HYPOTHYROIDISMPREPARED BY: MOHAMMED S. EL-LULU

MASTER OF CLINICAL NUTRITION

PALESTINE - GAZA……………………………………………………………………………..

Botanical Medicine of Clinical Nutrition

Thyroid Gland (Generally)

Thyroid is a small gland found

in the middle of the lower neck

(below the larynx or Adam’s

apple).

Thyroid works with pituitary

gland which produces thyroid

stimulating hormone (TSH).

TSH stimulates the thyroid

gland to produce the thyroid

hormones, T3 and T4.

2

Thyroid system diagram3

Thyroxin Hormone4

Iodine, a trace mineral, is essential for the synthesis of

the thyroid hormones:

{thyroxine (T4) and triiodothyronine (T3)}.

T4:T3 = 10:1 (80-100µg of T4 & 10µg of T3/day).

20% of T3 derived directly from thyroid gland &

80% by conversion from T4.

Thyroid hormones regulate metabolism in every cell

of the body and play a role in virtually all

physiological functions.

Regulating thyroid hormones 5

When the amount of thyroid hormone in blood drops,

the pituitary gland secretes a hormone called thyroid-

stimulating hormone (TSH).

TSH then stimulates the thyroid gland to increase its

uptake of iodine from the blood, so that more

thyroxine (T4) can be synthesized.

When necessary, thyroxine is then converted to the

metabolically active triiodothyronine (T3), a process

that involves removing one iodine atom from T4.

Regulating thyroid hormones

T3 t1/2 ≈ 24-36 hrs.

Vd ≈ 40 L.

T4 t1/2 ≈ 6-7 days.

Vd ≈ 10 L

Iodine accounts for 65%

of the molecular weight of

T4 and 59% of the T3.

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Pharmacokinetics Mechanism

Physiological actions of Thyroxin hormones

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Potentiates brain development.

Increase heart rate.

Increase cardiac output.

Increase ventilation rate.

Thickens of endometrium in female.

Deficiency is the underlying problem responsible for

the high rate of cancer (particularly breast, lung,

prostate and ovary)

Symptoms

Complications

Classification

Goiter

Nutrients

Herbal remedies

Hypothyroidism8

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Hypothyroidism

Hypothyroidism is a thyroid problem caused by an

underactive thyroid gland that produces insufficient

amounts of thyroid hormones.

May also develop from pituitary deficiency.

More likely due to inborn error of thyroid gland.

Hypothyroidism is seen in both sexes, but is more

common in women.

In pregnant: new born is at risk of cretinism.

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Basic symptoms of hypothyroidism11

weight gain, dry skin and hair,

hoarse voice, fatigue,

cold intolerance and puffy facial feature,

but these symptoms are minor compared to theeffects thyroid deficiency can have on the bodysince every cell in the body needs thyroid hormone.

Because the symptoms may be varied and difficultto define, often simulate other conditions, manypeople with an underactive thyroid gland may becompletely unaware of the problem.

Complications12

Untreated condition, patient is at risk for:

diabetes,

high blood pressure,

emphysema,

arthritis,

depression,

recurrent infections,

and migraine.

Classification of Hypothyroidism

Primary (1ry): due to

failure of the thyroid

gland itself

Secondary (2ry): due to

hypopituitarism

Tertiary (3ry): due to

failure of hypothalamus

Quaternary (4ry): due to

tissue insensitivity to

action of thyroid hormone

13

2ry

1ry

4ry

3ry

Goitrus Hypothyroidism14

Excess stimulation by TSH due to decreased

levels of circulating thyroid hormones, leads to

enlargement of thyroid gland; due to:

1- Iodine deficiency.

2- Certain anti-thyroid drugs.

3- Hashimoto’s thyroiditis: Immunological disorder

characterized by diffuse enlargement and

lymphocytic infiltration of the gland.

Natural Diet for Hypothyroidism -115

Essential fatty acids are anti-inflammatory and

necessary for hormone production. Take 1,000 to

1,500 mg flaxseed oil three times per day.

Seaweed, fish and algae should also be consumed

frequently. They are rich in iodine and essential

nutrients that maintain thyroid function balance.

Selenium rich foods as garlic and mushroom are

important for peripheral conversion of T4 to T3,

also regulate the amount of hormone produced.

Natural Diet for Hypothyroidism -216

Calcium & Magnesium:

Must be together. The optimal ratio is (3 Ca : 1 Mg).

Never supplement Ca without supplementing Mg,because the body will actually use its stored Mg toprocess the supplemented Ca.

Daily actions:

Try to do regular physical activity or exercise.

Hormone levels should be monitored on a regular basis.

Perform a daily thyroid self-massage. Gently stroke upand down the sides of the trachea.

Avoid anti-thyroid foods17

Foods that depress thyroid activity are broccoli,

cabbage, sprouts, cauliflower, kale, spinach, turnips,

soy, beans, and mustard greens.

These foods are rich in thiocyanates which have been

shown to interfere with iodine utilization by the

thyroid gland.

These foods should be included in the diet for

hyperthyroid conditions and avoided for

hypothyroid conditions.

Herbal remedies

Fucus vesiculosis

(Bladderwrack or kelp)

Avena sativa

(Green Oats)

Coleus forskohlii

(Makandi)

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Herbal content of Thyroid Assist™ Thyroid Assist™

Thyroid Assist™ Benefits19

Supports pituitary gland production of the thyroid

stimulating hormone (TSH).

Maintains T3 & T4 levels already within normal range.

Supports a balanced endocrine system.

Improves energy levels.

Maintains balanced metabolism and healthy weight.

Supports other functions of endocrine system for healthy

emotions, fertility, growth, temperature & performance.

Fucus vesiculosis (Bladderwrack or kelp)

Is a sea vegetable which is a prime source of iodine.

It has been used therapeutically for thousands of years, especially in Traditional Chinese Medicine.

Should be harvested from uncontaminated areas and screened for the presence of toxins and contamination.

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Avena sativa (Green Oats)

Is a general tonic traditionally.

Avena sativa can alleviate common nervous irritability.

It supports healthy sexual function.

Active ingredients are: saponins, flavonoids, minerals, alkaloids, steroidal compounds, Vitamins B1, B2, D, E, carotene and wheat protein.

21

Coleus forskohlii (Makandi)

Is Ayurvedic (Indian) remedy. Forskolinsupport thyroid hormone secretion.

Thyrotropin & Forskolinincrease the quantity of stimulatory guanine nucleotide-binding proteins in cultured thyroid follicles.

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How to not save money?

Just go to doctor.

Case Study

Assessment (anthropometrics) 24

Sex: Female

Age: 26

Height:1.62 m

Weight: 63 Kg

Body mass index: 24

Married and has 3 kids (normal birth).

Teacher, seasonally (Job creation)

Socio-economic status is growing slowly (satisfied)

Medical History25

Apparently healthy.

Before marriage, she suffered from acne for many

years, but the case turned for the better.

At last year 2010, she suffered from sore throat

more than 8 times.

She has a severe varicose veins in the 2 legs, with

accumulation of fluids around the right ankle.

She is quite in his life, no bad ideas about life.

Nutritional facts (a while)26

Good, healthy, natural, fresh, and not frozen foods.

The best beverage is water.

Fishes: 1-2 meals weekly.

Diary products: 1 cup daily of whole milk or yogurt.

Beans: 2 meals weekly and one eggs daily.

Vegetables: the table is rich daily especially sweet pepper,where the salad is essential dish at least 3 times weekly.

Crazy in seeds, nuts, chocolates, chips, and biscuits.

Very bad intake of fruits except cantaloupe and melon.

Red meat and poultry: very little.

Rice and breads alternate daily with 3 or 2 essential meals.

Not salty foods are preferred.

Complain (doctor visits)27

She complained from hard movement of neck.

Inadequate swallowing action.

Three swelling spots at right, center, and left of neck.

At primary health care center, a severe sore throatdiagnosed. And the treatment is Clarithromycin 500mg twicea day for 10 days, with Ibuprofen 400mg as need.

She encouraged to take thymus and chamomile as hot drink.

After 2 weeks the enlarged spots in left and center retainedto normal size, while the right one had remained.

In Shifa hospital after 4 months, examination by Ultra-Soundradiation of neck, the 3 spots remain even unseen.

Complain (doctor visits)28

The primary diagnosis was Goiter and lymphadenopathy.

The think of that was hypothyroidism.

She advised to get blood analysis (Thyroid markers- T4 & TSH,Calcium level, CBC, and chemistry).

Lab worker notices:

Hypothyroidism: Elevated TSH & Reduced T4

Subclinical Hypothyroidism: Elevated TSH & Normal T4

Calcium Ionized: 1.02 (1.07- 1.28 mmol/L)

TSH: 3.3 (0.4- 5.0) US normal level (0.3- 3.0), so it’s overactive.

T4: 8.0 (4.5- 12.5)

After that, tests as CBC, Cholesterol, Liver enzymes, Kidney functions,Blood glucose level and Lactate dehydrogenase were normal.

By CT test of neck and chest: the result indicated mild enlargementof thyroid gland and inflamed lymph node at right position of neck.

Analysis of obtained data 29

According to nutritional facts, she had a good dishes offood, but in fact she missed many nutrients due to verysmall serving and highly interesting in chips, chocolates,and biscuits.

Calcium level wasn’t sufficient so she needed Calciumsupplements as effervescent form.

Bad immunity is important target to improve, while therecurrent infections of throats haven’t changed.

Reduced calorie empty food can result in increasedamount of healthy foods, which supply essentialnutrients as Iodine, calcium, magnesium, omega 3, Vit-C,Vit-E, selenium, and many others.

Recommendations30

According to CT, & Ultra-Sound, an enlarged lymph

node at right neck should be removed by surgery.

According to the level of TSH which indicated high

level according to new US scale, and normal level

of T4, the case advised to get enough Iodine from

food sources without medical intervention.

Also, the case reported to get other blood analysis

for thyroid function after 3 to 4 months.

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