77-Year-Old Woman Diagnosed with Thyroiditis Linked to Dietary Habits, Study Suggests

Medical Case Overview: Understanding the Connection Between Diet and Thyroid Health in Older Adults

Thyroid disorders are increasingly being linked to lifestyle and dietary patterns, especially among aging populations. This case study explores the diagnosis and treatment of a 77-year-old female patient admitted to the First Affiliated Hospital of Xi'an Jiaotong University in August 2020. The patient presented with persistent fatigue, dizziness, and palpitations—symptoms later attributed to chronic thyroid inflammation (thyroiditis). Notably, her long-term consumption of iodine-rich foods, particularly seafood, may have played a significant role in the development of her condition.

Patient Profile and Medical Background

Gender: FemaleAge: 77 years oldPrimary Diagnosis: Hashimoto's Thyroiditis (autoimmune thyroiditis)Hospital: First Affiliated Hospital of Xi'an Jiaotong UniversityTreatment Duration: One week of inpatient care followed by ongoing outpatient managementTreatment Plan: Oral levothyroxine sodium and acarbose, combined with subcutaneous recombinant human insulin injections

The patient had a documented 10-year history of type 2 diabetes mellitus, with previously stable glycemic control. However, over the past two weeks, she began experiencing unexplained fatigue, which progressed to include lightheadedness, heart palpitations, and occasional chest tightness—all symptoms that improved slightly with rest but did not resolve spontaneously.

Initial Clinical Assessment

Upon initial consultation, the patient was alert and oriented, able to communicate clearly, and cooperative during physical examination. She reported difficulty sleeping and a longstanding dietary preference for high-iodine foods such as seaweed, shellfish, and saltwater fish—common ingredients in coastal Chinese cuisine.

No significant weight loss or gain was observed, ruling out metabolic extremes. Laboratory analysis revealed key abnormalities: free thyroxine (FT4) levels at 7.05 pmol/L (below normal range), and highly elevated sensitive TSH (thyroid-stimulating hormone) at 22.500 uIU/mL—indicative of primary hypothyroidism. A thyroid ultrasound confirmed diffuse enlargement with heterogeneous echotexture, linear hyper-echoic bands, and septation patterns consistent with autoimmune thyroiditis.

Diagnostic Conclusion

Based on clinical presentation, lab results, and imaging findings, the final diagnosis was established as chronic lymphocytic thyroiditis (Hashimoto's), complicated by pre-existing type 2 diabetes. The combination of prolonged iodine excess and age-related immune dysregulation likely contributed to the onset and progression of thyroid dysfunction.

Treatment Approach and Management Strategy

After discussing treatment options with the patient and her family, a dual therapeutic approach was initiated:

• Levothyroxine sodium tablets: Administered orally to restore normal thyroid hormone levels and alleviate symptoms of hypothyroidism such as fatigue, cold intolerance, and cognitive sluggishness.
• Acarbose and insulin therapy: Continued use of oral acarbose alongside subcutaneous recombinant human insulin to maintain optimal glucose regulation during hormonal adjustment.

This integrated strategy aimed to simultaneously address both endocrine imbalances—thyroid insufficiency and impaired glucose metabolism—while minimizing risk of complications associated with either condition.

Monitoring and Discharge Planning

Vital signs and symptom progression were closely monitored throughout hospitalization. By day three, the patient reported marked improvement in energy levels, with near-complete resolution of dizziness and palpitations. Blood glucose readings remained within target ranges (fasting: 90–130 mg/dL; postprandial: <180 mg/dL).

After seven days of successful stabilization, the patient was discharged with detailed instructions on medication adherence, lifestyle modifications, and follow-up scheduling.

Observed Treatment Outcomes

The therapeutic response was considered highly favorable. At discharge, all major symptoms—including fatigue, chest discomfort, and vertigo—had resolved completely. Repeat blood tests showed improved thyroid function parameters and sustained glycemic control.

Follow-up evaluations over the subsequent months confirmed no relapse of symptoms, and thyroid ultrasound follow-ups indicated stable gland morphology without nodule formation or further structural deterioration.

Long-Term Prognosis and Preventive Outlook

While some forms of thyroiditis can be self-limiting, elderly patients like this one often require active intervention due to reduced physiological reserve and higher susceptibility to complications such as myxedema, cardiovascular strain, or worsening glycemic instability. Early diagnosis and timely hormone replacement proved critical in preventing disease escalation.

Key Recommendations for Patients and Caregivers

To support lasting health improvements, the following guidelines were emphasized for the patient and her caregivers:

Lifestyle Modifications

Incorporate gentle daily exercise routines such as walking, tai chi, or light stretching to enhance circulation, improve mood, and support metabolic balance. Avoid strenuous activities that could trigger cardiac stress, particularly when managing coexisting conditions like diabetes and heart palpitations.

Nutritional Guidance

Maintain balanced iodine intake—neither excessive nor deficient. While iodine is essential for thyroid hormone synthesis, chronic overconsumption (especially from seaweed, kelp, and certain supplements) may provoke or exacerbate autoimmune thyroid diseases in genetically predisposed individuals.

Patients should consult with a registered dietitian to develop personalized meal plans emphasizing whole grains, lean proteins, vegetables, and controlled carbohydrate portions to benefit both thyroid and glucose health.

Ongoing Medical Surveillance

Consistent monitoring is crucial. Patients are advised to:

• Take prescribed medications regularly, including thyroid hormone replacements and antidiabetic agents.
• Perform daily self-monitoring of blood glucose using home testing kits.
• Schedule periodic checkups every 3–6 months to assess liver and kidney function, lipid profiles, HbA1c, and thyroid panel (TSH, FT4, anti-TPO antibodies).
• Undergo annual thyroid ultrasounds to detect any structural changes early.

Clinical Insights and Broader Implications

This case highlights an important yet often overlooked connection between dietary habits and endocrine health in older adults. Although the patient's symptoms initially appeared unrelated—fatigue and dizziness stemming from what seemed like routine aging—they ultimately pointed to a deeper imbalance rooted in nutrition and immune function.

Why Diet Matters in Thyroid Disease

Iodine plays a paradoxical role in thyroid health: it is necessary for hormone production, but excessive intake can trigger autoimmune attacks in susceptible individuals. In regions where iodized salt is widely used, additional iodine from seafood-heavy diets may push intake beyond recommended limits (150 mcg/day for adults, 250 mcg/day during pregnancy/lactation).

For seniors, whose immune systems may already be more reactive, this overload can accelerate the progression of latent autoimmune thyroiditis into symptomatic disease.

Prevention Through Awareness

Public education about the risks of unbalanced micronutrient consumption—particularly excess iodine—is vital. Individuals with a family history of thyroid disease, those with diabetes, or people experiencing unexplained fatigue should consider screening for thyroid dysfunction.

Adopting a holistic approach that combines medical treatment with mindful eating, regular movement, and preventive screenings offers the best defense against chronic endocrine disorders.

Final Thoughts

The recovery of this 77-year-old woman underscores the importance of early detection, individualized treatment, and proactive patient engagement. Her journey serves as a reminder that even seemingly minor lifestyle choices—like frequent seafood consumption—can significantly impact long-term health outcomes.

By integrating modern medicine with nutritional awareness and preventive care, clinicians can empower aging patients to live healthier, more vibrant lives—free from preventable complications of common but manageable conditions like thyroiditis.