{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T23:41:52Z","timestamp":1776469312063,"version":"3.51.2"},"reference-count":95,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Thyroid nodules are among the most frequently encountered endocrine\n                    abnormalities, affecting up to two-thirds of adults in iodine-sufficient\n                    regions. Although thyroid-stimulating hormone and genetic mutations have long\n                    been implicated in their pathogenesis, emerging evidence reveals a\n                    multifactorial interplay among inflammatory, hormonal, toxic, and micronutrient\n                    influences that extends beyond the classical model. This narrative review\n                    examines the converging biological pathways that contribute to thyroid nodule\n                    formation, emphasizing the integrative roles of inflammation, estrogen\n                    signaling, environmental endocrine disruptors, and micronutrient imbalance in\n                    altering thyroid cellular homeostasis. Chronic low-grade inflammation and\n                    oxidative stress create a permissive microenvironment for thyrocyte\n                    proliferation and clonal expansion. Estrogen receptor activation\u2014amplified by\n                    insulin and insulin-like growth factor 1 signaling\u2014enhances vascular and\n                    proliferative responses within thyroid tissue, contributing to the female\n                    predominance of nodular disease. Exposure to heavy metals and xenoestrogens\n                    disrupts thyroid peroxidase activity, deiodinase regulation, and immune\n                    tolerance, while deviations in iodine, selenium, zinc, and vitamin D status\n                    further impair redox balance and DNA repair mechanisms. Together, these factors\n                    promote a spectrum of structural changes ranging from microscopic hyperplasia to\n                    clinically significant nodules. Thyroid nodules represent a visible\n                    manifestation of intersecting metabolic and environmental stressors rather than\n                    a single endocrine defect. Integrating insights from molecular endocrinology,\n                    environmental toxicology, and nutritional science may advance early detection\n                    and preventive strategies targeting the inflammatory\u2013hormonal\u2013toxic axis of\n                    thyroid disease.<\/jats:p>","DOI":"10.1055\/a-2826-9576","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:58:08Z","timestamp":1772603888000},"page":"136-144","source":"Crossref","is-referenced-by-count":0,"title":["Unraveling the Origins of Thyroid Nodules: Inflammation, Hormones,\n                    Toxins, and Micronutrient Interactions"],"prefix":"10.1055","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1064-2257","authenticated-orcid":false,"given":"Angela D.","family":"Mazza","sequence":"additional","affiliation":[{"name":"Endocrinology, Metabolic Center for Wellness, Oviedo, United\n                    States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"issue":"08","key":"ref1","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1111\/j.1365-2362.2009.02162.x","article-title":"Very high prevalence of thyroid nodules detected by high-frequency (13 MHz)\n                    ultrasound examination","volume":"39","author":"S Guth","year":"2009","journal-title":"Eur J Clin Invest"},{"issue":"01","key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 american thyroid association management guidelines for adult patients with\n                    thyroid nodules and differentiated thyroid cancer","volume":"26","author":"R HaugenBryan","year":"2016","journal-title":"Thyroid"},{"issue":"12","key":"ref3","doi-asserted-by":"publisher","first-page":"4434","DOI":"10.1210\/jc.2015-3100","article-title":"The influence of patient age on thyroid 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Gore","year":"2015","journal-title":"Endocr Rev"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.envint.2019.02.026","article-title":"Bisphenol A exposure and risk of thyroid nodules in Chinese women: A\n                    case-control study","volume":"126","author":"L Li","year":"2019","journal-title":"Environ Int"},{"issue":"3\/4","key":"ref57","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1080\/26896583.2022.2149213","article-title":"Association between polychlorinated biphenyl exposure and thyroid hormones: A\n                    systematic review and meta-analysis","volume":"40","author":"C C Little","year":"2022","journal-title":"J Environ Sci Health C Toxicol Carcinog"},{"issue":"04","key":"ref58","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1667\/rr2889.1","article-title":"A pooled analysis of thyroid cancer incidence following radiotherapy for\n                    childhood cancer","volume":"178","author":"L H 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Zimmermann","year":"2021","journal-title":"Eur J Endocrinol"},{"issue":"05","key":"ref65","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1097\/MED.0000000000000190","article-title":"Selenium and the thyroid","volume":"22","author":"J Kohrle","year":"2015","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"issue":"03","key":"ref66","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1038\/s41574-019-0311-6","article-title":"Selenium in thyroid disorders\u2014essential knowledge for clinicians","volume":"16","author":"K H Winther","year":"2020","journal-title":"Nat Rev Endocrinol"},{"issue":"01","key":"ref67","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1080\/01635581.2022.2115082","article-title":"Relationship between serum levels of selenium and thyroid cancer: a systematic\n                    review and meta-analysis","volume":"75","author":"R Hao","year":"2023","journal-title":"Nutr 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