Hyperthyroidism Flashcards

1
Q

Hyperthyroidism

A

Hyperthyroidism = increased levels of thyroid hormones. This is sub-divided into:

  1. 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).
  2. 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hyperthyroidism - Signs and symptoms

A

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).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Grave’s disease (GD)

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Graves disease — characteristic signs / symptoms:

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hyperthyroidism - Causes and risk factors

A

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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hyperthyroidism - Investigations

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hyperthyroidism -Naturopathic approach

  1. Address micronutrient insufficiencies and ↓ oxidative stress
A

Naturopathic approach to hyperthyroidism:

  1. 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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hyperthyroidism -Naturopathic approach

  1. Inhibit thyroid hormone synthesis
A
  1. Inhibit thyroid hormone synthesis:
  • Avoid iodine and increase goitrogens:

e.g., raw kale in smoothies, or cabbage in coleslaw.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hyperthyroidism -Naturopathic approach

  1. Reduce inflammation and insulin resistance
A
  1. 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hyperthyroidism -Naturopathic approach

  1. Support the nervous system and address stress:
A
  • Support blood sugar balance and the HPA axis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hyperthyroidism -Naturopathic approach

  1. Assess and address gut health and pathogen load
A
  1. Assess and address gut health and pathogen load:
  • Possible 5R protocol. Prebiotics and probiotics. Identify and manage food allergenic triggers (gluten, dairy). Digestive support.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hyperthyroidism -Naturopathic approach

  1. Support thyroid hormone clearance
A
  1. 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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hyperthyroidism - Nutritional support

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hyperthyroidism - Carnitine

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hyperthyroidism - Vitamin D

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hyperthyroidism - Other natural approaches

A

Other natural approaches — stress and anxiety:

  • 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
17
Q

Herbal medicines for hyperthyroidism

A
  • Bugleweed (Lycopus virginicus) tincture:

regarded as a thyroxine antagonist. Used to manage mild hyperthyroidism — decreases T4.

  • Motherwort (Leonurus cardiaca):

Helps reduce cardiac signs / symptoms. Avoid in pregnancy, breastfeeding, diagnosed CNS and cardiac pathologies.

  • Lemon balm (Melissa officinalis) blocks thyroid hormone activity.