Categories: Diseases & Treatment Plans

Hypothyroidism​

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
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
Babiker, A., Alawi, A., Al Atawi, M., & Al Alwan, I. (2020). The role of micronutrients in thyroid dysfunction. Sudanese journal of paediatrics, 20(1), 13–19. https://doi.org/10.24911/SJP.106-1587138942
Bajaj, J. K., Salwan, P., & Salwan, S. (2016). Various Possible Toxicants Involved in Thyroid Dysfunction: A Review. Journal of clinical and diagnostic research : JCDR, 10(1), FE01–FE3. https://doi.org/10.7860/JCDR/2016/15195.7092
Bargiel, P., Szczuko, M., Stachowska, L., Prowans, P., Czapla, N., Markowska, M., Petriczko, J., Kledzik, J., Jędrzejczyk-Kledzik, A., Palma, J., Zabielska, P., & Maciejewska-Markiewicz, D. (2021). Microbiome Metabolites and Thyroid Dysfunction. Journal of clinical medicine, 10(16), 3609. https://doi.org/10.3390/jcm10163609
Bone, K. (2007). The Ultimate Herbal Compendium. Phytotherapy Press
Braun, L., & Cohen, M. (2015). Herbs and Natural Supplements, Volume 2. Elsevier Health Sciences.
Cayres, L., de Salis, L., Rodrigues, G., Lengert, A., Biondi, A., Sargentini, L., Brisotti, J. L., Gomes, E., & de Oliveira, G. (2021). Detection of Alterations in the Gut Microbiota and Intestinal Permeability in Patients With Hashimoto Thyroiditis. Frontiers in immunology, 12, 579140. https://doi.org/10.3389/fimmu.2021.579140
Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. Lancet (London, England), 390(10101), 1550–1562. https://doi.org/10.1016/S0140-6736(17)30703-1
Chung H. R. (2014). Iodine and thyroid function. Annals of pediatric endocrinology & metabolism, 19(1), 8–12. https://doi.org/10.6065/apem.2014.19.1.8
Hechtman, L. (2018). Clinical Naturopathic Medicine. Elsevier Health Sciences.
Ihnatowicz, P., Drywień, M., Wątor, P., & Wojsiat, J. (2020). The importance of nutritional factors and dietary management of Hashimoto’s thyroiditis. Annals of agricultural and environmental medicine : AAEM, 27(2), 184–193. https://doi.org/10.26444/aaem/112331
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., Sawka, A. M., & American Thyroid Association Task Force on Thyroid Hormone Replacement (2014). Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid : official journal of the American Thyroid Association, 24(12), 1670–1751. https://doi.org/10.1089/thy.2014.0028
Knezevic, J., Starchl, C., Tmava Berisha, A., & Amrein, K. (2020). Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?. Nutrients, 12(6), 1769. https://doi.org/10.3390/nu12061769
Paray, B. A., Albeshr, M. F., Jan, A. T., & Rather, I. A. (2020). Leaky Gut and Autoimmunity: An Intricate Balance in Individuals Health and the Diseased State. International journal of molecular sciences, 21(24), 9770. https://doi.org/10.3390/ijms21249770
Starchl, C., Scherkl, M., & Amrein, K. (2021). Celiac Disease and the Thyroid: Highlighting the Roles of Vitamin D and Iron. Nutrients, 13(6), 1755. https://doi.org/10.3390/nu13061755
Wu, H. J., & Wu, E. (2012). The role of gut microbiota in immune homeostasis and autoimmunity. Gut microbes, 3(1), 4–14. https://doi.org/10.4161/gmic.19320
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