Hyperthyroidism Flashcards
Hyperthyroidism
Hyperthyroidism = increased levels of thyroid hormones. This is sub-divided into:
- 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).
- Thyroiditis — ↑ release of stored hormones due to thyroid damage.
– Causes: Viral infections, autoimmune, amiodarone.
- Both increase metabolic rate / activity.
- Women being more frequently affected (10:1)
Hyperthyroidism - Signs and symptoms
Signs and symptoms:
- 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 (see later slide).
Grave’s disease (GD)
Grave’s disease (GD) = autoimmune hyperthyroidism: * 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
Graves disease — characteristic signs / symptoms:
Graves disease — characteristic signs / symptoms: * 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)
Hyperthyroidism - Causes and risk factors
Causes and risk factors:
- Family history of thyroid disorders (esp. maternal relatives).
Maternal TRABs cross the placenta — neonatal thyrotoxicosis.
- Stress (e.g., emotional shock).
- Inflammation / oxidative stress.
- Excess iodine intake — overstimulating thyroid hormone production.
- Dysbiosis and intestinal permeability. Propionate-producing bacteroides promote Treg / Th17 imbalance and GD. The levels of prevotella are often significantly higher in GD patients.
- Food allergy / intolerances.
- Heavy metals — e.g., mercury, cadmium.
- Smoking (cadmium) — risk for GD. 3-fold risk of developing orbitopathy. More severe disease.
- Other AI conditions — GD is associated with Type 1 diabetes, Coeliac disease and pernicious anaemia.
- Infections — Yersinia enterocolitica, Borrelia burgdorferi, hepatitis C (strong correlation).
- Vitamin D, selenium, CoQ10 deficiency.
Hyperthyroidism - Investigations
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)
Hyperthyroidism -Naturopathic approach
- Address micronutrient insufficiencies and ↓ oxidative stress
Naturopathic approach to hyperthyroidism:
- Address micronutrient insufficiencies and ↓ oxidative stress:
- 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).
Hyperthyroidism -Naturopathic approach
- Inhibit thyroid hormone synthesis
- Inhibit thyroid hormone synthesis:
- Avoid iodine and increase goitrogens:
e.g., raw kale in smoothies, or cabbage in coleslaw.
Hyperthyroidism -Naturopathic approach
- Reduce inflammation and insulin resistance
- Reduce inflammation and insulin resistance:
- 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
Hyperthyroidism -Naturopathic approach
- Support the nervous system and address stress:
- Support blood sugar balance and the HPA axis
Hyperthyroidism -Naturopathic approach
- Assess and address gut health and pathogen load
- Assess and address gut health and pathogen load:
- Possible 5R protocol. Prebiotics and probiotics. Identify and manage food allergenic triggers (gluten, dairy). Digestive support.
Hyperthyroidism -Naturopathic approach
- Support thyroid hormone clearance
- Support thyroid hormone clearance:
Support sulphation:
* 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).
55 * NAC (600–2000 mg), taurine (500–2000 mg).
Support glucuronidation:
* 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.
Hyperthyroidism - Nutritional support
Hyperthyroidism - Carnitine
Hyperthyroidism - Vitamin D
