Hypothyroidism

Published by NHC on May 31, 2021May 31, 2021

Hypothyroidism

Info
Description	A condition resulting in decreased production of thyroid hormones. Primary Hypothyroidism Elevated TSH Low thyroid hormone This generally indicates a defect in thyroid hormone synthesis Secondary Hypothyroidism Low TSH Low thyroid hormone This generally indicates pituitary gland dysfunction Subclinical Hypothyroidism Elevated TSH Normal thyroid hormones
Signs & Symptoms	Depression/low mood Fatigue Impaired cognition and memory Cold intolerance Cold extremities Shortness of breath Muscle weakness Iron deficiency anaemia Constipation Weight gain/ difficulty losing weight Bradycardia Diastolic hypertension Low appetite Menstrual irregularities Hyperprolactinaemia Hypercholesterolaemia Dry skin and mucous membranes Brittle hair and nails Nail ridging (Beau’s lines) Impaired fertility Miscarriage Premature delivery Stillbirth Low libido Nerve entrapment syndromes Decrease in sweating Puffy eyes and face Headaches Delayed relaxation phase reflexes Impaired immune response Impaired kidney function Goitre
Causes & Contributors	Autoimmune Hashimoto’s (Most common cause of hypothyroidism in Australia) Increased intestinal permeability Food allergy/intolerance Dysbiosis Possible viral involvement Yersinia enterocolitica Molecular mimicry Nutritional Iodine deficiency/excess Deficiencies in: selenium, tyrosine, zinc, iron Hypothalamic Pituitary Tumor Radiation Surgery Iatrogenic Thyroid surgery and ablation Medications Lithium Amiodarone Interferon-alpha Interleukin-2 Environmental Other diseases Amyloidosis Sarcoidosis Haemochromatosis
Pathophysiology/Aetiology	Hashimoto’s The cells of the thyroid are slowly destroyed by autoantibodies Antibodies bind to the thyroid preventing the adequate manufacturing of thyroid hormone (TSH receptors, thyroglobulin, thyroid peroxidase enzyme) Antibodies can also bind to the pancreas, adrenal glands and parietal cells of the stomach Wilsons Temperature Syndrome Hypothyroid symptoms and low body temperature with normal thyroid hormone levels Reduced peripheral conversion of T4 to T3
Physiology	TSH Produced by the pituitary gland, acting on the thyroid, causing it to release thyroid hormones T4 Accounts for 90% of the thyroid hormone produced by the thyroid Contains 4 iodine atoms T3 4 times more active than T4 Converted from T4 Contains 3 iodine atoms Selenium is needed for conversion of T3 to T4 RT3 An inactive form of T3 Produced in excess often during times of stress Selenium deficiency increases production TPO-Ab (Thyroperoxidase Antibodies) Factors that may increase TPO-Ab levels: Excess oestrogen: pregnancy, OCP, HRT Tamoxifen Liver diseases Tg-Ab (Thyroglobulin Antibodies) Can act as blocking antibodies and/or growth promoting antibodies
Commonly Affected	Women Elderly Post-menopausal women Having another autoimmune disease Recently pregnant/given birth
Complications	Increased severity and amount of symptoms Birth defects Myxoedema Peripheral neuropathy Goitre
Treatment
Best Therapeutic Treatment	Testing (for correct diagnosis) Full thyroid panel (preferred) TSH, T4, T3, RT3, Thyroid antibodies Helps differentiate between type of hypothyroidism Once diagnosis of type of hypothyroidism has been determined, proceed with further investigations/treatment as necessary. Dietary 30 day Restart Diet Gluten and dairy free Removal of dietary triggers Consume These: Iodised salt Seafood and seaweed Iodine Sushi Iodine Eggs Iodine Brazil nuts Selenium Avoid These: Goitrogens (cook thoroughly to reduce levels) Cabbage Broccoli Turnips Radishes, Horse radishes Mustard greens Soybeans Pine nuts Peanuts Millet Gluten May be implicated in Hashimoto’s aetiology Dairy May be implicated in Hashimoto’s aetiology Combination Product ThyroPlex (Bioceuticals) Lifestyle Exercise Stimulates thyroid gland secretion Increases tissue sensitivity to thyroid hormone Other treatments will vary depending on underlying cause
Herbal	Bladderwrack Contains high amounts of iodine More bioavailable than potassium iodide Coleus Increases thyroid hormone production
Nutritional	Iodine Deficiency is common Generally contraindicated in thyroxine use as it can lead to hyperthyroidism Communicate and manage with GP/endocrinologist Excess can also cause/contribute to hypothyroidism Tyrosine Needed for thyroid hormone production Deficiency with: Low protein intake Stress Anorexia Infections Selenium Needed for T4 to T3 conversion Zinc Iron Vitamin A Vitamin D Immune modulation Vitamin C Antioxidant
Dietary	Consume These: Iodised salt Seafood and seaweed Iodine Sushi Iodine Eggs Iodine Brazil nuts Selenium Avoid These: Goitrogens (cook thoroughly to reduce levels) Cabbage Broccoli Turnips Radishes, Horse radishes Mustard greens Soybeans Pine nuts Peanuts Millet Gluten May be implicated in Hashimoto’s aetiology Dairy May be implicated in Hashimoto’s aetiology *Give food swap ideas if necessary
Lifestyle	Exercise Stimulates thyroid gland secretion Increases tissue sensitivity to thyroid hormone
Pharmaceutical	Levothyroxine Eltroxin Eutroxsig Oroxine
Combination Products	ThyroPlex (Bioceuticals) Thyrobalance (Metagenics) ThyRestore (Biomedica)
More
Diagnostic Criteria	Increased TSH levels Decreased T4 or T3 levels
Testing/Examinations	TSH If TSH is above 2 or 2.5mU/L (reference range normally 0.3-5mU/L) testing of thyroid antibodies, T3 and T4 should be done. More sensitive test for detecting hypo-, hyperthyroidism than T4 T4 T3 RT3 Thyroid antibodies (TPO-Ab, Tg-Ab) Antibodies made by the immune system, directed at the thyroid These indicate an autoimmune component of the thyroid dysfunction Should be as low as possible (should not be present at all) Urinary Iodine Coeliac testing Intestinal permeability *Thyroid hormone levels fluctuate throughout the day and false negatives can occur
Images/Infographics

References

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Hypothyroidism​

Hypothyroidism

Hypothyroidism