Hypothyroidism

Hypothyroidism or myxedema is group of signs and symptoms that characterize a thyroid hormone deficiency. Primary hypothyroidism is the most common form, and is most common is the fifth and sixth decades of life, and is more common in women. Up to 75% of hypothyroid patients have circulating antibodies to thyroid antigens, which suggest an autoimmune component (see thyroiditis below). The second most common form is post-therapeutic hypothyroidism, primarily due to the administration of radioactive iodine therapy or surgery for hyperthyroidism. Secondary hypothyroidism occurs when there is failure of the hypothalamic-pituitary axis because of deficient TRH secretion from the hypothalamus or lack of TSH secretion from the pituitary. Rare inherited enzymatic defects can alter the synthesis of thyroid hormone and cause goitrous hypothyroidism. Mild hypothyroidism is common and is more often found in elderly women. (Berkow 1992, 1080-81; Rubin 2001, 600-01)

The signs and symptoms of hypothyroidism are often quite subtle and insidious, with initial symptoms such as lethargy, increased cold sensitivity and difficulty concentrating. The facial expression becomes progressively more and more dull in appearance, and the voice is hoarse and speech is slowed. Proteoglycans begin to accumulate in the extracellular matrix and bind with water, promoting the characteristic symptoms referred to as myxedema, including facial puffiness, puffy eyelids, peripheral edema and a swollen tongue. Changes begin to occur in the skin, including pallor and dryness, and the hair begins progressively more and more sparse: hair loss and a loss of the lateral eyebrows specifically is a common finding. The term myxedema madness refers to a worsening of the nervous afflictions, from poor concentration and forgetfulness to depression, anxiety and paranoia. Weight gain is a common symptom, mostly from decreased metabolism and fluid retention. The early symptoms of myxedema include a reduction in heart rate and volume from a decrease in both thyroid hormone and adrenergic stimulation, and as the condition progresses the heart may be enlarged, with pleural or abdominal effusions. Decreased peristalsis becomes an important clinical feature, and patients will often complain of chronic constipation and sometimes present with fecal impaction (myxedema megacolon). The continuing deposition of proteoglycans and proteins in the extracellular matrix, especially around the ligaments of the wrist and ankles produces nerve compression and carpal-tarsal tunnel syndrome. Women with hypothyroidism often develop menorrhagia, and as a result iron-deficiency anemia is often present, although in some cases the anemia may be related to impaired B12 absorption. (Berkow 1992, 1080-81; Rubin 2001, 600-01)

The challenge in the diagnosis of hypothyroidism is to differentiate it from its primary and secondary forms. Secondary hypothyrodism, caused by a failure of the hypothalamic-pituitary axis is comparatively uncommon, and in women presents with a history of amenorrhea rather than menorrhagia, skin depigmentation and hypoglycemia. Laboratory testing demonstrates a low level of circulating TSH in secondary hypothyroidism whereas in primary hypothyroidism serum TSH levels are typically elevated. It generally takes 6 weeks however for TSH levels to reflect the status of thyroid hormone in the blood because TSH in normally released in a pulsatile fashion, peaking during the night, and the changes in response are subtle, with TSH gradually responding to excess or diminished thyroid hormone. Thus TSH may not be a reliable indicator of thyroid function at the time of diagnosis. Serum T3 and T4 levels are also investigated, and in both forms levels are typically decreased, although patients with primary hypothyroidism may have normal circulating levels of T3. Certain medications however such as estrogen, as well as chronic illnesses and liver problems can cause alterations in protein concentration, and thus the total T4 and T3 measurements typically utilized may not accurately represent thyroid function. To this extent, laboratory tests that measure the free T3 and T4 levels are far more accurate determinants of thyroid function and should be used in preference. (Berkow 1992, 1080-81; Rubin 2001, 600-01)

Given the caveats associated with conventional testing procedures, there is good evidence to suggest that thyroid disorders may be more prevalent than previously suspected. In 1995, researchers studied 25,862 participants at the Colorado statewide health fair.  They discovered that among patients not taking thyroid medication, 8.9 percent were hypothyroid and 1.1 percent were hyperthyroid. This indicates 9.9 percent of the population had a thyroid problem that had most likely gone unrecognized. These figures suggest that nationally, there may be as many as 13 million Americans with an undiagnosed thyroid problem (Canaris et al 2000).

Medical treatment

The goal of medical treatment for hypothyroidism is focused upon halting the progression of the disease and to correct the underlying metabolic problems. The primary therapy consists of using some form of thyroid hormone to supplement or replace endogenous production to alleviate clinical signs and symptoms by restoring serum TSH and T4 values to normal. While desiccated porcine thyroid (armour thyroid) has been used for well over a 100 years, modern treatments have focused upon the usage of levothyroxine (synthroid, synthetic T4) is most commonly prescribed. Where the GI absorption of synthroid is poor, peripheral conversion of T4 into T3 is poor, or where a rapid clinical response is desired liothyronine (cytomel, synthetic T3) may be prescribed. Long term administration of levothyroxine has been linked to hypoglycemia, headaches, insomnia, bone loss, cardiac fibrillation and adrenal insufficiency (Iihara et al 2003; Korsic et al 1998; Sheppard et al 2002; Rey et al 2001).

Holistic treatment

Given that up to 75% of all patients that suffer from primary hypothyroidism display serum antibodies to thyroid antigens, a common approach in the holistic treatment is to resolve the underlying factors that promote autoimmune disease. This includes a strict avoidance of all potentially antigenic foods including dairy, cereals and legumes. Other potential dietary factors include the excessive consumption of goitrogens, or foods that inhibit iodine utilization, including:

• turnips
  
• cabbage
  
• mustard
  
• cassava root
  
• soy products
  
• peanuts
  
• pinenuts
  
• millet
  

Another important underlying mechanism of hypothyroidism in holistic circles is the concept of "adrenal stress." Many of the inherently stressful lifestyle habits that people follow in industrialized countries is far removed from what are our bodies have evolved to cope with on a chronic basis. Working long hours, a lack of sleep, an inability to fulfill oneself creatively or emotionally, and the excessive use of stimulants places enormous stress on the adrenals to mediate the physiological stress of sympathetic stimulation. Supporting the idea of a profound relationship between the thyroid and adrenals, there are several studies that indicate adrenal insufficiency can promote, occur concurrently, or as the result of primary hypothyroidism (Candrina and Giustina 1987; Roosens et al 1982). Thus supporting adrenal function is often a necessary component in treating hypothyroidism and other kind of thyroid disorder.

Deficiencies of key nutrients are also known to play a role in hypothyroidism. Vitamins A, B, C and E are all necessary for as well as zinc, copper, selenium. Zinc appears to enhance thyroid function, whereas copper slows it down. Selenium is a trace element that is essential to form the deiodinase enzymes that convert T4 (the hormone our thyroid gland makes) into the biologically active T3.

Lastly, hypothyroidism is often associated with autoimmune processes, immunoglobulins directed against thyroid antigens, and thus treatment should also be directed to inhibit the pathogenesis of autoimmunity (see: autoimmune disease).

1. Ensure proper nutrition.

• Avoid goitrogens (e.g. legumes, cruciferous vegetables), implement Paleolithic diet (especially if the condition has or is suspected to have an autoimmune component)
  
• Ensure adequate iodine (e.g. kelp, dulse, nori, hijiki, wakame, arame etc.), 600 mcg/day
  
• Ensure adequate zinc (e.g. seafoods, meats, seeds), 25 mg/day
  
• Ensure adequate copper (e.g. organ meat, eggs, nuts, seeds), 5 mg/day
  
• Ensure adequate selenium (e.g. organically grown liver, egg yolks, butter, nuts, grains, onions, garlic), 200 mcg/day
  
• Ensure adequate vitamin A (e.g. liver, egg yolks, butter), 10,000 IU/day
  
• Ensure adequate B vitamins (e.g. liver, egg yolks, leafy greens, yeast), 100 mg/day
  
• Ensure adequate vitamin C (e.g. fruit, vegetables), 2-3 g daily
  
• Ensure adequate vitamin E (e.g. nuts, seeds, egg yolks, butter), 400-800 IU/day
  
• Ensure adequate omega-3 fatty acids, EPA/DHA, 1000 mg each daily
  

2. Enhance metabolism. Botanicals to upregulate thyroid function. Many of these are also considered to be liver stimulants, as well as digestive and cardiovascular stimulants.

• liver stimulants: Oregon Grape (Mahonia repens), Barberry (Berberis vulgaris), Blue Flag (Iris versicolor), Brahmi (Bacopa monniera), Guggulu (Commiphora mukul), Coleus (Coleus forskohli), Turmeric (Curcuma longum)
  
• stimulants (dipanapachana): Pippali (Piper longum), Chinese Cinnamon (Cinnamomum cassia), Ginger (Zingiber officinale), Prickly Ash (Zanthoxylum clavaherculis), Cayenne (Capsicum minimum), Cardamom (Elettaria cardamomum), Costus (Saussurea lappa)
  

3. Support adrenal function and energetic systems in the body. Botanicals that support adrenal function as adaptogens, rasayanas (i.e. support ojas) or strengthen qi, jing, and Kidney yang.

• adaptogens: Siberian Ginseng (Eleuthrococcus senticosis), Reishi (Ganoderma lucidum)
  
• rasayanas: Ashvagandha (Withania somnifera), Haritaki (Terminalia chebula)
  
• qi restoratives: restoratives: American Ginseng (Panax quinquefolium), Huang Qi (Astragalus membranaceus), Dang Shen (Codonopsis pilosula), Licorice (Glycyrrhiza glabra)
  
• jing restoratives: Epimedium (Epimedium spp), Du Zhong (Eucommia ulmoides), Shu Di Huang (Rehmannia glutinosa)
  
• Kidney yang restoratives: Ginseng (Panax ginseng), Bai Ji Tian (Morinda officinalis), Deer Antler velvet
  

4. Modulate immune function.

• implement dietary changes to remove antigenic foods (e.g. dairy, cereals, grains, and legumes), i.e. elimination-challenge diet
  
• modulate immune function using botanicals such as Grifola (Grifola umbellata), Reishi (Ganoderma lucidum), Ashvagandha (Withania somnifera), Licorice (Glycyrrhiza glabra), Ginseng (Panax spp), Turmeric (Curcuma longum), Shu Di Huang (Rehmannia glutinosa), Dan Shen (Salvia miltiorrhiza), Huang Qin (Scutellaria baicalensis), Chai Hu (Bupleurum chinense)