DIETARY SUPPLEMENTS IN HYPOTHYROIDISM

SC I E NTI

ARUM POLO

NORUM

ACTA Acta Sci. Pol. Technol. Aliment. 20(4) 2021, 375?381

food.

pISSN 1644-0730

eISSN 1898-9594

ORIGINAL PAPER

Received: 30.07.2021 Accepted: 20.08.2021

DIETARY SUPPLEMENTS IN HYPOTHYROIDISM

Dagmara Woniak1, Sylwia Drzymala2, Juliusz Przyslawski1, Slawomira Drzymala-Czy1

1Department of Bromatology, Poznan University of Medical Sciences Marceliska 42, 60-354 Pozna, Poland 2Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences Szpitalna 27/33, 60-572 Pozna, Poland

ABSTRACT

Background. According to Statistics Poland (GUS, 2021), 15.8% of women and 2.5% of men suffer from thyroid disease. Although pharmacotherapy is the primary treatment, there is evidence that some vitamins and minerals can alleviate the symptoms of thyroid disease. A well-balanced and varied diet should cover the individual demand for energy and all necessary nutrients. However, dietary supplements are prevalent in Poland. This study aims to evaluate the frequency and reasons behind dietary supplementation in patients with hypothyroid diseases. Material and methods. 232 volunteers (203 women and 29 men) from Poland participated in the research. The research was conducted using a questionnaire. Participants were asked to provide information on their diagnosis, clinical manifestations of the disease, their lifestyles, and the use of dietary supplements with the effect on their health. Results. The medium age of participants was 27 years. Of them, 85% took dietary supplements. The most popular were vitamin D, magnesium, omega-3 acids, selenium, multivitamins, vitamins B, iron, vitamin C, and zinc. In addition, 53% of patients implemented lifestyle changes after a diagnosis of hypothyroidism. There was a correlation between the participants' age and the willingness to introduce lifestyles modifications: the younger the participants were, the eager they were to introduce modifications (r = -0.243, p = 0.010, 95% CI: -0.410 to -0.060). In addition, there was a correlation between the participants' age and the willingness to change their diets: the older the participants were, the more eager they were to change diets (r = 0.283, p = 0.003, 95% CI: 0.103?0.445). Patients indicated numerous health benefits of using dietary supplements. The vitamin D and vitamin and mineral complexes were indicated as the most beneficial. Conclusion. Dietary supplementation is prevalent in Poland, especially among hypothyroidism patients. Patients take a variety of supplements, claiming that they improve the condition of their skin, nails, memory, and others, which may be controversial. Therefore, it seems advisable to deepen the patients' supplementation knowledge (via contact with a physician, dietitian, etc.). Furthermore, reliable guidelines on supplementation for hypothyroidism patients based on clinical trials should be developed.

Keywords: hypothyroidism, Hashimoto's thyroiditis, dietary supplements, vitamins and trace minerals supplementation

INTRODUCTION

According to Statistics Poland (GUS, 2021), 15.8% of The results of studies from 2019 and 2014 indicated women and 2.5% of men suffer from thyroid disease. significant changes in thyroid diseases, particularly in

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Woniak, D., Drzymala, S., Przyslawski, J., Drzymala-Czy, S. (2021). Dietary supplements in hypothyroidism. Acta Sci. Pol. Technol. Aliment., 20(4), 375?381.

women (increase by 3.7 percentage points). Thyroid diseases are the most common in adults aged 60?69 (13.6%) and 70?79 (15.8%). Hypothyroidism is one of the most common diseases worldwide affecting up to 5% of the population according to European prevalence estimates (Chiovato et al., 2019). It is further estimated that another 5% of the population remains undiagnosed (Chiovato et al., 2019).

The thyroid gland secretes hormones, thyroxine (T4) and triiodothyronine (T3), that play an active part in children's growth and development and regulation of metabolic processes in adults' (Biondi and Cooper, 2019). Hypothyroidism is the result of insufficient production of thyroid hormones or inadequate activity of thyroid hormones in the target tissues (Almandoz and Gharib, 2012). Physicians extinguish two types of hypothyroidism: clinical/overt, in which the TSH is increased, and the T4 levels are low; and subclinical, in which the T4 levels are normal, but the serum TSH is elevated (Almandoz and Gharib, 2012; Biondi and Cooper, 2019). Two major causes of hypothyroidism are iodine deficiency and autoimmune (Hashimoto's) thyroiditis (Biondi and Cooper, 2019). The symptoms of the disease are often subjective and depend on the severity of biochemical hypothyroidism. They are mainly fatigue, cold intolerance, dry skin, constipation, weight gain, vocal changes, and muscle aches (Almandoz and Gharib, 2012; Biondi and Cooper, 2019). In addition, disturbed lipid profile, xerosis, decreased sweating, thickening of the skin, brittle hair, hair loss, oligomenorrhea and menorrhagia are also common (Almandoz and Gharib, 2012). Hypothyroidism is diagnosed on the basis of numerous factors, such as laboratory test results, existing symptoms, family history of thyroid dysfunction, the presence of a goitre or sonographic evidence of thyroid autoimmunity, and also the presence of circulating antithyroid antibodies: anti-TPO, anti-TG, and TSH receptors antibodies (Almandoz and Gharib, 2012; Biondi and Cooper, 2019).

The hypothyroidism is permanent in most patients. Therefore, patients require permanent thyroid hormone replacement (typically synthetic levothyroxine ? LT4) (Almandoz and Gharib, 2012).

Although pharmacotherapy is the primary treatment, there is evidence that vitamins and minerals, such as vitamin D, A, E, zinc and selenium, may

alleviate the symptoms of thyroid disease (Sworczak and Winiewski, 2011; Wlochal et al., 2014). A well-balanced and varied diet should cover the individual demand for energy and necessary nutrients (Przyslawski et al., 2016). According to Directive 2002/46/EC of the European Parliament and the Council on 10 June 2002, dietary supplements are foodstuffs. Therefore, supplements should only be used if consumers cannot cover their eating requirements from conventional food (Przyslawski et al., 2016; Wierzejska et al., 2014). Vitamin deficiencies are rare in healthy subjects in Poland and other developed countries, but many people still take dietary supplements (Sworczak and Winiewski, 2011; W?jciak et al., 2019). This study aims to evaluate the frequency and reasons behind dietary supplementation in patients with hypothyroid diseases.

MATERIAL AND METHODS

The study included 232 volunteers (203 women and 29 men) from Poland. The disproportion in sex ratio can be explained by the percentage ratio of thyroid disease in Poland (15.8% of women and 2.5% of men). A questionnaire was used to conduct the study. Participants were asked to provide information on their diagnosis, clinical manifestations of the disease and lifestyles. The questionnaire specifically asked if participants had changed their lifestyle since diagnosis and applied any dietary supplements. They were also asked to assess the influence of dietary supplementation on their health. The questionnaire was comprised of six open clause and eleven close clause questions (single and multiple-choice). The questionnaire was available online on different patients' Facebook groups, forums and websites concerning thyroid diseases. The questionnaire was originally in the Polish language.

The exclusion criteria included being under 18, the lack of diagnosis of hypothyroidism or a hyperthyroid diagnosis. 250 questionnaires were collected in general. However, 10 participants failed to complete the questionnaire and 8 participants were diagnosed with hyperthyroidism. Thus, 232 questionnaires remained.

The obtained data were analysed using MedCalc 19.6 (MedCalc Software, 1993?2020) and

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Woniak, D., Drzymala, S., Przyslawski, J., Drzymala-Czy, S. (2021). Dietary supplements in hypothyroidism. Acta Sci. Pol. Technol. Aliment., 20(4), 375?381.

GraphPadPrism 5.01 (GraphPad Software, Inc., La Jolla, CA, USA) statistical software. For all parameters, medians and 1st?3rd quartiles were calculated unless indicated otherwise. The Shapiro-Wilk test was used to check the normality of the data distribution. Statistical differences between groups were tested using Kruskal-Wallis, post-hoc tests (Dunn's multiple comparison test) and Chi2 for multidimensional contingency tables. The linear correlation between parameters was analysed using Spearman's test. A p-value of ................
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