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Nut 2 Sem 1 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What does HPT axis stand for?

A

Hypothalamus Pituitary Thyroid Axis

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2
Q

Describe the HPT Axis

A

TRH stimulates TSH release. TSH stimulates thyroid hormone release T4 and T3

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3
Q

What does TRH do?

A

Stimulates TSH release from anterior pituitary

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4
Q

What does TSH do?

A

Stimulates thyroid hormone production and activates iodine uptake.

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5
Q

What does T3 do?

A

4 x the strength of T4.
Increases growth, bone and CNS development

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6
Q

What does T4 do?

A

AKA thyroxine, 90% secreted by the thyroid hormone. Weak thyroid activity - inactive form.

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7
Q

What does Reverse T3 do?

A

Biologically inactive - protects tissues from excess thyroid hormones.

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8
Q

What do cells need?

A

T3

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9
Q

What does the thyroid hormone need for synthesis?

A

AA Tyrosine and Iodine
Iron: TPO is haem dependent
Selenium and Zinc: Co factors and receptor function
Vit D: Immune modulation in AI thyroid disorders
Vits A,C,E, B2,3,6,12: Support synthesis and function

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10
Q

Name 4 iodine rich foods

A

Seg vegetables, ocean fish, shellfish, eggs

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11
Q

What causes an iodine deficiency?

A

Diet
Pregnancy
Veganism

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12
Q

What causes iodine excess?

A

High goitrogen intake: soy, pine nuts, raw brassicas

Wolff-Chaikoff effect: Usually helps reject iodine and hormone synthesis. The effect is inhibited leading to hypo.

Over-iodised salt

Meds for the heart

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13
Q

How much T4 and T3 does the thyroid secrete?

A

T4: 80-100 MCG
T3: 10MCG

10% of T3 is derived from thyroid secretion
90% via peripheral conversion from T4

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14
Q

Where is T4 converted to T3/rT3

A

In peripheral tissues - liver and kidneys

The hormones are metabolised by deiodination sulphation and glucuronidation

T4 is highly bound and circulates freely
T3 less so

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15
Q

Discuss rT3

A

It can be bound to T3 receptors, blocking the action of T3
An increase in rT3 = decrease in T3

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16
Q

An increase in T4 converting to rT3? increases in……

A

Chronic stress/illness: Low metabolism called low T3 syndrome

High stress (cortisol), zinc, iron, selenium deficiency; liver dysfunction

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17
Q

An increase in rT3 can present as?

A

hypothyroidism

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18
Q

List 6 HPT disruptors

A

Disruptors interfere with HTP axis, synthesis, secretion, transport, metab, function

  1. Pesticides - reduce T4 half life
  2. Glyphosate - lowers TSH
  3. BPAs - affect thyroid hormone receptors
  4. Phthalates - affect synthesis/metabolism/trans
  5. Food packaging - inhibit iodide uptake
  6. Halogens - Fluoride: lower T4 to T3 / Chlorine: increase TSH and antibodies
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19
Q

List 6 things that avoid HPT disruptors

A
  1. Filtered water
  2. Organic food
  3. Fluoride free toothpaste
  4. Avoid farmed fish
  5. Avoid processed foods
  6. Avoid swimming pools
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20
Q

What’s the connection between the gut and thyroid?

A

Gut dysbiosis negatively affects the thyroid.
Microbes regulate iodine uptake and degradation
In AITD, low SCFA prod. is common as is elevated zonulin and elevated serum LPS.

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21
Q

What are the 5 hypothyroid classifications?

A
  1. Primary: Pathological processes within thyroid gland. TSH is higher due to low T4 and T3
  2. Secondary: Pathological processes are within pituitary gland with low TSH signalling to the thyroid gland to release more hormones.
  3. Tertiary: Inadequate TRH
  4. Peripheral: Insensitivity to thyroid hormones
  5. Subclinical: TSH slightly elevated and T4 is normal. There are T4 to T3 conversion issues. Elevated rT3
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22
Q

Name 10 signs and symptoms of hypothyroidism

A
  1. Fatigue
  2. Weight gain/can’t lose weight
    3.Heavy/irregular periods
  3. Puffy face/oedema
  4. Cold
  5. Joint pain/muscle weakness
  6. Hair loss/thinning
  7. Brain fog
  8. Constipation
  9. low libido
23
Q

What is subclinical hypothyroidism?

A

Elevated TSH, normal T4
Linked to heart failure and infertility

24
Q

What causes hypothyroidism?

A

Iodine deficiency/excess
Women are more at risk
Drug induced (lithium)
Congenital
Lack of nuts: tyrosine, iron, selenium, zinc, Vit D, C, E, B2,3,6,12
Postpartum thyroiditis: Immunologic rebound
Chronic stress: inhibits TSH release so T3 goes down and so does thyroid hormone receptor sensitivity. rT3 goes up.
Alcohol: Directly surpasses thyroid function, blunting TRH response.
Smoking: Conversion of cyanide to thiocyanate disrupts iodine absorption
Surgery of the neck or radiotherapy

25
Q

What is Hashimoto’s thyroiditis (HT)?

A

An autoimmune disease that attacks the thyroid tissue causing reduced thyroid hormones.

High TSH, low FT4, increased TPO

EBV and H.Pylori are implicated

26
Q

What causes Hashimoto’s?

A

Excess iodine
Genetic SNPs: VDR/MTHFR
Sleep apnoea
Heavy metals: Mercury increases TPO antibodies

27
Q

What allopathic treatments are available for hypothyroidism?

A

Levothyroxine
Drug absorption is affected by coffee, PPI use, coeliac disease, gastritis

28
Q

Name 4 natural approaches to hypothyroidism

A
  1. Address triggers / mediators
  2. Reduce inflammation and IR
  3. Reduce goitrogenic compounds
  4. Balance T-Cell functioning
29
Q

Discuss the triggers and mediators of hypothyroidism and what you would do about them.

A

a. Optimise micronutrient stats - support T4 to T3 conversion and review iodine status

b. Optimise digestion - bitters and enzymes

c. Support methylation - folate, B12, B6, B2, choline, zinc

d. Remove thyroid disruptors

e. Address possible dysbiosis/SIBO

f. Support HPA Axis

g. Assess for pathogens and heavy metals

h. Support detoxification and methylation (B-vits, NAC, milk thistle, flavonoids, fibre)

i. Assess for coeliac disease and food intolerances

30
Q

Discuss inflammation and IR in relation to hypothyroid.

A
  1. Optimise omg 3:6 and avoid junk and smoking
  2. Balance b/sugars and improve insulin sensitivity with low GI/GL foods, cinnamon and chromium to increase anti-ox and reduce oxidative stress.
31
Q

Discuss how to reduce goitrogenic compounds in relation to hypothyroidism.

A

Pre soaking, steaming and boiling reduces goitrogens.

32
Q

Discuss how balancing T-cell functioning supports the thyroid.

A
  1. Address intestinal perm which is critical for immune tolerance.
  2. Increase glutamine, aloe, zinc, vit A, DHA, EPA
  3. Raise commensal bacteria through pre and probiotic foods optimising fibre and focusing on rainbow for polyphenols.
  4. Support SIgA levels with probiotics- S.Boulardii, Omg 3, Zinc, Vit A&D
33
Q

Name 7 nutrients that support hypothyroid and why.

A
  1. Se: Antiox/Antiinflam and increases T3 (150-200 mcg)
  2. Zinc: Co-factor for D2 and has a role in TRH synthesis (15-30 mcg)
  3. Iron: TPO is a haem-containing enzyme used in hormone synthesis. Iron def decreases T4/3 (100 mg)
  4. Iodine: Decreases response of thyroid to TSH but too high and it can inhibit thyroid hormone secretion. (150-400 mcg)
  5. Vit A: Deficiency increases TSH and reduces iodine uptake. It is a thyroid hormone receptor modulator. (2000 IU)

6.Tyrosine: Thyroglobulin precursor (200 - 500 mg)

  1. Vit D: Deficiency higher in AITD and levels are correlated to thyroid antibodies.
34
Q

How does ashwagandha support hypothyroidism?

A

Improves TSH and T4 to T3 conversion.

35
Q

What is hyperthyroidism?

A

Increased levels of thyroid hormones which are subdivided into:

  1. Thyrotoxicosis: Increased synthesis of thyroid hormones - caused by Grave’s disease
  2. Thyroiditis: Increased release of stored hormones due to thyroid damage - caused by viral infections. AI
36
Q

What are 6 signs/symptoms of hyperthyroidism?

A
  1. Thinning / loss of hair
  2. Nervousness, insomnia
  3. Muscle weakness and tremor
  4. Weight loss despite increased appetite
  5. Palpitations
  6. Face/Neck signs
37
Q

What is Grave’s disease?

A

AI Hyperthyroidism with B and T-lymphocyte-mediated autoimmunity
Abnormal IgG
TPO antibodies

38
Q

What are the signs/characteristics of GD?

A
  1. Orbitopathy: Antibody-mediated inflam or orbital contents:
    - Photophobia: excess eye watering
    - Exophthalmos: eyeball protrusion
  2. Grave’s dermopathy: Painless rash - orange peel like lower legs and top of feet.
39
Q

What causes GD?

A

Fam History
Stress
Inflam/Oxidative stress
Excess iodine intake - over stimulating thyroid hormone
Dysbiosis
Food allergies/intolerances.
Heavy metals and smoking
Other AI conditions - coeliac, TY1DB
Vit D, Se, CoQ10 deficiency

40
Q

What is the naturopathic approach to hyperthroidism?

A
  1. Address micronut insufficiencies and lower oxidative stress:
    - Antiox: Se, Zn, Vits A, C, D, E
    - Energy: B-Vits, Mg, CoQ10
    - Glutathione support: NAC, Milk Thistle.
  2. Inhibit thyroid hormone synthesis
    - Avoid iodine/goitrogens - raw kale
  3. Reduce inflammation and IR
    - Optimise 3:6 ratio
    - Remove inflam factors - high arachidonic foods, refined carbs, alcohol
    - Quercetin inhibits LOX/COX
  4. Support Nervous system and address stress
    - B/Sugar balance and HPA axis
  5. Assess and address gut health/pathogen load
    - 5R protocol, pre and probiotics, allergens
  6. Support Thyroid hormone clearance
    - Support sulphation
    - Support glucuronidation
41
Q

How do you support ‘Sulphation’?

A
  1. Glucosinolates (brassicas)
  2. Vit E/A
  3. Se
  4. Sulphur foods (onions)
  5. Methionine and or folate/B12 (1000-3000MG)
  6. NAC (600-2000MG)
42
Q

How do you support ‘Glucuronidation’?

A

Quercetin rich foods
Mg and Green Tea
B-Glucuronidase inhibitors: milk thistle

43
Q

What other nutrient support should be considered with hyperthyroidism?

A

Eye Health - oxidative stress increases retroocular fibroblast proliferation leading to eye protrusion. Increase lutein and carotenoids

Increased metabolism means a need for more B-Vits

Weight Loss means more nutrient dense food (oil/avos/protein) required.

Vit D - can slow disease progression.

Ashwagandha increases resistance to stress

Passionflower - anxiolytics with calming effects on NS (nervines)

Lemon balm blocks thyroid activity

44
Q

How do you regulate blood glucose?

A

An increase in glucose stimulates insulin
This increases the uptake in cells

A decrease in glucose stimulates glucagon
This increases the release of glucose from glycogen, fatty acids and gluconeogenesis

45
Q

What is a GLUT protein?

A

A glucose transporter. It literally facilitates the transport for glucose.

46
Q

What is GLUT 1?

A

This is the basal glucose uptake without insulin

47
Q

What is GLUT 4?

A

This is insulin regulated and can increase glucose uptake 20-30 fold.

48
Q

What is GLUT 2?

A

Mediates glycolysis and gluconeogenesis

49
Q

What is Diabetes Mellitus?

A

A group of metabolic disorders with persistent hyperglycemia caused by deficient insulin secretion, resistance to action of insulin or both.

50
Q

Name 5 types of diabetes

A
  1. Type 1: AI - absolute deficiency
  2. Type 2: Insulin resistance/relative def
  3. Prediabetes: Hyperglycaemia
  4. Gestational: Develops during pregnancy
  5. Secondary: Pancreatic diseases
51
Q

What do HbA1c results indicate?

A

Normal: <42 mmol/mol
Pre: 42-47 mmol/mol
Diabetes:48 mmol/mol

52
Q

What is T2DM?

A

Chronic hyperglycemia due to mild/significant insulin deficiency with / without insulin resistance.

53
Q

What are the signs/symptoms of T2DM?

A

Increased urination
Increased thirst
Excess hunger
Extreme fatigue (muscles aren’t getting glycogen stores)
Poor wound healing

54
Q

What are the causes of T2DM?

A

Family history
Ethnicity
Diet: high GL increases glucose and insulin and LPS, ROS
Nut def. Vit C, E, B3, B5, B6, Mg, Cr, Zn, O3

Nut 2 Sem 1 (8 decks)

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