Thyroid diseases
Description:
The thyroid gland is found in the front of the neck around the Adam’s apple. It secretes a number of hormones (thyroxine (T4) and triiodothyronine (T3) and affects many of the bodies function including temperature regulation, metabolic rate protein synthesis and others.
The thyroid gland secretes T4 and T3 as a response to another hormone TSH secreted from the pituitary gland. The pituitary gland in turn is under the control of another hormone from the hypothalamus (TRH).
Therefore although problems with thyroid hormones are usually associated with thyroid gland, but sometimes problems in the pituitary or hypothalamus can be the cause.
The gland can either work excessively (hyperthyroidism), or produce insufficient hormone (hypothyroidism).
Hyperthyroidism
Excess production of T4 and T3 leads to a number of symptoms including anxiety, emotional lability, weakness, tremor, palpitations, heat intolerance, increase perspiration, weight loss despite a normal or increased appetite. In some conditions (Graves’ disease), the eyes can become very prominent (exophthalmos).
Causes:
- Graves’ disease is the most common cause of hyperthyroidism, and is an autoimmune disease where the body produces TSH antibodies which stimulate the thyroid gland.
- Toxic nodular goitre – these are benign tumours of the thyroid gland which secrete excessive T3 and T4.
- Iodine induced hyperthyroidism – this is rare but can sometimes follow high doses of iodine contrast used for x-rays, or the prolonged use of iodine rich drugs such as amiodarone.
- Thyroiditis describes a number of conditions where the thyroid gland becomes inflamed and temporarily produces too much T3 or T4. This can happen after viral infections, radiation and some drugs. It can frequently be followed by hypothyroidism.
Medical treatment –
This varies depending on the cause, but in most cases involves attacking the thyroid gland.
Graves’ disease – initially symptoms are controlled with beta-blocker drugs (metoprolol). Then the thyroid gland is attacked either by drugs ( Thionamides such as methimazole, carbimazole or propylthiouracil), surgery or radioactive iodine (I 131). There is no consensus of opinion about which is the best treatment. Drugs do have toxic effects, and frequently the condition recurs when they are stocked, radioactive iodine is easier but frequently too much of the gland is destroyed resulting in hypothyroidism, and surgery is not without risks.[Surprisingly although this is an autoimmune disease, little is done to find or treat the cause.]
Toxic nodular goitre – this can be treated similarly to Graves’ disease with drugs, radioactive iodine or surgery. However if the gland is large, or the nodules are significant then surgery is the usually treatment of choice.
Hypothyroidism
Reduced T4 and T3 leading to a number of symptoms including fatigue, cold intolerance, weight gain, constipation, dry skin, and muscle pains.
Over 95% of cases are due to failure in the thyroid gland (primary hypothyroidism), but occasionally it can be due to tumours in the pituitary gland or resistance to TSH or T3 or T4.
- The most common cause of hypothyroidism is Hashimoto’s hypothyroidism (named after a Japanese physician who discovered this condition) which is an autoimmune disease where the body attacks the thyroid gland, and high levels of antibodies to the thyroid gland (TPO) and thyroglobulin can be measured.
- In areas where the level of iodine in the soil is low, iodine deficiency goitre can also cause hypothyroidism.
- The drug amiodarone can produce both hyper and hypothyroidism, it should not be used for long-term treatment in patients with cardiac problems, but in any patient with thyroid function problems it should be stopped immediately.
Medical treatment – in nearly all cases this is a lifelong therapy, and the symptoms can be removed by replacing the missing thyroid hormones (T4 and T3). T4 (thyroxine) is in fact a pro hormone and has no actions, but is converted into T3 which is the active hormone. The reason that T4 tends to be used is that if the body does not require more thyroid hormone at the time, it will not convert the T4 into T3. The amount of thyroxine (T4) given to an individual patient is determined by measuring the T4 and TSH levels.
‘Natural’ therapies and thyroid diseases
- Lack of iodine in our diets – even if there is plenty in the soil, and iodised salt(which is tiny) is available, some people still do not eat sufficient iodine.
- There has also been a suggestion that may be chlorine and fluoride in water (which are in the same group on the periodic table is iodine) might be replacing iodine in some of the hormones.
- Lithium and iodine for hypothyroidism – in the 1980s the doctors at Walter Reed Army Hospital found they could treat hypothyroidism with iodine and lithium click here, however because other drugs are safer and more effective, this is rarely used today.
- Treating Hashimoto’s disease naturally – surprisingly although it is well known that Hashimoto’s disease is an autoimmune condition, doctors never look at the underlying cause to see whether this can be improved. Most autoimmune conditions can be helped if not reversed, and whether this will heal the Hashimoto’s disease is uncertain, but it certainly may stop it getting worse. Like most auto immune diseases, Hashimoto starts in the gut, and this is where the treatment is most effective
* Remove foods which could cause immune problems – eliminate gluten, too much sugar and possibly dairy products.
* Some believe that gut healing foods are also beneficial – a diet high in vegetables and fruit, bone broth and organic meats and fish.
* Probiotics – by replenishing the good bacteria in the gut, this can be beneficial
* Reduce stress in your life. - Low dose naltrexone – may well help (click here for more details) – and after a discussion with your health provider, should be considered.
* Supplements – a good multivitamin and multi mineral containing ideal levels of selenium, the B vitamins and vitamin D. A good supplement also should contain iodine, which is important
for the thyroid gland.
Iodine and thyroid disease – because about 50% of both T4 and T3 is iodine, this element can affect the thyroid gland and its production.
Hyperthyroidism can be caused by giving high doses of iodine to people who have previously been iodine deficient. Whether these people had subclinical Graves’ disease before, is unknown. Occasionally high doses of iodine found in x-ray contrast (coronary arteriograms) may cause hyperthyroidism, but this is rare.
Hypothyroidism due to iodine surprisingly also occurs in people with Hashimoto’s and Grave’s disease, because iodine in these situations can suppress the production of T4. However the amount required is quite considerable. It does however suggest that taking high doses of iodine in an attempt to improve hypothyroidism and Hashimoto’s thyroiditis may make the situation worse.
Should people with either hyper- or hypothyroidism be given iodine supplements as a form of treatment? Because the response to iodine is uncertain this should only be done with medical advice, and regular monitoring of the thyroid hormones. Surprisingly iodine can cause both hyper or hypothyroidism in some people, and therefore should not be tinkered with.
The amount of iodine found in iodised salt or in the average multivitamin and multi mineral supplement is relatively small, sufficient to prevent iodine deficiency but unlikely to adversely affect thyroid function. However deliberately taking high doses of iodine with sea vegetables or high dose supplements is not wise, especially in people who have thyroid problems.
Lifestyle & diet
Avoid toxins such as excess chlorine and fluoride. (whether the small amount found in water or toothpaste is sufficient to make a difference is uncertain).
A good healthy diet with plenty of fruit and vegetables, meat and fish, bone broth.
Reduce the stress in life
Nutritional supplements Hyperthyroidism
Good nutrition is essential for the mind to stay healthy.
- A good multivitamin / multimineral: to ensure that tissues have all the nutrients and minerals required to function perfectly. A good multi should contain sufficient iodine, selenium, B vitamins and other nutrients to optimise thyroid function.
- Omega 3 fish oils, 1–2 grams daily are very important for good cell function.
- Calcium and magnesium, 800-1,000mg/day, especially the magnesium, has a very calming effect, and can hep with many of the cardiovascular side effects of thyroid disease.
- Gut health – the importance of the gut in many diseases is only just being realised. Leaky gut allowing large molecules into the bloodstream, immune problems, changes in the gut bacteria, poor absorption and other problems are frequent in many people and may be the cause of Hashimoto’s thyroiditis. . A regular course of probiotics, a healthy diet, plenty of fibre or fibre drinks and omega 3 oil can help keep the gut and bowel working normally.
My personal approach to patients with thyroid diseases:
Hyperthyroid –
- find the cause and confirm the diagnosis with blood tests and scans as necessary.
- Control symptoms with beta blockers (metoprolol)
- Eat a good diet, and in Grave’s disease look at the gut with gluten and dairy free diet, good food as described above and probiotics.
- Take the supplements as suggested above [ the multis* containing phytonutrients which may affect cell signalling and sensitivity, may well help they symptoms]
- Treat with drugs (carbimazole) for some months and then reduce to see if the condition is improved.
- Then consider either more drugs or radio iodine therapy
Hypothyroid –
- find the cause and confirm the diagnosis with blood tests and scans as necessary.
- For Hashimoto’s patients – ideal diet as above – gluten free, not too much sugar, probiotics, reduce stress
- Take the supplements as suggested above [ the multis* containing phytonutrients which may affect cell signalling and sensitivity, may well help they symptoms]
- Start low dose thyroxine and monitor TSH and T4 levels till ideal levels are reached
- Continue regular monitoring long term
The Nutritional supplements I use and recommend to my patients
Supplements are frowned upon by the medical profession because they have not been shown in trials to give benefit. There are a number of reasons for that – few trials have been done, those which have been positive are ignored and also and most importantly, most trials have been done with poor quality supplements which do not provide the nutrients the body requires (in both quality and amount). We have seen huge benefits from our patients taking quality supplements which is why we recommend specific brands:
For patients with thyroid problems – USANA – Cellsentials*, Biomega, Active Calcium plus, probiotics