DIETARY GOITROGENS AND THYROID FUNCTION: IS THERE A LINK?

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This blogpost was prompted by a comment on a Whatsapp group about dietary goitrogens and thyroid disease. That discussion was related to soy. 
If you have hypothyroidism,the most important question that you’d like to be answered is:
Should you avoid food like soy and cruciferous vegetables (dietary goitrogens)?
 
WHAT ARE GOITROGENS?
According to Wikipedia “Goitrogens are substances (whether in drugs, chemicals, or foods) that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid gland. “
( In this post i will not discuss drugs or endocrine disrupting chemicals that affect thyroid function).
What are the common food that well-meaning healthcare practitioners sometimes ask you to avoid if you have hypothyroidism?
The commonest ones are soy and cruciferous vegetables. Cabbage, kale,broccoli, brussels sprouts,bok choy, cauliflower are the commonest cruciferous vegetables that you eat.
SOY AND GOITRE
The alleged association of soy with goitre has probably originated in animal studies and few isolated case studies reported in the sixties ,where few infants fed a soy formula had developed goitre.
What is the true association of soy and thyroid function? In an article in the journal Thyroid (2006) the authors looked at 14 trials (though thyroid function was not the primary health outcome in any trial). They commented that “the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function.”
What about soy interfering with supplemental thyroid hormone absorption?
An interesting case study reported in Endocrine Practice: May 2001 discusses a patient who needed very high doses of thyroid hormone replacement after she had undergone a thyroid gland removal for cancer.On enquiry it turned out that she was taking a “soy-cocktail “protein supplement immediately after taking her synthetic thyroid hormone! Once the intake of both were separated, she needed a lesser dose of thyroid hormone!So this was not a problem of soy being a goitrogen, but a problem of food interfering with  thyroid pill absorption.
Is it only soy that interferes with supplemental thyroid hormone absorption? NO!
Iron, calcium, proton-pump inhibitors like Omeprazole,coffee, cholestyramine and other food also interfere with thyroid absorption. 
This is why we recommend that you should take your thyroid pills on an empty stomach. Preferably avoid eating or drinking anything (other than water) one hour before and one hour afer taking your thyroid meds.Another suggestion from my practice partner Dr.Natasha Iyer is to take your thyroid meds in the middle of the night if you wake up to use the washroom. But no nibbling then!
What about cruciferous vegetables as goitrogens?
In animal studies very high intake of cabbage and turnip have been associated with hypothyroidism.However, animal studies cannot be extrapolated to humans!
A study reported in the New England Journal of Medicine, May 2010 talks about an 88 year old Chinese woman who was brought to the emergency department in myxedema coma (severe hypothyroidism leading to coma).She did not have thyroid dysfunction before. She was taking 1 to 1.5 kilograms of raw bok choy everyday for several months in the belief that it would take care of her diabetes! I don’t know whether her diabetes was affected of but it sure sent her into coma!
However, a small study which  looked at 10 people who ate 150 grams of cooked Brussels Sprouts everyday for 4 weeks, did not show any adverse effects on thyroid function.
IMPORTANT TAKEAWAYS
  • If you have hypothyroidism you can eat soy, cabbage, bok choy, cauliflower, broccoli, kale as long as you do not over-indulge!
  • Supplemental thyroid hormones should be taken away from food or supplements for best absorption.
You may be interested in reading the following posts:
(Watch for post on iodine and thyroid to be posted later).
REFERENCES
  1. Bell, MB, FACE, David SH, and Fernando Ovalle, MD. “Use of soy protein supplement and resultant need for increased dose of levothyroxine.”Endocrine Practice 7.3 (2001): 193-194.
  2. Chu, Michael, and Terry F. Seltzer. “Myxedema coma induced by ingestion of raw bok choy.” New England Journal of Medicine 362.20 (2010): 1945-1946.
  3. McMillan, M., E. A. Spinks, and G. R. Fenwick. “Preliminary observations on the effect of dietary brussels sprouts on thyroid function.” Human & Experimental Toxicology 5.1 (1986): 15-19.

STRESS AND AUTOIMMUNITY

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Does stress induce Autoimmune Disease? Or is stress a cause of Autoimmunity? The precise answer to the question of whether stress is an inducing agent or a causative agent is in the realm of medical minutiae, but there is no doubt that stress has a major impact on your autoimmune disease. This is not new information for most of you. Many of you have experienced worsening of your symptoms soon after some stressful event in your life or you have even tried to blame your significant other for “causing” stress in your life! Though it is true that empathic stress (later blog post) can affect you, it is not stress that is the problem; it is how you deal with it that decides your health! We do need some amount of stress to be alive! Is it eustress (positive stress) or distress (negative stress) that is affecting you?

In my patient intake form I have a section that talks about how you gauge your stress levels. Most of you fill in your health-related stress as an 8 or 10 out of 10. (One lady said it was 11 out of 10!). For many of you this stress comes from the physical pain or the uncertainty of not knowing what happens tomorrow or from being unable to work or from the lack of response to a particular drug or various other factors. In this blogpost I would like to focus more on the solutions to address stress, rather than the problem.

WHAT IS STRESS?

Dr. Hans Selye, who is considered to be one of the pioneers of stress research, in 1936 defined stress as “The non-specific response of the body to any demand for change. Everyone knows what stress is, but nobody really knows.”

YOUR STRESS RESPONSE IS DECIDED BY MANY FACTORS.

Some of the important factors affecting your stress response are:

  • Intrauterine influences-your mother’s stress when she was pregnant with you.
  • Your childhood experiences (ACE score, explained below)
  • Your gender
  • Your socioeconomic status
  • Your stress management strategies.

Intrauterine influences: Some of the factors that influence your stress response are operative when your mother was pregnant with you! There are many scientific studies that describe how stress experienced by women during pregnancy had adverse influence on the health of the children. The Dutch Winter Hunger Study and the Project Ice Storm study are among some of the often-quoted ones. The effects on the child depended on when during the mother’s pregnancy she had experienced the adversity. For example, children born to mothers who had experienced stress during the last part of their pregnancy were at higher risk for diabetes, heart disease and increased fat mass. The baby in the uterus predicted that it was being born into a world of scarcity and therefore needed to conserve fat! Some of these adverse health effects were trans-generational (affected at least 2 subsequent generations)! This is a truly fascinating field of study called Developmental Origin of Health and Disease (DoHAD).

ADVERSE CHILDHOOD EXPERIENCES (ACE) AND HEALTH

Dr. Vincent Felitti and Dr. Robert Anda’s landmark study of 1998 found a strong relationship between exposure to abuse or household dysfunction during childhood and multiple risk factors for many diseases in adults, including Autoimmune Disease. The higher the ACE score, the higher the incidence of disease. This effect was more pronounced in women and Autoimmune Disease.

We know that factors like sexual or physical abuse have a lot of adverse health effects, but when you check your ACE score you will realize that factors like living with an alcoholic caregiver or someone with mental illness or even being insulted or put down often has many adverse health influences. The point of this study is not to blame your parents but to realize how your health challenges may have an explanation in your childhood experiences and more importantly, these effects are not permanent! You can get better! A recent book Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal by Donna Jackson Nakazawa is a good book to read. Nakazawa is an award winning author who shares her journey through successfully dealing with Guillain Barre Syndrome (GBS).

 

ACE
From Viletti, Anda Study on ACE

Do you know your ACE score? Check here to download the form and find out.

IS IT ADRENAL FATIGUE?

During consultation some of you tell me that you have “Adrenal Fatigue” or that your “Adrenals are fired”. Is that true? In medical terms what you mean is that you have a dysregulated stress response or the medical terms HPA Axis (Hypothalamo-Pituitary-Adrenal Axis) dysfunction or Allostatic Load. What does it mean? (I will explain this concept in details on a webinar/series of blog posts later. On this post I’d like to focus on the solutions rather than the problem). Humans have had to deal with stress since time immemorial. What has changed now? Stress for our hunter-gatherer ancestors involved physical stress and was usually short-lived. Our bodies were used to short-lived stress and not the type of ongoing stress that we experience now.

WHAT CAN YOU DO TO TAKE CARE OF YOUR DYSREGULATED STRESS RESPONSE?

  1. Meditation
  2. MBSR (Mindfulness Based Stress Reduction)
  3. Expressive Writing
  4. Yoga
  5. Tai Chi,Qigong
  6. Art Therapy
  • MEDITATION:

As a long-term meditator and someone who has read many scientific papers on the neurobiology of meditation, this is my number one go-to when it comes to dealing with your dysregulated stress response. As I always say, the side effects of meditation are all good! What type of meditation should you do? My suggestion is to try several different ones and find out which one you like.

However, there are a few things to keep in mind when we talk about “therapeutic meditation”. • You need to elicit the Relaxation Response (RR) According to Dr. Herbert Benson from Harvard the relaxation response is a state of deep rest that elicits the following changes

  • Decreased heart rate
  • Decreased blood pressure
  • Decreased rate of breathing, and
  • Decreased muscle tension.

A Relaxation Response occurs when you meditate for at least 30-45 minutes. If you have never meditated before, start with 5-10 minutes of a guided meditation on an app or CD.

The best results of meditation have been shown in long-term meditators but meditating for as little as 8 weeks have shown many benefits!

  • MBSR (Mindfulness Based Stress Reduction):

According to Dr. Jon Kabat Zinn “Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally”. Dr. Kabat Zinn is Professor of Medicine Emeritus at the University of Massachusetts Medical Centre, where they have done many clinical studies on the health effects of MBSR. In one study of patients with psoriasis, MBSR along with photo therapy (UVB) or photo chemotherapy (PUVA) was found to show faster clearing of skin lesions.

  • EXPRESSIVE WRITING:

Professor James Pennebaker PhD, Professor of Psychology at the University of Texas, in a study found that writing about traumatic events was associated with fewer visits to the health center! It also improved immune function. No one has to read your writing and please don’t bother with punctuation or grammar! Check here to read about the guidelines for Expressive Writing.

  • YOGA
  • TAI CHI
  • QIGONG
  • ART THERAPY

REFERENCES

  1. Schulz, Laura C. “The Dutch Hunger Winter and the developmental origins of health and disease.” Proceedings of the National Academy of Sciences 107.39 (2010): 16757-16758. Cao-Lei, Lei, et al.
  2. “DNA methylation signatures triggered by prenatal maternal stress exposure to a natural disaster: Project Ice Storm.” PLoS One9.9 (2014): e107653.
  3. Felitti, Vincent J., et al. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.” American journal of preventive medicine 14.4 (1998): 245-258.
  4. Benson, Herbert, Martha M. Greenwood, and Helen Klemchuk. “The relaxation response: psychophysiological aspects and clinical applications.”The International Journal of Psychiatry in Medicine 6.1-2 (1975): 87-98.
  5. Kabat-Zinn, Jon, et al. “Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing photo therapy (UVB) and photo chemotherapy (PUVA).” Psychosomatic medicine 60.5 (1998): 625-632.
  6. Pennebaker, James W. “Writing about emotional experiences as a therapeutic process.” Psychological science 8.3 (1997): 162-166.
  7. Book: Expressive Writing: Words that Heal by James W Pennebaker.

PREDICTIVE AUTOANTIBODIES—YOU MAY HAVE AN AUTOIMMUNE DISEASE AND NOT KNOW IT!

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Any disease condition is a continuum. This means that you do not move from being well to having a disease overnight. Just as in Type 2 Diabetes, where you may have dysregulated blood sugar levels (Dysglycemia) many years before you develop the disease, so it is with many autoimmune conditions. You may have autoantibodies in your blood many years before developing the disease. Despite recent advances in treatment, there is a large percentage of people in whom long-term remission of the autoimmune disease cannot be achieved. This leads to poor quality of life and sometimes an early death. As this oft-quoted Benjamin Franklin axiom says “an ounce of prevention is worth a pound of cure”. Several scientific studies in the last few years have shown that you may have tell-tale evidence in your body 5-14 years before developing an autoimmune disease. An autoimmune condition develops when there is an interaction between your genes, an environmental trigger, your immune system and intestinal permeability. Your genes are present from birth but you do not develop an autoimmune disease until later. So what happens? In any autoimmune disease like it is in any other disease, it is an interaction between your genes and the environment that decides your health. As Dr. Eric Topol, a world-renowned cardiologist, geneticist, digital health pioneer, and medical innovator, says,“healthy aging is 100 percent due to genetics and 100 percent due to your environment”.

Autoimmune conditions develop when your immune system makes antibodies against your own tissue ( Autoimmunity).  This can lead to your healthy tissue losing their ability to function normally. For example, in Type 1 Diabetes, your own body makes antibodies against your own pancreatic cells which produce insulin. Insulin is the hormone that keeps your blood sugar in balance. The other, commoner diabetes is Type 2 Diabetes, in which antibodies to pancreatic tissue is not usually present. (Incidentally, these autoantibodies to pancreatic tissue have been found in about 5% of people otherwise diagnosed as Type 2 Diabetes.Watch for post on LADA , Latent Autoimmune Diabetes of the Adult).

In fact, a new staging approach is being used in Type 1 Diabetes taking into consideration the number of autoantibodies present. The staging starts well before the disease develops. This approach is used to prevent or delay the onset of the disease. Perhaps you can start prevention in your child when you are pregnant! Studies have shown the connection between vitamin D deficiency in mothers and autoimmunity in children.

Rheumatoid Arthritis (RA): RA is an autoimmune disease affecting joints, which is characterized by chronic inflammation, causing pain and stiffness in the joints and a poor quality of life. Half of the patients with RA already have X-ray evidence of joint damage at the time of diagnosis. Like most diseases, RA can be treated better if diagnosed early. Therefore, the ability to predict the disease before joint damage occurs will contribute to a better quality of life.

WHO SHOULD BE TESTED FOR AUTOANTIBODIES?

  • Anyone who has a diagnosed autoimmune condition. Studies have shown that if you have one autoimmune disease, the chances of your developing another one are much higher than in the general population.
  • To test for disease progression in people with autoimmune diseases.
  • Anyone with hypothyroidism who has never been tested for thyroid antibodies.
  • First degree relatives (a person’s parent, sibling or child) of people with an autoimmune condition.
  • Patients with painful and stiff joints who haven’t received a definitive diagnosis of RA yet.
  • Anyone interested in better health.

WHAT TESTS SHOULD YOU DO?

A complete workup is very important. However, the following must be included.

  • C-Reactive Protein: This is a marker of inflammation.
  • Vitamin D3 levels: Vitamin D has a major role in your immune system. Low levels of this vitamin have been associated with increased risk of autoimmune diseases. (Vitamin D)
  • Antibodies: This list increases by the day. There are some specialized tests available in some countries which I have not listed here. (For those of you interested in the detailed medical information, please read the article in Autoimmunity reviews6 (2015) Damoiseaux, Jan, et al.).

This table has a short list:

                      ANTIBODY              AUTOIMMUNE CONDITION
ANA Lupus, Scleroderma, Autoimmune Hepatitis, Sjogren’s Disease, Polymyositis, Dermatomyositis, Mixed Connective Tissue Disease, Juvenile Arthritis, Drug-induced Lupus.
Anti-Cyclic Citrullinated Peptide (Anti CCP) Rheumatoid Arthritis
Anti TPO & Anti Thyroglobulin Hashimoto’s Thyroiditis
Anti TSH Receptor Graves’ Disease
Anti-tissue transglutaminase (tTG) antibodies

Endomysial antibodies (EMA)

Deamidated gliadin peptide (DGP) antibodies

(IgA & IgG tests)

Celiac Disease

 

 

Islet Cell Cytoplasmic Autoantibodies (ICA) & Glutamic Acid Decarboxylase Autoantibodies (GADA) Type 1 Diabetes, Late Autoimmune Diabetes of the Adult(LADA).

WHAT IS THE DIFFERENT ABOUT THE FUNCTIONAL AND METABOLIC MEDICINE APPROACH?

Fig 1: Functional & Metabolic Medicine approach versus Conventional Approach:Fork in the road.

Slide1
Fig 1

WHAT SHOULD YOU DO?

  • Meet a practitioner who understands the Functional & Metabolic Medicine approach to autoimmunity. There are no pharmaceutical drugs that can be used to prevent autoimmune diseases before they develop.
  • Stop smoking (Easier said than done!). Exposure to cigarette smoke has been associated with higher risk of Rheumatoid Arthritis in those susceptible to it.
  • Reduce toxic exposure.
  • Reduce inflammation.
  • Manage stress.
  • Maintain adequate Vitamin D3 levels (Vitamin D)

REFERENCES

  • Avouac, Jérôme, Laure Gossec, and Maxime Dougados. “Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review.” Annals of the rheumatic diseases7 (2006): 845-851.
  • Catrina, Anca I., et al. “Lungs, joints and immunity against citrullinated proteins in rheumatoid arthritis.” Nature Reviews Rheumatology 11 (2014): 645-653.
  • Damoiseaux, Jan, et al. “Autoantibodies 2015: From diagnostic biomarkers toward prediction, prognosis and prevention.” Autoimmunity reviews6 (2015): 555-563.
  • Nielen, Markus MJ, et al. “Increased levels of C‐reactive protein in serum from blood donors before the onset of rheumatoid arthritis.” Arthritis & Rheumatism 8 (2004): 2423-2427.
  • Notkins, Abner Louis. “New predictors of disease.” Scientific American3 (2007): 72-79.

VITAMIN D AND AUTOIMMUNITY

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In recent years vitamin D deficiency has become like an epidemic all over the world. Besides autoimmunity, low vitamin D is associated with many diseases like heart disease, diabetes, cancer, hypothyroidism and many more. In fact, almost every cell in your body has vitamin D receptors.

There are 2 forms of vitamin D3 that you need to keep in mind. The one that is usually tested by most practitioners is Vitamin D3. Your body has to convert Vitamin D3 to the active form 1,25 Dihydroxyvitamin D3[1,25(OH)2 D3]. Most of you are familiar with the action of vitamin D in protecting your bones and maintaining blood calcium levels—the “classical” actions of vitamin However, scientific studies in the last several years have shown that vitamin D has several other actions as well—the “non-classical” actions. These are the actions of vitamin D on bone marrow, immune system, breasts, prostate, heart, muscles and intestine. With respect to autoimmune disease, the immunomodulatory (affecting your immune system) actions of Vitamin D are very important.

Vitamin D has the effect of increasing the activity of the innate immune system while restraining the activity of the adaptive immune system. (Chapter 9). This is the reason why adequate vitamin D3 levels are important for treating and perhaps preventing autoimmune diseases. A substantial number of studies have shown an association between low vitamin D and increased incidence of autoimmune diseases like Rheumatoid Arthritis(RA), Multiple Sclerosis(MS), Psoriasis, Inflammatory Bowel Disease (IBD), Type 1 Diabetes, Sjogrens, Lupus and many more. One example that is often cited is the increasing incidence of MS as one moves away from the equator. This is thought to be related to lesser sun exposure at higher latitudes than at the equator.

1,25 DIHYDROXYVITAMIN D3.

In autoimmune conditions sometimes measuring only vitamin D3 levels may not be enough. A few scientific studies have shown that some people with autoimmune disease have high levels of 1,25 Dihydroxyvitamin D3. This is why sometimes we need to measure both the forms of vitamin D. I remember quite a few occasions when my patients (In India) have called me to say that the lab technician has informed them that “no doctor advises this (1,25 OH)2 D) test” so it is unnecessary!

WHY DO PEOPLE BECOME VITAMIN D DEFICIENT?

Humans obtain vitamin D from either food (fortified), supplements or sunlight exposure. Your blood vitamin D levels depend on several factors.

Air quality: Excessive carbon particles in air from burning of fossil fuels may reduce the amount of vitamin D producing UVB rays from reaching your exposed skin.

Skin color: People with dark skin require about 10 fold more exposure to sunlight to produce the same amount of vitamin D as people with lighter skin color.

How much of your skin is exposed? The more bare skin the bigger the surface area of absorption of sunlight.

Use of sunscreens: Though theoretically use of sun screens can block the UVB rays, rarely do people use adequate quantities of sunscreen to bar all UVB from reaching their skin.

Gut Health: If you have unhealthy gut or you have inflammatory bowel disease (IBD), your absorption of vitamin D from supplements is poor.

Liver and Kidney Health: Some types of liver disease may affect bile production. This can affect vitamin D function. In chronic kidney disease (CKD) the vital step of conversion of vitamin D to its active form is affected and this can lead to severe vitamin D deficiency. This is why patients with CKD have their 1,25 Dihydroxyvitamin D3 measured regularly.

Vitamin D receptor (VDR): If you have a genetic variation in VDR you may need a higher dose of vitamin D supplementation.

How much vitamin D3 you take will decide your blood levels of the vitamin. Very low or very high doses, may both be detrimental unless you monitor regularly.

HOW MUCH VITAMIN D SHOULD YOU TAKE AS A SUPPLEMENT?

How much supplementation of vitamin D you need depends on what your blood reports show. It may not be the same dose for everyone because of individual variations. However, it is a much better idea to take a smaller dose (4000-5000 IU) every day rather than a very high dose once a week or once a month. Sometimes a larger dose may be necessary for a short period of time until your blood levels are in the optimal range.

Ideally you should get your vitamin D from sensible sun exposure AND supplementation.

 WHAT IS MOST IMPORTANT ABOUT VITAMIN D AND AUTOIMMUNE CONDITIONS?

Low vitamin D levels have been associated with many autoimmune conditions like

Rheumatoid Arthritis (RA), Multiple Sclerosis(MS), Psoriasis, Inflammatory Bowel Disease (IBD), Type 1 Diabetes, Sjogrens, Lupus and many more. This is because vitamin D affects your immune system function.

Maintaining adequate vitamin D levels may be a major way to prevent developing autoimmune disease. In fact, studies have shown that maintaining adequate vitamin D levels during childhood can prevent the development of Type 1 Diabetes by 29%! This is true for several other autoimmune conditions as well.

If you already have an autoimmune condition maintaining adequate vitamin D levels will make a major difference to how you heal the disease.

Some of you  may need to measure both vitamin D3 and 1,25 Dihydroxyvitamin D3.

DO YOU KNOW IF YOU HAVE HASHIMOTO’S THYROIDITIS?

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THYROID OVERVIEW

The thyroid gland is a butterfly shaped gland situated at the base of the neck. It is a part of a large network of glands comprising the endocrine system. The thyroid gland produces hormones that regulate metabolism, growth and development. Thyroid diseases occur when the gland produces either too little hormone (hypothyroidism) or too much hormone (hyperthyroidism).

The most common thyroid diseases are:

  • Hashimoto’s Thyroiditis
  • Grave’s Disease
  • Goiter
  • Thyroid Nodules

Hashimoto’s Thyroiditis (HT) and Graves’ Disease (GD) are Autoimmune Thyroid Disorders (AITD). Autoimmune conditions develop when your own immune system considers your own tissue as harmful foreign invaders that need to be destroyed.

HASHIMOTO’S THYROIDITIS

This is also known as chronic lymphatic thyroiditis and is the commonest cause of hypothyroidism worldwide. Some of you may have it but not know it because, you have not been tested for Thyroid Antibodies. A regular thyroid test done by most practitioners does not include an Anti TPO or Antithyroglobulin Antibody (Anti TG) test. The main reason being that in conventional medicine there is nothing much that can be done to reduce the antibodies apart from prescribing Levothyroxine (Synthroid/Eltroxin/Thyronorm). However, this is where the Functional and Metabolic Medicine approach differs. We know that when we address gut health, nutrient depletions, your HPA Axis dysfunction (Dysregulated Stress response), reduce toxic exposure, maintain adequate Vitamin D3 and help you make lifestyle changes, antibodies to many autoimmune conditions either reduce or disappear. Am I suggesting that you should stop your thyroid medications? Definitely not! However, the amount of medication that you need may be less. Some of you will still need lifelong thyroid medication if your immune system has destroyed most of your normal tissue or you have been diagnosed late.

Symptoms of hypothyroidism:

  • Fatigue
  • Weight gain
  • Depression
  • Anemia
  • Cold feet & palms
  • High cholesterol
  • Lack of motivation
  • Slow movements
  • Hoarse voice
  • Loss of libido
  • Ringing of the ears
  • Hair loss
  • Palpitations
  • Breathlessness
  • Intolerance to heat or cold
  • Carpal Tunnel syndrome
  • Loss of outer third of eyebrow
  • Memory loss
  • Poor concentration
  • Loss of drive
  • Mood swings
  • Irregular menstruation
  • Infertility
  • Constipation
  • Goiter (enlarged thyroid)

THYROID HORMONE SYNTHESIS

The two most important hormones produced by the thyroid gland are tetraiodothyronine (thyroxine or T4) and triiodothyronine (T3).

HYPOTHALAMIC-PITUITARY-THYROID (HPT) AXIS 

Slide1

As shown in the picture, the thyroid gland is influenced by two other hormones.

  • Thyroid Releasing Hormone (TRH) from the hypothalamus in the brain and
  • Thyroid Stimulating Hormone (TSH) from the pituitary gland, located at the base of the brain.

The hypothalamus, pituitary and thyroid glands along with the hormones they produce are together called the Hypothalamic-Pituitary-Thyroid (HPT) Axis. The thyroid gland produces T4 and some T3. The more active form of the hormone is T3. The conversion of T4 to T3 happens mostly in liver, kidneys and brain. Most of the thyroid hormones are bound to thyroid binding globulin (TBG). It is the unbound form of the hormones, the Free T3 and Free T4 that are important for thyroid hormone actions. This is why measuring only TSH, Total T3 & Total T4 do not provide an accurate picture of thyroid function.

If thyroid hormone levels are low in the blood, the hypothalamus and pituitary detect this.TRH released from the hypothalamus stimulates the pituitary to produce TSH, which in turn acts on the thyroid gland to produce thyroid hormones.TSH levels can go up if adequate thyroid hormones are not produced as a result of autoimmune destruction of thyroid tissue or because of nutritional deficiencies, like iodine deficiency.

There are few enzymes called deiodinases which are important for activation and inactivation of T4. One of them called the DIO2 (Type2 Deiodinase), which is present in the brain, is very important for thyroid hormone actions. This is relevant in thyroid hormone replacement (Ref Chapter 7).

FUNCTIONS OF THYROID HORMONES:

It is likely that every cell in the body is a target for thyroid hormones. The most important functions are:

Lipid Metabolism: Thyroid hormones are important for lipid metabolism. This is the reason for raised cholesterol and triglyceride levels when your thyroid function is deficient. Thyroid hormones are also important for carbohydrate metabolism.

Brain Development in the fetus is dependent on the mother’s thyroid function. This is the reason for checking thyroid function before contemplating a pregnancy. Normal thyroid hormone levels are also important for normal development of children.

Reproduction: Thyroid dysfunction can lead to infertility in some people.

Cardiovascular System: Thyroid hormones increase heart rate, contractility and cardiac output.

Central Nervous System: Thyroid hormones are intimately associated with mental state. In fact, about 20 % of people with depression may have undiagnosed hypothyroidism.

FACTORS AFFECTING THYROID FUNCTION

  • Iodine
  • Iron
  • Zinc
  • Selenium Vitamins A, B complex, C, D& E
  • Tyrosine
  • Stress
  • Inflammation
  • Drugs like lithium, amiodarone.
  • Heavy metal toxicities
  • Pesticides
  • Exposure to Endocrine Disruptors like Bisphenol-A
  • Infections
  • Trauma

THYROID FUNCTION TESTS:

Below is a list of thyroid function tests. All the tests may not be necessary for all of you. However, this is a decision to be made by you in consultation with a knowledgeable doctor.

  • TSH
  • Free & Total T3
  • Free & Total T4
  • Anti TPO & Anti Thyroglobulin Antibody (For Hashimoto’s Thyroiditis)
  • Anti-TSH receptor Antibody (For Graves’ Disease)
  • Thyroglobulin
  • Thyroid Binding Globulin
  • rT3
  • Tests for nutrient depletions like Iron,vitamin D3, Selenium,Zinc, Iodine etc.
  • Tests for heavy metal toxicities

TRH is usually not tested for because the TSH test is sufficiently sensitive.

TREATMENT : Please check my previous post:http://www.betterforlife.in/blog/2016/05/thyroid-hormone-replacement-only-t4-or-a-combination-of-t3-and-t4/

ACTION STEPS:

  1. Get the right tests done. If you have not been tested for thyroid antibodies, you DO NOT KNOW whether you have Hashimoto’s Thyroiditis (Autoimmune Thyroid Disease)
  2. Do not stop or reduce your thyroid medications without discussion with a knowledgeable doctor.
  3. Maintain adequate Vitamin D3 levels
  4. Check for nutrient depletion.
  5. Maintain good gut health.
  6. Look for anemia.
  7. Reduce your toxic burden
  8. Address your dysregulated stress response.