Hyperthyroidism treatment is available at Morningside, Parkhurst, Bedfordview, Fourways, & West Rand clinics. In Pretoria at Irene and Brooklyn as well as in the Western Cape at Cape Quarter, Claremont, Constantia, Stellenbosch, Paarl and Willowbridge clinics and KwaZulu-Natal at Umhlanga, Durban & Ballito clinics.
Underactive thyroid: Having an underactive thyroid (also known as hypothyroidism) is often overlooked or misdiagnosed and can be the underlying cause of these symptoms. Patients and their doctors make to common mistake to disregard these signs of thyroid hormone deficiency, mistaking them for normal aging.
Overactive thyroid: (also known as hyperthyroidism) afflicts fewer people than hypothyroidism, but the symptoms can be equally devastating. Subclinical hyperthyroidism is characterized by suppressed thyroid stimulating hormone (TSH) levels which are accompanied by normal thyroid hormones (T4 and T3) levels. Hyperthyroidism has been associated with increased rates of cardiovascular disease; arrhythmia being one in particular. Overt hyperthyroidism can lead to compromises bone health, elevated blood glucose levels, and often causes anxiety in sufferers. Fortunately, a simple blood test for TSH, T3 and T4 can reveal an underlying thyroid condition and help direct treatment to improve the symptoms experienced.
The thyroid is a butterfly-shaped organ located just below the Adam’s apple in the neck. This gland is made up of small sacs which are filled with an iodine-rich protein called thyroglobulin, along with the thyroid hormones thyroxine (T4) and small amounts of triiodothyronine (T3).
The primary function of these two hormones (T4 and T3) is to regulate the body’s metabolism by controlling the rate at which the body converts oxygen and calories into energy. It is actually the case that the metabolic rate of every cell in the body is regulated by thyroid hormones, primarily T3.
In healthy individuals the thyroid gland is unnoticeable to the touch. A visibly enlarged thyroid gland is referred to as a condition goiter. Historically, goiter was most frequently caused by a lack of dietary iodine. However, in countries where salt is iodized, goiter of iodine deficiency is rare, and not of great concern.
The production of the hormones T4 and T3 in the thyroid gland is regulated by the hypothalamus and pituitary gland, which are both situated in the brain. To ensure stable levels of thyroid hormones, the hypothalamus monitors circulating thyroid hormone levels and responds to low levels by releasing thyrotropin-releasing hormone (TRH). This TRH then stimulates the pituitary to release thyroid stimulating hormone (TSH). When thyroid hormone levels increase, production of TSH decreases, which in turn slows the release of new hormone from the thyroid gland.
Cold temperatures: Being exposed to cold temperatures can cause the TRH TRH levels to increase. This is thought to be an intrinsic mechanism that helps keep the human body warm in cold weather.
Elevated levels of cortisol: When an individual experiences stress, and in conditions such as Cushing’s syndrome, it causes TRH, TSH and thyroid hormone levels to lower, thus negatively affecting the thyroid.
A Diet deficient in iodine: The thyroid gland needs iodine and the amino acid L-tyrosine to make T4 and T3. If one does not consume enough iodine as part of a balanced diet it can limit how much T4 the thyroid gland can produce and lead to hypothyroidism.
T3 is the biologically active form of thyroid hormone. The majority of T3 is produced in the peripheral tissues by conversion of T4 to T3 by a selenium-dependent enzyme. Various factors including nutrient deficiencies, drugs, and chemical toxicity may interfere with conversion of T4 to T3.
Another related enzyme converts T4 to an inactive form of T3 called reverse T3 (rT3). Reverse T3 does not have thyroid hormone activity; instead it blocks the thyroid hormone receptors in the cell hindering action of regular T3.
Carrier proteins: Ninety-nine percent of circulating thyroid hormones are attached to carrier proteins, which makes them metabolically inactive. The remaining “free” thyroid hormone, the majority of which is T3, binds to and activates thyroid hormone receptors, exerting biological activity. Even if there are very small changes in the amount of carrier proteins it will affect the percentage of unbound hormones found in the blood. Oral contraceptives, pregnancy, and conventional female hormone replacement therapy may increase thyroid carrier protein levels and, thereby, lower the amount of free thyroid hormone available.
1.There are various blood tests that can be ordered to diagnose and monitor hypothyroidism. These include: Thyroid Stimulating Hormone (TSH), Total T4, Total T3, Free T4 (fT4), Free T3 (fT3), Reverse T3 (rT3), Thyroid peroxidase antibody (TPOAb), and Thyroglobulin antibody (TgAb).
The most common test is testing the levels of Thyroid stimulating hormone (TSH) when screening for thyroid dysfunction. In the last decade the diagnostic strategy for using TSH measurements has changed as a result of the sensitivity improvements in these assays. It is now recognized that the TSH measurement is a more sensitive test than T4 for detecting both hypo- and hyperthyroidism. As a result, some countries and many doctors promote a TSH-first strategy for diagnosing thyroid dysfunction in patients, and cutting out other less sensitive tests.
In 2008 many labs adopted the reference range for TSH, which is very broadly stated as 0.45 to 4.50 μIU/mL, (as recommended by both the Endocrine Society and the American Medical Association). Note though, that this range is an improvement over the previous data of 0.45-5.5 mIU/L. but it is still considered too broad by many clinicians.
Health Renewal suggests an optimal level of TSH between 1.0 and 2.0 µIU/mL, as some studies have noted that a TSH above 2.0 may be associated with adverse cardiovascular risk factors. However, while a measure of TSH alone is a useful screening tool in assessing thyroid function, Health Renewal advocates additional testing, including Free T3 and T4 levels, to provide a more complete evaluation of the thyroid.
Please Note: TSH values will fluctuate during the day, and thus not always give the same results. Infection and various other factors will also influence these measurements, and thus no single measurement of TSH should be considered diagnostic.
2.Basal Body Temperature: Before the development of accurate thyroid function blood tests an alternative method that was widely used for assessing thyroid status was the basal body temperature test. The temperature is taken when the body is at complete rest, immediately after waking and before beginning any activity. The normal basal temperature 36.5 º C -36.8ºC for a healthy individual. It is believed by some alternative practitioners that a 5-day consecutive temperature reading below 36.5 º C is indicative of hypothyroidism.
3.Tests for T4 and T3: Thyroid hormones can be tested in both their free and protein-bound forms. When tests for Total T4 and Total T3 are required this would include testing for both the unbound form of the hormone, as well as the protein-bound forms. When testing only the unbound form of the hormone it is referred to as “free” T3 /T4. Each of these tests gives information about how the body is making, activating, and responding to thyroid hormone. If a patient has clinical hypothyroidism they will present with below normal levels of free T3 and T4. In subclinical hypothyroidism the TSH will be elevated while the thyroid hormone levels are still in the normal reference range.
4.Reverse T3: Certain individuals with apparently normal T4 and T3 hormone levels still display the classic symptoms of hypothyroidism. This may be due to an excessive production of reverseT3 (rT3). rT3 is inactive and may interfere with the action of T3 in the body. Two aspects that may play a role in lowering the thyroid hormone action is stress and extreme exercise, which causes the suppression in the production of TSH and T3 and elevating rT3 levels.
5.Autoimmune antibodies: When evaluating the thyroid it is also important to consider that the most common cause of overt hypothyroidism in the United States is an autoimmune disorder known as Hashimoto’s thyroiditis. This condition is characterized by the body producing antibodies to the thyroid gland, which then damages the gland. Hashimoto’s thyroiditis is diagnosed by doing standard thyroid testing in conjunction with testing for the presence of these particular antibodies called antithyroglobulin antibodies (AgAb) and thyroperoxidase antibodies (TPOAb). Some people with celiac disease or sensitivity to gluten are at increased risk for developing autoimmune thyroid disease and should be evaluated.
Elevated thyroid antibodies are often associated with chronic urticaria, also called hives. Studies report that as many as 57.4% of patients with hives have the presence of anti-thyroid antibodies. An August 2010 paper suggests that treatment with T4 improves the itching associated with urticaria, but did not advise treatment with T4 unless the patient was hypothyroid.
6.Hypothalamic pituitary axis (HPA): There is an intimate relationship between the thyroid, the adrenal glands and the sex hormones. If hypothyroidism is suspected in an individual, it is commonly recommended that the adrenal glands as well as the sex hormones are evaluated.
If an individual’s thyroid does not function optimally it can lead to either an over- or underactive thyroid. Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormones, characterized by a reduction in metabolic rate. The main symptoms that accompany hypothyroidism are fatigue, weakness, increased sensitivity to cold, constipation, unexplained weight gain, dry skin, hair loss or coarse dry hair, muscle cramps and depression. These symptoms will not give ample warning of the manifestation of the condition since they takes years to develop. The slower the metabolism gets as the condition worsens, the more obvious the signs and symptoms will become. If hypothyroidism goes untreated, the signs and symptoms could become severe, such as a swollen thyroid gland (goiter), slow thought processes, or in worst cases, dementia.
Subclinical hypothyroidism, an often under-diagnosed thyroid disorder, which manifests as elevated TSH, with normal T4 and normal T3 levels. Individuals with subclinical hypothyroidism are at greater risk for developing obvious hypothyroidism. It is interesting to note that an August 2010 study reported that 8.3% of women with no history of thyroid disease suffer from subclinical hypothyroidism.
There is evidence that the standard blood test reference range for TSH levels may cause many cases of hypothyroidism to be missed. It is accepted by most physicians that reference range for TSH between 0.45 and 4.5 µIU/mL is indicative of normal thyroid function. In reality, though, a TSH reading of more than 2.0 may indicate lower-than-optimal thyroid hormone levels.
According to a study reported in Lancet, various TSH levels that fall within the “normal range” are associated with adverse health outcomes. As an example:
There is another and separate problem brought on by these overly broad normal ranges for TSH. People already diagnosed and being treated for hypothyroidism are often not taking correct doses of thyroid replacement hormones. A November 2010 study reported that about 37% of people being treated for hypothyroidism were taking incorrect doses, about half too much and another half too little hormone, making the treatment ineffective.
Most of the bodily systems will be affected in some or other way, which includes:
Gastrointestinal problems: Constipation is one of the very common symptoms caused by hypothyroidism. Constipation is normally caused due to reduced motility of the intestines. In some cases, this situation can lead to intestinal obstruction or abnormal enlargement of the colon causing further complications. Hypothyroidism is also associated with decreased motility in the esophagus, which can cause difficulty in swallowing, heartburn, indigestion, nausea, or vomiting. If an individual also has little intestinal bacterial growth abdominal discomfort, flatulence, and bloating can occur.
Depression and psychiatric disorders: Various disorders such as panic disorders, depression, and changes in cognition are frequently associated with thyroid disorders. It has become a common mistake that hypothyroidism is misdiagnosed as depression. A study published in 2002 suggests that that thyroid function is especially important for bipolar patients: Results suggest that nearly 75% of patients with bipolar disorder have a thyroid profile that may be suboptimal for antidepressant response.
Cognitive decline: If a patient has low thyroid function they can suffer from slowed thinking, delayed processing of information, difficulty recalling names, and so forth. Patients with subclinical hypothyroidism will show signs of decreased working memory, and decreased speed of sensory and cognitive processing. To prevent a misdiagnosis of depression, an evaluation of thyroid hormones along with TSH may help avoid this
Cardiovascular Disease: Hypothyroidism, and subclinical hypothyroidism, are associated with increased levels of blood cholesterol, increased blood pressure, and increased risk of cardiovascular disease. Even patients with subclinical hypothyroidism are more likely to develop cardiovascular disease than healthy individuals with a fully functioning healthy thyroid.
High blood pressure: Hypertension is a very common symptom among patients with hypothyroidism. In a 1983 study, 14.8% of patients with hypothyroidism had high blood pressure, compared with 5.5% of patients with normal thyroid function. Hypothyroidism has been recognized as a cause of secondary hypertension. It has been suggested that increased peripheral vascular resistance and low cardiac output can be the possible link between hypothyroidism and diastolic hypertension.
High cholesterol and atherosclerosis: Overt hypothyroidism is characterized by hypercholesterolemia and a marked increase in low-density lipoproteins (LDL) and apolipoprotein B. These changes accelerate atherosclerosis, which causes coronary artery disease. As TSH levels increase the risk of heart disease increases with it, even in patients that only have subclinical hypothyroidism. Hypothyroidism that is caused by autoimmune reactions is associated with stiffening of the blood vessels. It has been founds that thyroid hormone replacement therapy may slow the progression of coronary heart disease by inhibiting the progression of plaques.
Homocysteine: Treating hypothyroid patients with thyroid hormone replacement might attenuate homocysteine levels, which in itself is an independent risk factor for cardiovascular disease. There is a strong inverse relationship between homocysteine and free thyroid hormones, and this confirms the effect of thyroid hormones on homocysteine metabolism.
Elevated C-reactive protein: Overt and subclinical hypothyroidism are both associated with increased levels of low-grade inflammation, as indicated by elevated C-reactive protein (CRP). A 2003 clinic study observed that CRP values increased with progressive thyroid failure and suggested it may count as an additional risk factor for the development of coronary heart disease in hypothyroid patients.
Metabolic Syndrome: In a study of more than 1,500 subjects, researchers found that those with metabolic syndrome had statistically significantly higher TSH levels (which means that had a lower thyroid hormone output) than healthy control subjects. Subclinical hypothyroidism was also correlated with elevated triglyceride levels and increased blood pressure. Slight increases in TSH may put people at higher risk for metabolic syndrome.
Reproductive system problems: Menstrual irregularities and struggles with infertility are common problems experienced by women. With proper treatment one can restore a normal menstrual cycle and improve fertility rates.
Fatigue and weakness: These are well-known and common symptoms of hypothyroidism. In addition, chilliness, weight gain, paresthesia (tingling or crawling sensation in the skin) and cramps are common. Cramps are often absent in elderly patients when compared with younger patients.
In hyperthyroidism (which is the opposite of hypothyroidism) the thyroid gland produces too much thyroid hormone, which can significantly accelerate the body's metabolism. Typical symptoms related to hyperthyroidism include sudden weight loss, a rapid heartbeat, sweating, nervousness or irritability. Hyperthyroidism affects a much smaller group of people and only about one percent of the population will have this condition. It is usually caused by Graves’ disease, which is characterized by symptoms such as rapid heartbeat, sweating, nervousness, tremors, muscle weakness, sleep difficulties, increased appetite and sudden weight loss. Affected individuals can also experience thyroid storm, a potentially deadly medical emergency.
Medical Treatment of Grave’s disease:
Nutritional Support of Hyperthyroidism:
The most commonly prescribed treatment for low thyroid hormone levels entails thyroid hormone replacement therapy. The goal of thyroid hormone replacement is to relieve symptoms and to provide sufficient thyroid hormone to allow the elevated levels of TSH to decrease to within the normal range.
Conventional treatment almost always begins with synthetic T4 (levothyroxine) preparations like Eltroxin®. The physician will normally start with low doses, because a rapid increase in thyroid hormone may result in cardiac damage. It can happen that hypothyroid symptoms persist, despite T4 treatment. It has been suggested that in such a case a combination treatment of T3 and T4 be used to alleviate symptoms. Deficiencies in nutrients like selenium can disable the body from converting T4 to biologically active T3.
Desiccated Thyroid: Armour thyroid, Nature-throid, and Westhroid are prescription medications that contain desiccated porcine thyroid gland. Natural thyroid extracts have been used since 1892 and were approved by the FDA in 1939. Ultimately, there may not be a single correct approach to low thyroid hormone levels. Instead, the best option may be to monitor thyroid levels through regular blood testing and systematically try various protocols to see what yields the best resolution of symptoms. Some people may find it preferable to begin with T4 supplementation then move to a combination T3-T4 therapy if they experience no improvement from T4 alone.
Absorption of Thyroid Hormone Medications: Coffee, aluminum antacids, ferrous sulfate (iron), calcium carbonate, soy and possibly grapefruit juice can all decrease the absorption of thyroid hormone prescriptions. Most doctors simply advise patients to take thyroid hormone away from any food or medication. While most people take thyroid hormone in the morning, a December 2010 paper suggests that it is more effective time to take thyroid medication is just before bed.
Iodine: The body needs iodine to make thyroid hormone. Iodized salt has proven to be effective at preventing iodine deficiency. Iodize salt has been available since 1924 when the Morton Salt Company began selling is. During pregnancy T4 production doubles, causing increases in daily iodine requirements. Iodine deficient pregnant women cannot produce the thyroid hormones that are needed for proper neurological development of their growing babies, and are at high risk of giving birth to infants with cognitive impairment and learning delay. It is very interesting to note that even moderate iodine deficiency in a pregnant woman can lower her infant’s IQ from 8 to 16 points.
People who avoid iodized salt or adhere to a salt-restricted diet may become iodine deficient. Diets both low and high in iodine are associated with hypothyroidism.
Selenium: After iodine, selenium is probably the next most important mineral affecting thyroid function.
Zinc: Zinc may be helpful in patients with low T3 and may contribute to conversion of T4 to T3.
Iron: Iron deficiency hinders the manufacturing of thyroid hormone by reducing activity of the enzyme thyroid peroxidase.
Copper: Copper is important for normal brain development and its deficiency can leave the hypothalamus unable to regulate thyroid hormone effectively.
Vitamin E: Vitamin E may reduce the oxidative stress caused by hypothyroidism.
Vitamin D: Deficiency of vitamin D may increase risk of autoimmune thyroid disease. Moreover, other evidence suggests that vitamin D deficiency is more common among individuals with thyroid cancer or thyroid nodules, compared to the general population. Given the many benefits of adequate vitamin D, it makes sense to supplement if needed.
Vitamin B12: Hypothyroid patients are often vitamin B12 deficient, and require supplementation.
DHEA and Pregnenolone: Japanese researchers reported that concentrations of DHEA, DHEA-sulfate, and pregnenolone-sulfate are significantly lower in hypothyroid patients compared to age and sex matched healthy controls.
Rhodiola rosea: Given the fact that stress can influence thyroid status, it may be beneficial for some individuals with hypothyroidism to consider adaptogenic herbs such as Rhodiola. Adaptogenic herbs can will support the adrenal glands and thus improve the body’s response to stress.
Some foods contain goitrogenic substances that reduce the utilization of iodine. These foods include canola oil, and vegetables from the Brassica family (e.g., cabbage and Brussels sprouts.) The actual content of goitrogens in these foods is relatively low, however, and cooking significantly reduces the impact of these goitrogens on thyroid function.
For those patients that struggle with hypothyroidism, raw goitrogenic foods and soy foods that have not undergone fermentation and/ or food processing should be consumed in moderation and discontinued if symptoms should appear.
Thyroid hormone supplementation: If hormones are necessary, work with an experienced medical provider to find a hormone supplement that works best for you. TSH Target: An ideal TSH level is between 1 and 2 µIU/mL. TSH levels lower than this may increase risks and symptoms associated with hyperthyroidism. TSH levels higher than this may increase the risks and symptoms associated with hypothyroidism.
For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be overemphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. There is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.
Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he / she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to. The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.
The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, you will have to complete an in-depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation, your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which the Doctor will decide which blood tests need to be requested from your local pathology laboratory.
Once your blood results are received, they will then be analysed by your Health Renewal doctor who will begin working on a unique prescription plan for you with the compounding pharmacy. At your pre-scheduled second appointment 2 weeks later, the results and examination findings will be discussed with you. This will determine what abnormalities or deficiencies exist and you will be advised on your treatment options.
In-office treatments such as Carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction ED, menopause or PMS. If you need to lose weight our RID medical weight loss program may be recommended. All these recommendations will be summarised on a sheet/print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality and are not rancid nor contain Hg (mercury ) or PCB'S (which is very important for Omega 3 Essential fatty acids EFA's).
1. You are kindly requested to bring any supplements that you are currently taking, along to your consultation. The doctor can check the ingredients in take this into account when prescribing a treatment plan for you.
2. Also, if you have had any blood work done in the past 6 months, please bring the results along to the consultation. Should you not be in possession of the hard copies, please request these results from the lab you visited. Usually your ID number is sufficient.
Depending on the exact prescription given, you may be required to return to the doctor within 2 to 3 months’ time, in order to ensure optimum thyroid hormone levels are achieved. This will be determined by a repeat blood test and may be requested by your Health Renewal doctor.
You should ensure that you are current with your gynaecological visits/breast exams/mammograms (for female patients) and prostate exams (for male patients) as recommended by your GP/gynaecologist.
After the two week follow up, the initial blood results will be discussed and patient specific nutraceuticals may be initiated. A second follow up another evaluation and blood test at 8 weeks is recommended to measure serum improvements in your Lipogram, homocysteine and other essential blood results. Follow up appointments should be very 6 months.
The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.
Some days you need some help staying motivated to live a healthy lifestyle. Our compilation of health and wellness quotes and sayings provide the inspiration or the laugh you need to keep making positive choices for your overall wellbeing.
Here are ten quotes from great thinkers to challenge, motivate and inspire us to exercise, eat right and live healthier lives: Health and intellect are the two blessings of life.
Hyperthyroidism treatment is available at Morningside, Parkhurst, Bedfordview, Fourways, & West Rand clinics. In Pretoria at Irene and Brooklyn as well as in the Western Cape at Cape Quarter, Claremont, Constantia, Stellenbosch, Paarl and Willowbridge clinics and KwaZulu-Natal at Umhlanga, Durban & Ballito clinics.
Underactive thyroid: Having an underactive thyroid (also known as hypothyroidism) is often overlooked or misdiagnosed and can be the underlying cause of these symptoms. Patients and their doctors make to common mistake to disregard these signs of thyroid hormone deficiency, mistaking them for normal aging.
Overactive thyroid: (also known as hyperthyroidism) afflicts fewer people than hypothyroidism, but the symptoms can be equally devastating. Subclinical hyperthyroidism is characterized by suppressed thyroid stimulating hormone (TSH) levels which are accompanied by normal thyroid hormones (T4 and T3) levels. Hyperthyroidism has been associated with increased rates of cardiovascular disease; arrhythmia being one in particular. Overt hyperthyroidism can lead to compromises bone health, elevated blood glucose levels, and often causes anxiety in sufferers. Fortunately, a simple blood test for TSH, T3 and T4 can reveal an underlying thyroid condition and help direct treatment to improve the symptoms experienced.
The thyroid is a butterfly-shaped organ located just below the Adam’s apple in the neck. This gland is made up of small sacs which are filled with an iodine-rich protein called thyroglobulin, along with the thyroid hormones thyroxine (T4) and small amounts of triiodothyronine (T3).
The primary function of these two hormones (T4 and T3) is to regulate the body’s metabolism by controlling the rate at which the body converts oxygen and calories into energy. It is actually the case that the metabolic rate of every cell in the body is regulated by thyroid hormones, primarily T3.
In healthy individuals the thyroid gland is unnoticeable to the touch. A visibly enlarged thyroid gland is referred to as a condition goiter. Historically, goiter was most frequently caused by a lack of dietary iodine. However, in countries where salt is iodized, goiter of iodine deficiency is rare, and not of great concern.
The production of the hormones T4 and T3 in the thyroid gland is regulated by the hypothalamus and pituitary gland, which are both situated in the brain. To ensure stable levels of thyroid hormones, the hypothalamus monitors circulating thyroid hormone levels and responds to low levels by releasing thyrotropin-releasing hormone (TRH). This TRH then stimulates the pituitary to release thyroid stimulating hormone (TSH). When thyroid hormone levels increase, production of TSH decreases, which in turn slows the release of new hormone from the thyroid gland.
Cold temperatures: Being exposed to cold temperatures can cause the TRH TRH levels to increase. This is thought to be an intrinsic mechanism that helps keep the human body warm in cold weather.
Elevated levels of cortisol: When an individual experiences stress, and in conditions such as Cushing’s syndrome, it causes TRH, TSH and thyroid hormone levels to lower, thus negatively affecting the thyroid.
A Diet deficient in iodine: The thyroid gland needs iodine and the amino acid L-tyrosine to make T4 and T3. If one does not consume enough iodine as part of a balanced diet it can limit how much T4 the thyroid gland can produce and lead to hypothyroidism.
T3 is the biologically active form of thyroid hormone. The majority of T3 is produced in the peripheral tissues by conversion of T4 to T3 by a selenium-dependent enzyme. Various factors including nutrient deficiencies, drugs, and chemical toxicity may interfere with conversion of T4 to T3.
Another related enzyme converts T4 to an inactive form of T3 called reverse T3 (rT3). Reverse T3 does not have thyroid hormone activity; instead it blocks the thyroid hormone receptors in the cell hindering action of regular T3.
Carrier proteins: Ninety-nine percent of circulating thyroid hormones are attached to carrier proteins, which makes them metabolically inactive. The remaining “free” thyroid hormone, the majority of which is T3, binds to and activates thyroid hormone receptors, exerting biological activity. Even if there are very small changes in the amount of carrier proteins it will affect the percentage of unbound hormones found in the blood. Oral contraceptives, pregnancy, and conventional female hormone replacement therapy may increase thyroid carrier protein levels and, thereby, lower the amount of free thyroid hormone available.
1.There are various blood tests that can be ordered to diagnose and monitor hypothyroidism. These include: Thyroid Stimulating Hormone (TSH), Total T4, Total T3, Free T4 (fT4), Free T3 (fT3), Reverse T3 (rT3), Thyroid peroxidase antibody (TPOAb), and Thyroglobulin antibody (TgAb).
The most common test is testing the levels of Thyroid stimulating hormone (TSH) when screening for thyroid dysfunction. In the last decade the diagnostic strategy for using TSH measurements has changed as a result of the sensitivity improvements in these assays. It is now recognized that the TSH measurement is a more sensitive test than T4 for detecting both hypo- and hyperthyroidism. As a result, some countries and many doctors promote a TSH-first strategy for diagnosing thyroid dysfunction in patients, and cutting out other less sensitive tests.
In 2008 many labs adopted the reference range for TSH, which is very broadly stated as 0.45 to 4.50 μIU/mL, (as recommended by both the Endocrine Society and the American Medical Association). Note though, that this range is an improvement over the previous data of 0.45-5.5 mIU/L. but it is still considered too broad by many clinicians.
Health Renewal suggests an optimal level of TSH between 1.0 and 2.0 µIU/mL, as some studies have noted that a TSH above 2.0 may be associated with adverse cardiovascular risk factors. However, while a measure of TSH alone is a useful screening tool in assessing thyroid function, Health Renewal advocates additional testing, including Free T3 and T4 levels, to provide a more complete evaluation of the thyroid.
Please Note: TSH values will fluctuate during the day, and thus not always give the same results. Infection and various other factors will also influence these measurements, and thus no single measurement of TSH should be considered diagnostic.
2.Basal Body Temperature: Before the development of accurate thyroid function blood tests an alternative method that was widely used for assessing thyroid status was the basal body temperature test. The temperature is taken when the body is at complete rest, immediately after waking and before beginning any activity. The normal basal temperature 36.5 º C -36.8ºC for a healthy individual. It is believed by some alternative practitioners that a 5-day consecutive temperature reading below 36.5 º C is indicative of hypothyroidism.
3.Tests for T4 and T3: Thyroid hormones can be tested in both their free and protein-bound forms. When tests for Total T4 and Total T3 are required this would include testing for both the unbound form of the hormone, as well as the protein-bound forms. When testing only the unbound form of the hormone it is referred to as “free” T3 /T4. Each of these tests gives information about how the body is making, activating, and responding to thyroid hormone. If a patient has clinical hypothyroidism they will present with below normal levels of free T3 and T4. In subclinical hypothyroidism the TSH will be elevated while the thyroid hormone levels are still in the normal reference range.
4.Reverse T3: Certain individuals with apparently normal T4 and T3 hormone levels still display the classic symptoms of hypothyroidism. This may be due to an excessive production of reverseT3 (rT3). rT3 is inactive and may interfere with the action of T3 in the body. Two aspects that may play a role in lowering the thyroid hormone action is stress and extreme exercise, which causes the suppression in the production of TSH and T3 and elevating rT3 levels.
5.Autoimmune antibodies: When evaluating the thyroid it is also important to consider that the most common cause of overt hypothyroidism in the United States is an autoimmune disorder known as Hashimoto’s thyroiditis. This condition is characterized by the body producing antibodies to the thyroid gland, which then damages the gland. Hashimoto’s thyroiditis is diagnosed by doing standard thyroid testing in conjunction with testing for the presence of these particular antibodies called antithyroglobulin antibodies (AgAb) and thyroperoxidase antibodies (TPOAb). Some people with celiac disease or sensitivity to gluten are at increased risk for developing autoimmune thyroid disease and should be evaluated.
Elevated thyroid antibodies are often associated with chronic urticaria, also called hives. Studies report that as many as 57.4% of patients with hives have the presence of anti-thyroid antibodies. An August 2010 paper suggests that treatment with T4 improves the itching associated with urticaria, but did not advise treatment with T4 unless the patient was hypothyroid.
6.Hypothalamic pituitary axis (HPA): There is an intimate relationship between the thyroid, the adrenal glands and the sex hormones. If hypothyroidism is suspected in an individual, it is commonly recommended that the adrenal glands as well as the sex hormones are evaluated.
If an individual’s thyroid does not function optimally it can lead to either an over- or underactive thyroid. Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormones, characterized by a reduction in metabolic rate. The main symptoms that accompany hypothyroidism are fatigue, weakness, increased sensitivity to cold, constipation, unexplained weight gain, dry skin, hair loss or coarse dry hair, muscle cramps and depression. These symptoms will not give ample warning of the manifestation of the condition since they takes years to develop. The slower the metabolism gets as the condition worsens, the more obvious the signs and symptoms will become. If hypothyroidism goes untreated, the signs and symptoms could become severe, such as a swollen thyroid gland (goiter), slow thought processes, or in worst cases, dementia.
Subclinical hypothyroidism, an often under-diagnosed thyroid disorder, which manifests as elevated TSH, with normal T4 and normal T3 levels. Individuals with subclinical hypothyroidism are at greater risk for developing obvious hypothyroidism. It is interesting to note that an August 2010 study reported that 8.3% of women with no history of thyroid disease suffer from subclinical hypothyroidism.
There is evidence that the standard blood test reference range for TSH levels may cause many cases of hypothyroidism to be missed. It is accepted by most physicians that reference range for TSH between 0.45 and 4.5 µIU/mL is indicative of normal thyroid function. In reality, though, a TSH reading of more than 2.0 may indicate lower-than-optimal thyroid hormone levels.
According to a study reported in Lancet, various TSH levels that fall within the “normal range” are associated with adverse health outcomes. As an example:
There is another and separate problem brought on by these overly broad normal ranges for TSH. People already diagnosed and being treated for hypothyroidism are often not taking correct doses of thyroid replacement hormones. A November 2010 study reported that about 37% of people being treated for hypothyroidism were taking incorrect doses, about half too much and another half too little hormone, making the treatment ineffective.
Most of the bodily systems will be affected in some or other way, which includes:
Gastrointestinal problems: Constipation is one of the very common symptoms caused by hypothyroidism. Constipation is normally caused due to reduced motility of the intestines. In some cases, this situation can lead to intestinal obstruction or abnormal enlargement of the colon causing further complications. Hypothyroidism is also associated with decreased motility in the esophagus, which can cause difficulty in swallowing, heartburn, indigestion, nausea, or vomiting. If an individual also has little intestinal bacterial growth abdominal discomfort, flatulence, and bloating can occur.
Depression and psychiatric disorders: Various disorders such as panic disorders, depression, and changes in cognition are frequently associated with thyroid disorders. It has become a common mistake that hypothyroidism is misdiagnosed as depression. A study published in 2002 suggests that that thyroid function is especially important for bipolar patients: Results suggest that nearly 75% of patients with bipolar disorder have a thyroid profile that may be suboptimal for antidepressant response.
Cognitive decline: If a patient has low thyroid function they can suffer from slowed thinking, delayed processing of information, difficulty recalling names, and so forth. Patients with subclinical hypothyroidism will show signs of decreased working memory, and decreased speed of sensory and cognitive processing. To prevent a misdiagnosis of depression, an evaluation of thyroid hormones along with TSH may help avoid this
Cardiovascular Disease: Hypothyroidism, and subclinical hypothyroidism, are associated with increased levels of blood cholesterol, increased blood pressure, and increased risk of cardiovascular disease. Even patients with subclinical hypothyroidism are more likely to develop cardiovascular disease than healthy individuals with a fully functioning healthy thyroid.
High blood pressure: Hypertension is a very common symptom among patients with hypothyroidism. In a 1983 study, 14.8% of patients with hypothyroidism had high blood pressure, compared with 5.5% of patients with normal thyroid function. Hypothyroidism has been recognized as a cause of secondary hypertension. It has been suggested that increased peripheral vascular resistance and low cardiac output can be the possible link between hypothyroidism and diastolic hypertension.
High cholesterol and atherosclerosis: Overt hypothyroidism is characterized by hypercholesterolemia and a marked increase in low-density lipoproteins (LDL) and apolipoprotein B. These changes accelerate atherosclerosis, which causes coronary artery disease. As TSH levels increase the risk of heart disease increases with it, even in patients that only have subclinical hypothyroidism. Hypothyroidism that is caused by autoimmune reactions is associated with stiffening of the blood vessels. It has been founds that thyroid hormone replacement therapy may slow the progression of coronary heart disease by inhibiting the progression of plaques.
Homocysteine: Treating hypothyroid patients with thyroid hormone replacement might attenuate homocysteine levels, which in itself is an independent risk factor for cardiovascular disease. There is a strong inverse relationship between homocysteine and free thyroid hormones, and this confirms the effect of thyroid hormones on homocysteine metabolism.
Elevated C-reactive protein: Overt and subclinical hypothyroidism are both associated with increased levels of low-grade inflammation, as indicated by elevated C-reactive protein (CRP). A 2003 clinic study observed that CRP values increased with progressive thyroid failure and suggested it may count as an additional risk factor for the development of coronary heart disease in hypothyroid patients.
Metabolic Syndrome: In a study of more than 1,500 subjects, researchers found that those with metabolic syndrome had statistically significantly higher TSH levels (which means that had a lower thyroid hormone output) than healthy control subjects. Subclinical hypothyroidism was also correlated with elevated triglyceride levels and increased blood pressure. Slight increases in TSH may put people at higher risk for metabolic syndrome.
Reproductive system problems: Menstrual irregularities and struggles with infertility are common problems experienced by women. With proper treatment one can restore a normal menstrual cycle and improve fertility rates.
Fatigue and weakness: These are well-known and common symptoms of hypothyroidism. In addition, chilliness, weight gain, paresthesia (tingling or crawling sensation in the skin) and cramps are common. Cramps are often absent in elderly patients when compared with younger patients.
In hyperthyroidism (which is the opposite of hypothyroidism) the thyroid gland produces too much thyroid hormone, which can significantly accelerate the body's metabolism. Typical symptoms related to hyperthyroidism include sudden weight loss, a rapid heartbeat, sweating, nervousness or irritability. Hyperthyroidism affects a much smaller group of people and only about one percent of the population will have this condition. It is usually caused by Graves’ disease, which is characterized by symptoms such as rapid heartbeat, sweating, nervousness, tremors, muscle weakness, sleep difficulties, increased appetite and sudden weight loss. Affected individuals can also experience thyroid storm, a potentially deadly medical emergency.
Medical Treatment of Grave’s disease:
Nutritional Support of Hyperthyroidism:
The most commonly prescribed treatment for low thyroid hormone levels entails thyroid hormone replacement therapy. The goal of thyroid hormone replacement is to relieve symptoms and to provide sufficient thyroid hormone to allow the elevated levels of TSH to decrease to within the normal range.
Conventional treatment almost always begins with synthetic T4 (levothyroxine) preparations like Eltroxin®. The physician will normally start with low doses, because a rapid increase in thyroid hormone may result in cardiac damage. It can happen that hypothyroid symptoms persist, despite T4 treatment. It has been suggested that in such a case a combination treatment of T3 and T4 be used to alleviate symptoms. Deficiencies in nutrients like selenium can disable the body from converting T4 to biologically active T3.
Desiccated Thyroid: Armour thyroid, Nature-throid, and Westhroid are prescription medications that contain desiccated porcine thyroid gland. Natural thyroid extracts have been used since 1892 and were approved by the FDA in 1939. Ultimately, there may not be a single correct approach to low thyroid hormone levels. Instead, the best option may be to monitor thyroid levels through regular blood testing and systematically try various protocols to see what yields the best resolution of symptoms. Some people may find it preferable to begin with T4 supplementation then move to a combination T3-T4 therapy if they experience no improvement from T4 alone.
Absorption of Thyroid Hormone Medications: Coffee, aluminum antacids, ferrous sulfate (iron), calcium carbonate, soy and possibly grapefruit juice can all decrease the absorption of thyroid hormone prescriptions. Most doctors simply advise patients to take thyroid hormone away from any food or medication. While most people take thyroid hormone in the morning, a December 2010 paper suggests that it is more effective time to take thyroid medication is just before bed.
Iodine: The body needs iodine to make thyroid hormone. Iodized salt has proven to be effective at preventing iodine deficiency. Iodize salt has been available since 1924 when the Morton Salt Company began selling is. During pregnancy T4 production doubles, causing increases in daily iodine requirements. Iodine deficient pregnant women cannot produce the thyroid hormones that are needed for proper neurological development of their growing babies, and are at high risk of giving birth to infants with cognitive impairment and learning delay. It is very interesting to note that even moderate iodine deficiency in a pregnant woman can lower her infant’s IQ from 8 to 16 points.
People who avoid iodized salt or adhere to a salt-restricted diet may become iodine deficient. Diets both low and high in iodine are associated with hypothyroidism.
Selenium: After iodine, selenium is probably the next most important mineral affecting thyroid function.
Zinc: Zinc may be helpful in patients with low T3 and may contribute to conversion of T4 to T3.
Iron: Iron deficiency hinders the manufacturing of thyroid hormone by reducing activity of the enzyme thyroid peroxidase.
Copper: Copper is important for normal brain development and its deficiency can leave the hypothalamus unable to regulate thyroid hormone effectively.
Vitamin E: Vitamin E may reduce the oxidative stress caused by hypothyroidism.
Vitamin D: Deficiency of vitamin D may increase risk of autoimmune thyroid disease. Moreover, other evidence suggests that vitamin D deficiency is more common among individuals with thyroid cancer or thyroid nodules, compared to the general population. Given the many benefits of adequate vitamin D, it makes sense to supplement if needed.
Vitamin B12: Hypothyroid patients are often vitamin B12 deficient, and require supplementation.
DHEA and Pregnenolone: Japanese researchers reported that concentrations of DHEA, DHEA-sulfate, and pregnenolone-sulfate are significantly lower in hypothyroid patients compared to age and sex matched healthy controls.
Rhodiola rosea: Given the fact that stress can influence thyroid status, it may be beneficial for some individuals with hypothyroidism to consider adaptogenic herbs such as Rhodiola. Adaptogenic herbs can will support the adrenal glands and thus improve the body’s response to stress.
Some foods contain goitrogenic substances that reduce the utilization of iodine. These foods include canola oil, and vegetables from the Brassica family (e.g., cabbage and Brussels sprouts.) The actual content of goitrogens in these foods is relatively low, however, and cooking significantly reduces the impact of these goitrogens on thyroid function.
For those patients that struggle with hypothyroidism, raw goitrogenic foods and soy foods that have not undergone fermentation and/ or food processing should be consumed in moderation and discontinued if symptoms should appear.
Thyroid hormone supplementation: If hormones are necessary, work with an experienced medical provider to find a hormone supplement that works best for you. TSH Target: An ideal TSH level is between 1 and 2 µIU/mL. TSH levels lower than this may increase risks and symptoms associated with hyperthyroidism. TSH levels higher than this may increase the risks and symptoms associated with hypothyroidism.
For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be overemphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. There is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.
Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he / she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to. The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.
The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, you will have to complete an in-depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation, your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which the Doctor will decide which blood tests need to be requested from your local pathology laboratory.
Once your blood results are received, they will then be analysed by your Health Renewal doctor who will begin working on a unique prescription plan for you with the compounding pharmacy. At your pre-scheduled second appointment 2 weeks later, the results and examination findings will be discussed with you. This will determine what abnormalities or deficiencies exist and you will be advised on your treatment options.
In-office treatments such as Carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction ED, menopause or PMS. If you need to lose weight our RID medical weight loss program may be recommended. All these recommendations will be summarised on a sheet/print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality and are not rancid nor contain Hg (mercury ) or PCB'S (which is very important for Omega 3 Essential fatty acids EFA's).
1. You are kindly requested to bring any supplements that you are currently taking, along to your consultation. The doctor can check the ingredients in take this into account when prescribing a treatment plan for you.
2. Also, if you have had any blood work done in the past 6 months, please bring the results along to the consultation. Should you not be in possession of the hard copies, please request these results from the lab you visited. Usually your ID number is sufficient.
Depending on the exact prescription given, you may be required to return to the doctor within 2 to 3 months’ time, in order to ensure optimum thyroid hormone levels are achieved. This will be determined by a repeat blood test and may be requested by your Health Renewal doctor.
You should ensure that you are current with your gynaecological visits/breast exams/mammograms (for female patients) and prostate exams (for male patients) as recommended by your GP/gynaecologist.
After the two week follow up, the initial blood results will be discussed and patient specific nutraceuticals may be initiated. A second follow up another evaluation and blood test at 8 weeks is recommended to measure serum improvements in your Lipogram, homocysteine and other essential blood results. Follow up appointments should be very 6 months.
The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.
Some days you need some help staying motivated to live a healthy lifestyle. Our compilation of health and wellness quotes and sayings provide the inspiration or the laugh you need to keep making positive choices for your overall wellbeing.
Here are ten quotes from great thinkers to challenge, motivate and inspire us to exercise, eat right and live healthier lives: Health and intellect are the two blessings of life.
