Case Study: How Can Dietary Supplement Use Lead to Thyroid Disease?

Vitamins and supplements
Vitamins and supplements
A patient presented with intentional 10-pound weight loss, suppressed thyroid-stimulating hormone, and increased FT4 and TT3 levels.

At the the 26th American Association of Clinical Endocrinologists Annual Scientific Sessions & Clinical Congress, Sarah Fishman, MD, PhD, of Lenox Hill Hospital, in New York, NY, presented a case of a patient who developed thyroid disease when taking an unregulated dietary supplement containing excessive iodine.

The case involves a 39-year old male patient who stated that he had an intentional 10-pound weight loss over a 2-month period after starting a dietary supplement that was a “fad” at his office. He claimed that this supplement was used to “promote increased energy and weight loss,” however, he could not recall the name of the supplement at the time of presentation.

The patient’s physical exam was unremarkable and he was negative for exophthalmos, thyromegaly, thyroid nodules, tremor, and hyperreflexia. Laboratory analysis found a suppressed thyroid-stimulating hormone (TSH) level (<0.03 IU/mL), an increased free total thyroxine (FT4) level (2.88 ng/dL), and an increased triiodothyronine (TT3) level (470 ng/dL). Additionally, the patient was negative for TSH receptor and thyroglobulin antibodies, but had a positive thyroperoxidase antibody titer (56 IU/mL).

The study authors noted that thyroid ultrasound revealed “multiple nodules, a left-sided sub-centimeter nodule, and two nodules in the right lobe, the largest of which was 1.3 cm hypoechoic, with internal vascularity.” A biopsy was conducted and the nodule was found to be benign. 

After investigation, the supplement was identified as “Survival Shield X2,” which the patient discontinued. The authors noted that, after 2 months, the patient’s thyroid function tests were within normal limits and thyroperoxidase antibody titers gradually returned to normal by 8 months.

The authors stated that this particular unregulated supplement contains 1950 mcg of potassium iodide in one daily serving, which greatly exceeds the recommended daily value of iodine (150 mcg). “Many supplements exempt from FDA approval contain iodine and may have unknown risks to consumers,” Dr Fishman stated.

Dietary supplements have been increasing in popularity and are often promoted as weight loss aids or energy boosters. In addition, some claim to promote increased thyroid health; these supplements often contain iodine at amounts higher than the recommended daily allowance.  In addition to the development of both hypo-and hyperthyroidism, iodine excess has been associated with autoimmune thyroid disease.

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Fishman S, Morris M, Goldman R, Poretsky L. Can dietary supplements provoke thyroid disease? Abstract 1011. Presented at: 26th American Association of Clinical Endocrinologists Annual Scientific Sessions & Clinical Congress; May 3-7, 2017; Austin, TX.

This article originally appeared on MPR