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Nutrition 2 (Semester I) > 6a. Endocrine Health - Thyroid > Flashcards

6a. Endocrine Health - Thyroid Flashcards

1
Q

What is TRH?

A

Thyrotropin releasing hormone

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2
Q

What does TRH do?

A

Stimulates TSH release from the anterior pituitary gland

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3
Q

What does TSH do?

A

Stimulates thyroid hormone production from the thyroid gland - T4 and T3
Activates iodide uptake via the Na/iodide symporter (SIS)

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4
Q

What percentage of thyroid hormone is T4?

A

90%

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5
Q

What is the alternative name for T4?

A

Thyroxine

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6
Q

Which of T4 and T3 is the strongest, more active hormone?

A

T3 - 4x the strength of T4

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7
Q

What does T3 do?

A

Increases growth
Bone development
CNS development
Increases BMR/HR
Activates metabolism

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8
Q

What does RT3 do?

A

Protects tissues from excess thyroid hormones
Biologically inactive - puts the handbrake on T3

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9
Q

What are iodothyronine deiodinases?

A

Selenoproteins that regulate thyroid hormone homeostasis

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10
Q

What does deiodinase 1 and 2 do (D1/D2)?

A

Convert T4 to T3

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11
Q

What does deiodinase 3 do (D3)?

A

Converts T4 to RT3

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12
Q

What does thyroid peroxidase (TPO) do?

A

Enzyme that helps produce T4 and T3
(catalyses iodination of tyrosine residues in thyroglobulin)

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13
Q

Which nutrients are needed to make TPO?

A

Tyrosine
Iodine
Iron

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14
Q

Which minerals are needed as co-factors in the synthesis of enzymes and thyroid hormones?

A

Se
Zn
Cu

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15
Q

Which vitamins are needed to support thyroid hormone synthesis and function?

A

ACE
B2, B3, B6, B12

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16
Q

What is the role of vit D in thyroid synthesis?

A

Immune modulation in AI thyroid disorders and VDR polymorphism

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17
Q

Examples of iodine rich foods

A

Sea veg
Ocean fish
Shellfish
Eggs
Dairy

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18
Q

What is the cause of iodine deficiency?

A

Dietary deficiency

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19
Q

Who is more at risk of iodine deficiency?

A

Low/no fish or dairy in diet
Pregnant women
Vegans

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20
Q

Why can high goitrogen foods cause thyroid disorders?

A

Goitrins, thiocyanates and nitriles in the foods reduce iodine uptake and have anti-TPO activity

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21
Q

Examples of goitrogen foods

A

Raw brassicas
Soya (fermented ok)
Millet
Peanuts
Pine nuts

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22
Q

How can people consume excess iodine?

A

Over-iodised salt
Animal milk rich in fortified iodine
Iodine-containing supplements
Radiocontrast dyes
Some medications

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23
Q

What is the Wolff-Chaikoff effect?

A

Helps reject excess iodine

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24
Q

What can inhibited Wolff-Chaikoff effect lead to?

A

Subclinical or clinical hypothyroidism

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25
Q

Where is T4 converted to T3 or RT3?

A

Liver
Kidneys

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26
Q

How are the thyroid hormones metabolised?

A

Deiodination
Sulphation
Glucuronidation

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27
Q

Which thyroid hormone decreases if RT3 increases?

A

T3

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28
Q

In which situations does an increase in T4 to RT3 occur?

A

Chronic illness - to low metabolism
High stress
Zn/Se/Fe deficiency
Fasting/significant calorie restriction
Advancing age

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29
Q

Which thyroid pathology does increased RT3 present as?

A

Hypothyroidism

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30
Q

What do HPT disrupters interfere with?

A

HPT axis
Thyroid hormone synthesis, secretion, transportation, metabolism and function

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31
Q

Examples of HPT disrupters

A

Fluoride
Chlorine
Pesticides
BPAs
Phthalates
Bromine
Glyphosate

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32
Q

Ways to avoid HPT disrupters

A

Drink filtered water
Fluoride free toothpaste
Eat organic
Avoid farmed fish/processed foods
Limit time in chlorinated pools
Avoid plastic packaging

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33
Q

Examples of medications that exert effects on thyroid function

A

Dopamine/glucocorticoids - decrease TSH secretion
Beta blockers - reduce T4 to T3
Diuretics/NSAIDs - reduce T4 to T3 binding
Oestrogen - increase thyroglobulin

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34
Q

Why does gut dysbiosis negatively effect thyroid function?

A

Microbes regulate iodine uptake and degradation

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35
Q

What intestinal imbalances are common in AITD?

A

Low SCFA production
Elevated zonulin (intestinal permeability)
Elevated serum LPS (chronic low grade inflammation)

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36
Q

Optimal range of TSH in testing

A

0.4 - 2.5

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37
Q

Optimal range of total T4 in testing

A

70 - 150

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38
Q

Optimal range of free T4 in testing

A

12.8 - 19.5 pg/ml

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39
Q

Optimal range of free T3 in testing

A

3.2 - 4.5

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40
Q

Optimal range of RT3 in testing

A

11 - 18 ng/dl

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41
Q

How is subclinical hypothyroidism interpreted in testing?

A

High TSH
Normal T4
Normal T3

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42
Q

How is hypothyroidism interpreted in testing?

A

High TSH
Low T4
Low T3

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43
Q

How is subclinical hyperthyroidism interpreted in testing?

A

Low TSH
Normal T4
Normal T3

44
Q

How is hyperthyroidism interpreted in testing?

A

Low TSH
High T4
High T3

45
Q

How is secondary hypothyroidism interpreted in testing?

A

Low TSH
Low T4
Low T3

46
Q

What is the best test for testing iodine status?

A

Urine iodine test

47
Q

What should iodine levels be in children/adults?

A

100-199 mcg/L

48
Q

What should iodine levels be in pregnancy?

A

150-249 mcg/L

49
Q

What iodine level is considered as insufficiency?

A

<100 mcg/L

50
Q

What iodine level is considered as severe deficiency?

51
Q

What signs of hypothyroidism can be seen during a physical exam?

A

Goitre
Dry skin
Nail beading
Thinning eyebrows
Hair loss
Low BP
Bradycardia (<60 BPM)

52
Q

Which SNPs on a thyroid report may suggest a thyroid imbalance?

A

HLA - AI
TNF - inflammation
SLCO1B - transport of hormones into cells
VDR - vit D as a co-factor
BCO1 - retinol as a co-factor
SULT/UGT - detoxification

53
Q

What is primary hypothyroidism?

A

Pathology is occurring within the thyroid gland
TSH is high due to low T4/T3

54
Q

What is secondary hypothyroidism?

A

Pathology is occurring within the pituitary gland
Low TSH to signal to thyroid gland to release T4/T3

55
Q

What is tertiary hypothyroidism?

A

Inadequate TRH

56
Q

What is peripheral hypothyroidism?

A

Insensitivity to thyroid hormones

57
Q

What is subclinical hypothyroidism?

A

Slightly high TSH and normal T4/T3

58
Q

General signs/symptoms of hypothyroidism

A

Fatigue
Weight gain
Puffy face
Intolerance to cold
Joint/muscle pain/weakness
Dry skin
Hair loss/thinning
Constipation
Fertility problems
Goitre
Bradycardia

59
Q

Risk factors/causes of hypothyroidism

A

Iodine deficiency/excess
Women
Age
Lack of nutrients - Fe, Se, Tyrosine, Zn, D, C, Cu, B2/3/6/12
Chronic stress - inhibits TSH release
Infection/inflammation
Alcohol
Smoking
Drug induced - amiodarone/lithium

60
Q

What is Hashimoto’s thyroiditis?

A

AI disease
Attacks thyroid tissue causing reduced thyroid hormones

61
Q

What is the ratio of women:men of getting Hashimoto’s?

62
Q

What are the testing markers for Hashimoto’s?

A

High TSH
Low T4
Increased anti-thyroid peroxidase (TPO) antibodies

63
Q

Which two infections are implicated in Hashimoto’s?

A

EBV
H. pylori
(as triggers for the AI)

64
Q

What are the risk factors/causes of Hashimoto’s?

A

Excess iodine
Coeliac disease
Genetic polymorphisms - VDR, MTHFR
Heavy metals
Triclosan - found in personal care products

65
Q

What is the allopathic treatment for Hashimoto’s?

A

Levothyroxine (synthetic T4)

66
Q

When is it best to take levothyroxine?

A

Empty stomach in the morning
Take food/other drinks at least 1hr after

67
Q

What can affect the absorption of levothyroxine?

A

Coeliac disease
Coffee
PPIs

68
Q

Common triggers and mediators in the development of thyroid disorders

A

Iodine status
Micronutrient insufficiencies
Intestinal permeability
Inflammation
Food sensitivities
Goitrogens
HPA axis imbalance (stress)
SNPs
Medications
Environmental toxins
Radiation
Surgery

69
Q

Naturopathic approach to hypothyroidism

A

Address micronutrient status
Review iodine status
Optimise digestion
Support methylation
Remove thyroid disruptors
Address possible dysbiosis
Increase SCFA producers
Address stress
Support detoxification/elimination
Avoid heavy metals
Assess for coeliac disease
Identify food intolerances
Increase exercise
Reduce inflammation
Blood sugar balance
Reduce goitrogenic compounds
Address intestinal permeability

70
Q

Why is Zn needed for thyroid support?

A

Co-factor for D2
TRH synthesis

71
Q

How could Zn deficiency be indicated on a test?

A

Low T3
High RT3

72
Q

Supplement dosage for Zn in thyroid support

A

15-30 mg/day

73
Q

Why is Fe needed for thyroid support?

A

TPO is a haem-containing enzyme needed in initial steps of hormone synthesis
Deficiency decreases T4 and T3

74
Q

Supplement dosage for Fe in thyroid support

A

10mg - maintenance
30mg - deficient
(test before)

75
Q

Why is iodine needed for thyroid support?

A

Modulates thyroid response to TSH

76
Q

Supplement dosage for iodine in thyroid support

A

150-400mg/day

77
Q

Why is Se needed for thyroid support?

A

AO
Anti-inflammatory
Increases T3

78
Q

Supplement dosage for Se in thyroid support

A

150-200mg/day

79
Q

Why is tyrosine needed for thyroid support?

A

Thyroglobulin precursor

80
Q

Supplement dosage for tyrosine in thyroid support

A

200-500mg/day

81
Q

Why is vit A needed for thyroid support?

A

Modulates thyroid hormone receptor function

82
Q

What can insufficiency in vit A cause?

A

Increases TSH
Reduces iodine uptake in thyroid

83
Q

What can cause vit A insufficiency?

A

Low intake
BCO1 SNP

84
Q

Supplement dosage for vit A for thyroid support

A

2000 iu/day

85
Q

What role does vit D have in thyroid support?

A

Immune-modulatory

86
Q

Supplement dosage for vit D for thyroid support

A

2000 iu/day

87
Q

Herbal approaches to hypothyrodism

A

Nigella sativa (1g/day) - reduces TSH/TPO
Thyroid glandulars - provides T4/3, relevant AAs and micronutrients
Ashwagandha - improves TSH/T4/T3 levels
Guggul - enhances iodine uptake

88
Q

What is hyperthyroidism?

A

Increased levels of thyroid hormones

89
Q

What are the two sub-divisions of hyperthyroidism?

A

Thyrotoxicosis
Thyroiditis

90
Q

What is thyrotoxicosis?

A

Increased synthesis of thyroid hormones

91
Q

What is the key cause of thyrotoxicosis?

A

Grave’s disease (80%)

92
Q

What is thyroiditis?

A

Increased release of stored thyroid hormones due to thyroid damage

93
Q

What are the key causes of thyroiditis?

A

Viral infections
AI

94
Q

Who is more affected by hyperthyroidism?

A

Women (10:1)

95
Q

Key signs/symptoms of hyperthyroidism

A

Weight loss
Thirst
Diarrhoea
Tachycardia
Palpitations
SOB
Goitre
Irritability
Nervousness
Anxiety
Insomnia
Warm, moist skin
Sweating
Heat intolerance

96
Q

What is Grave’s disease?

A

AI hyperthyroidism

97
Q

What two antibodies are present in Grave’s disease?

98
Q

Characteristic signs/symptoms of Grave’s disease

A

Red, swollen eyes
Eyelid retraction
Eyeball protrusion
Excess eye watering
Double vision
Painless rash - lower legs/top of feet

99
Q

Causes/risk factors for hyperthyroidism

A

Family history
Stress
Inflammation
Excess iodine intake
Dysbiosis
Food allergy/intolerance
Heavy metals
Smoking
Infections
Vit D/Se/CoQ10 deficiency

100
Q

What FT3/FT4 ratio distinguishes Grave’s from thyroiditis?

101
Q

What markers will be present in thyroiditis?

A

Raised CRP and ESR

102
Q

Natural approach to support hyperthyroidism

A

AO - ACE, Se, Zn, D
Energy - B vits, carnitine, Mg, CoQ10
Glutathione support
Avoid iodine
Increase goitrogens
Reduce inflammation (increase O3 but not via fish)
Quercetin
Support blood sugar balance
Support stress/HPA axis
Address gut health
Support sulphation
Support glucuronidation
Increase calorie intake - nuts/seeds/avocado/olives/protein rich

103
Q

Why is carnitine important in hyperthyroidism?

A

Antagonises thyroid hormones inhibiting T4/T3
Prevents/reverses muscle weakness

104
Q

Supplement dosage of carnitine to support hyperthyroidism

A

2000-4000mg/day

105
Q

Why is vit D important in hyperthyroidism?

A

Immune modulator
May slow disease progression

106
Q

Herbal approaches to hyperthyroidism

A

Passionflower/valerian - nervines - reduce stress
Ashwagandha
Mg/theanine - reduce anxiety
Lemon balm - blocks thyroid hormone activity

Nutrition 2 (Semester I) (15 decks)

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