Hypothyroidism Flashcards

1
Q

Primary

A

Pathological processes are within the thyroid gland .
TSH is higher due to low T4 and T3 (e.g., iodine deficiency, autoimmune, viral infections, drug induced, postpartum).

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

Secondary

A

Secondary : Pathological processes are within the pituitary gland inadequate TSH to signal the thyroid gland to release more hormones. TSH is low (hypopituitarism).

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

Tertiary

A

Inadequate TRH (hypothalamic disease).

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

Peripheral

A

Peripheral: Insensitivity to thyroid hormones.

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

Subclinical

A

TSH is slightly elevated and T4 is normal. T4 to T3 conversion issues, ↑ RT3 or thyroid cell receptor resistance.

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

General signs and symptoms:

A
  • Fatigue.
  • Weight gain / inability to lose weight
  • Heavy or irregular menstrual periods
  • Puffy face, swollen eyelids, oedema
  • Intolerance to cold, cold extremities
  • Joint and muscle pain / weakness
  • High cholesterol (usually LDL)
  • Dry skin, elbow keratosis, brittle nails
  • Hair loss / thinning of hair and eyebrows
  • Brain fog / concentration problems
  • Depression
  • Easy bruising
  • Constipation
  • Gas / bloating
  • Headaches
  • Low libido
  • Fertility problems
  • ↑ miscarriage risk
  • Goitre
  • Bradycardia
  • Carpal tunnel syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Subclinical hypothyroidism (SCH):

A
  • Elevated TSH levels with normal free T4 levels. Often undetected (up to 10% of the population) and requires naturopathic support
  • Linked to an increased risk of heart failure, coronary artery disease events and infertility. Fertility improves and miscarriage risk reduces when addressed.
  • It can cause cognitive impairment, fatigue, and altered mood.
  • Higher serum TSH levels (> 10 mU / L) and thyroid autoantibodies, increase the risk of SCH progression to overt hypothyroidism
  • Optimal status is a TSH of 2.5 or less.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes and risk factors:

A
  • Iodine deficiency or iodine excess
  • Women
  • Increasing age
  • Drug induced
  • Congenital
  • A lack of other nutrients
  • Postpartum thyroiditis
  • Chronic stress
  • Infection/inflammation
  • Alcohol
  • Smoking
  • Post-ablative therapy or surgery
  • Hereditary link
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hashimoto’s thyroiditis (HT)

A

An autoimmune disease that attacks thyroid tissue causing reduced thyroid hormones.
* Female to male ratio is at least 10:1.
*↑ TSH, low FT4, ↑ antithyroid peroxidase (TPO) antibodies.
* Anti thyroglobulin (anti-Tg) and TSH receptor blocking antibodies (TBII) may also be present.
* EBV and H. pylori are often implicated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HT: Causes and risk factors

A
  • Excess iodine highly iodinated thyroglobulin is more immunogenic.
  • Genetic polymorphisms VDR, MTHFR (link to AITD).
  • HT often co-exists with coeliac disease . Gluten free diets have been shown to reduce antibody titres.
  • Sleep apnoea and HT may influence each other.
  • Heavy metals mercury, lead, cadmium ↑ TGO antibodies. Metallothioneins (selenocysteine) in the thyroid bind to cadmium
  • Triclosan found in personal care products e.g., toothpastes. Resembles structure of thyroid hormones.
  • ↑ pro inflammatory cytokines e.g., IL 6, TNF α , IL 12, IL 10.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Naturopathic approach to hypothyroidism

A
  1. Address triggers and mediators (identify the cause!)
  2. Reduce inflammation and IR
  3. Reduce goitrogenic compounds
  4. Balance T cell functioning ( Th1 / Th2 / Th17 / T reg cell balance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Address triggers and mediators

A
  • Optimise micronutrient status support T4 to T3 conversion. Review iodine status (low / excess).
    Consider nutritive herbs such as nettle (e.g., nettle tea).
  • Optimise digestion e.g., digestive bitters, enzymes etc.
  • Support methylation folate, B12, B6, B2, choline, betaine, zinc. Consider genetic testing.
  • Remove thyroid disruptors
  • Address possible dysbiosis/SIBO common in HT
  • Address stress, support HPA axis (positively influences HPT).
  • Assess for pathogens (e.g., stool test) and heavy metals/ environmental toxins (e.g., GPL Tox, hair toxin analysis).
  • Heavy metals avoidance; use natural chelators,
    e.g., coriander and chlorella.
  • Support detoxification and elimination (HT sufferers are often poor detoxifiers) e.g., B vitamins, ↑ glutathione ( NAC, milk thistle, resveratrol, etc.), flavonoids, carotenoids, fibre, chlorophyll (green juice).
  • Support SCFA producers (e.g., pro/prebiotics, fibre, polyphenols
  • Assess for coeliac disease (total IgA should be included with TtgA ).
    Higher incidence in AITD.
  • Identify food intolerances (gluten, wheat. lactose etc.) and cross reactive foods (e.g., Elimination diet / Autoimmune Paleo diet).
  • Increase exercise . Identify and manage sleep disorders. Sleep apnoea and HT have a bi directional influence.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Reduce inflammation and IR

A
  • Optimise omega 3:6 ratio, avoid trans fats, sugar, alcohol, high GL foods, smoking , limit arachidonic acid (Hs CRP < 1).
  • Blood sugar balance and improve insulin sensitivity low GI / GL foods, cinnamon, chromium etc.)
    *↑ antioxidant sources to oxidative stress.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Reduce goitrogenic compounds:

A
  • Pre soaking, steaming or boiling reduces goitrogens.
    Cooking destroys goitrogens by stimulating the production of myrosinase, an enzyme that helps deactivate goitrogenic glucosinolates . It is beneficial to still include these foods.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Balance T-cell functioning ( Th1 / Th2 / Th17 / T reg cell balance)

A
  • Address increased intestinal permeability : Critical for immune tolerance, T reg cells (maintain tolerance). glutamine (10 g BID), aloe, zinc carnosine, vit A, D, EPA and DHA (3 4 g), curcumin
  • Commensal bacteria produce butyrate ( e.g., roseburia , Akkermansia spp.) supports T reg cells. Raise through pre and probiotic foods / supplements ; optimising dietary fibre ; focusing on a rainbow of colour for the polyphenols .
  • Support SIgA levels (probiotics including S. boulardii , zinc, A, D, omega 3, colostrum) for immune tolerance and reduced food reactions.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hypothyroid: Supplements

A

Selenium
Zinc
Iron
Iodine
Vitamin A
Tyrosine
Vitamin D

17
Q

Selenium

A
  • Antioxidant, anti inflammatory , ↑ T3.
  • Selenoenzymes : Glutathione peroxidases (GPX), thioredoxin reductases (TR), deiodinases and selenoprotein P play key roles in thyroid function.
  • Narrow therapeutic range excessive levels may enhance the effects of iodine deficiency, while proper supplementation may alleviate iodine excess.
    *↓ inflammatory cytokines and thyroid antibodies.

Supplement dosage of selenomethione : 150-200 mcg /day

18
Q

Zinc

A
  • Co factor of D2 and has a role in TRH synthesis.
  • DNA binding component of thyroid receptors chelates zinc ions, forming ‘zinc fingers’ which mediate specificity in binding to T3 response elements (TRE) to activate transcription factors.
  • Zinc deficiency is associated with enhanced expression of hepatic D1 , which ↑ thyroid hormone
  • Low levels of free T3 and normal T4, but elevated RT3 are associated with mild to moderate zinc deficiency.

Supplement dosage:
15-30 mg / day

19
Q

Iron

A
  • TPO is a haem-containing enzyme used in the initial steps of hormone synthesis (adds iodine to thyroglobulin).
  • Iron deficiency anaemia decreases : T4 and T3, peripheral conversion of T4 to T3 and hepatic deiodinase.
  • Iron deficiency anaemia blunts the efficacy of iodine supplementation.
  • Iron supplementation (correction) has been shown to reduce RT3 and increase T3 and T4 in adolescent girls.

Supplement dosage: Approx. 10mg maintenance, 30 mg/day if deficient, check levels before

20
Q

Iodine

A
  • Decreases response of the thyroid to TSH, but at high concentrations, inhibits thyroid hormone secretion.
  • Modulates thyroid response to TSH ( -ve feedback).
  • If unsure, urinary iodine loading test to assess status.
  • Huge variability in iodine content in kelp / seaweed, foods, and supplements, and in absorption of
    topically applied Lugol’s iodine avoid taking alongside iodine supplements (additive effect). Although Lugol’s should not be advised orally as it is not a food supplement.

Supplement dosage: 150-400 mcg baseline to optimal dose).
DO NOT use in AITD, hyperthyroid or thyroxine use).

21
Q

Vitamin A

A
  • Deficiency increases TSH. Supplementation can reduce TSH and increase T3.
  • Deficiency reduces iodine uptake in thyroid .
  • Via its role in retinoic acid receptors (RAR), vitamin A modulates thyroid hormone receptor function.
  • Insufficiency from low intake or BC01 SNPs.

Supplement dosage: 2000 IU

22
Q

Tyrosine

A
  • Thyroglobulin precursor and supports stress adaptation short term.
  • Avoid high doses long term and with thyroxine use.

Supp. dosage: 200-500 mg

23
Q

Vitamin D

A
  • Deficiency is significantly higher in those with AITDs.
  • Levels inversely correlated with thyroid antibodies.
  • Immune modulatory role (T-reg cells).
  • Supplementation found to be beneficial even in those with ‘normal’ levels.
  • Aim for vitamin D levels of 100-150 nmol / L.

Supplement doses:
2000 IU (or more)

24
Q

Antioxidants and Other

A

Antioxidants: Vitamins C, E, cysteine, glutathione.

Other: Copper (deiodinase cofactor), B2, B3 (energy metabolism).