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Anti Aging Oral Boards > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Does suppressing TSH cause bone loss?

A

No

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2
Q

Vitamin deficiencies that cause a decreased production of T4

A 
Deficiency of:
Zinc
Copper
Vitamins:
A
B2
B3
B6
C
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3
Q

What enzyme is required for the conversion of T4 to T3?

A

5’ deiodinase

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4
Q

Name the types of Deiodinase

A

Type I
Type II
Type III

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5
Q

Where is type I deiodinase found and what does it do?

A

Thyroid, liver and kidney

Plays important role in the production of T3

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6
Q

Where is type II deiodinase found and what does it do?

A

Pituitary, hypothalamus and brown fat

Converts T4 to T3

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7
Q

Where is type III deiodinase found and what does it do?

A

Inner ring of T4 and T3

It catalyzes deiodination of the inner ring of T4 and T3 which inactivates the hormone

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8
Q

Things that affect 5’ deiodination production

A 
Selenium deficiency
Stress
Cadmium, mercury or lead toxicity
Starvation
Inadequate protein intake
High carbohydrate diet
Elevated cortisol
Chronic illness
Decreased kidney or liver function
Inflammation
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9
Q

Nutrient deficiencies that cause poor T4 to T3 conversion

A 
Iodine
Iron
Selenium
Zinc
Vitamins A, B2, B6 and B12
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10
Q

Medications that cause poor T4 to T3 conversion

A 
Beta blockers
Birth control pills
Estrogen
Lithium
Phenytoin
Theophylline
Chemotherapy
Glucocorticoids
Interleukin six
Clomipramine
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11
Q

Dietary problems that cause poor conversion of T4 to T3

A 
Too many cruciferous vegetables
Low protein diet
Low-fat diet
Low carbohydrate diet
Excessive alcohol
Walnuts
Soy
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12
Q

Toxins that cause poor conversion of T4 to T3

A 
Fluoride
Lead
Mercury
Pesticides
Dioxins
PCB
Phthalates
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13
Q

Disease conditions that can cause poor conversion of T4 to T3

A 
Aging
Diabetes
Radiation
Stress
Surgery
Inadequate production of DHEA or cortisol
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14
Q

Excess nutrients that can cause poor conversion of T4 to T3

A

Alpha lipoid acid (600 mg or greater)
Copper
Calcium

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15
Q

Factors associated with low T3 or increased reverse T3

A 
Increased epinephrine, norepinephrine
Toxic metal exposure
Elevated levels of IL-6, TNF alpha and INF-2
free radicals
aging
Fasting
stress
prolonged illness
diabetes
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16
Q

Hormones that will increase T4 to T3 conversion

A 
Growth hormone
Glucagon
Insulin
Glucagon
Melatonin
Estrogen
Testosterone
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17
Q

Vitamins minerals and amino acids that will increase conversion of T4 to T3

A 
Selenium
Iodine
Zinc
Vitamin a
Vitamin B2
Vitamin D
Potassium
Iodine
Iron
Tyrosine
Also: high-protein diet and Ashwaganda
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18
Q

Lab studies to evaluate thyroid function

A 
TSH
Free T4
Free T3
Reverse T3
Thyroid antibodies:
Anti-thyroglobulin antibody
Antimicrosomal antibodies
Anti-thyroperoxidase antibody (Anti-TPO)
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19
Q

Celiac disease is associated with what thyroid disease?

A

Hashimoto’s thyroiditis

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20
Q

Patients with hives have a higher frequency of what thyroid disease?

A

Hashimoto’s thyroiditis

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21
Q

What causes hair loss?

A 
Hereditary
Iron deficiency
Hypo or hyper thyroidism
Cortisol too high or too low
Metal toxicity
Low progesterone in a woman
Progestins
B vitamin deficiencies, Particularly biotin (B7)
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22
Q

What does thyroid binding globulin do and where is it produced?

A

It stores thyroid hormone.

Is produced in the liver

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23
Q

Name three proteins in the blood responsible for carrying thyroid hormones

A

Thyroid binding globulin
Transthyretin
albumin

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24
Q

What can increase thyroid binding globulin?

A

Estrogen

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25
Q

What can thyroid binding globulin be affected by?

A

Illness, liver disease and medications. They can all decreased levels

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26
Q

What amino acid is used as a building block for thyroid hormones?

A

Tyrosine

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27
Q

How to take a basal body temperature

A

Take the temperature under the arm for 10 minutes. Do before arising. Do it for three days.

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28
Q

What toxins can affect thyroid function?

A 
PCBs
Dioxins
DDT
Hexachlorobenzene
Phthalates
Heavy metals (lead, arsenic, mercury)
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29
Q

Where is T4 converted to T3?

A

Liver and kidneys

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30
Q

How much stronger is T3 than T4?

A

Five times stronger

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31
Q

Of the thyroid hormone molecules that bind to receptors, what percent are T3 and what percent are T4?

A

90% T3

10% T4

32
Q

What two parts of the body does T3 have a direct effect on?

A

Mitochondria and the heart

33
Q

Other names for T4 (levothyroxine sodium)

A 
Synthroid
Levothyroid
Lovoxyl
Eltroxin
All our immediate release and may contain lactose which can interfere with thyroid absorption
34
Q

What are other names for T3 (liothyronine sodium)

A

Cytomel
Triostat (injection)
Liothyronine sodium (generic)
All are immediate release

35
Q

Different forms of desiccated thyroid hormone

A

Armour (porcine) ratio: T4 to T3 = 4:1

Thyrolar (Liotrix) ratio: T4 to T3 = 4:1

36
Q

Optimal TSH, free T3 and reverse T4

A

TSH

37
Q

Causes of elevated rT3

A 
Chronic fatigue syndrome/fibromyalgia
Yo-yo dieting
Heavy-metal toxicity
Infections
Physical and mental stress
38
Q

What will an elevated rT3 do to the conversion of T4 to T3?

A

It will inhibit conversion of T4 to T3

39
Q

You have fT3 and rT3. Which will occupy the receptor sites?

A

Free T3

40
Q

Patient has high rT3 but all the other labs will be normal. What will the patients symptoms be?

A

Like they have hypothyroidism

41
Q

What to do if rT3 is elevated?

A

Since rT3 is derived from T4, lower the T4 or take pt off of it
Give T3. T3 will lower the TSH and subsequent production of T4 by the thyroid gland and inappropriate conversion to rT3

42
Q

Besides adjusting the thyroid hormone, what else could be done if rT3 is elevated?

A

Eliminate stress
Growth hormone
Treat selenium deficiency
Tree iodine deficiency

43
Q

How should the patient take thyroid replacement in regards to meals and supplements?

A

Take on an empty stomach. No food for one hour before our one hour after.
No vitamins during this time for either. Calcium interferes with the absorption

44
Q

Agents that lower absorption or elevate excretion of thyroid

A 
Ferrous sulfate
Sucralfate (for ulcers)
Bile acids sequestration
Lactose
Calcium carbonate
Aluminum hydroxide (antacid)
45
Q

Medications that alter thyroid function

A 
Haloperidol
Lithium
Amiodarone
BCP
Metoclopramide
Cimetidine
Clomiphene
Dilantin
Tegretol
Phenobarbital
Tamoxifen used for more than one year
Rifampin
Ritonavir
Sertraline
46
Q

How many milligrams of iodine required per year for the metabolism of thyroid hormone?

A

50 mg

47
Q

What percent of T4 secreted daily is diodinated to yield T3 and reverse T3 in equal parts?

A

70%

48
Q

80% of circulating T3 comes from where

A

Peripheral monodeionization of T4 at the thyroglobulin ring. This occurs in the liver, kidney and other tissues. Circulating rT3 is made the same way

49
Q

What should be functioning well first before thyroid replacement is started?

A

Adrenal function and gut function. If the patient starts to feel more fatigued with thyroid dosage is increased, this is indicative of adrenal fatigue or overdosage of the thyroid replacement

50
Q

How long should you wait after an acute MI before starting thyroid replacement

A

Two months

51
Q

Low magnesium levels will cause what complication with thyroid replacement?

A

Racing hear or irregular heart beats

52
Q

What are the therapeutic actions of iodine?

A 
Antibacterial
Into cancer
Antiparasitic
Antiviral
Mucolytic agent
53
Q

How do you measure iodine levels?

A

Via a challenge test. Give the patient 50 mg of iodine and then do a 24 hour urine. If the excrete out 90% or more they don’t need iodine. If they are excreting 1% they would need 50 mg of iodine. If they excrete 50% then they would need 25 mg.

54
Q

What conditions to be treated with iodine?

A 
Fibrocystic breast disease
To patrons contracture
Excess mucus production
Fatigue
Hemorrhoids
Headaches and migraines and headaches
Keloids
Ovarian cyst
Parotid duct stones
Pyronie's (bent penis disease)
Sebaceous cyst
55
Q

What percent of the worlds population is affected by the iodine deficiency disorder?

A

72%

56
Q

What are the causes of iodine deficiency?

A

The ground in the area is deficient in the highline
Diet without ocean fish for sea vegetables
In adequate use iodized salt
Diet high in pasta and bread which contain bromide (bromide binds to the iodine receptors)
Fluoride use (inhibits iodine binding)
Vegan and vegetarian diets
Sucralose (contains chlorinated table sugar)
Medications

57
Q

What medication will cause an iodine deficiency?

A 
Atrovent inhaler (contains bromide)
Ipratropium nasal spray (contains bro mine)
Pro-Panthine (contains bro mine)
Flonase (contains fluoride)
Flovent (contains fluoride)
58
Q

What are the tissues that use iodine?

A 
Thyroid
Breast
Prostate
Kidneys
Spleen
Liver
One
Salivary gland
Intestines
59
Q

Supplementation with iodine and iodide

A

That’s something they both since different tissues concentrate different forms of iodine

60
Q

How many months of iodine supplementation does it take for saturation is reached?

A

3 to 6 months

61
Q

What percent of patients being treated for hypothyroidism will need to adjust the dose (decrease) of thyroid hormone once the iodine deficiency has been corrected?

A

33%

62
Q

I can too much iodine in the diet result in thyroid -itis?

A

It can cause iodine to be trapped by thyroglobulin. Elevated levels of thyroglobulin prompt the immune system to react and cause inflammation. This may also increase the risk for thyroid cancer

63
Q

What are optimal ferritin levels for optimal thyroidfunction? What if the patient is cycling?

A

Ferritin levels should be over 100 ng/mL. They should be greater than 130 ng/mL if patient is cycling

64
Q

How can a diet high in soy affect thyroid function?

A

It may inhibit it. A study of 37 adults who at a high soy diet for 3 months. 1/2 of the subjects developed symptoms of low thyroid function

65
Q

What did a study of critically ill patients with low thyroid function who were supplement with selenium show?

A

Selenium 200 mcg showed normalization of TT3, TT4, rT3 and improvement of the T3/rT3 ratio

66
Q

What diseases are associated with hypothyroidism?

A 
ADHD
CVD
CHF
Depression
CFS/Fibromyalgia
Ankylosing spondylitis
Insulin resistance
67
Q

What CVD markers are commonly elevated with hypothyroidism?

A

CRP and homocysteine

68
Q

What thyroid hormone ratio is a predictor of mortality in CHF?

A

Low T3/rT3

69
Q

What does T3 supplementation in CHF do?

A

It increases CO and decreases SVR

70
Q

V tach in CHF was seen with what thyroid abnormalities?

A

Low T3 or low T3/T4 with increased rT3

71
Q

Low thyroid marker was predictive of AF post CABG?

A

Low fT3

72
Q

What thyroid marker was a strong predictor of death in cardiac patients?

A

Low T3

73
Q

What thyroid marker was a strong predictor of mortality in patients first year post acute MI?

A

High rT3

74
Q

SSRIs + ? Improved depression in patients with PTSD

A

T3

75
Q

CFS and fibromyalgia are associated with high or low T3?

A

Low T3

76
Q

Lower TSH and higher T4 are associated with what cardio metabolic parameters according to a study in the Journal of Clinical Endocrinology?

A

Improved insulin sensitivity, higher HDL and better endothelial function

77
Q

What are optimal thyroid lab values?

A

TSH:

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