Whole Systems Approach: Thyroid Health Dr. Amber Merrick, BSc ND - - PDF document
9/29/15 Whole Systems Approach: Thyroid Health Dr. Amber Merrick, BSc ND S About Me S Licensed ND S Med School, Digestion, EBV, thyroid nodules S Functional Medicine S My GOAL S I want to INSPIRE others to take control of their health; so
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Thyroid Health
S Licensed ND S Med School, Digestion, EBV, thyroid
nodules
S Functional Medicine S My GOAL
S “I want to INSPIRE others to take control
LOOK your best!”
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Patient-Centered Care, Integrative
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Science-based healthcare Approach
S
Integrating BEST medical practices
S
Healthy Foundations
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Energy Production (mitochondria), Detoxification, Brain health/methylation factors, Diet (Nutrients) and Digestion, Stress and Inflammation, Lifestyle and Environment S
Cellular Health
S
Organ Health
S
System Health
S
State of health
S Sachin Patel
S “Life is all about energy, not time. Energy amplifies
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S Thyroid Gland; Interactions with the Body S Thyroid Disorders
S Hypothyroid, Hyperthyroid, Autoimmune S What’s Going Wrong? S Signs and Symptoms S Lab tests S Nutrient and Botanical Solutions
S 1967 – “Diseases of the Thyroid are not common in
medical practice”
Robbins Pathology Text
S 1995 – 11.7% abnormal TSH
S 13 million undiagnosed abnormal thyroid (Gay et al, 1995)
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Hypothyroid
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Hyperthyroid
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Hashimoto’s (Hypo)
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Grave’s Disease (Hyper)
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Goitre (Both)
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Thyroid Nodules (Both) – Hashimoto’s, Iodine def, Cancer (5%)
S
Thyroid Cancer (90% differentiated)
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S How much stimulation the thyroid is receiving S Ideal 1-2 mIU/L <1 mIU/L >2 mIU/L
Hypothyroid due to pituitary issues Hypothyroid due to inadequate iodine or goitrogen exposure Hypothyroidism due to stress Presence of antibodies Hyperthyroidism Thyroid hormone cell receptor insensitivity Healthy response to medications
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S Are NOT energy dependent S Will maintain steady uptake of T4 and T3 in low energy
states
S Does not happen in ANY other cell of body (that require
ATP to transport T3 into the cell)
S ALL OTHER CELLS NEED HEALTHY MITOCHONDRIA!
S Thyroxine – 2 tyrosine + 4 bound iodine S How much storage form of thyroid hormone is the thyroid
able to make?
S How close is patient to iodine adequacy? S Ideal 14-18 (reference range 10-28pmol/L)
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S Triiodothyronine (2 tyrosine + 3 bound iodine) S How much of the active form of thyroid hormone is the
thyroid able to make/peripheral tissues able to convert from T4?
S How close is patient to iodine adequacy? S Ideal 5-6 pmol/L (reference range 4.3-8.1)
Mineral Context TSH fT4:fT3 Comment Optimal 1.5-<2.5 3:1 Iodine excess (mild) N or decreased >3:1 Increased storage form Iodine excess (severe) decreased >3:1 Inhibition of homogenesis Iodine deficiency N or increased <3:1 Preferential production T3 Selenium deficiency N or decreased >3:1 Impaired conversion Zinc deficiency elevated >3:1 Impaired TRH and conversion I, Se or Zn deficiency N or increased “Normal or Low values” “push, pull effect”
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S Reverse T3 – mirror image of T3; can bind to T3
receptors but will not evoke a T3 action
S rT3 is made during the conversion of T4 as a natural
buffer against hyperthyroidism
S High rT3 with Low Se and High/Low Cortisol S Reference range 140-540 pmol/L S Ideal rT3:T3 <100:1
S Antibodies against a major enzyme, Thyroid Peroxidase,
in thyroid hormone production
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S Signifies autoimmunity S The higher it is, the more likely Hashimoto’s or Graves
Disease
S The higher it is, the greater the oxidative stress within the
thyroid gland
S Can predict risk of thyroid disease in future (within 5
years)
S Anti-thyroglobulin Antibody S Less specific and sensitive than TPO Ab, but MORE
specific for detecting autoimmune nodular goitre in iodine deficient areas
S Can signify whether you should exercise caution with
iodine dosing
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S Thyroid Receptor Antibodies S Mimics TSH, and increases regulate thyroid production S Important to do in suspected HYPERthyroidism
Reference Values Optimal Values
Anti-TPO Ab <60 IU/L <20 IU/L Anti-TG Ab <40 IU/L <20 IU/L TR Ab <1-1.8 IU/L None
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S Hypothyroidism
S Synthetic T4 – Levothyroxine sodium (Synthroid, Levoxyl,
Eltroxin)
S Synthetic T3 – Liothyronine sodium (Cytomel, Triostat) S BOTH – Liotrix (Thyrolar) NDT, ERFA, Porcine, Armour
S Hyperthyroidism:
S Propylthiouracil (PTU) and methimazole (also known as
Tapazole)
S stop the thyroid from producing T3 and T4 hormones.
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S Substances that disrupt the production of thyroid
hormones
S Halogens: Bromines (flame retardants, pesticides, soda),
Fluorine, Lithium, Chlorine
S Soy >30g per day S Brassicas S Medications: B-blockers, Theophylline, Amiodarone, PTU,
chemotherapy
S Perchlorate S Organochlorine pesticides S PCB’s S PDBE’s (97% of US residents) S BPA
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S Mercury, Lead, Cadmium S Blood Test – If positive…TROUBLE S Hair Mineral Analysis S Provoked Urinalysis (not with amalgams)
S Candida – 50% increase in hypothyroidism S Lyme, Chlamydia, Shigella, EBV, Hepatitis, Aspergillus,
H.pylori
S Blood? Stool? S Treatment – Berberis 8-12 weeks
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S Clean Lifestyle, Diet, Environment and Attitude S SWEAT!! S Detoxification: Remove heavy metals S Selenium, Glutathione, DMPS S Treat Leaky gut S Hypoallergenic diet S Gluten? S Probiotics
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Component of T4 and T3
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Iodine deficiency is most common cause of Thyroid disease worldwide
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In Iodine SUFFICIENT areas, Autoimmune thyroid disease (Hashimoto’s) is most common cause
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May stimulate antibody production and increase risk of autoimmune thyroid disease
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Random urinary iodine
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Reflects dietary intake
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Best time is first morning void
S
Iodine (mcg)/creatinine (mmol) x 8.85 = corrected
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Minimum 100mcg/L Adults and Children
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Minimum 150mcg/L Pregnant or lactating S
Iodine – Luggol’s or potassium iodide
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S
Most accurate Test:
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Whole Blood Selenium S
Brazil nuts, Selenomethionine – 100-200mcg
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NOTE: If high levels of mercury exposure – always supplement with Selenium
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Correct Iodine prior to Se supplementation Optimal Activity of Thyroid Enzymes >1.0 mcmol/L For Grave’s or Hashimoto’s >1.5mcmol/L Protection against thyroid cancer >1.6mcmol/L
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S Required for T4T3; T3 to bind to receptor S Plasma Zinc S Can be influenced by: S Infection, inflammation, trauma (low) S Catabolic states (increase) S Hormone levels S Food intake (low) S Run hsCRP
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S Not as sensitive as blood, but can be useful:
S Zinc deficiency decreases gastrin (responsible for taste bud
growth and development)
S Other factors can affect taste
S
Decreases TPO Ab in adequate amounts
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25-OH D blood test
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Generally decreased in Thyroid disorders, especially Autoimmune
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Optimal 150-200 nmol/L
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Excess >250nmol/L
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RDA – 2000IU per day…but you may need more!!!
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S Cofactor for TPO enzymes S If Iron deficient, blunts responsiveness to Iodine and
Tyrosine supplementation
S Ferritin (Measure of iron storage)
S All labs are normal S Metabolism accelerates to normal ONLY when thyroid hormone
concentration within cells is high enough to override resistance.
S Medications that inhibit uptake of T3 into cells: S Diazepam, Lorazepam, alprazolam S Toxins that inhibit T3 uptake: S PCBs, PBDEs, Triclosan, BPA, Pesticides
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S Most common form of Thyroid Disease in North America S Most often middle-aged women S Autoimmune:
S Rosmarinic Acid (polyphenol decreases TPO Ab)
S
Polyphenols (ImmunoCare – 1 per day) S Selenium – 200mcg S D3 S Liposomal Glutathione (increases glutathione peroxidase
and prevents damage of thyroid gland)
S Botanicals:
S Seaweed – Fucus vesiculosus “Bladderwrack” - good
bioavailability of iodine; Antioxidant effect and decreases LDL cholesterol
S Blue Flag (Iris versicolor) S Commiphora merkel – “guggul”
S Topical: Myrrh essential oil with 3 parts olive oil
S Massage over thyroid once per day
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Lycopus virginicus
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905 patients; 87% improvement
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Officially recognized in Germany as prescription S
Rauwolfia serpentina (caution drug interactions)
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Topical: Lemonbalm essesntial oil in 3 parts olive oil
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Massage over thyroid once daily S
CoQ10, Carnitine 2g/d, Vit D
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Minimize ROS
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Quit smoking
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Selenium, Vit E, C, NAC (increase Glut perox.)
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CVD
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Hypercholesterolemia
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Depression, Bipolar
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Fibromyalgia, CFS
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Migraines
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T3 use for above conditions is well documented
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S
Probably if you answer YES to more than 2:
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Hard time falling asleep?
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Wake frequently at night?
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Hard time waking in morning and feeling unrefreshed?
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Bright lights bother you more than they should?
S
Startle easily due to noise?
S
Take others too seriously and are easily defensive?
S
Don’t cope well emotionally with certain people or events in life?
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Does it take a long time to get over a stressful event?
S
Shaky, sweaty or nauseous when you need to eat?
S
Nausea is the face of a stressful situation?
S
Seem to crave salt?
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Do you feel better after 6pm?
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S Anxiety/Nervousness S Inability to cope with stress S Impatience S Irritability S Light-headedness, dizziness S Shaky, trembling S Racing or pounding heart S Trouble sleeping S Nausea or flushing during
stress
S Decreased blood sugar S Sweating S Salt or sweet craving
S 50% of hypothyroid patients may have an adrenal
problem…must address FIRST!
S Too much or too little cortisol can block the conversion of
T4T3
S If you start on thyroid meds without treating the adrenals:
S SSx hyperthryoidism S Increased T3 or rT3 on labs
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S Being on T4 ONLY; Adrenals NEED T3 S Years of undiagnosed hypothyroidism S Chronic stress – biological, environmental (Fl, Cl, heavy
metals, etc.), emotional or physical
S Eating high carb diet with low fat
S Blood Serum Cortisol:
S 8am, noon, 4pm
S 24 Hour Salivary Cortisol:
S 8am, noon, 4pm, 11pm
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S 3 at home tests:
S Pupil test S Temperature Test S Blood Pressure Test * (Dr. James Wilson, Adrenal Fatigue:21st Century Stress Syndrome)
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S Care for your healthy adrenals:
S Vitamin C – 1000mg S B vitamins (esp. B5 &B6) S Vit. E, Calcium, Magnesium, trace minerals S Herbs: Licorice Root*, Ashwaghanda, Ginseng, RHODIOLA
ROSEA
S Adrenal Glandulars (Cortex ONLY)
S Laugh and enjoy life S Meditation, Yoga, Breathing S Sleep and Rest S 3 Meals per day S Avoid over-stimulating exercise
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S High night time cortisol
S Melatonin 1-3mg S Phosphatidylserine (PS) 300-1000mg S Zinc 25-50mg (with Cu) S Holy Basil S Relora
S Treat Adrenals first before addressing thyroid… S But what if I’m already on thyroid meds??
S Clear rT3
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S Take control of your own health! S You know your body…GET TESTED (especially TPO) S Care for your adrenals
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Integrated Health Care and Fitness Studio 577 Ontario Street
905-988-9160 www.integratedhealthcare.ca Follow me on Facebook Amber Merrick ND www.doctoramber.com