simple version. These are nine building blocks that your body can't make on its own. They're what protein breaks down into, except your body absorbs them almost instantly, so no heavy digestion required. They go straight to work, feeding your muscle, building your muscles, supporting your metabolism, and that's what we all need. So since I started taking them every day, sometimes two, three times a day, I've noticed better energy, faster recovery, muscle building, yes, at the age of 52, alongside my hormones, way more consistency in my workouts.

3:18And I genuinely feel leaner and stronger. I really do. I have more muscle now than I had in my 20s when I was competing in bodybuilding competitions. More muscle now, because I'm feeding it the right way. So even on rest days, especially when I'm eating maybe a little bit less, I still take them to stay on track. The brand I choose and have been using now for four years is Keon. They're a sugar free non GMO vegan easy to digest and they taste amazing. That's why I put them in my water all day long. So if you're trying to lose fat without losing muscle, if you're on a GLP, you better, you had better be taking these every single day. So you want to go to get Keon.com forward slash thyroid for 20% off. That's GT K I O N dot com forward slash THY R O ID forward slash thyroid for 20% off.

4:30Get them Nango, get the berry. They're just all good. They're all good. You will love it. So I don't know any other body part where we can find something growing out of it and everyone just says, oh, it's probably fine. Let's just watch it. You have something growing on your liver. We investigate it. Something growing on your ovaries. We investigate it. Something growing in your breast. We investigate it. But when there's a thyroid nodule, patients are often told, I don't worry about it. Your TSH is normal. We'll ultrasound it again in a year. Now, I'm not saying that every thyroid nodule is dangerous. Most are actually benign. And I'm not saying every nodule needs a biopsy surgery. It does not. But something caused that thyroid tissue to change a nodular goiter deserves an explanation, a proper evaluation and a plan to treat it.

5:30Just being told your TSH is normal is not an explanation. So today we're going to break down what thyroid nodules and goiters actually are. Why they form what they can tell us about thyroid function and when they become concerning. What do we have to do? Also, I want to talk about what may help to shrink them and what to know if someone recommends removing part or all of your thyroid. All right, so first up, a nodule and a goiter are not the same things. So let's define the terms first. A thyroid nodule is a distinct lump or it's an area within the thyroid that is just lumpy and bumpy. It might be solid. It could be fluid filled, which we call cystic or it can be a mixture of both. So you can have one nodule or many nodules. A goiter simply means that the thyroid gland is enlarged. It may be enlarged evenly. That's called the diffuse goiter. It may contain multiple nodules and that's called a multi nodule goiter.

6:37But here's a point that gets missed. A goiter does not tell us whether the thyroid is working too slowly, too quickly or whether it's normal. The first thing you can have a goiter with hypothyroidism, they can have it with hyperthyroidism. You can have a goiter even if your thyroid hormones fall inside that normal lab reference range, right within normal limits. The same is true of many nodules. A normal TSH doesn't make the structure of the thyroid irrelevant. It's not even connected. So when we test your blood, the blunt test evaluate the function of your thyroid gland. How much thyroid hormone is your gland making? Is it converting T4 to T3? That's what the blood test evaluate. Altar sound evaluates the structure of the gland. And we really need both when there is a growth or an enlargement that you don't need it all the time. Not everybody needs to run out and get an ultrasound. I'm going to tell you when you might need to explore a little bit further.

7:39So how would you know that you have a nodule or a goiter and then who's actually meeting an ultrasound. Let's talk about that. So again, I'm not recommending routine thyroid ultrasound for every person with fatigue, weight gain, hair loss, hypothyroidism, Hashimoto's. And ultrasound is a structural test. We use it when there's a reason to suspect a structural problem. So, you know, I mean routine screening of let's say asymptomatic symptom free adults can uncover tiny incidental nodules that never would have caused harm anyways. And then with the sense of happening or with the sense of doing to the poor person is causing anxiety and then they have repeat imaging unnecessary biopsies sometimes unnecessary surgery or God forbid radioactive iodine treatment that makes the person radioactive and you can't even be around other human beings for a while. So that just seems silly if it's not needed many, many, many, many nodules can be there and cause no symptoms.

8:44And they're really the first noticed usually during a physical examination or just incidentally if you're having a CT scan or an MRI of like the head neck and chest, then sometimes it's like, oh, and by the way, we were checking for something else, but there's this tiny little nodule on your thyroid. So it can be picked up that way as well. Now symptoms that you would have are signs that can occur that would trigger you to go, you know what, maybe I should get an ultrasound just to check this out because this is kind of weird. If you're actually feeling a lump bump or fullness in the lower front of the neck. So I often tell the story of the six doctors that Miss diagnosed me, if you haven't heard that, I tell it quite often. You'll hear it on one of the bogus. Six doctors Miss diagnosed me because they were testing TSH only. Oh, yeah, no, everything's normal. Everything's fine. You're within normal limits. And then the seventh doctor actually touched my throat and said swallow and felt a little nodule. And that's where she said, you know what we can do with thyroid ultrasound here, but based on your labs dot, dot, dot, you have oshumotos. So it could be a palpable lump or bump or fullness.

9:57Maybe one side of the thyroid or your neck is appearing larger than the other. This is where practitioners like myself can be out and about. And we can spot an enlarged thyroid. We can spot a goiter. I always say if somebody knows Rachel Ray, please send her my way because I'm looking at her and she obviously has a full neck, a visible goiter. Somebody's not treating her thyroid properly. That's for sure. You also might have a visible enlargement that moves when you swallow and I'm not talking about like a little Adam's apple. I'm talking about a visible engment that maybe swells up and shrinks down. You might experience neck pressure, maybe a tight sensation, difficulty swallowing, choking, feeling that food or pills are getting stuck. And shortness of breath, especially when you're lying flat, although if your experience to map, please go to the ER. But if it's minor and you're like, yeah, just when I lay back down and you know, I'm lying in my, I don't know, sauna or I lay down to go to bed. And then all the sudden, I'm like, clearing my throat and choking persistent horseness or an unexplained change in your voice.

11:12Tender or suddenly like an enlarged area, tender area on your neck. This can happen when a cysts on your thyroid actually bleeds and you become very, very tender and we'll get into that in a moment. And then just an enlarger suspicious lymph node in the neck. That's when an ultrasound is really appropriate. And your clinician that you're working with that they can actually see the symmetry. They can see the thyroid love for the enlargement. Then you will have an ultrasound done just to check it. And like, let's just do it so we can check that box and make sure there's nothing else going on. Another high risk category, significant high risk category is childhood radiation to the head or neck exposure to radioactive fallout. And if you have a lower risk category relative with thyroid cancer or an inherited thyroid cancer syndrome. Those are times where OK, it's appropriate to have that thyroid ultrasound.

12:14Now here is what does not automatically mean that you need an ultrasound. If you just have high both thyroid symptoms, if you use a higher LOTSH positive thyroid antibodies low free T3 elevator reverse T3. a test, deserve attention, your symptoms deserve attention, but without a palpable abnormality, then there's no need for a thyroid ultrasound at that point. No need whatsoever. Because an ultrasound will answer a totally different question. It's answering the question, is there structural abnormality that we can see the swelling, the palpable nodules, goiters? That's where we bring in the ultrasound. So you can look at your neck in the mirror while swelling a sip of water. And you can really try to notice whether there's obvious fullness or asymmetry there. But that's obviously not a diagnostic test. So please do not repeatedly poke at your thyroid trying to find something. If you notice a change or you have any one of these indicators that we just talked about,

13:18then see a qualified clinician who can examine your neck. I pause there, right? Because a qualified clinician who can examine your neck is different from a qualified clinician who can properly optimize you. Those are two different things. Remember, we have thyroid nodules on in one bucket and we have your thyroid function, optimization of your free T3, reverse T3, optimization of your thyroid hormones in another bucket. Now these buckets cross over and we're going to get to that in a moment. But we don't look at you and say, oh, because you have symptoms and a low free T3, you need a thyroid ultrasound. We also don't recommend going to just your PCP and saying, hey, can you also, while you're doing this thyroid ultrasound, optimized thyroid because they're probably not going to know what they're doing. That's a separate podcast. I've gotten into that enough. You all know that you have to fall into the optimal range and not just normal if you actually

14:22want to feel your best and be optimized. Okay. So now let's talk about why do these nodules and goiters even form where they come from? There's actually not just one single cause. There's many. Think of a nodule or goiters as a physical response to one or more types of stress or stimulation. This is where I come back to the whole point of if your thyroid gland is growing something out of it, maybe pay attention to it because that particular gland, IE, the thyroid, is under stress and it needs some love and support. So the number one, the number one cause of nodules and goiters is iodine deficiency, defecency. It means you're not taking it because you're listening to all these IG influencers out there that are scaring the BG's side of you for using iodine. Well, again, I always go back to the science.

15:23The thyroid gland needs iodine to produce T4 and T3. The thyroid gland needs iodine to convert T4 and T3. Every single one of your 40 trillion cells in your body have a receptor site honor for iodine. If you don't take it because you're listening to the IG influencers, then you know what's going to attach to that receptor site? All right. Chlorine and bromide. Three toxic halides or halogens, whatever form they're in, bromide, IDE or the INE form, doesn't matter. They're toxic. They're toxic to your thyroid gland and they're toxic to you as a human being, IE cancer. So you know, avoid the iodine. Sure. Keep avoiding that iodine and then call me when you get cancer because your body is loaded with toxic halogens or call me when you have to have your thyroid gland removed because you have goiters out the wazoo and now it's time. So again, when iodine supplies inadequate, the thyroid gland has to adapt and work harder.

16:24I'm going to say that again, when iodine supply is inadequate, IE, you're not taking it or you're avoiding foods with it because you read a book or you listen to a podcast, and iodine supply is inadequate. The thyroid gland has to adapt and work harder. Now what this is going to mean is that TSH gets stimulated and then that local growth signal of TSH because remember the brain is talking to your thyroid, sending out thyroid stimulating hormone, I.e. TSH to stimulate the thyroid gland and then that can stimulate growth. So that can actually cause thyroid cells to enlarge and multiply. And over time, that can contribute to a diffuse goiter or nodules or a multinogil gland. Iodine deficiency is not this fringe theory here. It is one of the major established causes of goiter and nodule thyroid change. Iodine deficiency is also a well-established cause of goiter worldwide and research continues

17:29to associate inadequate iodine intake with a higher risk of nodule thyroid disease. Now people hear that the United States iodized the salt and they assume that the deficiency is impossible, but that is totally false reassurance. Salt ionization in the United States is voluntary. They don't use the right form of iodine, the modern foods of light doesn't reliably provide adequate iodine. Most of the sodium that Americans consume come from processed package in restaurant foods, but manufacturers almost always use non-iodized salt when they're making the food. And then if you're using sea salt or kosher salt or hinolan salt, the other specialty salts with the real minerals in it, they're not iodized. They don't contain iodine unless the label specifically says that they are. Honestly, many people have stopped using table salt or they avoid salt altogether. They eat very little seafood, they're avoiding dairy. So those are where you could find trace amounts of iodine.

18:29But again, even if you're using regular table salt, it doesn't contain the right form of iodine. And then when you get into the food supply seaweed, that can range from very little iodine to extremely large amounts. So it's not a precise daily dosing strategy to just eat seaweed or eat kelp. In some areas, that source seaweed and kelp contains heavy metals or radioactive iodine material, so not really a good source. But this is exactly why I consider iodine intake when I see a goiter or a nodule. Now it doesn't mean that every single one was caused by iodine deficiency and doesn't mean that every person is going to be healed and shrink their goiters or nodules by taking iodine, but it's going to help. And iodine deficiency needs to be investigated as a potential major driver. And we can't just dismiss it because you live in the United States and you think that you're getting it enough from salt. Okay, number two, having autoimmune thyroid disease.

19:32So Hashimoto's can create chronic inflammation and a lumpy, irregular, or enlarged thyroid. Now some apparent nodules, those are inflammatory changes. They're also called pseudonodules. While true nodules can also coexist with Hashimoto's, also grave disease can cause a more uniformly enlarged gland because the thyroid stimulating antibodies continually activate that TSH receptor. So that's where we see that enlargement with grave disease and a dumping of thyroid hormone. So a person can have an enlarged thyroid because it's under an autoimmune attack or because it's being overstimulated with graves antibodies. This is why a full thyroid evaluation matters. This is why we say TSH alone doesn't tell you any part of the story really. It certainly doesn't tell you whether thyroid nodules are present. And then three, we have this normal tissue overgrowth, cysts, and prior bleeding.

20:38What do I mean by that? Many benign nodules and most of them are benign. But many, many, many benign nodules are just areas where thyroid cells have overgrown. Now others can be these little cysts that are filled partly or completely with fluid. And nodule can also, when I mentioned before, bleed internally and suddenly become larger or painful. Now don't freak out when I say it's bleeding. I mean, that sudden growth can be frightening for sure. But rapid enlargement from bleeding is different from a cancer simulation or progressive growth caused by tumor. Regardless, both need evaluation for sure. We're not going to blow it off. But I just want you to know that sometimes that can occur from that bleeding of the nodule itself. Autonomous or hot nodules, that's another, you know, some interesting cause, interesting result, let's say. So these little guys, these nodules, they begin producing thyroid hormone on their own,

21:40independently, without even being stimulated. Like basically they're doing it without instructions from TSH. These are called autonomously functioning or hot nodules. At first, in the very beginning, thyroid levels can appear optimal actually. Like, don't even just normal. We only say normal, say optimal. And then over time, that TSH becomes suppressed and the person can develop the hyper symptoms, the palpitations, anxiety, heat intolerance, tremor of the hands, sleep disruption, aphib, whatever. So when we have that and we're seeing this indication of graves, this is where we might use something called a thyroid uptake scan to determine whether a nodule is functioning autonomously or not. Because ultrasound alone can't tell us whether a nodule is hotter cold. And then there's genetics, age, hormones, radiation exposure. So nodules become way more common with age and are more common in women.

22:44So family history, prior radiation to the head or neck, especially during childhood, like we mentioned earlier, this all raises concern. A family history of thyroid cancer also increases concern. So the estrogen dominance, PCOS, now called PMOS, and insulin resistance. These are all risk factors. So let's talk about the hormonal and metabolic environments surrounding the thyroid. So thyroid tissue has estrogen receptors. And estrogen can act as a growth signal in both benign and in malignant thyroid cells. So this helps explain why the nodules and really proliferative thyroid conditions are far more common in women. Far more common in women. Now this does not mean that estrogen is bad, ladies. It doesn't mean that every woman with a nodule has too much estrogen or needs to go off or estrogen therapy. The issue may be just relative estrogen dominance.

23:44So estrogen extreme ratio without enough progesterone to provide that balance. We see this all the time when a woman is not ovulating. We see it in perimenopause. We see it in PCOS that low progesterone state that results then in an estrogen dominance state because of the low progesterone. Now PCOS is notorious for this. And then we also see with PCOS combining this irregular ovulation and low progesterone with insulin resistance, which is another factor in nodules. So research has found increased thyroid volume and a higher frequency of nodule goiter in women with PCOS with insulin resistance appearing to be the important part of the association. So insulin is not only a blood sugar hormone. Chronically elevated insulin also acts as a growth signal. This is why it's tied to increased risk of cancer because we're stimulating growth

24:44pathways. This is why it's tied to Alzheimer's and the growth of the plaque that we're finding in Alzheimer's. So it can interact with insulin-like growth factor pathways and may encourage thyroid cell proliferation, i.e. growth of potential cancer cells in the thyroid. Now multiple studies have linked insulin resistance, hyperinsulinemia, obesity, and metabolic syndrome with larger thyroid volume or swelling and a greater prevalence of thyroid nodules. So when I see a woman with nodules, especially alongside waking around the middle, cravings, energy crashes, elevated fasting insulin, PCOS, irregular cycles, of course we never just look at TSH. But we also don't just look at the thyroid panel. I want to investigate the metabolic terrain too. So fasting glucose, fasting insulin, even with an A1C, all of that is checked alongside obviously all of the hormones.

25:45I want to consider how is she producing and metabolizing estrogen? Is she ovulating and making adequate progesterone? Is she constipated and potentially recirculating estrogen through the gut? How is liver detox functioning? What's her alcohol exposure, body composition, inflammation, environmental estrogen exposures? So in select in patients, obviously we do a Dutch test because a Dutch test can show patterns and estrogen metabolites, including how estrogen is moving through that two, four, and 16 hydroxy pathway, and how well the metabolites are being methylated. Now we also test estrone. So if you're working with a hormone provider that's not testing estrone, they don't know what they're doing with hormones, just get away. And then there's another layer with genetic testing. So we do genetic testing at the Advanced Lyron hormone clinic because genetic testing might reveal variance affecting methylation and detoxification, antioxidant defense, or estrogen signaling.

26:46Now, a Dutch test or DNA report cannot prove that a particular pathway caused a thyroid nodule. They just reveal this hormonal or metabolic pattern that may be contributing to the environment in which the abnormal thyroid tissue grows occurred. So that information helps us build out more individualized plans for patients, but it doesn't replace an ultrasound or if a biopsies needed or any other kind of risk assessment. So this is why I say over and over again, we can't just say, well, even if you get a biopsie, the biopsie has been on, so come back next year. I mean, benign is fantastic. We want to hear that. But I still want to know and ask the question, why the growth signals may be present and what can we improve for gestural and status, insulin sensitivity, the gut, bowel, regularity, liver support, body, con, diet, sleep movement, maybe exposure to endocrine disruptors, all of that we need to know. The thyroid cancer, of course, we have to talk about it, but it should not dominate

27:49the conversation because most thyroid nodules are not cancer. So let's not panic over every nodule. We just have to identify it. And then that just means we have to get that ultrasound. And are those goiters measuring high enough to warrant a biopsy? So again, we have to ask two different questions. Is the thyroid producing and converting hormones appropriately? That's one question. Question number two is does a thyroid contain a structural abnormality that needs to be characterized? So for the functional side, no, I want to complete thyroid panel, not just TSH alone, like you know all the ones that we check. Maybe we throw in some graze antibodies if we're suspecting a nodule. Reverse C3 is not optional in my evaluation because it helps show whether T4 is being converted toward active T3 or not. But all of those tests don't determine whether a nodule is malignant because that is a structural and cytologic question. But it is essential to understanding how the thyroid hormone system is functioning.

28:52So if the gland itself, again, is producing a growth, are we going to blow it off? Are we going to look further to see what's going on? So we have to know how large is the dimension? Is that that nodule solid, cystic, mixed? What's the risk category? What are the margins of the nodule? Is it taller? More than wider? Are there suspicious calcifications? Are any lymph nodes abnormal? Does it meet the criteria for a fine needle aspiration? We need to know all of this information. So when does an nodule need biopsy? So biopsy decision should be based on the radiologist and the ultrasound pattern size, on the size alone. And not fear alone either. You don't just jump into a fine needle aspiration just because you're scared. So a fine needle aspiration removes the cells from the nodule, so a pathologist can evaluate them. And different ultrasound risk systems use some different size thresholds.

29:54So in general, a smaller nodule with highly suspicious features may warrant a biopsy. While larger nodule with very low risk features may be safely monitored, but either way, we need to come back and we need to look at your thyroid function, i.e. all of the markers, because we want to know is your thyroid functioning on its own? Like is it functioning well? Is it optimal? Is it optimal? So here are just some red flags where you want to, you just look for and this is where you're going to be evaluated promptly. A new lump, one that's enlarging, porousness, change in voice, trouble swallowing. We talked about that, the shortness and breath, neck pressure, visible enlargement, heart or fixed mass, lymph node enlargement, rapid growth, a history of childhood or neck radiation, strong family history of thyroid cancer, or symptoms, if you do have symptoms of excess thyroid hormone, like hyperthyroidism, with a low TSH, elevated free T3, elevated free

30:58T4, positive TSI antibodies, that's where we want to check it out, because we don't want a large grudder compressing your tray here, your esophagus growing downward behind the breastbone, I've heard of that as well. So we just want to make sure that it's nothing to be worried about. But again, the lesson here, the take home message is we don't just watch and wait, we don't just wait a year, we do something about it and we check it. And how we shrink the nodules and goiters, iodine, iodine and actually optimizing your thyroid, I mean those two things are huge, they're absolutely huge. So start on iodine anyways, because it's good for you, your body and your full thyroid. And then let's actually do the full thyroid panel. Let's get you optimized. And those two things alone can help reduce any nodule or goiter or anything that you got

31:58going on. Now the bottom line is if you do have any of those symptoms that we went over and over again today, yes, you get the ultrasound. But if you've been told you have a nodule, goiter, you had it ultrasound, it's very, very small, they're not doing anything else with it, then then you leave it. But you also optimize your thyroid hormones. Please do not leave this alone. The information shared on the Thyroid Fixer Podcast is intended solely for informational and educational purposes. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with your physician or other qualified healthcare provider with any questions you may have regarding a medical condition, treatment or before making changes to your healthcare regimen, including medications, supplements or other therapies. Use of the information provided in this podcast does not establish a doctor, patient or client provider relationship between you and the host or between you and any other healthcare professionals featured on the show. Any medical opinions or statements made by guests are their own and do not necessarily

33:01reflect those of the host or affiliated parties. Statements regarding dietary supplements or health related products mentioned in this podcast have not been evaluated by the FDA. These products are non-attended to diagnose, treat, cure or prevent any disease. Some episodes of the Thyroid Fixer Podcast may include sponsorships or affiliate links. The host may receive compensation for discussing or promoting certain products or services. Many such sponsorships or affiliations will be clearly disclosed during the episode. All opinions expressed are those of the host or guests and do not necessarily reflect the views of any sponsors. The inclusion of a product or service does not imply endorsement by any healthcare professional featured on this podcast.