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Soy isoflavones inducing overt hypothyroidism in a patient with chronic lymphocytic thyroiditis: a case report
© The Author(s). 2017
Received: 17 May 2017
Accepted: 4 August 2017
Published: 5 September 2017
Many people have thyroid conditions that make them susceptible to hypothyroidism. If the foods they eat may interfere with the production of thyroid hormone, which can lead to development of serious hypothyroidism. The danger of health drinks should always be noted.
A 72-year-old Japanese woman was previously diagnosed with chronic lymphocytic thyroiditis caused by a goiter and had an elevated thyroid-stimulating hormone level (6.56 μIU/ml), a high anti-thyroid peroxidase antibody level (>600 IU/ml), and a high antithyroglobulin level (> 4000 IU/ml) but normal levels of free triiodothyronine (3.08 pg/ml) and thyroxine (1.18 ng/ml). She presented to our hospital with sudden-onset general malaise, edema, and hoarseness with an elevated thyroid-stimulating hormone (373.3 μIU/ml) level and very low triiodothyronine (< 0.26 pg/ml) and thyroxine (0.10 ng/ml) levels. It was determined that for 6 months she had been consuming a processed, solved health drink (“barley young leaf”) in amounts of 9 g/day, which included soybean and kale powder extract. Hypothyroidism might be affected by ingredients of health drinks. She discontinued consumption of the health drink immediately and began taking 12.5 μg of levothyroxine. The amount of levothyroxine was gradually increased every 3 days up to 100 μg. At day 61, her thyroid-stimulating hormone level had decreased (6.12 μIU/ml), her free triiodothyronine (2.69 pg/ml) and thyroxine (1.56 ng/ml) levels had increased, and her general condition was improved. Among risky foods lowering thyroid function, some experimental studies have revealed that isoflavones reduce thyroid function. Therefore, we measured the presence of isoflavones in the patient’s frozen serum with thin-layer chromatography. After she discontinued consumption of the health drink, two components quickly disappeared, and the other three components gradually decreased. On the basis of developing solvent composition and a positive ferric chloride reaction in thin-layer chromatography experiment, the five ingredients that disappeared or decreased were highly suspected to be soy isoflavones.
This case emphasizes that consuming health drinks that include soy isoflavone powder extracts can lead to severe hypothyroidism.
KeywordsIsoflavones Soybean Barley young leaf kale Hypothyroidism Chronic lymphocytic thyroiditis Thin-layer chromatography
Many people have thyroid conditions that make them susceptible to hypothyroidism. For example, 10% of a disease-free population was reported to have positive results for anti-thyroid peroxidase antibodies (TPOAb) or antithyroglobulin (anti-Tg) , indicating that many patients have potentially chronic lymphocytic thyroiditis. However, there are many exogenous foods influencing the thyroid. If the foods interfere with the production of thyroid hormone, they can cause serious hypothyroidism.
We report a case of a patient with severe hypothyroidism induced by consuming a health drink. To the best of our knowledge, there are almost no other reports of patients with severe hypothyroidism induced by isoflavone. The components of the substances suspected to be isoflavones disappeared or decreased along with the clinical impairment of our patient. To the best of our knowledge, this is the first report of the presence of isoflavone in the serum of a patient with severe hypothyroidism.
A 72-year-old Japanese woman had been followed because of chronic lymphocytic thyroiditis caused by a goiter. She had an elevated thyroid-stimulating hormone (TSH) level (6.56 μIU/ml), a high TPOAb level (> 600 IU/ml), and a high anti-Tg level (> 4000 IU/ml) but normal levels of free triiodothyronine (T3; 3.08 pg/ml) and thyroxine (T4; 1.18 ng/ml). Her past medical history included only hypertension. She did not have any fever or neck pain suggestive of subacute or painless thyroiditis during recent months, and she had not taken any medication that would reduce thyroid function. Her social, family, and environmental histories were also unrevealing.
Patient’s laboratory findings on admission
Blood cell counts
Occult blood test
Fecal occult blood test
Patient’s clinical course based on laboratory findings after discharge
fT4, ng ml
Isoflavone, one of the isoflavonoids, is associated with breast cancer, prostate cancer, cerebral infarction, and myocardial infarction [5–7]. Moreover, some researchers have reported that soy isoflavone might reduce thyroid function by suppressing thyroid peroxidase [2, 3]. In our patient, the components of the substances suspected to be isoflavones had disappeared or decreased along with her clinical impairment. To the best of our knowledge, this is the first case report in which the presence of isoflavone has been examined in the serum of a patient with severe hypothyroidism. This point is unique; to the best of our knowledge, there have been almost no other reports in which the presence of isoflavone has been examined in patient serum. The other following two mechanisms of hypothyroidism by soybean are considered: (1) An alcohol-soluble component in soybean inhibits iodide uptake , and (2) phytic acid salt in soybean chelates the essential minerals, especially zinc, for thyroid hormone production [9, 10]. Our patient presented with severe hypothyroidism after 6 months of regular consumption of a health drink. Because the thyroid contains several months’ storage of thyroid hormone , overt hypothyroidism might present late. It is necessary to investigate further the detailed mechanisms of hypothyroidism caused by soy isoflavones.
This case emphasizes that consuming health drinks that include soy isoflavone powder extract can lead to severe hypothyroidism.
Availability of data and materials
All data generated or analyzed for this report are included in this published article.
YN, IO, MF, and MI conceived of and designed the laboratory measurements. YN, IO, MF, and MI analyzed the data. YN wrote the first draft of the manuscript. IO critically revised the manuscript. YG, MT, TO, NS, YK, and HG jointly developed the structure and arguments for the paper. IO and YK made critical revisions and approved the final version of the manuscript. All authors read and approved the final manuscript.
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Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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- Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489–99.View ArticlePubMedGoogle Scholar
- Chang HC, Doerge DR. Dietary genistein inactivates rat thyroid peroxidase in vivo without an apparent hypothyroid effect. Toxicol Appl Pharmacol. 2000;168:244–52.View ArticlePubMedGoogle Scholar
- Munro IC, Harwood M, Hlywka JJ, Stephen AM, Doull J, Flamm WG, et al. Soy isoflavones: a safety review. Nutr Rev. 2003;61:1–33.View ArticlePubMedGoogle Scholar
- Kaneko H, Yamato Y, Teramura Y, Fujiwara T, Suzuki A, Kawamura A, et al. Metabolites of micafungin in rats and dogs. Jpn J Chemother. 2002;50:88–93.Google Scholar
- Yamamoto S, Sobue T, Kobayashi M, Sasaki S, Tsugane S. Japan Public Health Center-Based Prospective Study on Cancer Cardiovascular Diseases Group. Soy, isoflavones, and breast cancer risk in Japan. J Natl Cancer Inst. 2003;95:906–13.View ArticlePubMedGoogle Scholar
- Kokubo Y, Iso H, Ishihara J, Okada K, Inoue M, Tsugane S, JPHC Study Group. Association of dietary intake of soy, beans, and isoflavones with risk of cerebral and myocardial infarctions in Japanese populations: the Japan Public Health Center-based (JPHC) study cohort I. Circulation. 2007;116:2553–62.View ArticlePubMedGoogle Scholar
- Kurahashi N, Iwasaki M, Sasazuki S, Otani T, Inoue M, Tsugane S, Japan Public Health Center-Based Prospective Study Group. Soy product and isoflavone consumption in relation to prostate cancer in Japanese men. Cancer Epidemiol Biomarkers Prev. 2007;16:538–45.View ArticlePubMedGoogle Scholar
- Tran L, Hammuda M, Wood C, Xiao CW. Soy extracts suppressed iodine uptake and stimulated the production of autoimmunogen in rat thyrocytes. Exp Biol Med (Maywood). 2013;238:623–30.View ArticleGoogle Scholar
- Zhou JR, Erdman Jr JW. Phytic acid in health and disease. Crit Rev Food Sci Nutr. 1995;35:495–508.View ArticlePubMedGoogle Scholar
- Szkudelski T. Phytic acid-induced metabolic changes in the rat. J Anim Physiol Anim Nutr (Berl). 2005;89:397–402.View ArticleGoogle Scholar
- Ingbar SH, Woeber KA. The thyroid gland. In: Williams RH, editor. Textbook of endocrinology. 6th ed. New York: Saunders; 1981. p. 117–247.Google Scholar