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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