The obtained data show that people struggling with thyroid diseases, especially with autoimmune thyroid diseases, need nutrition information about their disease. A high percentage of respondents who decide to modify their diets on their own initiative clearly confirms, that the recommendations they receive are not sufficient. There is a gap in existing studies on nutritional guidance and its effectiveness in patients suffering from these types of diseases, but similar results were obtained in studies on other groups of patients. Arana et al.  Investigated type 2 diabetes patients receiving dietary advice from a nurse in form of a general healthy eating leaflet. The participants of the study reported the need for an individual approach and conversation that would help them make appropriate diet changes, adapted to their living conditions. Another study assessed the nutritional status of patients with various cancer types, with as many as 69% of them reporting great interest in obtaining nutrition guidance in their disease . A study by Maneze et al.  in turn investigated the information-seeking experiences of type 2 diabetes patients and its impact on self-management behaviour. The study found that the main cause of confusion and distrust in this group of patients, were the inconsistent, insufficient and incomprehensible recommendations they got from healthcare professionals. This corresponds in some extent with our results, where relatively low satisfaction with the guidance received from health care specialists, and relatively low willingness to follow their recommendation at the same time were observed.
There may be several reasons for such situations. The first is dissatisfaction with the communication between healthcare professionals and patients, which seems widespread. Therapeutic communication with the patient, which responds to the basic emotional needs, brings many benefits, e.g. greater sense of security, better treatment results and care process, more patients’ willingness to cooperate in the treatment process . Physicians perceived as empathetic showed better treatment adherence and higher level of satisfaction among their patients. A key factor facilitating patient’s engagement in the process of treatment and care is adequate time devoted to communication, as the studies confirm .
On the other hand, however, medical specialists often have to deal with complex nutritional needs of the patient, especially in the case of comorbidities, while having a limited time that they can devote to individual patient. Pachocka et al.  reported that the vast majority of primary care physicians (84.2%) do not have enough time to provide dietary advice. Additionally, half of them do not consider their knowledge in this area sufficient. But what is even more important, 48% of physicians declared that they do not believe in the effectiveness of dietary counseling. In another study examining GPs' views on the nutritional care provision to patients with chronic diseases, some respondents showed interest in taking measures to improve patients nutritional behaviour, but noticeable percentage expressed lack of feasibility conviction and profitability of such efforts. This position was against the expectations of patients, who generally considered nutritional care and guidance as important, although the study drew attention to their limited capacity to apply behaviour changes. Limited time spent on dietary counselling during the visit, and also lack of appropriate nutritional education among physicians might be factors that have some impact on this observation. Deficiencies in the nutritional and preventive healthcare knowledge among medical personnel were observed in a Polish study by Bator .
Although studies suggest limited capacity to change nutritional behaviours among the patients, which was also observed in our study, they express a clear need to obtain effective education in this regard. Salmasi et al.  found that they expect receiving information in a concrete, factual form, especially with regard to how the disease could affect them, their quality of life and the activities they like, as well as what can they do to help themselves to limit the negative health outcomes. Salmasi’s examined subjects felt that the perfect educational program should enable them to consult health education experts, preferably in real time conversation.
Actual effectiveness of health education intervention in patients suffering different diseases was evaluated in a number of studies, including the one by Ghisi et al., Ozturk et al.  and Alikari et al. . Usually the studies confirm successful improvement of patients' knowledge, physical activity, food consumption and self-efficacy and quality of life, although the better knowledge tends to translate into an implementation of recommendations in only a limited scale, which again confirms our observation. Again communication skills among the staff responsible for such programmes implementation seems to play a crucial role, as evidenced by Adam et al , who observed promising results in terms of changes in diet and physical activity while evaluating the use of a patient-centered communication approach (healthy conversation skills) of dietitians in supporting women in achieving optimal weight gain during pregnancy and good health behaviour. Good results were also reported in systematic reviews addressing interdisciplinary nutritional care for patients with diabetes. where nutritional education was associated with a reduced risk of the disease. The study showed the interventions provided by dietitians to be more effective than those provided by non-dietitians. Another review by Mitchell et al.  found that dietary consultation for adults in primary care settings appeared to be effective in improving diet quality, diabetes tests results, weight loss, and reduction of weight gain during pregnancy. This observations are in line with the one presented in our study, where both guidance satisfaction and behaviour change were tended to be more effective in case of dietitians compared to other categories of medical staff.
Overall, our study confirms that patients show great interest and a willingness to change their eating habits when being diagnosed. They do not remain passive and look for specific dietary information. However, when preferring easily available sources over the reliable ones, they may receive recommendations that are inadequate to their health status, making them ineffective or even harmful. There is a clear need for systematic patients’ education, which might help them to understand the disease, follow medical recommendations, and effectively change dietary behaviours in a longer time perspective. Our study confirms other findings in terms of the need to implement professional nutritional counseling delivered by qualified staff and supplementing regular medical care provided by medical and nursing staff with a separate category of dietitian services, since medical professionals often lack the necessary time or specialized nutrition knowledge to be able to provide effective guidance.