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 you can FEEL and LOOK your best!” 1

9/29/15 What is a Whole Systems Approach? S Patient-Centered Care, Integrative S Science-based healthcare Approach S Integrating BEST medical practices S Healthy Foundations S 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 “Health”? S Sachin Patel S “Life is all about energy, not time. Energy amplifies time. Energy is the currency of Life.” 2

9/29/15 Overview 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 What’s Up with the Thyroid? 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) 3

9/29/15 The Thyroid Gland How it all works? 4

9/29/15 Thyroid Disorders S Hypothyroid S Hyperthyroid Hashimoto’s (Hypo) S Grave’s Disease (Hyper) S S Goitre (Both) Thyroid Nodules (Both) – Hashimoto’s, Iodine def, Cancer (5%) S S Thyroid Cancer (90% differentiated) 5

9/29/15 Lab Values - TSH S How much stimulation the thyroid is receiving S Ideal 1-2 mIU/L <1 mIU/L >2 mIU/L Hypothyroid due to pituitary Hypothyroid due to issues inadequate iodine or goitrogen exposure Hypothyroidism due to Presence of antibodies stress Hyperthyroidism Thyroid hormone cell receptor insensitivity Healthy response to medications 6

9/29/15 Pituitary Thyroid Hormone Receptors 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! Lab Values – fT4 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) 7

9/29/15 Lab Values – fT3 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) Relationship T4:T3 Mineral TSH fT4:fT3 Comment Context Optimal 1.5-<2.5 3:1 Iodine excess N or decreased >3:1 Increased (mild) storage form Iodine excess decreased >3:1 Inhibition of (severe) homogenesis Iodine N or increased <3:1 Preferential deficiency production T3 Selenium N or decreased >3:1 Impaired deficiency conversion Zinc deficiency elevated >3:1 Impaired TRH and conversion “Normal or Low “push, pull I, Se or Zn N or increased values” effect” deficiency 8

9/29/15 Lab Values: rT3 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 Lab Values: Anti-TPO Ab S Antibodies against a major enzyme, Thyroid Peroxidase, in thyroid hormone production 9

9/29/15 Anti-TPO Ab 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) Lab Values: Anti-TG Ab 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 10

9/29/15 Lab Values: TR Ab S Thyroid Receptor Antibodies S Mimics TSH, and increases regulate thyroid production S Important to do in suspected HYPERthyroidism Lab Values Reference Values Optimal Values Anti-TPO <60 IU/L <20 IU/L Ab Anti-TG <40 IU/L <20 IU/L Ab TR Ab <1-1.8 IU/L None 11

9/29/15 My tests are back…NOW WHAT? Thyroid Medications 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 . 12

9/29/15 Goitrogens 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 Goitrogens S Perchlorate S Organochlorine pesticides S PCB’s S PDBE’s (97% of US residents) S BPA 13

9/29/15 Goitrogens: Heavy Metals S Mercury, Lead, Cadmium S Blood Test – If positive…TROUBLE S Hair Mineral Analysis S Provoked Urinalysis (not with amalgams) Infections and Thyroid S Candida – 50% increase in hypothyroidism S Lyme, Chlamydia, Shigella, EBV, Hepatitis, Aspergillus, H.pylori S Blood? Stool? S Treatment – Berberis 8-12 weeks 14

9/29/15 Treatment of Infections and Detoxification 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 Iodine: Do I need it? S Component of T4 and T3 S Iodine deficiency is most common cause of Thyroid disease worldwide In Iodine SUFFICIENT areas, Autoimmune thyroid disease (Hashimoto’s) is most S common cause S May stimulate antibody production and increase risk of autoimmune thyroid disease S Random urinary iodine S Reflects dietary intake S Best time is first morning void S Iodine (mcg)/creatinine (mmol) x 8.85 = corrected S Minimum 100mcg/L Adults and Children S Minimum 150mcg/L Pregnant or lactating Iodine – Luggol’s or potassium iodide S 15

9/29/15 Selenium S Most accurate Test: S Whole Blood Selenium Optimal Activity of Thyroid >1.0 mcmol/L Enzymes For Grave’s or Hashimoto’s >1.5mcmol/L Protection against thyroid cancer >1.6mcmol/L Brazil nuts, Selenomethionine – 100-200mcg S NOTE: If high levels of mercury exposure – always supplement with S Selenium S Correct Iodine prior to Se supplementation 16

9/29/15 Tyrosine Zinc S Required for T4  T3; 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 17

9/29/15 Zinc Tally Test 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 Vitamin D3 S Decreases TPO Ab in adequate amounts S 25-OH D blood test S Generally decreased in Thyroid disorders, especially Autoimmune S Optimal 150-200 nmol/L S Excess >250nmol/L RDA – 2000IU per day…but you may need more!!! S 18

9/29/15 Iron S Cofactor for TPO enzymes S If Iron deficient, blunts responsiveness to Iodine and Tyrosine supplementation S Ferritin (Measure of iron storage) Peripheral Tissue Resistance 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 19

9/29/15 Hashimoto’s Thyroiditis 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) Polyphenols (ImmunoCare – 1 per day) S S Selenium – 200mcg S D3 S Liposomal Glutathione (increases glutathione peroxidase and prevents damage of thyroid gland) Treatment: Hypothyroid 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 20

9/29/15 Treatment: Hyperthyroid S Lycopus virginicus S 905 patients; 87% improvement S Officially recognized in Germany as prescription S Rauwolfia serpentina (caution drug interactions) S Topical: Lemonbalm essesntial oil in 3 parts olive oil S Massage over thyroid once daily S CoQ10, Carnitine 2g/d, Vit D S Minimize ROS S Quit smoking S Selenium, Vit E, C, NAC (increase Glut perox.) Differential Diagnoses S CVD S Hypercholesterolemia S Depression, Bipolar S Fibromyalgia, CFS S Migraines S T3 use for above conditions is well documented 21