Inadvertent Excessive Soy Intake as Part of a Weight Loss Program Leading to Rapid Growth of Multinodular Goiter

Abstract Background: Over the past few decades consumption of soy products has gained popularity in the U.S. in part due to reports of potential health and weight loss benefits. However, concerns have emerged regarding soy as a potential endocrine-disrupting chemical (EDC) leading to thyroid dysfunction amongst other health issues. Studies have shown a potential association of high soy intake with risk of hypothyroidism and simple goiter (1), but less is known regarding its impact on multinodular goiter. Clinical Case: A 33-year-old female originally from Bolivia without significant medical history presented to our endocrine clinic with complaints of right-sided neck swelling. The swelling was insidious in onset, had gradually increased in size over the past 3-4 months, and become uncomfortable. She denied dysphagia, cough, or shortness of breath. Prior to the onset of symptoms, she had enrolled in a commercial weight loss program. The diet program consisted of limiting caloric intake to multiple meal replacement bars during the day followed by a light dinner of fish and non-starchy vegetables. Examination revealed a palpable right-sided thyroid mass and enlarged thyroid gland. Lab work showed normal TSH, fT4, and T3 levels, positive anti-thyroid peroxidase antibody (anti-TPO Ab) 588 (<=35.0 IU/ml), and negative thyroid-stimulating immunoglobulins (TSI). Ultrasound of the thyroid confirmed the presence of a 4 cm dominant right thyroid nodule and multinodular goiter. Subsequent fine-needle aspiration of thyroid nodule was consistent with benign nodular goiter. Upon further investigation, it was discovered that the meal replacement bars contained a significant amount of soy protein resulting in an excessive intake of 20-40 grams of soy protein daily. We discussed treatment options, and the patient declined thyroid surgery in favor of surveillance following discontinuation of the weight loss products. The patient was advised to consume a varied diet and given follow-up appointments for monitoring. Conclusion: Inadvertent excessive soy intake via meal replacement bars may have triggered the rapid growth of a multinodular goiter in our patient despite reported adequate dietary iodine intake. Soy products often contain isoflavones that may exert an adverse effect on the thyroid by inhibition of TPO, disruption of iodine metabolism, and/or estrogenic activity. We advise that caution be exercised with high soy protein consumption especially in patients with underlying risk factors for multinodular goiter. References: Messina, M. and Redmond, G., 2006. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid, 16(3), pp.249-258.

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SUN-501 Grave’s Disease Concealing the Diagnosis of Pancreatic Carcinoma

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.747 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Zubina S Unjom ◽

Nitish Nandu ◽

Janice L Gilden

Keyword(s):

Weight Loss ◽

Pancreatic Carcinoma ◽

Medical History ◽

Pancreatic Head ◽

Islet Cell Antibodies ◽

Thyroid Peroxidase ◽

The Past ◽

Grave’S Disease ◽

Grave's Disease ◽

One Year

Abstract Background: Hyperthyroidism is a disease that presents with various nonspecific symptoms. Unintentional weight loss can often be the presenting complaint. We present a patient with unexplained weight loss that was attributed to Grave’s hyperthyroidism, but was later discovered to be secondary to pancreatic carcinoma. Case Description: A 58-year-old man with no significant medical history, was referred to the endocrine clinic for weight loss, low energy, and abnormal TFT’s. He reported 45 lb. weight loss over the past one year. Past Medical history was notable for opioid use, and is enrolled in the Methadone program for the past 10 years. Family history is significant for type 2 diabetes. He smokes ½ a pack of cigarettes, denies alcohol or drug use. On exam, heart rate was 84 bpm with fine tremors on outstretched upper extremities, no proptosis, lid lag, thyromegaly, or pretibial edema, normal reflexes. His labs were TSH=0.01; (n=0.270 - 4.20 uIU/mL), FT4=2.1; (n= 0.55 - 1.60 ng/dL), FT3=283;(n=2.52 - 4.34 pg/mL) Thyroglobulin Ab 4 IU/ml, Thyroid peroxidase Ab > 900 IU/ml, TSI 358(n=<140%). He was diagnosed with Grave’s disease and was started with Methimazole and Propranolol, which were titrated to an optimal range over the next few months. However, the patient was lost to follow up, and presented one year later to the ED with complaints of abdominal pain, jaundice for one-week, greasy diarrhea for 6 months, also reporting noncompliance with thyroid medications during this time. On examination, he was icteric and jaundiced with hepatomegaly, trace pedal edema. Although LFT’s were previously normal, the labs now showed alkaline phosphatase=533, (n=40-129 IU/L); AST=107 units (n= 0-32 IU/L), ALT=213units (n= 0-40 IU/L), total bilirubin 11.4 (n= 0-1.0 mg/dl), TSH=0.01, FT4=0.6, FT3=3.2. Ultrasound showed gallbladder sludge, CT abdomen-dilatation of the pancreatic duct in neck and body of pancreas, MRCP- marked pancreatic ductal dilatation and soft tissue fullness within the pancreatic head. CA 19-9= 64.8, he underwent ERCP, and was later diagnosed with adenocarcinoma of the Pancreatic head. He was discharged with referrals to GI and Oncology for further treatment. Discussion:Although weight loss and diarrhea are nonspecific, and can often result from hyperthyroidism, this case highlights the importance of further investigation for other causes and avoiding attribution to a single diagnosis. Other diagnoses were only looked into when the patient presented with painless jaundice and hepatomegaly several months later. The effects of autoimmune hyperthyroidism on the pancreas function remain unclear. However, patients with Grave’s hyperthyroidism have a higher number of islet cell antibodies, as compared to controls. Further studies are required in this regard. We also emphasize the importance of patient education and compliance which can lead to earlier diagnosis, and overall better outcomes.

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Pharmacist-managed weight-loss program using meal-replacement product

American Journal of Health-System Pharmacy ◽

10.2146/ajhp110450 ◽

2012 ◽

Vol 69 (17) ◽

pp. 1456-1458 ◽

Cited By ~ 1

Author(s):

Jacqueline Milton-Brown ◽

Ann Smith Barnes ◽

Uche Anadu Ndefo ◽

Goldina Ikezuagu Erowele

Keyword(s):

Weight Loss ◽

Weight Loss Program ◽

Meal Replacement ◽

Replacement Product

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Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults

Journal of Obesity ◽

10.1155/2020/8026016 ◽

2020 ◽

Vol 2020 ◽

pp. 1-24

Author(s):

Sean Bourke ◽

John Magaña Morton ◽

Paul Williams

Keyword(s):

Weight Loss ◽

Weight Loss Program ◽

Minor Effect ◽

Pharmacologic Treatment ◽

Health Coach ◽

Meal Replacement ◽

Weight Loss Programs ◽

Measured Weight ◽

Low Carbohydrate ◽

A Minor

Background. Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described. Methods. Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants. Results. Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were −6.5 ± 0.03 kg, −7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; −7.7 ± 0.04 kg, −8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and −7.7 ± 0.1 kg, −8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets. Conclusion. A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.

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Relations of Hedonic Hunger and Behavioral Change to Weight Loss Among Adults in a Behavioral Weight Loss Program Utilizing Meal-Replacement Products

Behavior Modification ◽

10.1177/0145445513501319 ◽

2013 ◽

Vol 37 (6) ◽

pp. 790-805 ◽

Cited By ~ 9

Author(s):

Kelly R. Theim ◽

Joshua D. Brown ◽

Adrienne S. Juarascio ◽

Robert R. Malcolm ◽

Patrick M. O’Neil

Keyword(s):

Weight Loss ◽

Behavioral Change ◽

Weight Loss Program ◽

Behavioral Weight Loss ◽

Meal Replacement ◽

Hedonic Hunger

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Effect of a Weight Loss Digital Health Platform on Metabolic Syndrome: A 6-Month Prospective Study in China (Preprint)

10.2196/preprints.24660 ◽

2020 ◽

Author(s):

Conor Senecal ◽

Maria Collazo-Clavell ◽

Mariza de Andrade ◽

Christopher G. Scott ◽

Alexander Lee ◽

...

Keyword(s):

Metabolic Syndrome ◽

Weight Loss ◽

Prospective Study ◽

Digital Health ◽

Cost Effective ◽

Smartphone Application ◽

Weight Loss Program ◽

Meal Replacement ◽

Face To Face

BACKGROUND Metabolic Syndrome represents a collection of measurement that together increase cardiovascular risk and all-cause mortality and is is present with increasing frequency around the globe, including China. Digital health applications may provide a cost-effective and scalable way to promote weight loss and improve metabolic syndrome and its constituents. OBJECTIVE Evaluate a prospective weight loss program delivered via a digital health platform in China. METHODS Prospective study in China of changes in body weight and metabolic syndrome parameters at 6 weeks and 6 months after starting using a smartphone application combined with a wireless scale and meal replacement biscuits guided by e-coaching. All participants had or were at high risk for metabolic syndrome. The study was conducted completely online, without face-to-face contact RESULTS 218 individuals, 55% women, median age 47, participated in this prospective study with at least 6 months of follow-up. Median weight loss at 6 weeks and 6 months was 7.3kg (2.7 BMI units) and 8.4 kg (3.1 BMI units)(P<0.001) respectively. At baseline, 60% met the criteria for metabolic syndrome and this dropped to 38% at 6 weeks (P<0.001) and stayed at 38% at 6 months (P<0.001). The was a reduction in the prevalence of all components of metabolic syndrome during follow up. CONCLUSIONS In this prospective observational study, a program using non face to face interaction through a mobile application and e-coaching to guide weightless with a wireless scale and meal replacement biscuits was associated with improvement in the majority components of metabolic syndrome as well as weight loss through six months. This represents a scalable weight loss program that may be helpful in combating metabolic syndrome at scale.

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Relationship of Weight-Related Eating Behaviors and Weight Loss of Participants Enrolled in a Proprietary Weight Loss Program

Nutrition and Metabolic Insights ◽

10.1177/1178638820928413 ◽

2020 ◽

Vol 13 ◽

pp. 117863882092841

Author(s):

Megan Block ◽

Kendra K Kattelmann ◽

Jessica Meendering ◽

Lacey McCormack

Keyword(s):

Weight Loss ◽

Emotional Eating ◽

Eating Behaviors ◽

Health Coaching ◽

Weight Loss Program ◽

Meal Replacement ◽

Cross Sectional ◽

Weight Loss Programs ◽

Clinically Significant ◽

The Relationship

Background: There is a need for improving long-term success in meal replacement programs and identifying the variables that affect weight loss and maintenance in a proprietary weight loss program that includes health coaching. Objective: The aim of this study is to evaluate weight-related eating behaviors of participants with clinically significant weight loss (CSWL) in a proprietary weight loss program. Study Design, Setting, and Participants: A cross-sectional sample of participants (n=1,454) enrolled in a proprietary weight-loss program that includes meal replacements and health coaching were queried via an on-line survey for weight-related eating behaviors and weight history. Main Outcome Measures and Analysis: Weight-related eating behaviors of routine restraint (RR), compensatory restraint (CR), susceptibility to external cues (SEC), and emotional eating (EE) were assessed using the Weight Related Eating Questionnaire. CSWL was defined as having achieved a weight loss greater than 10% of starting weight. Participants were dichotomized into those with CSWL (n=973) and with no CSWL (n=481). The relationship between CSWL (controlling for age and sex) as the dependent variable and weight-related eating behaviors (RR, CR, SEC, and EE) as the independent variables was assessed using logistic regression (Stata/SE 14). Results: Those with CSWL have higher odds of having RR (OR: 1.3, p<0.05) and CR (OR: 1.1, p<0.05) and lower odds of SEC (OR: 0.7, p<0.05) and EE (OR: 0.8, p<0.05) eating behaviors than those without CSWL. Conclusions: Weight-related eating behaviors of participants in proprietary meal replacement weight-loss programs who have successfully lost weight differ compared to those who have not. Knowledge of the relationship between CSWL and weight-related eating behaviors can be used by coaches to assist participants in reinforcing those behaviors that support weight-loss. These results are limited to participants who self-select for proprietary meal-replacement weight-loss programs and cannot be generalized to other weight-loss or maintenance programs.

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