Peripheral Neuropathy - Long-term untreated hypothyroidism can cause damage to the peripheral nerves - the nerves that transmit information from the brain and spinal cord to the rest of the body. Signs and symptoms of peripheral neuropathy might include numbness and tingling or pain in the affected area. Peripheral neuropathy can also cause weakness of the muscles and loss of muscle control.
There are so many reasons for low thyroid function, yet I see many patients whose doctors have ignored this problem. One young female patient had more than 30 percent body fat and was unable to change her body no matter how hard she worked. She ate perfectly, exercised with a trainer every day, yet her body wouldn’t budge. She also had a slightly depressed mood and other vague symptoms.
Hypothyroidism is a condition related to having an underactive thyroid gland that doesn’t properly make or release thyroid hormones. The thyroid gland normally releases many crucial hormones that travel throughout the bloodstream and reach receptors that are found throughout the whole body, so a disturbance in thyroid function can cause widespread, noticeable health problems.
Hypothyroidism is generally treated with a single daily dose of levothyroxine, given as a tablet. An experienced physician can prescribe the correct form and dosage to return the thyroid balance to normal. Older patients who may have underlying heart disease are usually started at a low dose and gradually increased while younger healthy patients can be started on full replacement doses at once. Thyroid hormone acts very slowly in some parts of the body, so it may take several months after treatment for some features to improve.
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Too much iodine can damage your thyroid and make you feel sluggish, a symptom of hypothyroidism. “It’s like Goldilocks: If you have too much, it’s no good. If you have too little, it’s no good,” Blum says. You’ll find iodine in iodized salt, supplements and those same large predator fish. Ask your doctor to give you a 24-hour urine test for iodine. If you have too much, stop taking the types of multivitamins that have iodine. You want your keep iodine levels between 100 to 200 mcg/L range, Blum says.
It’s imperative dietitians have a good understanding of the metabolic changes associated with thyroid disease so they can set realistic goals and expectations for clients. Most people with hypothyroidism tend to experience abnormal weight gain and difficulty losing weight until hormone levels stabilize. Moreover, it’s common for patients with Graves’ disease to experience periods of high and low thyroid hormone levels, so it may take several months to achieve a balance. During this time, it’s essential clients focus on healthful behaviors such as eating nutritious foods, exercising regularly, managing stress, and sleeping adequately rather than focus on the numbers on the scale.
Because it helps balance hormone levels, selenium can lower the risk for experiencing thyroid disorder during pregnancy (postpartum thyroiditis) and afterwards. Other studies have shown that when selenium deficiency is resolved through supplementation, patients experience on average 40 percent reduction in thyroid antibodies compared to a 10 percent increase in the placebo group. Selenomethionine is the preferred form of selenium supplementation as it is the form found naturally in food and about 90% of it is absorbed.
The development of TSH radioimmunoassay (43) provided the first sensitive and specific marker of systemic thyroid hormone status (Figure). Clinicians could now titrate therapy to achieve a serum TSH within the normal range as a specific marker of replacement adequacy (44). For patients who were once treated with doses that normalized their symptoms, BMR, or serum PBI, the use of serum TSH revealed such doses to be typically supratherapeutic (45, 46). Maintenance doses of l-thyroxine ranged from 200 to 500 mcg/d before the institution of the TSH assay and then became typically closer to 100 to 150 mcg/d (Appendix Table). Implementation of the TSH radioimmunoassay also provided a means to diagnose much milder, or even subclinical, cases of hypothyroidism that may have been undiagnosed with earlier, less sensitive, diagnostic methods (47).
Treatment for hyperthyroidism - Hyperthyroidism is the opposite of hypothyroidism; it is a condition in which the thyroid gland is over-producing the thyroid hormones thus causing a hormone imbalance in the body. Hyperthyroidism can be treated with radioactive iodine and/or anti-thyroid medications, both of which are meant to reduce and normalize the thyroid function. In some cases, these treatments can cause permanent hypothyroidism if too much medication is administered.
Thyroid hormone replacement has been used for more than a century to treat hypothyroidism. Natural thyroid preparations (thyroid extract, desiccated thyroid, or thyroglobulin), which contain both thyroxine (T4) and triiodothyronine (T3), were the first pharmacologic treatments available and dominated the market for the better part of the 20th century. Dosages were adjusted to resolve symptoms and to normalize the basal metabolic rate and/or serum protein-bound iodine level, but thyrotoxic adverse effects were not uncommon. Two major developments in the 1970s led to a transition in clinical practice: 1) The development of the serum thyroid-stimulating hormone (TSH) radioimmunoassay led to the discovery that many patients were overtreated, resulting in a dramatic reduction in thyroid hormone replacement dosage, and 2) the identification of peripheral deiodinase-mediated T4-to-T3 conversion provided a physiologic means to justify l-thyroxine monotherapy, obviating concerns about inconsistencies with desiccated thyroid. Thereafter, l-thyroxine mono-therapy at doses to normalize the serum TSH became the standard of care. Since then, a subgroup of thyroid hormone–treated patients with residual symptoms of hypothyroidism despite normalization of the serum TSH has been identified. This has brought into question the inability of l-thyroxine monotherapy to universally normalize serum T3 levels. New research suggests mechanisms for the inadequacies of l-thyroxine monotherapy and highlights the possible role for personalized medicine based on deiodinase polymorphisms. Understanding the historical events that affected clinical practice trends provides invaluable insight into formulation of an approach to help all patients achieve clinical and biochemical euthyroidism.
Of course not everyone is a candidate for natural hypothyroid treatment methods. However, many people assume they aren’t a candidate because they have had their condition for a long time, or perhaps they received thyroid surgery or radioactive iodine treatment. While these factors can definitely make it more challenging to restore one’s health back to normal, and in some cases impossible (for example, someone who has had their thyroid gland completely removed), many people who fall under this category can be still benefit from following a natural hypothyroid treatment protocol.
Once again, if you look to the anatomy, you find the thyroid gland located in the throat, the center of our communication with the world. Andrea has found in her practice that people with hypothyroid tend to “swallow down” what they really want to say. It’s been very healing for them to learn to speak their truth. On the flip side, she has found that people with hyperthyroid are talking too much, and can benefit by listening more.
If you suffer from hypothyroidism, you should not eat them raw. Goiter is a substance that inhibits iodine uptake to create the T4 hormone. The family of crucifers are: bok choy, broccoli, Brussels’ sprouts, cabbage, cauliflower, kale, mustard greens, radishes, soy, soy milk, soy lecithin (often used as a filler in vegetarian food) and tofu. Cooking them reduces their goitrous properties, however, so they can still be an important part of a diet for thyroid health.
Studies have indicated that individuals with lower selenium levels are at higher risk for low T3 (50). Selenium has been shown to reduce rT3 levels and improve active T3 status (51). It also reduces anti-thyroid anti-body formation (52). Be sure to get selenomethionine which is the most effective form of selenium for reducing anti-body formation and improving thyroid function.
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A meta-analysis of randomized, placebo-controlled studies has shown benefits of selenium on both thyroid antibody titers and mood in patients with Hashimoto’s, but this effect seems more pronounced in people with a selenium deficiency or insufficiency at the outset.15 Conversely, an excessive intake of selenium can cause gastrointestinal distress or even raise the risk of type 2 diabetes and cancer. So clients will benefit from having their selenium levels tested and incorporating healthful, selenium-rich foods in to their diets, such as Brazil nuts, tuna, crab, and lobster.15
Congenital hypothyroidism - Congenital hypothyroidism means that a baby is born with the condition. This occurs when a baby is born without a thyroid or with only a partly formed one. Sometimes, the baby will have part or all of the thyroid in the wrong place in the body (called ectopic thyroid). In some babies, the thyroid cells or their hormones do not work right. All of these issues lead to lifelong hypothyroidism for that human being.
From the early 1890s through the mid-1970s, desiccated thyroid was the preferred form of therapy for hypothyroidism (Appendix Table, available at www.annals.org). This preference was reinforced by the unique ability of desiccated thyroid to reproduce a normal serum PBI (33). The predominance of natural thyroid products was illustrated by prescribing patterns in the United States: In 1965, approximately 4 of every 5 prescriptions for thyroid hormone were for natural thyroid preparations (38). Concerns about inconsistencies in the potency of these tablets arose (26) after the discovery that some contained anywhere from double to no detectable metabolic activity (39). The shelf-life of desiccated tablets was limited, especially if the tablets were kept in humid conditions (36). There were reports of patients not responding to desiccated thyroid altogether because their tablets contained no active thyroid hormone. It was not until 1985 that the revision of the U.S. Pharmacopeia standard from iodine content to T3/thyroxine (T4) content resulted in stable potency (38), but by then the reputation of natural thyroid products was tarnished (40).
Thyroid disease and disorder symptoms and signs depend on the type of the thyroid problem. Examples include heat or cold intolerance, sweating, weight loss or gain, palpitations, fatigue, dry skin, constipation, brittle hair, joint aches and pains, heart palpitations, edema, feeling bloated, puffiness in the face, reduced menstrual flow, changes in the frequency of bowel movements and habits, high cholesterol, hoarseness, brittle hair, difficulty swallowing, shortness of breath, a visible lump or swelling in the neck, tremors, memory problems, depression, nervousness, agitation, irritability, or poor concentration.
Other causes of hypothyroidism include surgical removal of the thyroid (usually for cancer), radiation therapy of the head and neck, or complications of medical therapies for hyperthyroidism. (Patients with overactive thyroids are often treated with radioactive iodine or anti-thyroid medications that reduce thyroid functioning. These effects can be extensive and permanent, and thyroid supplementation is often required flowing these interventions.) Certain medications can worsen or promote hypothyroidism or interfere with thyroid replacement therapy. One such drug is lithium, used for treating psychiatric conditions such as bipolar disorder.
When a patient is suspected to have a thyroid disorder a comprehensive thyroid profile is ordered, in the form of a blood test. The test results will give precise measurements of Free T3 and T4 and their ratios to each other. If the results indicate that for example, the patient’s T3 level is too low then the patient will be checked for deficiencies in essential nutrients which are required for hormone production. Many times this will correct the thyroid without the need for prescription hormones.
It's important to note, however, that selenium has what doctors call a "narrow therapeutic window." In optimal amounts, it can help ensure good thyroid function and have other benefits, but is toxic in amounts not that far above "normal." This is especially important to remember if you are taking a multi-vitamin that contains zinc as well as a zinc supplement.
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