CAUSES AND TREATMENT OF HYPOTHYROIDISM by stephan2

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									         CAUSES AND TREATMENT OF HYPOTHYROIDISM

Many individuals throughout the United States commonly experience ailments
such as exhaustion, mental dullness, depression, minor constipation, a
consistent chilled sensation, dry skin, brittle nails, and joint aches. Other more
serious complaints include uncontrollable weight gain, hair loss, low blood
pressure, high cholesterol, frequent infections, ringing in the ears or dizziness,
and loss of interest in sex. Although these individual symptoms may be related
to any number of health conditions, one in particular, hypothyroidism, may be
often overlooked. Fortunately, research suggests that the treatments for
hypothyroidism are largely effective and noninvasive and may contribute to
improved quality of life for those individuals with this condition.

What is Hypothyroidism?
The thyroid gland, positioned like a bow just below the larynx (voice box),
secretes the hormones that regulate metabolism in every cell of the body. In a
healthy thyroid, two tyrosine molecules—each containing two atoms of iodine—
combine to produce thyroxin or T4 (containing 4 molecules of iodine). When the
thyroid functions properly, some of the T4 is converted to T3 (triiodothyronine)
which is the more active thyroid hormone. Some T1 and T2 are also formed, but
their function is not yet well understood. The production and secretion of T4 are
regulated by another hormone, thyrotropin or TSH (thyroid stimulating hormone)
which is synthesized and released by the pituitary gland. TSH is secreted in
response to a feedback mechanism in the body. In other words, as signals reach
the pituitary that more T4 is needed throughout the body, the gland releases
more TSH. When the TSH reaches the thyroid gland, it responds by increasing
its production and release of T4. In a similar manner, as T4 levels rise, signals
are sent to the pituitary which then reduces its secretion of TSH (Weetman A.
Hypothyroidism: screening and subclinical disease. Br. Med J. 1997; 314:1175-
79).

Hypothyroidism is the term used to describe the condition where insufficient
amounts of the appropriate thyroid hormones are available. In most instances,
the problem lies with the thyroid gland and not the pituitary gland. Many years
ago, the most common cause of hypothyroidism was iodine deficiency.
However, with the advent of iodized salt, iodine deficiencies are rarely seen in
the United States and usually occur only in individuals who consume large
amount of foods that block iodine utilization (e.g., uncooked turnips, cabbage,
mustard, cassava root, soybeans, peanuts, pine nuts, and millet). Other causes
include:
     Lymphocytic thyroiditis following hyperthyroidism. Thyroiditis refers to an
       inflammation of the thyroid gland. When the inflammation is caused by a
       particular type of white blood cell, the condition is referred to as
       lymphocytic thyroiditis. This condition is particularly common after
       pregnancy and can actually affect up to 8 percent of women after they
       give birth. In these cases, a hyperthyroid phase, in which excessive
      amounts of thyroid hormone leak out of the inflamed gland, is followed by
      a hypothyroid phase that can last for up to 6 months. The majority of
      affected women eventually return to a state of normal thyroid function
      although there is a possibility of remaining hypothyroid.
    Post-therapeutic hypothyroidism. Sometimes hyperthyroidism is treated
      by means of thyroid destruction from radioactive iodine or surgery. The
      treatment can leave the patient’s thyroid unable to produce sufficient
      amounts of thyroid hormones.
    Pituitary or hypothalamic malfunction. If for some reason the pituitary
      gland or the hypothalamus is unable to signal the thyroid and instruct it to
      produce thyroid hormones, a decreased level of circulating T4 and T3 may
      result, even if the thyroid gland itself is normal. If this defect is caused by
      pituitary disease, the condition is called “secondary hypothyroidism.” If the
      defect is due to hypothalamic disease, it is called “tertiary hypothyroidism.”
      A pituitary injury may result after brain surgery or if there has been a
      decrease of blood supply to the area. In these cases of pituitary injury, the
      TSH that is produced by the pituitary gland is deficient and blood levels of
      TSH are low. Because the thyroid gland is no longer stimulated by the
      pituitary TSH, hypothyroidism results. This form of hypothyroidism can,
      therefore, be distinguished from hypothyroidism that is caused by thyroid
      gland disease, in which the TSH level becomes elevated as the pituitary
      gland attempts to encourage thyroid hormone production by stimulating
      the thyroid gland with more TSH. Usually, hypothyroidism from pituitary
      gland injury occurs in conjunction with other hormone deficiencies, since
      the pituitary regulates other processes such as growth, reproduction, and
      adrenal function.
    Medications. Medications that are used to treat an over-active thyroid
      (hyperthyroidism) may actually cause hypothyroidism. These drugs
      include methimazole (Tapezole) and propylthiouracil (PTU). The
      psychiatric medication, lithium, is also known to alter thyroid function and
      cause hypothyroidism. Interestingly, drugs containing a large amount of
      iodine such as amiodarone (Cardorone), super saturated potassium iodide
      solutions (SSKI), and Lugol’s solution can cause a decrease in thyroid
      function, thereby resulting in low blood levels of thyroid hormone. In
      addition, a growing body of evidence suggests that fluoride may inhibit the
      functioning of the thyroid gland (Fragu P."The history of science with
      regard to the thyroid gland (1800-1960)" Ann
      Endocrinol (Paris) 60(1):10-22, 1999; Schuld A. "Over 150 common
      symptoms and associations: Fluoride poisoning and hypothyroidism"
      Parent’s of Fluoride Poisoned Children, Vancouver, BC, Canada, 1999;
      Grimbergen, G.W. "A Double Blind Test for Determination of Intolerance to
      Fluoridated Water. Preliminary Report", Fluoride 7:146-152, 1974; Wilson,
      RH and DeEds, F. "The Synergistic Action Of Thyroid On Fluorine
      Toxicity" Endocrinology 26:851, 1940).
Currently, the most frequent cause of hypothyroidism is Hashimoto’s disease, an
autoimmune response in which antibodies in the blood destroy tissues in the
thyroid gland. As a result, the thyroid decreases in size and reduces its
production of thyroid hormones (Murray M and Pizzorno J. Encyclopedia of
Natural Medicine. Rocklin CA: Prima Publishing, 1998:558-563). According to
some estimates, as many as 11 million Americans suffer from some degree of
hypothyroidism. However, it is believed that, because its symptoms mimic those
of other health conditions and limitations of testing, most of the cases of
hypothyroidism are misdiagnosed (Quick Access to Integrative Medicine.
Newton, MA:Integrative Medicine Communications, 2000:158-159).

Diagnostic Considerations
Considerable controversy exists over the most effective method for diagnosing
hypothyroidism. Until recently, it was common to diagnose hypothyroid states
based on careful medical histories (including family histories), complete physical
examination, basal body temperature (see below) and Achilles reflex time. With
the advent of sophisticated laboratory measurements, these techniques have
become less commonly used in favor of blood tests of circulating levels of
protein-bound iodine (PBI), T4, TSH, and even T3. However, evidence suggests
that these blood tests are not sensitive enough to diagnose the milder, most
common form of hypothyroidism and many clinicians are returning to basal body
temperature, medical history, and reflex assessments (Schachter, M. The
diagnosis and treatment of hypothyroidism. Health World Online;
http://www.healthy.net) for diagnosing the disease. Additional research is
indicated to determine the most effective diagnostic protocol.

Measuring Basal Body Temperature
The basal body temperature is perhaps the most sensitive functional test of
thyroid function (Langer SE and Scheer JF. Solved: the riddle of illness. New
Canaan, CT: Keats, 1984) yet it can be performed at home using little more than
a thermometer. The procedures for measuring basal body temperature follow.
    1. Shake down a glass thermometer to below 95 degrees Fahrenheit and
       place it by your bed before going to sleep. An ovulation thermometer may
       be beneficial because it measures temperature in tenths of a degree.
    2. On waking, place the thermometer in your armpit for a full ten minutes. It
       is important to move as little as possible; lying and resting with eyes
       closed is best. Do not get up, even to go to the bathroom, until the ten-
       minute test is completed.
    3. After ten minutes, read and record the temperature and date.
    4. Record the temperature for at least three mornings, ideally at the same
       time of day, and give the information to your physician. Menstruating
       women must perform the test on the second, third, and fourth days of
       menstruation.

Interpreting the Results
In those individuals with a normally functioning thyroid, axillary measures of basal
body temperature should be between 97.6 and 98.2 degrees Fahrenheit. Basal
body temperatures below this range are quite common and may reflect
hypothyroidism. High basal body temperatures (above 98.6 degrees Fahrenheit)
are less common but may be evidence of hyperthyroidism. Common signs and
symptoms of hyperthyroidism include bulging eyeballs, fast pulse, hyperactivity,
inability to gain weight, insomnia, irritability, menstrual problems, and
nervousness (Murray and Pizzorno, 1998).

Treatment Options
The medical treatment of hypothyroidism usually involves the use of thyroid
hormone supplementation. Among those who prefer to use synthetic hormones,
evidence suggests that generic forms may be as effective as non-generics.
However, because synthetic thyroid hormone (e.g., levothyroxine) is limited to T4
only, many health professionals prefer the use of desiccated natural thyroid from
a bovine or porcine source because it includes all the thyroid hormones. In
addition to thyroid hormone supplementation, research supports a treatment
protocol that includes:
    Lifestyle modifications. As indicated, several foods have been shown to
       inhibit thyroid function including brussel sprouts, cabbage, kale, mustard,
       peaches, peanuts, pears, rutabaga, spinach, strawberries, and turnips.
       These foods should be avoided by those with hypothyroidism. However,
       other foods, such as kelp and dulse, have been shown to promote thyroid
       function and should be included in the diet (Balch JF and Balch PA et al.,
       Prescription for Nutritional Healing, 2nd ed. Avery Publishing Group; NY,
       NY; 1997; 214). In addition, exercise has been shown to stimulate thyroid
       gland secretion and increase tissue sensitivity to thyroid hormones. Other
       benefits of exercise may be found in its ability to contribute to weight loss
       without adversely affecting metabolism (Lennon D. Nagle F, Stratman F.
       et al., Diet and exercise training effects on resting metabolic rate. Int J
       Obesity 9 (1985): 39-47).
    Vitamin and Mineral supplements. A number of nutrients have been
       shown to contribute to healthy thyroid function including zinc, selenium, B
       vitamins, vitamin C, vitamin E and vitamin A. It is interesting to note that
       people with hypothyroidism have been shown to have an impaired ability
       to convert beta-carotene to vitamin A, so care should be taken to ensure
       that supplementation for these individuals includes actual vitamin A in
       addition to or instead of beta-carotene (Murray and Pizzorno, 1998).
       Because selenium, a trace mineral, is involved in the conversion of T4 to
       T3, low selenium levels may lead to low T3 levels. In addition to its other
       adverse effects, mercury may diminish thyroid function because it
       displaces selenium.
    Botanicals. Among the botanicals shown to stimulate thyroid function
       with a resultant increase in thyroid hormone production are Coleus
       foreskohlii (Bartram T. Encyclopedia of Herbal Medicine. Dorset, England:
       Grace Publishers; 1995:304) and Commiphora guggul (Tripathi YB,
       Malhotra OP; Tripathi SN; Thyroid stimulatory action of (z)-guggulsterone:
       Mechanism of action. Planta Medica, 1998; 54:271-277). Hawthorne
       (Crataaegus oxyacantha) has also been used to address some of the
       cardiovascular issues (e.g., elevated cholesterol levels) that may
       accompany hypothyroidism (Bartram, 1995).
      Other modalities. Other methods of addressing hypothyroidism and its
       symptoms include massage, acupuncture, hydrotherapy, and
       homeopathy. Although most of these treatment methods have yet to be
       the focus of clinical investigations, it is possible that their utilization may
       yield substantial benefits in the treatment this condition.

Prognosis
The beneficial effects of treatment of hypothyroidism are usually evident within
two to three weeks of starting the course of therapy. However, it is important to
emphasize that, while symptoms may be alleviated and patients may experience
a greater sense of well-being, in most cases, treatment for hypothyroidism is life-
long. In addition, those patients taking exogenous thyroid may be at risk for the
development of osteoporosis. Patients are well advised to work proactively with
their health care provider to monitor both the measures of thyroid function
described earlier as well as measures of bone density (e.g., DEXAscan) or bone
metabolites such as deoxypyridium and pyridinum that may signal onset of
increased bone loss.

Well-treated patients with hypothyroidism may look forward to a vibrant life with
lowered risks of degenerative disease and reduced morbidity and mortality
(Schachter, 2001).

								
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