Hyperthyroidism

Question 1

Hyperthyroidism

Answer 1

Increased levels of
thyroid hormones. This is sub divided into:
1. Thyrotoxicosis
2. Thyroiditis

Question 2

Thyrotoxicosis

Answer 2

Thyrotoxicosis (increased synthesis of thyroid hormones):
‒ Key causes : Grave’s disease (80%). Multinodular goitre
(20%, often secretes T3, older women). Adenoma (5%). Iodine induced <1% (urinary iodine increases).

Question 3

Thyroiditis

Answer 3

Thyroiditis —↑ release of stored hormones due to thyroid damage.
– Causes : Viral infections, autoimmune,
* Both increase metabolic rate / activity.
* Women being more frequently affected (10:1).

Question 4

Signs and symptoms:

Answer 4

• Skin / appendages: Thinning or loss of hair. Warm, moist skin. Sweating and heat intolerance.
• Nervous system: Irritability, nervousness, insomnia and anxiety. Lid retraction. Psychosis.
• Musculoskeletal: Muscle weakness, fine motor tremor.
• Gastrointestinal: Weight loss despite increased appetite. Thirst and diarrhoea.
• Cardiovascular: Tachycardia, palpitations and shortness of breath on exertion. AF, heart failure and worsening angina.
• Reproductive: Menstrual irregularities.
• Face / neck: Goitre and Grave’s orbitopathy

Question 5

Grave’s disease (GD)

Answer 5

• B and T-lymphocyte mediated autoimmunity.
• Abnormal IgG ( TRAbs ) occupy TSH receptors on thyroid follicular cells. Leads to thyroid hyperplasia (enlargement), excess production and secretion of thyroid hormones.
• TPO antibody found in most people with GD. TSH receptor gene SNPs can increase antibody binding to the receptor.

Question 6

Graves disease characteristic signs / symptoms

Answer 6

• Grave’s orbitopathy (in 25%): Antibody mediated inflammation of orbital contents. Often asymmetrical.
  – Photophobia . Excess eye watering. Red, swollen eyes / eyelids. Eyelid retraction: Visible sclera. Deterioration in visual acuity.
  – Exophthalmos , eyeball protrusion. Lid lag. Double vision.
• Grave’s dermopathy: Painless rash appears thick lumpy and red like ‘orange peel’ (lower legs, top of feet).

Question 7

Causes and risk factors

Answer 7

• Family history of thyroid disorders
• Stress
• Inflammation / oxidative stress.
• Excess iodine intake
• Dysbiosis and intestinal permeability.
• Food allergy/intolerances
• Heavy metals
• Smoking
• Other AI conditions
• Infections
• Vitamin D, selenium, CoQ10 deficiency.

Question 8

Investigations

Answer 8

Hyperthyroidism usually presents with low TSH, high FT3 and FT4 (sometimes T4 is normal).
* Grave’s disease (GD): T3 / T4 ratio > 20 or FT3 / FT4 ratio > 0.3 is suggestive of GD.
Used to differentiate GD from thyroiditis.
– Presence of TRAbs and TPO antibodies ( TPOAbs ).
TR3U (resin radioactive iodine) increased uptake.
* Subclinical hyperthyroidism: Defined as having a ‘low but detectable’ TSH of 0.1 to 0.4 mIU / L. T3 / T4 are usually normal.
* Thyroiditis: Raised ESR and CRP (inflammatory markers).

Question 9

Naturopathic approach to hyperthyroidism

Answer 9

1. Address micronutrient insufficiencies and ↓ oxidative stress
2. Inhibit thyroid hormone synthesis
3. Reduce inflammation and insulin resistance
4. Support the nervous system and address stress
5. Assess and address gut health and pathogen load
6. Support thyroid hormone clearance

Question 10

1. Address micronutrient insufficiencies and ↓ oxidative stress

Answer 10

• Antioxidants : Selenium, zinc, vitamins A, C, D, E.
• Energy: B vitamins (co enzymes in Krebs), carnitine (fatty acid oxidation), magnesium (can also reduce tremors) and CoQ10.
• Glutathione support NAC, milk thistle, resveratrol, selenium.

Selenium supplementation (200 mcg) slows eye disease (GD).

Question 11

2. Inhibit thyroid hormone synthesis

Answer 11

• Avoid iodine and increase goitrogens: e.g., raw kale in smoothies, or cabbage in coleslaw.

Question 12

3. Reduce inflammation and insulin resistance

Answer 12

• Optimise omega 6:3 ratio (not fish iodine), GLA.
• Remove inflammatory factors high arachidonic acid foods (meat and eggs), trans fats, alcohol, refined carbohydrates.
• Quercetin (500 mg x 2 daily) inhibits LOX and COX, ↓ NF κB .

Question 13

4. Support the nervous system and address stress

Answer 13

Support blood sugar balance and the HPA axis

Question 14

5. Assess and address gut health and pathogen load

Answer 14

Possible 5R protocol. Prebiotics and probiotics. Identify and manage food allergenic triggers (gluten, dairy). Digestive support.

Question 15

6. Support thyroid hormone clearance

Answer 15

Support sulphation
Support glucuronidation

Question 16

Support sulphation:

Answer 16

• Glucosinolates (brassicas)
• Vitamin E, vitamin A.
• Selenium induces SULT (sulfotransferase enzymes).
• Sulphur foods (e.g. onions etc.)
• Methionine (1000-3000 mg) and/or folate/B12 (methylation)
• NAC (600-2000 mg), taurine (500-2000 mg).

Question 17

Support glucuronidation

Answer 17

• Quercetin, luteolin and chrysin rich foods ( honey, propolis, broccoli, peppers, celery, parsley, rosemary, onions).
• Magnesium and green tea.
• β-glucuronidase inhibitors : milk thistle, strawberry, reishi , probiotics, citrus, watercress, brassicas, turmeric.

Question 18

Hyperthyroid Supplements

Answer 18

L-Carnitine
Vitamin D
Quercetin
Selenium
Zinc
B vitamins

Question 19

Hyperthyroid Nutritional Support

Answer 19

Eye health - Increase lutein and other carotenoids to reduce oxidative stress. 10- 20 mg supplemental lutein used.

Increased metabolism - B vitamin complex and B vitamin rich foods.

Weight loss -
* Faster metabolism increases need for calories, focusing on nutrient density; e.g., nuts, seeds, avocado, olives, coconut, high vegetables, legumes and other protein rich foods.
* Bitter foods / herbs nutrient absorption.

Question 20

Hyperthyroid Supplements: Carnitine

Answer 20

• Peripherally antagonises thyroid hormones (inhibiting nuclear entry of T3 and T4)
• Can prevent or reverse muscle weakness.
• Can prevent the possible lethal outcome of a ‘thyroid storm’ (a medical emergency more common in severe Grave’s disease; high T3, progressive tachycardia to circulatory collapse).
  *↑ T3 / T4 →↑ metabolism -> carnitine turnover and urinary loss deprives tissues of L carnitine, conc.
  in skeletal muscle may contribute to myopathy.

Dosage: 2,000 to 4,000 mg
daily

Question 21

Vit D

Answer 21

• Key role in innate and adaptive immunity.
• May slow disease progression . Low levels found in hyperthyroid patients.
• Low status exacerbates accelerated bone turnover, low BMD and risk of fracture (seen in untreated cases).
• Test and optimise levels or use 2000 IU daily whilst waiting for test results.

Question 22

Other natural approaches
stress and anxiety:

Answer 22

• Passionflower and valerian anxiolytics with calming effects on the nervous system ( ‘nervines’ GABA inducing). Can help to control the symptoms of an overactive thyroid.
• Adaptogens such as ashwagandha to increase resistance to stress. Although avoid herbs that are too energetically stimulating.
• Address anxiety with magnesium (avoid citrate form as it makes bowel symptoms worse), theanine , ↓ caffeine and alcohol
• Incorporate stress reduction techniques, e.g., breathing exercises