Hypothyriodism |
1. INTRODUCTION
In our treatment of thyroid disorders, including hypothyroidism, hyperthyroidism, goiter, thyroiditis and thyroid eye disease, I use a combination of acupuncture, herbs, supplements, diet and lifestyle recommendations. None of the treatment modalities we employ can cure thyroid disorders but we believe our treatments can help with symptom management and with some of the side effects of the conventional medications used for thyroid disorders. We recommend that anyone wishing to use complementary and alternative medicine (CAM) to consult with their physician before using any CAM therapy.
Medications, such as Armour Thyroid and Synthroid have been developed that treat hypothyroidism favorably. The majority of people with hypothyroidism should be using one of these medications under the supervision of a physician with expertise in treating thyroid disorders. We realize that thyroid disorders constitute a very complicated disease process and we sincerely hope the following article helps clarify the role that our treatments can play in helping people with thyroid disorders to have a better quality of life.
2. THE THYROID GLAND AND THYROID HORMONE METABOLISM
Located just below and on either side of the larynx, the cells of the thyroid glands manufacture T4 (thyroxine) and T3 (triiodothyronine). Together they are known as thyroid hormones. The thyroid gland is the only gland, which stores its secretory product in large quantities, normally about a 10 day supply. T3 and T4 are synthesized by attaching iodines to the amino acid tyrosine, stored for some period of time and then secreted into the blood. Thyroid stimulating hormone (TSH) stimulates most of the steps. T4 normally is secreted in greater quantity than T3 but T3 is several times more potent. Moreover as it circulates in the blood and enters cells throughout the body, most T4 is converted into T3 by removal of one iodine. T3 is the more active of the two forms. The thyroid gland also produces another hormone known as rT3 or reverse T3 (3,3’,5’-triiodothyronine). The synthesis of the thyroid hormones requires the amino acid tyrosine and the trace mineral iodine.
Thyroid hormones regulate: 1) oxygen use and basil metabolic rate, 2) cellular metabolism and 3) growth and development. The secretory activity and size of the thyroid gland are by: 1) the level of iodine in the thyroid gland and 2) by negative feedback systems involving both the hypothalamus and the anterior pituitary. Although needed for synthesis an abnormally high concentration of thyroid iodine suppresses release of thyroid hormones.
Low levels of T3 stimulate the hypothalamus to secrete thyrotropin releasing hormone (TRH) and the anterior pituitary to secrete TSH. TRH also stimulates the anterior pituitary to secrete TSH. Then TSH stimulates virtually all aspects of thyroid gland activity. The thyroid gland releases T3 and T4 until the metabolic rate returns to normal. Conditions that increase ATP demand – a cold environment, hypoglycemia, high altitude, pregnancy – also trigger this negative feedback system and increase the secretion of the thyroid hormones.
In a case study described by Hyman and Liponis in their book, Ultra-Prevention, they note that Synthroid requires activation or conversion by the body to the active form of thyroid hormone (T3) which the body actually uses. Most people are able to make this conversion. However, some people can not. This may be due to a nutrient deficiency (e.g. inadequate selenium) or a hormonal issue (e.g. taking the birth control pill) or for genetic reasons. They feel that the solution is to give a different medication that contains the active thyroid hormone T3 such as Cytomel, Thyrolar or Armour thyroid. Thyroid extracts, such as Armour thyroid, Westhroid and Naturethyroid, contain two biologically active hormones (thyroxine and triiodothyronine), whereas the most commonly prescribed thyroid-hormone preparations contain only thyroxine. Cytomel is simply pure T3 and Thyrolar is a synthetic T4/T3 drug.
3. WHAT IS HYPOTHYROIDISM?
Hypothyroidism is caused by an underproduction of thyroid hormone. Symptoms include fatigue, loss of appetite, inability to tolerate cold, a slow heart rate, weight gain, painful premenstrual periods, fertility problems, a milky discharge from the breasts, muscle weakness, muscle cramps, dry and scaly skin. The illness develops slowly, and early symptoms such as fatigue, lack of zest, and sensitivity to cold may be attributed to other sources, such as stress. Hashimoto’s thyroiditis is the most common autoimmune disorder that causes hypothyroidism. In it’s normal course, it begins with an episode of hyperthyroidism, which spontaneously converts to hypothyroidism.
According to researchers the incidence of tinnitus (ringing in the ears) can be correlated to the severity of hypothyroidism. Light-headedness, dizziness and vertigo can also be symptoms of hypothyroidism.
4. WHAT IS HYPERTHYROIDISM?
Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone, resulting in an overactive metabolic state. Hypersecretion of thyroid hormones increases oxygen use by body cells, elevates heat production, and increases food intake. Common symptoms include increased metabolic rate, a constant feeling of being hot, increased perspiration, weight loss despite a good appetite, hair loss, insomnia, rapid heart beat, goiter, tremor of extended fingers, nervousness and sometimes protruding eyeballs. The most common form of hyperthyroidism is Grave’s disease, which is an autoimmune disorder, and which affects about 2.5 million Americans. The person produces antibodies that mimic the action of TSH but are not regulated by the normal negative feedback controls. As a result the thyroid gland is continually bombarded with stimulation to grow and produce thyroid hormones. Grave’s patients often have a condition called exophthalmos, or thyroid eye disease, which cause the eyes to protrude.
Hyperthyroidism follows a course similar to many inflammatory autoimmune disorders, that is, with periods of flare-ups and remission; whereas hypothyroidism appears to follow a steadier course. The excess production of thyroid hormones in hyperthyroidism speeds up all body processes, and also malabsorption occurs. As a result, all nutrients in the body are depleted at a greater rate. The diet should therefore be increased in all nutrients.
5. CHINESE MEDICAL VIEW OF HYPOTHYROIDISM
The most common Chinese Medical patterns seen in hypothyroidism are:
Spleen Yang Deficiency which manifests as tiredness, muscular weakness, sallow complexion, poor appetite, feeling of cold, cold limbs, dislike of speaking and loose stools.
Kidney Yang Deficiency which manifests as extreme tiredness, exhaustion, listlessness, mental depression, lack of will power, no desire to go out, soreness of the lower back, frequent pale urination, bright white complexion, feeling of cold, cold limbs especially of the legs, diarrhea, weak knees, lack of sexual desire in both men and women.
Phlegm which manifests as tiredness, lethargy, a slight feeling of dizziness, a feeling of heaviness of the body and cloudiness of the mind, numbness and chronic catarrh.
Liver Qi Stagnation which manifests as melancholy, moodiness, depression, fluctuation of mental state, nausea, vomiting, epigastric pain, unhappiness, irregular periods, painful periods PMS and irritability.
Blood Deficiency which manifests as dizziness, poor memory, numbness, blurred vision, insomnia, sallow complexion, amenorrhea or scanty periods, depression, anxiety or lack of spirit of initiative, and in severe and long standing cases, dry tongue, dry skin, dry hair and withered nails.
6. CHINESE MEDICAL VIEW OF HYPERTHYROIDISM
Hyperthyroidism is thought by some Chinese medical doctors to start with an excess fire syndrome which later becomes yin deficiency fire. Several hyperthyroid symptoms such as heart palpitation, general hyperactivity, excessive perspiration, heightened appetite, aversion to heat and in more severe cases, wasting of the muscles are characteristic of a Yin deficiency syndrome.
Masses and nodules are often described in Chinese medicine in terms of entangled qi, accumulated phlegm and static blood. Because of their location just over the lungs they are described as being primarily phlegm masses. There is general agreement that ultimately the Yin gets damaged and must be replenished and that the thyroid swelling due to Phlegm excess, must be resolved.
Some of the Chinese medical patterns mentioned in the Chinese literature for hyperthyroidism are:
Disturbance of Qi by Sorrow and Anger involves a weakening of the Stomach and Spleen Qi (which may be the result of emotional factors or diet) produces Turbid and Moist substances, which are raised to the thyroid area by the stimulus of excess Liver Qi. It manifests as swelling in the neck and protrusion of the eyes.
Liver Qi Stagnation causes the fluids to accumulate and transform into Phlegm which then obstructs the neck with Qi and gradually induces goiter. Lingering Liver Qi transforms into fire, which is manifested in fidgeting and irritability. If the fire consumes body fluids and stomach Yin the resulting Yin Deficiency produces heat. Liver Qi Stagnation manifests as melancholy, moodiness, depression, fluctuation of mental state, nausea, vomiting, epigastric pain, unhappiness, irregular periods, painful periods PMS and irritability.
Heart Yin Deficiency which manifests as palpitations or severe palpitations with fear, fidgeting, forgetfulness, insomnia and profuse sweating.
Deficiency of Qi and Kidney Fluids causes insufficiency of water, which leads to excessive heat, which in turn harms the vital energy. Excessive heat also hurts the Yin and often involves the Heart, Liver and Stomach.
Spleen Yang Deficiency causes indigestion and loose stools, and produces Phlegm, which goes up to the neck and causes the enlarged thyroid or nodules, or goes to the eyes to induce exophthalmos.
Liver Fire Flaring Up which manifests as irritability, propensity to outbursts of anger, high-pitched tinnitus, deafness, temporal headache, dizziness, red face and eyes, thirst, bitter taste, dream-disturbed sleep, constipation with dry stools, vomiting of blood, coughing of blood and nose bleeds.
Damp Phlegm which manifests as expectoration of very profuse phlegm which is white and sticky, no appetite, no thirst, a feeling of stuffiness of the chest and epigastrium, swellings and lumps and joint problems.
Kidney Yin Deficiency and Liver Yin Deficiency which manifests as dull occipital or vertical headache, insomnia, sallow complexion, dream-disturbed sleep, numbness of limbs, flushed cheeks, dizziness, dry eyes, blurred vision, propensity to outburst of anger, soreness of the low back, dry throat, tinnitus, night sweats, feeling of heat in the palms and soles, difficult-dry stools, scanty menstruation or amenorrhea, delayed cycles and infertility in women.
7. GOITER
Definition of goiter
Goiter is an enlargement of the thyroid gland. It can be caused by an iodine deficiency, by eating foods that contain goitrogens (goiter-causing substances), of by other disorders that interfere with thyroid hormone production. Some people with goiter also have hypothyroidism.
Foods recommended for goiter
Clam, kombu, kelp and seaweeds in general. Seafoods like kelp, seaweeds, clam, oysters, sardines and other saltwater fish are nature’s richest source of iodine.
Foods to be avoided in case of goiter
Foods, known as goitrogens, interfere with the absorption of iodine, and should be avoided by those who have goiter. These foods include: rapeseed (used to make canola oil), Brussel sprouts, cauliflower, turnips, cassava root, cabbage, mustard, soybeans, millet, sweet potatoes, maize, lima beans, peanuts and pine nuts. Cooking usually inactivates goitrogens.
Relation between iodine and goiter
Thyroid hormones are made from iodine and the amino acid tyrosine. A deficiency of iodine results in the development of a goiter. The recommended daily allowance (RDA) for iodine is 150 micrograms. One gram of table salt contains 70 micrograms of iodine. Too much iodine, however, can actually inhibit thyroid gland synthesis. Excessive iodine intake can result in either hypothyroidism or hyperthyroidism. Therefore it is recommended that dietary levels or supplementation of iodine not exceed 1 milligram per day for any length of time.
Could long-term use of iodine-containing foods cause hyper or hypothyroidism?
The opinion of a California acupuncturist cited by Dharmananda in his Thyroid Disease article was that patients suffering from hyperthyroidism should avoid iodide-containing foods because iodine provides the “substrate for increased thyroxine production which, over the long term, may delay or counteract the effectiveness of herbal therapy (TCM) or antithyroid therapy (Western medicine)…” No supporting research, however, was mentioned in making this statement. Two other studies were reviewed which also considered iodine to be potentially harmful by worsening hyperthyroidism. In contrast, however, more than a dozen clinical trials using iodine-containing ingredients claim a high level of positive responses. Nevertheless it behooves one to be alert to the possible ill effects of iodine-containing foods or herbs in cases of hyperthyroidism.
According to the Health Concerns article on Hypothyroidism excessive iodine intake can result in either hypothyroidism or hyperthyroidism. Sources of iodine include foods (iodized salt, milk, water, seaweed, ground beef) dietary supplements drugs and solutions used in certain lab tests. Many nutritional supplements contain 150mcg of iodine. While that amount of iodine should prevent a deficiency, it is not clear whether supplementing with iodine is necessary or desirable for most people.
8. RECOMMENDED FOODS FOR HYPOTHYROIDISM
Primarily grains, vegetables, seaweeds, legumes, sprouts, herbs, micro algae, omega-3 and GLA foods and oils, and small amounts of spices. Include some raw vegetables or sprouts if desired, but most food should be cooked, either moderately for those with signs of severe coldness or deficiency or cooked lightly for all others. Seaweeds are taken unless there is diarrhea. Non-acidic fresh fruits (not their juices) should be taken in moderation. Supplementation with fish or other animal products such as eggs is useful. Proportions of foods in the daily diet: 45% grains, 35% vegetables, 10% fruit, 5% beans and other legumes, 5 % other recommended foods. Also include molasses, egg yolks, parsley, apricots, dates, prunes, fish or chicken, raw milk and cheeses. Drink distilled bottled water only.
9. FOODS TO AVOID IN HYPOTHYROIDISM
Broccoli, turnips, cabbage, mustard greens, cassava root, kale, soybeans, peanuts, pine nuts and millet. These foods contain goitrogenous chemicals, which disrupt the body's ability to use iodine. Cooking usually inactivates goitrogens. Eat only moderate amounts of peaches, pears, spinach, and Brussel sprouts. If you have severe symptoms omit these foods entirely. Avoid processed and refined foods, including white flour and sugar.
Avoid fluoride (including that found in toothpaste and tap water) and chlorine (also found in tap water). Chlorine, fluoride and iodine are chemically related. Chlorine and fluoride block iodine receptors in the thyroid gland, resulting in reduced iodine-containing hormone production and finally in hypothyroidism.
Because garlic may reduce iodine uptake, it should not be used by persons with hypothyroidism.
10. RECOMMENDED FOODS FOR HYPERTHYROIDISM
Eat plenty of broccoli, Brussel sprouts, cabbage, cauliflower, kale, mustard greens, peaches, pears, rutabagas, soybeans, spinach and turnips. These help to suppress thyroid hormone production.
11. FOODS TO AVOID IN HYPERTHYROIDISM
Avoid dairy products for at least three months. Also avoid stimulants, coffee, tea, nicotine, alcohol and soft drinks because all these increase the metabolic rate.
12. RESEARCH SHOWING THE EFFICACY OF CHINESE HERBS IN TREATING THYROID DISEASES
According to Subhuti Dharmananda in his article “Treatments for Thyroid Disease with Chinese Herbal Medicine” the basic herbal treatment for hypothyroidism is to administer Qi and Yang tonics. In one study published by Kuang Ankun et al in 1988, which he reviews, it was found that the Chinese herbs improved clinical symptoms, reduced cholesterol and thyroid-stimulating hormone levels, and increased T3 and T4. The addition of thyroxine (at 60mg/day) gave even better results.
A study using Chinese herbs on people with hypothyroidism published by Zha in 1993 is cited by a Health Concerns website article on Hypothyroidism. In his study Zha found that after one year, symptoms of hypothyroidism were markedly improved and blood levels of thyroid hormones had significantly increased
Dharmananda reviewed another study published by Chagdu and Peili in 1990 involving 22 patients suffering from hypothyroidism. 17 had their clinical symptoms eliminated and the T3, T4 and TSH levels returned to normal. The other 5 patients showed partial improvement in both symptoms and laboratory values. Thyroxine tablets were also provided as needed during the two months treatment period.
The results of a study published by Ziyou and Haifa in 1992 on 38 patients with Hashimoto’s thyroiditis reviewed by Dharmananda showed that among the group treated with Chinese herbs 55% of those with hyperthyroid conditions and 93% of those with hypothyroid conditions had normal thyroid levels following treatment. There was no significant difference between this outcome and the results of using Western medicine in the control group.
13. RESEARCH SHOWING THE EFFICACY OF ACUPUNCTURE IN TREATING THYROID DISEASES
A clinical study was published in 1988 by Guo Xiaozong et al and reviewed by Dharmananda in his article on Thyroid Diseases. In the study acupuncture was used to treat benign thyroid nodules (thyroid adenoma, nodular goiter, or cystic goiter, but not thyroid carcinoma or thyroiditis). The acupuncture treatment revealed a long-term effective rate of 90% in resolving the nodules. Nearly half of the individuals were cured (measured by palpation of the neck and by ultrasonography), and most of the remaining individuals showed marked improvement.
14. NUTRITIONAL SUPPORT FOR HYPOTHYROIDISM
Desiccated thyroid or thyroid extract - To replace deficient thyroid hormone. Available by prescription only. At this time it appears that thyroid hormone replacement is necessary in the majority of people with hypothyroidism. Naturopathic physicians prefer the use of desiccated natural thyroid complete with all thyroid hormones. Armour Thyroid is an example of thyroid extract. It contains two biologically active hormones (thyroxine and triiodothyronine) whereas most commonly prescribed thyroid-hormone preparations contain only thyroxine. One study done by Bunevicius et al in 1999 and published in the New England Journal of Medicine shows that the combination of the two hormones contained in desiccated thyroid is more effective than thyroxine alone for those with hypothyroidism.
Vitamin A – is necessary for the proper metabolism of iodine. It is also important for the function of the pituitary gland, which secretes a substance that regulates the thyroid. Vitamin A is also needed for proper immune function and for healthy eyes, skin and hair. According to research cited in a Health Concerns website article, people with hypothyroidism have been shown to have an impaired ability to convert beta-carotene to vitamin A. For this reason, some doctors suggest taking supplemental vitamin A (approximately 5,000-10,000 IU per day) if they are not consuming adequate amounts in their diet. Food sources include liver, fish liver oils, green and yellow fruits and vegetables, apricots, asparagus, beet greens, broccoli, cantaloupe, carrots, collards, dandelion greens, dulse, garlic, kale, mustard greens, papayas, peaches, pumpkin, red peppers, spirulina, spinach, sweet potatoes, Swiss chard, watercress and yellow squash.
L-Tyrosine - Low plasma levels have been associated with hypothyroidism. The synthesis of the thyroid hormones requires the amino acid tyrosine. Note: Take with water or juice. Do not take with milk. Take with 50 mg vitamin B6 and 100 mg vitamin C for better absorption.
Vitamin B2 (riboflavin) – is necessary for normal thyroid hormone manufacture, for red blood cell formation, cell respiration, growth, antibody production, etc. Food sources include cheese, egg yolks, fish, legumes, meat, milk, poultry, spinach, whole grains and yogurt; asparagus, avocados.
Vitamin B3 or (niacin) – is necessary for normal thyroid hormone manufacture, aids in the functioning of the nervous system and is a memory enhancer. Food sources include avocados, brewer's yeast, broccoli, carrots, dates, eggs, figs, fish, peanuts, potatoes, prunes, tomatoes, wheat germ and whole wheat products.
Vitamin B6 (pyridoxine) - is necessary for normal thyroid hormone manufacture, is required by the nervous system and is needed for normal brain function. It is involved in more bodily functions than almost any other single nutrient. Food sources include: brewer's yeast, carrots, chicken, eggs, fish, peas, spinach, sunflower seeds, walnuts, and wheat germ.
Vitamin B12 - aids folic acid in the production of red blood cells. It is also required for proper digestion, absorption of foods, the synthesis of protein and the metabolism of carbohydrates and fats. In animals, a tissue vitamin B12 deficiency was associated with a slight reduction of type I5’-deiodinase activity in liver and with a significant reduction of the T3 level in serum. Use a lozenge or sublingual form for best absorption. Food sources include: Brewer's yeast, clams, eggs, herring, mackerel, dairy products, meat and fish; also dulse, kelp, kombu and nori.
Vitamin B Complex - B vitamins improve cellular oxygenation and energy and are needed for proper digestion, immune function, red blood cell formation and thyroid function. Particular attention should be given to vitamin B complex in cases of hyperthyroidism because it is needed for the metabolism of the extra carbohydrates and protein.
Vitamin C – is necessary for normal thyroid hormone manufacture, for immune function and for stress hormone production. Caution: Do not take extremely high doses of Vitamin C - this may affect the production of thyroid hormone. Food sources include berries, citrus fruits, green vegetables, asparagus, avocados, Brussel sprouts, cantaloupe, collards, kale, mangos, onions, papayas, green peas, persimmons, pineapple, spinach, strawberries and tomatoes.
Vitamin E – increases the absorption of iodine and is an important antioxidant that improves circulation and immune response. Persons suffering from hyperthyroidism need to be aware that excessive amounts of Vitamin E may stimulate the thyroid gland. Food sources include cold pressed vegetable oils, dark green leafy vegetables, legumes, nuts, seeds and whole grains; also brown rice, dulse, eggs, kelp, flaxseed, oatmeal, cornmeal, sweet potatoes, watercress, wheat and wheat germ.
Essential Fatty Acids - Necessary for proper function of the thyroid gland. Note: You need to take a Vitamin E supplement when taking essential fatty acids.
Zinc functions together with vitamin E and vitamin A in the manufacture of thyroid hormone. In animal studies zinc deficiency, although having no impact on T4 concentrations, resulted in an approximately 30% decrease in levels of serum T3 and fT4. Food sources include pumpkin seeds, squash seeds, sunflower seeds, seafood, oysters (the highest), crabmeat, herring, organ meats, mushrooms, brewer’s yeast, soybeans, eggs, wheat germ, meats, liver and turkey.
Selenium Available animal and human evidence strongly supports a relationship between altered thyroid hormone metabolism and selenium deficiency, although evidence also suggests high intakes of selenium might exert a detrimental influence on thyroid hormone metabolism. Food sources include tuna, herring oysters, clams, chicken liver, brewer’s yeast, wheat germ and bran, whole grains, wheat flour, puffed wheat, sesame seeds, Brazil nuts and sunflower seeds.
15. LIFESTYLE RECOMMENDATIONS
Daily aerobic exercise for 15 to 20 minutes. Exercise stimulates thyroid gland secretion and increases tissue sensitivity to thyroid hormone.
Do not smoke. Researchers have found that smoking is associated with Grave’s disease and it especially increases the risk for the development of more severe ophthalmopathy. If you are a smoker you also have an increased risk of hypothyroidism. Cigarettes contain thiocyanate, a chemical that adversely affects the thyroid gland and acts as an anti-thyroid agent. Researchers have found that smoking may increase the risk of hypothyroidism in patients with Hashimoto’s thyroiditis.
Multiple chemical sensitivities may play a role in hypothyroidism. According to studies cited in the Health Concerns article on Hypothyroidism preliminary studies have found an association between multiple chemical sensitivities and hypothyroidism. One study found a correlation between high blood levels of lead and low thyroid hormone levels in people working in a brass foundry. Occupational exposure to polybrominated biphenyls and carbon disulfide has also been associated with decreased thyroid function.
Watch your alcohol consumption. Alcohol intake may play a role in thyroid disease. A study done by Keck et al in 1988 and reviewed by Kelly in his Thyroid Metabolism article found that among patients with alcohol-induced liver cirrhosis, low T3 and T4, elevated rT3 (reverse T3), and normal TSH values have been observed. In these subjects an abolished circadian rhythm and elevated cortisol levels have also frequently been observed.
Get plenty of good quality sleep. Sleep deprivation may play a role in thyroid hormone metabolism. Another study reviewed by Kelly found that the reported pattern of thyroid hormone response to a night of sleep deprivation included significant increases in T4, fT4, T3 and rT3.
According to an article by Gina Nick, PhD, ND in Townsend Letter for Doctors & Patients Feb/Mar 2005 p. 65 she states that "The synthesis of thyroxine requires H2O2. Therefore, suppression of ROS (reactive oxygen species) by superoxide dismutase, catalase and antioxidants must not be too effective. As always, careful, well-informed balance is the rule."
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