Download THYROID PROBLEMS

THYROID PROBLEMS
A Guide for management and prevention of thyroid problems
CONTENTS
CHAPTER
CHAPTER
CHAPTER
CHAPTER
CHAPTER
CHAPTER
CHAPTER
CHAPTER
1:
2:
3:
4:
5:
6:
7:
8:
Thyroid gland and its functions
Hypothyroidism
Hyperthyroidism
Thyroid Cancers
Other miscellaneous diseases of thyroid gland
Hypothyroidism and weight loss
Dealing with depression in thyroid disease
Thyroid disorders: infertility, pregnancy, and breastfeeding
References
Further Reading
Disclaimer
The information provided in this eBook should not be construed as personal
medical advice or instruction. No action should be taken based solely on the
contents of this ebook.
Readers should consult appropriate health professionals on any matter relating to
their health and well being.
The information and opinions provided here are believed to be accurate and
sound, based on the best judgment available to the author, but readers who fail
to consult appropriate health authorities assume the risk of any injuries. This
website is not responsible for errors or omissions.
CHAPTER1
Thyroid gland and its functions
Gland
Glands are organs or groups of cells which take substances from the blood and
modify them chemically so that they can be secreted later for further in various
chemical reactions.
There are two kinds of glands: endocrine and exocrine glands.
Endocrine gland
This type of gland secretes its substances directly into blood like thyroid gland.
Exocrine gland
This type of gland secretes its substances through channels or ducts like sweat
glands and salivary glands.
Hormone
Hormones are chemical substances produced in the body by endocrine glands,
which are transported by blood to other organs of the body to stimulate and
regulate their functions.
Thyroid gland
Thyroid gland, one of the most important glands of our body, is a brownish red
small bowtie or butterfly-shaped gland weighing less than two ounces and it
appears larger in men than women. It is located in the lower part of neck
wrapped around the windpipe behind the Adam’s apple area. It is divided into two
halves called right and left lobes. Entire blood supply passes through the thyroid
once in every hour.
How thyroid gland works?
Thyroid gland produces two very important hormones named as T3
(triiodothyroxine) and T4 (thyroxine). These hormones increase the overall
metabolism of body cells. Apart from T3 and T4, thyroid gland also produces
calcitonin which is necessary to regulate the calcium levels in blood.
The thyroid hormone is made up of two components; thyroxine and iodine.
Thyroid cells are the only cells in the body with the ability to absorb iodine.
Iodine is a vital trace mineral found in our food and drinking water. Thyroid gland
takes up iodide from blood, convert it to active form of iodine which later
combines with an amino acid called tyrosine. Tyrosine combines with three iodine
molecules to make triiodothyronine or T3 and with four iodine molecules it makes
thyroxine or T4. In normal thyroid gland about 80% of T4 and 20% of T3 is
produced but T3 is four times more potent than T4. Later thyroxine bounds to
thyroglobulin which is a polysaccharide-protein material. Secretion of thyroid
hormones is under the influence of another hormone of pituitary gland (small part
in our brain) called thyroid-stimulating hormone (TSH). Thyroid stimulating
hormone controls the rate of secretion of the thyroid hormones.
Thyroxine has many functions like stimulation of overall metabolism (conversion
of oxygen and calories to energy) of body, increase oxygen consumption and heat
production. It promotes protein synthesis and is essential for normal growth. It
also plays vital role in organ development especially central nervous system.
Every cell in the body needs thyroid hormones for regulation of their metabolism.
Functions of thyroid gland
Thyroid gland plays a vital role in maintaining the body’s temperature,
metabolism, immune system functions, structure of the bones, maturation, and
hormonal equilibrium, overall well being, texture and quality of hair, skin and sex
drive, mood elevation and emotional balance.
Hormones produced and released by thyroid gland travel through bloodstream and
reach cells of the body. These hormones help our cells to convert oxygen and
calories into the energy needed for proper functioning of body. As these hormones
affect almost every cell of the body, malfunctioning of thyroid gland can leads to
loads of problems in various parts of our body.
All body systems and functions need adequate amounts of this hormone. The
thyroid along with the adrenals is probably the gland most susceptible to the
tremendous stress of our fast paced society. It is the thermostat of the body. It
produces hormones that work to keep our metabolic rate stable and keep energyproducing processes in balance. The thyroid is essential in protein synthesis,
growth, temperature regulation, and oxygen consumption of cells. If the thyroid is
depleted or deficient, the rest of the body functions poorly. With low thyroid
cholesterol can shoot up to dangerous levels.
Thyroid disease, both hyperactive and under-active, is so extraordinarily
prevalent today that even by conservative estimates it may strike up to 15
percent of the adult population. Women are particularly susceptible, and the
disease tends to run in families. A possible reason for the increase in thyroid
disease is the high prevalence of auto-immune disease today. Immunity in general
is being assaulted by toxic chemicals in food, water, and air. Under-active or
hypothyroid conditions can cause low energy.
CHAPTER 2
HYPOTHYROIDSIM
Definition
The term Hypothyroidism (hypo-means “under” or “below” normal) refers to a
condition in which thyroid gland fails to produce enough thyroid hormone to
maintain body metabolism. In other words, thyroid gland is underactive.
Risk factors for Hypothyroidism
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Age over 50 years
Family history of thyroid disease
Obesity
Female gender
Surgery of thyroid gland
Exposure of neck to X-ray or radiations.
Hypothyroidism is more common in whites and Asians. African-Americans are at
low risk
Having autoimmune disorder like Type-1 diabetes, rheumatoid arthritis, Addison’s
disease, and multiple sclerosis
Having Down’s syndrome
Having bipolar disorders
Causes of Hypothyroidism
Causes of hypothyroidism are diverse and following are some major causes of this
disease:
Autoimmune disease
Our immune system consist of organs, tissues, cells, and cell products such as
antibodies that differentiates self from non-self and protects our body from nonself entities like pathogenic organism or harmful substances. In this disease,
immunes system mistakenly recognizes thyroid gland cells and its enzymes as nonself or invaders and attacks them. After destruction by immune system, not
enough thyroid cells and its enzymes left that leads to hypothyroidism. It can
begin suddenly or can follow a slow long-term course. Most common form of this
type of hypothyroidism is Hashimoto’s thyroiditis. It is more common in women
than men.
Radiation treatment
Patients with hyperthyroidism sometime need to be treated with radioactive
iodine to destroy thyroid gland tissue. All these patients can lose part or all of
their thyroid gland which can lead to hypothyroidism.
Surgical removal of gland
A part or whole of thyroid gland is surgically removed in patients with
hyperthyroidism or thyroid cancer. In case of complete removal, these patients
may turn out to be hypothyroid.
Thyoiditis
It is the inflammation of thyroid gland caused by some infection or autoimmune
attack. It can lead to underactive thyroid gland or complete cessation of its
activity resulting in hypothyroidism.
Medicines
Medicines like lithium, interferon, and interleukin-2 can harm thyroid gland and
its normal functions.
Congenital hypothyroidism (at birth)
Some babies are born with structural or functional problems in thyroid gland
which could turn into congenital hypothyroidism.
Iodine levels
Iodine is essential for thyroid gland to work properly. Normally we take iodine
from our food (dairy products, water, chicken, beef, pork, fish, and iodized salt)
and drinking water that reaches thyroid gland through our blood. In case of
imbalanced iodine levels in food can lead to thyroid problems. Deficiency of
iodine is serious problem in many underdeveloped countries. Taking too much
iodine in diet supplements like kelp (seaweed) or supplements sold with false
promise of weight loss can lead to thyroid problems.
Damage to pituitary gland or hypothalamus
Thyroid gland secretes thyroid hormone under the influence of pituitary gland and
the hypothalamus (both reside in brain). Damage to pituitary gland or
hypothalamus e.g. by tumor, radiation or surgery can affect thyroid gland
functioning and it may stop secreting required amount of thyroid hormone.
Symptoms
When thyroxine (T4) level is low, the body cells will be deprived of necessary
thyroid hormone and overall body functions start slowing down. The body will
make less energy and heat, brain will function less efficiently and bowels will
move more slowly. As every cell of your body will be affected, a wide range of
symptoms are seen in hypothyroidism including changes that are usually not
noticed by the patient like increase in cholesterol levels and plaque formation in
arteries (hardening) which can ultimately lead to heart attack. The course of
disease also varies from few months to many years.
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Less energy
Inappropriate weight gain (5-20 pounds)
Unable to lose weight with diet control and/ or exercise
Constipation (sometimes severe)
Low body temperature (increased sensitivity to cold)
Fatigue
Dry and brittle hair fall out easily
Coarse, scaly and dry skin
Swelling around eyes and face
Speech problems
Muscular and joint pain
Problems with menstrual cycles
Troubles in conceiving
Depression
Mood swings
Concentration problems
Loss of interest in normal daily activities
Forgetfulness
Additional symptoms may include:
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Hair loss
Less sweating
Lack of sex drive
Frequent infections
Snoring and sleep disturbances including difficult awakening in the morning
Shortness of breath and tightness in the chest
• Feeling of pins and needles in the hands and feet
• Strange feeling in the area of neck or throat
• Yellow or orange colored skin due to the pigment carotene from fruits and
vegetables.
• Recurrent sinus infections
• Severe menstrual cramps
Diagnosis of Hypothyroidism
As symptoms of hypothyroidism are highly variable, blood tests measuring the
thyroid hormone levels are usually done for confirmation.
Blood tests
Thyroid-Stimulating Hormone (TSH) test
Thyroid Stimulating Hormone (TSH) is the key test used in diagnosis of
hypothyroidism. A level of TSH determines how much thyroxine (T4) thyroid gland
is being asked to produce. If the level of TSH is high, it gives the diagnosis of
hypothyroidism. High level of TSH in blood means there isn’t enough T4 in blood
and thyroid gland is being asked to produce more T4. In case of problems with
pituitary gland (e.g. tumor) enough TSH is not available in blood and in turn
thyroid gland will not produce required amount of T4. But in typical and most
common form of hypothyroidism T4 is found to be low with high level of TSH.
T4 Tests
The hormone T4 resides in blood both in attached and free form. Most of T4
(more than 98%) is bounded to a protein called thyroxine-binding globulin (TBG).
Unlike free T4 (1-2%), T4 in bounded form can not enter the cell. Measuring the
levels of both bounded and free T4 can give estimate of how much free T4 is
available for cells.
Additional laboratory abnormalities may include:
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Cholesterol levels (increased)
Liver enzymes (increased)
Serum prolactin (increased)
Serum sodium (low)
Complete blood count (CBC) may show anemia
Diagnostic dilemma of hypothyroidism
Although, diagnosis of hypothyroidism is considered by many as quite
straightforward, millions of people with mild to moderate forms of
hypothyroidism remain undiagnosed. One limiting factor is that there are no
specific sign(s) or symptom(s) of this disease. Symptom’s spectrum is variable and
some patients with mild variations in lab tests will feel just fine while others will
be quite symptomatic. Some may have severe hypothyroidism and still show no or
few signs and others may be very sick by the time they visit their healthcare
provider and learn that they are hypothyroid. The results of thyroid function test
often but not always correlate with the degree of signs and symptoms that makes
situation grimmer.
The Thyroid Stimulating Hormone (TSH) assays are commonly used to diagnose
hypothyroidism. Laboratory results are often misleading due to the complexity
and inherent shortcomings. Rarely, a blood chemistry panel would show true
condition because it carries only 30% accuracy. It is common for a patient of
hypothyroidism to have completely normal thyroid panel. This is why thyroid
panel is considered by many as inadequate for correct diagnosis of
hypothyroidism. Thyroxine Stimulating Hormone (TSH) test is not as accurate as
considered by many and is subject to extreme error. This test lacks high
sensitivity and specificity. Some healthcare providers may take TSH tests as sole
indicator for the diagnosis and chances are they get absolutely wrong diagnosis. If
you are having the symptoms suggesting thyroid problem and been declared free
of thyroid problem on the basis of your thyroid panel results, its better to consult
some other physician for second opinion.
A patient with typical symptoms of hypothyroidism (weight gain, hair loss, low
blood sugar, depression and dry skin etc.) may have low TSH levels which will be
taken by most as hyperthyroidism though it is common for hypothyroid patients to
have low TSH levels. Ignoring the clinical presentation some healthcare providers
may recommend hyperthyroidism treatment in such cases.
To aggravate the things further, there is great variation in “normal’ reference
range for TSH among various laboratories in U.S. Some laboratories follow the
reference range from approximately 0.5 to 5.0 while others recommend the range
of 0.3 to 3.0. These two conflicting ranges are followed by physicians according to
their own preferences. The result is obvious, millions of Americans have TSH level
ranging from 3.0 to 5.0 and will they get thyroxine replacement therapy or not
depend upon their physician’s preference. Same problem shows up when patients
are given hormone replacement therapy to make their TSH level fall in range of
2.5 to 5.5, whereas some other physicians may take it as an indication of
hypothyroidism. This is why one sees conflicting opinions over single thyroid
panel. Ironically, you could be declared free of any thyroid problem or as
hypothyroid on the basis of range followed by your healthcare provider.
The measurement of serum thyroxine (T4) levels is similarly full of hazard
provides snapshot of blood thyroxine levels and have limited relationship to the
amount of T3 binding to tissue receptors. It also lacks information about viability
of T4 to T3 conversion. One alternative to this problem was provided by Baisier,
which involves assay of T3 and T4 excretion in urine over 24 hours period but this
assay is not adopted by many as they consider this test not viable in clinical
practice. Yet one more sensitive test is available called as Thyrotropin Releasing
Hormone (TRH) assay which measure the levels of TRH. TRH is released by
pituitary to stimulate release of TSH. This requires injection followed by series of
blood samples at 15, 30, and 45 minute intervals. This test is highly sensitive and
specific but it is not used often due to high cost and inconvenience.
One simple procedure is recommended by many as the best tool to diagnose (not
always) hypothyroidism is by keeping a basal body temperature chart. The basal
body temperature is your temperature when you wake up in the morning. The
Barnes Basal Temperature Chart Method is most widely used for this purpose. You
can download basal temperature chart and use it for recording your daily
temperature values. Take your temperature in the morning using simple mercury
thermometer as soon as your wake up before eating or drinking anything and
getting out of bed. This will give your body’s lowest temperature value of the
day. This lowest value correlates well with your thyroid function. Next readings
should be taken at three and six hour interval. Woman should start taking the
temperature on the second day of menstruation because of considerable rise in
temperature is seen around the time of ovulation and can result in false results.
Some healthcare providers now recommend taking oral temperature as the
preferred method because some pitfalls with axillary temperature test like
difference of one degree while temperature reading is taken in axilla.
Your oral temperature should be 98.0 in the morning before rising. The oral
temperature for the rest of day is 98.6 to 99 (from 8 am to 11 am). Hypothyroid
patients can have below normal temperature values by 1-3 degrees. Twenty
minutes after taking lunch is the best time for taking temperature because
thyroid functions maximum at this time. Being hypothyroid and having normal or
high temperature values means having some sort of infection raising your
temperature. After your infection is resolved, temperature should come back to
below normal values. Patients taking thyroxine replacement therapy for
hypothyroidism can easily find if they are taking too much thyroxine by this
method.
Treatment
Most patients of hypothyroidism will need life long thyroxine replacement
therapy. Thyroxine replacement will restore the deficient hormone and body
functions. Hypothyroid patient should get their hormone levels checked at
specified intervals by their healthcare provider (every six month or yearly). The
key factor for successful treatment and to avoid treatment failures is to take your
pills regularly without missing your daily pill. Set a time for your medication that
suits you well and find a way to remember taking your pills every day like
associating it with brushing your teeth. Pills can be taken with any liquid except
soy milk. Don’t try to swallow the pills without liquid as it decreases the amount
of drug absorbed. Pills can be given to infants and children by crushing them and
mixing it with some suitable liquid, or breast milk and dispense with medicine
dropper. Thyroxine is weakened when dissolved in liquid therefore should be
dispensed as quickly as possible.
The interchanging of brands of thyroxine is not recommended. Once you get used
to one brand and your thyroid panel is normal, you should stick with the same
brand. Always check the brand and strength of medicine you buy. In case you
forget taking you pill, it should not be serious matter as thyroxine stays in your
blood for quite a long time. If you missed your pill in the morning you should take
it at any time of day when you remember it. If you missed your yesterday’s pill do
not take two pills next day.
Conventional Treatment
1. Levothyroxine/Synthetic T4 (Synthroid)
This is the most commonly prescribed drug for thyroid hormone replacement.
Most common brand name of this drug is Synthroid, however, Levoxyl,
Levothyroid, Unithroid and many other brands are available outside U.S.
Side effects
While most people tolerate Levothyroxine quite well, in some patients allergic
reactions are seen. The most common symptoms are:
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Rashes
Hives
Wheezing
Itching
Difficult breathing
Levothyroxine taken in high doses can lead to many side effects especially of
hyperthyroidism. You should call your health care provider if you feel any of
these:
• Feeling hot when other people are cold
• Fever
• Tachycardia (increased heart rate)
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Palpitations
Skipping heart beats
Difficult breathing
Sleep disturbances
Mood swings
Alopecia (hair loss)
Flushing
Muscular tremors
Anxiety and irritability
High blood pressure
Vomiting
Diarrhea
Abdominal cramps
Drug Interactions with Levothyroxine
Levothyroxine may interact with other medicines including commonly used overthe-counter preparations. Some medicines with potential of interactions with
Levothyroxine are:
Antacids (gas-relieving medicines)
Antacids can bind to levothyroxine thus decreasing absorption of levothyroxine in
body. Four hour gap between these two drugs is recommended.
Calcium supplements
Calcium binds to levothyroxine and decreases the amount of drug available. Again
four hour gap is recommended between these two drugs.
Antidepressant drugs
Some antidepressants may alter the availability of levothyroxine in body, and
dose of levothyroxine may need to be adjusted in such cases. This combination
can also cause arrhythmias (irregular heart beats). Consult your physician before
starting antidepressant while taking levothyroxine treatment.
Diabetes medications
Diabetic patients may need their diabetic medications doses to be readjusted if
they are taking levothyroxine.
Digoxin
Levothyroxine if combined with digoxin can makes it less effective. It could be
dangerous and dose of digoxin may need to be readjusted.
Estrogens (birth control pills, patches)
Estrogens have negative effect on the level of levothyroxine in blood making it
less effective. Consult your healthcare provider before taking birth control pills or
patches with levothyroxine.
Iron supplements (multivitamins containing iron)
Iron has binding capacity to levothyroxine in digestive tract, thus decrease the
amount of drug available for absorption. Separate levothyroxine and irons
supplements ingestion for at least four hours.
Seizure Medications (Phenobarbital, Phenytoin, Carbamazepine )
Taking levothyroxine with some seizure medications may change the amount of
levothyroxine available for absorption.
Sucralfate
Sucralfate binds to levothyroxine in the digestive tract, decreasing the absorption
of levothyroxine. Make sure to separate levothyroxine and sucralfate ingestion by
at least four hours.
Theophylline
Level of theophylline may be affected by levothyroxine in blood. Theophylline
dose adjustment may be required in such cases.
Warfarin
Combination of warfarin and levothyroxine increases the risk of bleeding. Close
monitoring is required and dose of warfarin may need to be adjusted when you
start or stop taking levothyroxine.
Use of Levothyroxine during pregnancy
Levothyroxine is considered safe in pregnancy and does not cause any harm to
fetus as very little drug passes placenta to the fetus. However, dose of
levothyroxine may needs to be revised during pregnancy.
Levothyroxine and breastfeeding
Only small amounts of levothyroxine passes through breast milk, so it should not
be problematic if thyroid hormone levels of nursing mother are kept normal.
However, nursing mother should always consult their healthcare provider before
starting levothyroxine while they are breastfeeding.
Some facts about Synthroid
Synthroid is one of the top five drugs sold in the U.S., and millions of people who
suffer from thyroid disorders including hypothyroidism, goiter and thyroid nodules
take this thyroid hormone replacement drug. Synthroid a synthetic drug used in
thyroid problems has long history of manufacturing problems, stability and subpotency
concerns and reliability issues. It was included in the letter sent by FDA to Synthroid’s
manufacturer Knoll Pharmaceuticals which was later released for public. FDA asked
Synthroid to apply for a new drug application way back in 2001 in order to remain
legally on the market. Not surprisingly as you would expect from these
multimillionaire companies, Knoll Pharmaceuticals requested FDA to exempt them
from this new drug application (NDA) and also waive requirements for adequate and
well controlled studies. FDA denied this request and said they would have to go
through this New Drug Application process because synthroid has a history of problems
and patients needs a precise dose of levothyroxine sodium. FDA further said
“Although you claim that Synthroid has been carefully manufactured, the
violations of current good manufacturing practices discussed above indicate that
Knoll has not always manufactured Synthroid in accordance with current standards
for pharmaceutical manufacturing”.
Later on FDA approved Synthroid and surprisingly Abbott spokesperson Smoter in an
interview said in interview that “It's the same size, the same colors, and same shape.
The only difference is that, for easier identification, where the pills used to say
“Flint” they now say “Synthroid”
Liothyronine/Synthetic T3 (Cytomel)
In some patients liothyronine (cytomel) is prescribed in combination with
levothyroxine. It is a synthetic version of T3, an active thyroid hormone in body.
In healthy person, thyroid gland produces T4 and little amount of T3 which is the
active hormone used by cells of body. Recent research supports this idea of
supplementing T3 along with T4 due to impaired conversion of T4 to T3 in some
patients. However, some practitioners oppose this idea because according to
them, T4 would ultimately be converted to T3 in body so there is no need of
giving extra T3.
Side effects of Liothyronine (Cytomel)
Most people taking cytomel tolerate it well, while some may experience some
side effects. Mostly, the side effects are usually seen when high dose of cytomel
is used and symptoms of hyperthyroidism seen. Some of these symptoms are quite
serious and you should immediately consult your healthcare provider in case of
overdose. Symptoms due to overdosing include:
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Feeling hot when other people are cold
Flushing
Chest pain and heart attack
An irregular heart rhythm (arrhythmia)
Tachycardia (increased heart rate)
Palpitations
Weight loss (with normal or increased diet)
Feeling hot all the time and increased sweating
Fever
Anxiety and irritability
Sleep disturbances
Mood swings
Muscular tremors
Difficult breathing
Diarrhea, vomiting,
Abdominal cramps
Hair loss
Menstrual problems
Seizures.
Allergic reactions are also seen with cytomel. The most common symptoms are:
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Rashes
Hives
Wheezing
Itching
Difficult breathing
Drug interactions with Cytomel
Calcium
Calcium has the binding capacity with cytomel in digestive tract and decrease the
amount of drug available for absorption. Four hour interval should be followed.
Seizure medicines
Seizure medicine may decrease the amount of cytomel available in body.
Theophylline
Cytomel may alter the level of theophylline in blood.
Antidepressants
Combination of cytomel with antidepressant especially tricyclic antidepressants
may enhance the effects of both drugs. Also, this combination may increase the
risk of arrhythmias (irregular heart beats).
Warfarin
Warfarin combined with cytomel can increase the risk of bleeding. Close
monitoring by your health care professional is required for combined use of both
drugs.
Diabetes Medicines
Diabetic patients may need their diabetic medications doses revised if they are
taking cytomel.
Digoxin
Cytomel if given with digoxin can make it less effective and also increases toxic
effects of digoxin.
Estrogens
Estrogens can decrease the level of cytomel for absorption and can make it less
effective. Consult your healthcare provider before taking birth control pills or
patches with cytomel.
Use of Cytomel during pregnancy
Cytomel is considered safe in pregnancy and does not cause any harm to fetus as
very little drug passes placenta to the fetus. However, dose of cytomel may need
to be revised during pregnancy.
Cytomel and breastfeeding
Only small amounts of cytomel pass through breast milk, therefore, it should not
be problematic if thyroid hormone levels of nursing mother are normal. However,
nursing mother should always consult their healthcare provider before starting
cytomel while breastfeeding.
Liotrix/Synthetic T4 and T3 Combination
Liotrix (Thyrolar) is a combination of T4 and T3. Though not prescribed regularly,
some physicians who are in favor of supplementing T3 with T4, prefer this
combination.
Natural Thyroid (Armour thyroid)
Armour thyroid is a “natural” product, derived from thyroid glands of pigs. It has
been in used for about 100 years until levothyroxine hit the market. Armour
thyroid available in tablet form have very characteristic odor which many people
consider very unpleasant. Animal thyroid may sound more “natural”, but not
without side effects like:
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These are not purified and may contain proteins which are not normally present in
human body and these proteins may cause allergic reactions.
The ratio of T4 and T3 in animals is not same as in humans and not quite natural
to us.
The ratio of T4 and T3 may vary in every batch making it more difficult to
maintain the required blood levels
Armour Strengths
Armour tablets are available in following strengths.
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2.
3.
4.
5.
6.
7.
Armour
Armour
Armour
Armour
Armour
Armour
Armour
Thyroid
Thyroid
Thyroid
Thyroid
Thyroid
Thyroid
Thyroid
½ grain (30 mg)
1 grain (60 mg)
1½ grain (90 mg)
2 grain (120 mg)
3 grain (180 mg)
4 grain (240 mg)
5 grain (300 mg).
Ingredients of Armour
1.
2.
3.
4.
5.
6.
Porcine Thyroid Powder formulation according to U.S. Pharmacopeia
Sodium
Microcrystalline Cellulose (used as filler in tablet)
Calcium Stearate (It gives stabilizing effect and also lubrication to formula)
Dextrose (Sugar)
Opadry White (Titanium dioxide, but also contains trace amounts of polyethylene
glycol (waxy solid) , Polysorbate 80 (which is an emulsifier help in blending the
ingredients), and Hydroxypropyl Methycellulose (provide bulking)
Side effects of Armour thyroid
Being a natural product, armour thyroid is quite safe. Most of the side effects see
due to overdose and symptoms of hyperthyroidism are seen.
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Feeling hot when other people are cold
Flushing
Chest pain and heart attack
An irregular heart rhythm (arrhythmia)
Tachycardia (increased heart rate)
Palpitations
Weight loss (with normal or increased diet)
Feeling hot all the time and increased sweating
Fever
Anxiety and irritability
Sleep disturbances
Mood swings
Muscular tremors
Difficult breathing
Diarrhea, vomiting,
Abdominal cramps
Hair loss
Menstrual problems
Seizures.
Drug interactions
Antacids (gas-relieving medications)
Antacids can bind to armour thyroid thus decreasing absorption of drug in
body.
Calcium supplements
Calcium binds to armour thyroid, decreasing the amount of drug available for
absorption.
Diabetes medications
Diabetic patients may need their diabetic medicines doses revised, if they are
taking armour.
Estrogens (birth control pills, patches)
Estrogens can decrease the level of armour for absorption and can make it less
effective. Consult your healthcare provider before taking birth control pills or
patches with armour.
Seizure medications (Phenobarbital, Phenytoin, Carbamazepine )
Medicines used for seizure control can decrease the amount of armour thyroid.
Theophylline
Levels of theophylline may be affected by armour thyroid in blood.
Warfarin
Combination of warfarin and armour thyroid may increase the risk of bleeding.
Use of Armour thyroid during pregnancy
Armour thyroid is considered safe in pregnancy and does not cause any harm to
fetus as very little drug passes placenta to the fetus. However, dose may need
to be revised during pregnancy.
Armour thyroid and breastfeeding
Only small amounts of armour pass through breast milk, therefore, it should
not be problematic if thyroid hormone levels of nursing mother are normal.
However, nursing mother should always consult their healthcare provider
before starting armour while breastfeeding.
Does Armour going towards ban?
Rumors that armour is being discontinued, taken off the market, banned by FDA,
gotten rid off etc. are there to remain with armour. FDA has taken no such action
like banning the armour. Armour is in use even before FDA established. FDA only
wants other companies marketing the formula of armour (with different
combination of ingredients, or single ingredient without approval of FDA) should
go through FDA’s approval process. That’s all. Armour is FDA-regulated
prescription drug. Also, in terms of consistency problems, the levothyroxine
sodium drugs have recently come under heavy FDA fire for problems with stability
and potency. So armour is going to stay in the market and if FDA initiates any
process for its approval, Forest, off course will be ready to accept the challenge
as they and millions of users have strong confidence in armour.
Follow up
The overall goal of the treatment is to keep your TSH within normal range. Once
the TSH and thyroxine levels return back to normal range and symptoms start
resolving, you can visit your health care professional every six months or a year
for thyroid testing. You should consult your healthcare provider if:
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Symptoms of disease are returning back
You are having any symptom of hyperthyroidism
You want to start or stop the treatment or change in dose is required
You want to change your thyroxine brand.
You are feeling significant weight changes
You want to stop the thyroxine treatment because you think you can do well
without it.
In most cases, prevention of hypothyroidism is not possible but it can be
successfully controlled and complications avoided. Prevention of the disease is
only applicable in cases where availability of required amount of iodine is
problem like in underdeveloped countries. The disease can be prevented by
supplementing the iodine (e.g. iodized salt) to masses. In U.S. iodine deficiency is
not a problem thanks to wide scale supplementation of iodine in food. To prevent
the progression of the disease early diagnosis and treatment are important.
Newborn babies, pregnant women, and people at risk should be evaluated for
their thyroid functioning.
Hypothyroidism and subclinical hypothyroidism: Treatment controversy
A study published in the March 2005 Archives of Internal Medicine, compared the
standard treatment of hypothyroidism levothyroxine/T4 verses combinations of
levothyroxine plus T3.Effects of treatments on quality of life, psychometric and
physiological measurements were evaluated. It was concluded that the
combination therapy has no extra benefits over single standard therapy of T4 and
treatment of hypothyroidism with levothyroxine alone is sufficient for hypothyroid
patients. The study further stated that levothyroxine alone should remain the
drug of choice for treatment of hypothyroidism until clear advantages of
levothyroxine-T3 combination are demonstrated. Despite the results of this study
most patients involved in study preferred the combinational therapy. One major
concern shown by practitioners not in favor of T3-T4 combination is short half life
of T3. Use of T3 may result in significant fluctuations in the hormone levels, On
other hand, two other studies comparing T4 verses T4-T3 combination therapy
shown clear improvements in both mood and cognition in case of combination
therapy. In other study, marked improvement in all symptoms was seen when
patients receiving synthetic T4 were switched to desiccated thyroid extract.
Subclinical Hypothyroidism
In subclinical hypothyroidism TSH levels are high but T4 and T3 levels are found
within normal ranges, whereas in typical hypothyroid patients T4 levels are high
and T4-T3 levels are low. This is puzzling for most practitioners because TSH
levels are usually high when T4 and T3 levels are low. What are the exact effects
of subclinical hypothyroidism on body metabolism remain unclear because the
levels of T4 and T3 are within normal ranges. Should patients with subclinical
hypothyroidism be treated or not remains controversial. Few studies have shown
no benefit of giving thyroxine replacement therapy to these patients. There are
number of endocrinologists and physicians who are in favor of treating such
patients. Subclinical hypothyroidism can lead to overt hypothyroidism and should
be treated according to David F. Gardner MD, a professor of medicine. According
to him, subclinical hypothyroidism incidence in general population is about 5-10%
and in women over the age of 60 could be as high as 15-20%. Patients with
subclinical hypothyroidism, if untreated can face adverse affects like
neuropsychiatric symptoms, altered myocardial functions, abnormal lipids, and
atherosclerosis. Elderly patients may have higher risk of progression to overt
disease.
It remains unclear that if treatment of patients with subclinical hypothyroidism
outweigh the higher costs of testing and treatment. Experts against the treatment
would argue that thyroid levels can vary widely and overtreatment of these
patients can have potential side effects like hyperthyroidism.
Nutrition for thyroid conditions
Diet plays a pivotal role in thyroid health. Iodine deficiency has been known to
cause depressed thyroid function and eventually goiter. Supplement of iodized
salt does not solve the problem completely. Many foods are now known to block
iodine in our body. For example peanuts, peanut butter and soybeans essential
ingredients of preformed foods used as textured vegetable protein and soybean
oil are known to block iodine consumption. Refined sugars and grains have many
negative effects on normal thyroid functions and these being consumed in large
quantities.
Chemical pollutants, mercury, pesticides, and fluoride (present in toothpaste)
suppress thyroid gland functions. Mercury is known to diminish thyroid function
because it displaces the selenium which is involved in conversion of thyroid
hormone T4 to T3. Many dietary oils being consumed at large scale can also affect
thyroid health. Soybean known for anti-thyroid properties is the source of many
vegetable oils or polyunsaturated oils present in almost every commercially
prepared food.
In one study healthy subjects without the history of previous thyroid disease were
fed 30 gm of soybeans per day for one month, goiter developed in these
individuals with high levels of thyroid stimulating hormone (TSH). One month
after stopping the intake of soybean, TSH levels in these individuals came back to
normal and goiter reduced in size.
Foods which can depress thyroid functions are broccoli, cabbage, brussels sprouts,
cauliflower, kale, spinach, turnips, soy, beans, and mustard greens. These foods
should be included in the diet for hyperthyroid conditions and avoided for
hypothyroid conditions. Avoid refined foods, sugar, dairy products, wheat,
caffeine, alcohol. Iodine rich foods like fish, vegetables, kelp, and root vegetables
like potatoes are good for hypothyroid patients. Diet rich in vitamin B complex
like whole grains, raw nuts, and seeds, and food rich in vitamin A, such as yellow
and dark green vegetables can be used. Cabbage, mustard greens, broccoli,
Brussels sprouts, kale, spinach, peaches and pears slow down the production of
thyroid hormone.
Coconut oil still doing wonders
The coconut is rightly called “tree of life’, is providing food, drink, material for
housing, and fuel. And its medicinal uses are enormous. Research has proven that
it has excellent anti-bacterial, anti-viral and antifungal properties. Interestingly,
coconut oil has shown remarkable benefits for AIDS patients. Coconut oil contains
medium chain fatty acids which have tremendous health benefits. It promote slow
metabolism and also help in weight loss common problems of thyroid disease.
Unlike soybean oil a common ingredient in our food industry items, it helps
thyroid a lot. Coconut oil also has thermogenic properties which mean it has
ability to raise the body temperature and thus metabolism that result in weight
loss. Coconut oil is also known to reduce the appetite and help those trying to
lose weight. Research has also shown that it also reduces the lipoproteins and
cholesterol (remember thyroid patients usually have high cholesterol levels). One
research done in Philippines (coconut is commonly used in tropical areas) showed
that in study population, there were no signs of kidney disease or hypothyroidism.
Vitamins and minerals
B-Vitamins
B vitamins play important role in synthesis of T4 in body. B-Complex supplement
contains adequate vitamin B. Both B-50 and B-100 can be taken as prescribed by
your healthcare provider. As niacin (Vitamin B3) can lower thyroid hormone levels
therefore regular blood tests are recommended.
Iodine
Iodine deficiency is the main culprit for hypothyroid disorders especially in many
underdeveloped countries. Supplementation of iodized salt in the developed
countries has helped to control hypothyroidism due to iodine deficiency. Iodine
supplementation without its deficiency is not recommended because its excess is
also detrimental for thyroid gland.
Zinc
Studies have shown that extreme deficiency of zinc can lead to hypothyroidism.
Its deficiency is rare in developed countries. Zinc is a part of many multi-vitamin
preparations.
Selenium
The synthesis of both T3 and T4 require selenium. If T3 levels are found to be low
as compared to T4, multi-mineral supplement with selenium would be a good
choice. However, in case of combined deficiency of both iodine and selenium,
selenium supplementation can aggravate the hypothyroid condition. Healthcare
provider should be consulted before starting any such supplementation.
Vitamin A
As hypothyroidism can cause impairment of body’s ability to convert betacarotene to vitamin A, supplementation of vitamin A is given especially to those
patients not consuming enough vitamin A in diet.
L-tyrosine helps thyroid gland for its normal functions. Hypertensive patients
(with high blood pressure) should not use it without prior consultation with their
healthcare provider.
Calcium and magnesium
These minerals are important in number of metabolic processes. Calcium and
magnesium must be present together in sufficient quantities, or the body will not
be able to use either. The optimal ratio is 3 parts calcium to 1 part magnesium.
Never supplement calcium without supplementing magnesium because the body
will actually use its stored Mg to try and process the supplemented Ca that can
deplete body’s stored calcium reserves.
Alternative Medicine
Regardless of which alternative treatment you decide to use, thyroid function
needs to be carefully evaluated and is likely to need specialist medical advice.
Some people have had great success using only alternative medicine while others
must utilize a combination of alternative and conventional medicine. Many
alternative therapies have shown or at least claimed to work well for hypothyroid
patients. These include: herbal medicines, homeopathy, biofeedback training,
detoxification therapy, acupuncture, environmental medicine, magnetic field
therapy, osteopathy, qigong, and yoga.
Herbs:
Number of herbs can help hypothyroid patients in controlling the thyroid disorder
and reducing severity of symptoms. Mostly herbs are recommended and used for
being safe and free of side effects. However, a specialist must be consulted
before using any herb to avoid any untoward side effects from wrong selection as
some herbs are very harmful.
One of the most widely used herbs for hypothyroidism is tea. Oatstraw, horsetail,
gotu kola, alfalfa along with some other are used to make this tea. Two to four
cups of this tea are given daily to hypothyroid patients. Some other herbs
recommended to hypothyroid patients are kelp, Irish moss, bladderwrack, and
coleus foreskohlii. Bladderwrack contains iodine and widely used in
hypothyroidism patients. Coleus foreskohlii helps to stimulate overall thyroid
function and thus increase in production of thyroid hormones. Guggul and
hawthorne are used to control high cholesterol levels in hypothyroid patients.
Chinese herbs like American Ginseng, Bitter melon, Asian Ginseng, garlic, ginger,
and corydalis are widely used. Other Chinese herbs include licorice, green tea,
ligustrum, sweet annie and shiitake. Black cohosh is useful in dealing with
menstrual problems caused by hypothyroidism and also known for its role in
treating infertility in women. Black Cohosh is found to be useful in the curing
menstrual problems caused by hypothyroidism and can even treat infertility in
women. Gentian or mugwort are bitter herbs that can help in mild
hypothyroidism. Avena sativa is another herb that is used to help curing various
nervous disorders as it is the best nervine tonic. In hypothyroidism, depression
and anxiety is common and therefore, Avena sativa can help calming the mood
and restoring the brain chemistry. Avena sativa is known for its role in curing
various nervous disorders. Depression and anxiety in hypothyroid patients can be
reduced by using Avena sativa.
Homeopathy:
Homeopathic medicines offer good prognosis in hypothyroidism. Various
homeopathic drugs are used in hypothyroid patients including Lapis alb, Calcare
phos, Iodium, Calcarea carb, Spongia, Lycopus, Thyroidinum and Calcarea iod.
However, qualified homeopath should be consulted before starting any treatment.
Thyroid neck-check
If you have family history of hypothyroidism, feeling its symptoms, try neckcheck. Hold a mirror in your hand and focus on the area below the Adam’s apple
in your neck. Take a drink of any liquid and swallow it. Look at your neck and
check for any protrusion in this area. If you see any bulge, call your health care
provider.
CHAPTER 3
Hyperthyroidism
Definition
The term hyperthyroidism or thyrotoxicosis refers to a condition in which excess
levels of thyroid hormones (T4 and T3) are present in blood. In other words, the
thyroid gland is overactive.
In more than 70% cases, cause of thyrotoxicosis is Graves’ disease. Graves’ disease
is caused by antibodies in the blood that makes thyroid to grow and secrete
thyroid hormones in excess. Positive family history is often present and/or history
of other autoimmune diseases e.g. diabetes. Hyperthyroidism is more common in
young adults between the age of 20 and 40 and is more common in women then
men (6:1). Its high incidence in women may relate to extreme hormonal shifts in
women and over-activity of the thyroid gland. The hormonal changes took place in
womanhood, adolescence, menopause, in periods and during or after pregnancy
may play role in this disease.
The second most common cause of hyperthyroidism is toxic solitary nodule of
thyroid, also known as Plummer’s disease. Inflammation of thyroid gland due to
some viral infections, tumors of testes or ovaries, ingestion of large amount of
thyroid hormones or iodine can also lead to hyperthyroidism.
Symptoms
As thyroid hormone control the rate of all the processes in the body (metabolism),
increased levels of these hormones tend to speed up every function of the body.
Symptoms of hyperthyroidism are usually not appreciated by the patient, as it
usually starts slowly and symptoms may be mistaken for simple stress.
Hyperthyroidism produces symptoms of high calorific turnover and includes:
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Palpitations
Anxiety
Thirst
Sweating
Weight loss (despite normal or increased dietary intake)
Increased appetite
Heat intolerance
Thinning of the skin
High blood pressure
Increased sweating
Restlessness
Inability to rest or sleep leading to fatigue
Frequent bowel movements and intermittent diarrhea
Gynecological symptoms including amenorrhoea (absence of menstrual
periods), menstrual irregularities, infertility or recurrent miscarriages.
• Enlarged thyroid gland (goiter)
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Thyroid gland enlargement and protrusion of the eyes are two important
diagnostic symptoms that require additional workup to confirm or rule out a
diagnosis of hyperthyroidism.
Diagnosis of Hyperthyroidism
Diagnosis of hyperthyroidism is usually straightforward. History and physical
examination help to make tentative diagnosis. Following physical examination
findings are common:
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Enlarged thyroid gland
Rapid pulse
Tremor of fingertips
Other symptoms previously described
Confirmation of hyperthyroidism diagnosis is obtained through lab tests for the
detection of levels of thyroid hormones in the blood
• T3 (high)
• T4 (high)
• Thyroid stimulating hormone (TSH) ( low)
Thyroid scan
Thyroid scan determines the functioning of thyroid gland. A radioisotope is used
which is concentrated by the thyroid gland just like iodine uptake. It is usually
done along with Iodine uptake scan. These scans are not recommended in case of
pregnancy because iodine can cause developmental problems within the baby’s
thyroid gland.
Iodine Uptake Scan
Iodine uptake scan measures the level of iodine uptake by the thyroid gland. Cells
of thyroid gland take iodine from our blood and use it to make thyroid hormone.
In hyperthyroid patients, thyroid gland takes up too much iodine, which can be
confirmed through this scan.
Thyroid Binding Globulin
Thyroid hormones in blood are attached to a protein called thyroid binding
globulin (TBG). Variation in the level of TBG is found in some families as a
hereditary trait. Except false changes in the level of T4, TBG causes no other
problem. A patient may be misdiagnosed if results of this test are interpreted
along with other tests of thyroid panel.
Thyroid Ultrasound
Ultrasound is used to image thyroid gland and identify nodules if present.
Ultrasound will detect the consistency of the nodule, size, and any changes along
the course of time. Ultrasound guided needle biopsy improves the accuracy of the
test.
Thyroid Antibodies
This test is used to detect antibodies against patient’s own thyroid tissue. High
levels of antibodies are found in patients with Hashimoto’s thyroiditis. High levels
of thyroid antibodies give strong evidence of the disease.
Thyroid Needle Biopsy
Thyroid needle biopsy has become a reliable test to differentiate benign and
malignant nodules. Information provided by this test surpasses any other test and
it provides definitive information in more than 75% of cases.
X-ray scan, CAT scan, and MRI scan
These radiographic procedures are used to detect any cancerous growth.
Treatment
Three treatment modalities are most commonly used for hyperthyroidism
including:
1. Medical therapy ( antithyroid drugs)
2. Surgery
3. Radioactive iodine therapy
As no single treatment is appropriate for all patients, the choice is made
considering various factors like:
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Age of patient
Severity of disease
Underlying pathology
Gland size
Pregnancy
Patient’s preference
The choice of treatment is best made by multidisciplinary professionals including
endocrinologist, radiotherapist, physician, and experienced thyroid surgeon.
Antithyroid drugs
An antithyroid agent is a hormone antagonist that acts against thyroid hormone.
Propylthiouracil (pro pil thye oh YOOR ah sill)
This drug lowers the amount of thyroid hormone produced by thyroid gland. It is
commonly prescribed to patients of hyperthyroidism and Graves’ disease.
Side effects
The important side effect of this drug is that it lowers the number of white blood
cells (WBCs) in the blood. This increases the chance of various infections. If the
number WBCs decreased markedly (agranulocytosis), fatal infections can lead to
very serious consequences. Other side effects include:
• Thrombocytopenia (decrease in the number of platelets, which are important
in blood clotting)
• Allergic reactions
• Skin rashes, itching, and hives
• Hair loss and skin pigmentation
• Nausea
• Vomiting
• Numbness
• Headache
• Heartburn
• Loss of taste
• Joint and muscle pain
• Whitening of hair
• Nosebleeds, black or bloody stools or blood in urine (may indicate low
platelets)
• Hepatitis and hepatic necrosis (rare)
• Goiter, weight gain, and swollen salivary glands
• Nephritis, glomerulonephritis, and acute renal failure
Contraindications
Propylthiouracil is contraindicated in patients hypersensitive to this drug, and also
in lactating women.
Drug Interactions:
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Actions of anticoagulants may be potentiated by anti-vitamin-K like effect
of propylthiouracil.
Propylthiouracil may alter disposition of beta-blockers, digoxin, and
theophylline which necessitate dose adjustments of these drugs.
It may increase the effect of oral blood thinners like warfarin (Coumadin).
Therefore, close monitoring is required if both drugs are given in same
patient.
Propylthiouracil in Pregnancy
Classified as Drug Class D in pregnancy, this drug considered safe. However, about
12% cases of fetal goiter cases have been reported after propylthiouracil
treatment.
Methimazole (Tapazole®)
Indications
It is also used to treat hyperthyroidism. Its common use is before surgery or
radioactive iodine therapy to decrease the levels of thyroid hormone and to
minimize the effects of thyroid gland manipulation. The drug is as effective in
elderly as in younger adults.
Adverse effects
Less common but serious side effect of methimazole is decrease in white blood
cells (WBCs) termed as agranulocytosis (if reduced markedly). These patients have
higher rates of infections including infection of throat, gastrointestinal tract and
skin. Series of complete blood count (CBC) is performed and drug is discontinued
if WBC count is found in lower limits. Other side effects include:
• Thrombocytopenia (decrease in the number of platelets, which are important
in blood clotting)
• Headache, depression, drowsiness
• Skin rashes, urticaria, pruritus, , skin pigmentation, and abnormal hair loss
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Goiter
Nausea, vomiting, salivary gland swelling
Weight gain
Joint and muscle pain
Decrease in the number of white blood cells and platelets
Abnormal sensations like burning, prickling and tightness
Hepatitis and jaundice
Drug interactions
Actions of anticoagulants may be potentiated by anti-vitamin-K like effect of
methimazole.
• In case of pregnancy or breast feeding, an alternative drug like propylthiouracil
is used.
• Methimazole may decrease the beta-blocker clearance, thus dose adjustment
may be required for patients receiving beta-blockers.
• Methimazole may also increase levels of digoxin.
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Contraindications
Methimazole is contraindicated in patients sensitive to methimazole, nursing
mothers, and in pregnancy.
Carbimazole
It is a pro-drug (A precursor or forerunner of a drug), converted to its active form
methimazole after absorption. It reduces production of the thyroid hormones T3
and T4 (thyroxine)
Side Effects
Please see under methimazole
Contraindications
Please see under methimazole
Drug interactions
Please see under methimazole
Radioiodine therapy
Radioiodine therapy is used to damage or destroy the thyroid cells to ultimately
reduce the increased production of thyroid hormone. Radioiodine usually given
orally, enters bloodstream and taken up by overactive thyroid cells. Radioiodine
damages the thyroid cells, thus reducing the over-production of thyroid
hormones. Radioiodine not taken up by thyroid cells will be excreted through
urine or transformed into non-radioactive form. Treatment with radioiodine may
take several weeks to months for its effects.
Advantages of radioiodine therapy are:
• Cosmetic advantages over surgery
• Avoid risks of hemorrhage, recurrent laryngeal nerve palsy or hypocalcaemia
associated with surgery
• Side effects of radioiodine therapy are uncommon
Disadvantages of radioiodine therapy are:
• Slower response to treatment (may take several weeks to months for its
effects)
• Contraindicated in pregnant or breastfeeding patients
• High risks in children
• High incidence of hypothyroidism following treatment with radioiodine and
patient may need life long thyroxine replacement therapy
• High relapse rate after initial treatment therefore more therapeutic sessions
may be needed
Therapy for symptomatic relief in hyperthyroidism
Patients with hyperthyroidism may experience high fever, nausea, profuse
perspiration, and tachycardia (160 beats /min). Propylthiouracil and methimazole
due to delayed onset of action, are ineffective in controlling these symptoms.
Potassium Iodide (Lugol’s Solution), and beta-blockers are often prescribed with
antithyroid medicines to control these acute symptoms. Beta-blockers decrease
heart rate, control tremors and palpitations, lessen agitation, and reduce
peripheral conversion of T4 to T3. Treatment is usually given for several weeks.
Most commonly used agents include Propranolol (Inderal®), atenolol (Tenormin®),
and metaprolol (Lopressor®).
Natural remedies for Hyperthyroidism
Traditional Chinese treatment
Traditional Chinese medicine considers hyperthyroidism as a combination of Qi
and Yin deficiency which is responsible for weakness and fatigue due to prolonged
overstimulation.
Thyro-H #450 is formula for the treatment of hyperthyroidism. It contains
tonifying Qi and nourishing Yin. It purges the liver fire and resolve phlegm
stagnation. Oyster shell, Scrophularia and Arnemarrhea are herbs used in this
formula which dissolve lumps and hard masses. These are used to treat goiter and
hyperthyroidism. Gardenia and Prunella reduces the symptoms like increased
heart rate, increased blood pressure, and muscular tremors. This formula contains
number of other herbs effective in hyperthyroidism. Another Chinese patent
medicine called Hsiao Yao Wan is known for its regulation of endocrine system
and its positive role in the treatment of hyperthyroidism.
Life style and exercise (Chinese view)
Traditional Chinese treatment also gives importance to changes in life style,
balanced diet and exercise for successful treatment of hyperthyroidism. This
treatment strictly prohibit vigorous exercises, saunas, hot tubs, cigarette
smoking, caffeine, and recommend consumption of foods like burssel, broccoli,
cabbage, sprouts, cauliflower, mustard greens, peaches, soybeans, spinach and
turnips. It recommends relaxing exercises like walking, Qi Gong and Tai Chi.
Minerals and Supplements
Following are few minerals and supplements found effective in hyperthyroidism:
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Vitamin C combined with B-complex is used to treat the psychological
effects of disease including stress,
Primrose oil rich in essential fatty acids is very effective supplement for
autoimmune disorders.
Vitamin C along with minerals like Zinc, Copper, Selenium, iodine and
amino acid tyrosine can be used to promote healthy functioning of thyroid
gland
Calcium and magnesium are cofactors for many metabolic processes.
Hyperthyroidism is known to cause magnesium deficiency.
Omega-3 fatty acids boost immune system and also known to reduce
inflammation
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Bromelain reduces swelling and inflammation
Nutrition
The hyperthyroid patient’s diet should be rich in fruits, vegetables, skinless
chicken, fish, whole grains, skinless turkey and beans. Few other useful food
products which help the body resist the symptoms of this disease are kelp, garlic,
seaweed, pulses, egg yolk, radishes, beetroot, oatmeal, mushrooms, bananas,
watercress, brewers yeast and seafood.
Following may interfere with normal thyroid function and should be avoided.
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Broccoli
Cabbage
Cauliflower
Kale
Spinach
Soy
Beans
Brussels sprouts
Mustard greens
Refined foods, wheat, caffeine, dairy products and alcohol should not be used.
Herbs
Herbs are recommended for being safe and with little or no side effects. For
treatment of any disease including hyperthyroidism through herbs, professional
should be consulted for proper diagnosis and treatment and before taking any
herb as some may be very harmful.
• Motherwort helps in regulating the tachycardia (rapid heartbeat).
• Tumeric potentiates the effects of bromelain and is recommended for the
treatment of hyperthyroidism.
• If excessive mineral iodine is a cause of hyperthyroidism, gypsywort herb can
reduced the effects of iodine.
• A tincture of herb is recommended for treatment and prevention
• Use of wine vinegar to decoct equal portions of the bark of the oak and male
fern roots can be used as a topical rub on throat for its soothing effects
• To counter inflammation, an extract of turmeric called curcumin is found to
be very effective.
• Dandelion root regulates the liver function and thus benefits the thyroid gland.
• Irish moss and Iceland moss are natural source of iodine required by thyroid
gland.
• Valerian is known for its calming effects and as an aid to sleep.
• Bugle is an herb found in Europe, parts of North Africa, and some parts of Asia.
It tastes bitter, and is ranked high in herbal medicine. Bugle is specifically
used for treating hyperthyroid patients and to alleviate the symptoms like
tightness of chest, palpitations and muscular tremors. Bugle is commonly used
in combination with herbs like skullcap and valerian herbs.
• Lemon Balm is so called because it carries the scent of lemons. It has potent
anti-thyroid activity and herbalist commonly used it for this purpose. Lemon
balm also known to inhibit the binding of thyroid-stimulating hormones
receptors. Along with other potent effects, lemon balm provides relief from
palpitations and relaxes the heart. It is also used to treat nausea and vomiting.
No side effects have been reported yet.
Following herbs should be avoided in case of hyperthyroidism:
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Ashwagandha
Bladderwrack
Gotokola
Ephedra
Caffeinated green tea
Chineses or Korean ginseng
Homeopathy
Homeopathy offers number of medicines in the treatment of hyperthyroidism. It
is, however, recommended to seek professional homeopathic practitioner’s advice
for proper diagnosis and treatment. In homeopathy, person’s constitutional type
along with his emotional, physical and intellectual makeup is considered before
starting treatment. Homeopathy offers good prognosis in case of hyperthyroidism.
Medicine like Calcare phos, Lapis alb, Calcarea carb, Iodium, Spongia,
Thyroidinum, and Calcarea iod are often prescribed in patients with
hyperthyroidism.
Aromatherapy for Hyperthyroidism
It is type of herbal medicine. Essential oil is one of the most important ingredients
used in Aromatherapy. Essential oil may include lavender, tea tree, bergamot and
rosemary. The combination of lavender and rosemary oil provides soothing effect
to the nerves. Rosemary oil helps relieving pain and improves circulation.
Lavender oil has antiviral, antibacterial, antispasmodic and anti-inflammatory
properties.
Acupressure treatment for hyperthyroidism
Instead of inserting needles as in acupuncture this technique involves application
of finger pressure to acupuncture points to stimulate them for relief. Following
points are used in the treatment of hyperthyroidism through acupressure.
More on etiology of thyroid disease
Iodine Supplementation: What to be aware of?
Since iodine deficiency disease still remains a health problem in many undeveloped
and some developed countries, iodine supplementation is being practiced in many
parts of the world. It is a fact that administration of iodine in any chemical form can
induce thyrotoxicosis. It is usually occurs when incremental rise in mean iodine intake
in the prevention programs. It can also occur with the use of radio-contrast media or
amiodarone. Once study shows that overt hypothyroidism, subclinical hypothyroidism,
and autoimmune thyroiditis were found to be increasing with iodine intake in China.
Perchlorate: A new threat to the health of Americans
According to FDA study, a toxic chemical known as perchlorate a byproduct of rocket
fuel found common in what the Americans are eating or drinking. Various perchlorate
containing compounds include rockets (ammonium perchlorate), fireworks displays
and fertilizers. According to study 93% of the milk and lettuce supply has been found
contaminated with perchlorate and at least 22 states of U.S are with contaminated
water supplies. A study done by the Centers of Disease Control and Prevention
sampled 3,000 people all across the country and every one had detectable levels.
Perchlorate has been found in wide range of eatables like tomatoes, spinach, citrus,
melons, cucumbers and even the organic vegetables are contaminated. It is not
restricted to those areas in U.S with contaminated water supplies but almost
everyone is taking it one way or another.
Perchlorate and thyroid
Pregnant women and children are at high risk. The tops most concern is the ability of
this toxin to interfere with thyroid function by displacing iodine in the body. The
consequences are huge like hypothyroidism, goiter, thyroid cancer, breast disease,
disruption of menstrual cycle, weak immune system, and poor growth and mental
retardation in infants since it is also present in breast milk. Congenital hypothyroidism
was found much higher in vastly contaminated areas. Even if you are taking
appropriate level of iodine in diet, perchlorate can cause substantial changes in
thyroid hormone levels, and one can expect the implications in folks with low iodine
intake.
Stress
Stress affects every system of our body. Stress leads to hormonal inbalance and
release of cortisol. Chronic stress can lead to severe hormonal imbalances and
deficiencies. Thyroid disease can also lead to stress due to its overall impact over
health, body systems and mental well being of a person. It seems that both thyroid
disease and stress have bidirectional relationship but is still to be determined.
Pathologists at The College of American Pathologist indentified stress as the main
trigger of Graves’s disease. Stress negatively effect the immune system and interfere
with body’s own mechanism of fighting disease.
Genetics
Genetics plays significant role in thyroid diseases. People with positive family history
of thyroid problems are more prone to thyroid disorders. All they can do is to keep an
eye over their thyroid functions by regular (like yearly) thyroid testing.
Menopause
Menopause can adversely affect thyroid gland. Subclinical thyroid problems are
especially important in these women.
Environmental Factors
There are number of identified environmental factors that can predispose a person to
thyroid dysfunction. When these environmental factors are withdrawn, it leads to
drop in thyroid antibody levels, and patient improves dramatically.
For example, avoiding gluten causes thyroid disease improvement. Avoiding pollen
has positive effects in relieving the symptoms of Graves’ disease by reducing the
allergic response.
Patients with autoimmune thyroid disease are found to be low in selenium. Though
the exact role of selenium is unclear, many studies show that patients with Graves’
disease using selenium and other antioxidant vitamins like vitamin C and beta
carotene showed better response than those who were on single antithyriod therapy.
Cigarette smoking has many adverse effects on thyroid functioning and can directly
damage the thyroid cells. Patients with subclinical hypothyroidism and smoke have
higher serum thyrotropin concentrations and high serum cholesterol and low density
lipoproteins. Smoking reduces thyroid hormone secretion in patients with subclinical
hypothyroidism and further complicates the disease. Also, infants whose mothers are
smokers have high serum thyroglobulin levels and thiocyanate concentrations leading
to thyroid problems in these children. Importantly, smokers are twice as likely to
develop Graves’ disease as nonsmokers. The overall effects of smoking on thyroid
gland have been attributed to thiocyanate, because its concentrations have been
found higher in smokers than nonsmokers.
Sex steroids and estrogens and chemicals like aspartame can also trigger an immune
reaction that can leads to thyroid inflammation and thyroid anti-body production.