The Adrenal Thyroid Revolution Professional Mastermind WEBINAR 3

THYROID HEALTH FOR MIND, MOOD, AND METABOLIC REGULATION IN EXHAUSTING TIMES

Your Thyroid

Two major thyroid hormones

•  Thyroxine (T4 ) and triiodothyronine (T3)

•  Required for homeostasis of all cells

•  Influence cell differenOaOon, growth, and metabolism

•  Considered the major metabolic hormones because they target virtually every Ossue

TSH

•  Regulates thyroid hormone producOon, secreOon, and growth

•  Is regulated by the negaOve feedback acOon of T4 and T3

•  Iodine accumulaOon in the thyroid is an acOve transport process that is sOmulated by TSH

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Thyroid Hormone Plays a Major Role in Growth and Development Thyroid hormone iniOates or sustains differenOaOon and growth

SOmulates formaOon of proteins, which exert trophic effects on Ossues Is essenOal for normal brain development

EssenOal for childhood growth

Untreated congenital hypothyroidism or chronic hypothyroidism during childhood can result in incomplete development and mental retardaOon

Thyroid hormones are essenOal for neural development and maturaOon and funcOon of the CNS Decreased thyroid hormone concentraOons may lead to alteraOons in cogniOve funcOon

•  PaOents with hypothyroidism may develop impairment of aXenOon, slowed motor funcOon, and poor memory

Thyroid Hormone Influences the Female Reproductive System Normal thyroid hormone funcOon is important for reproducOve funcOon

Hypothyroidism may be associated with: •  menstrual disorders •  inferOlity •  risk of miscarriage •  other complicaOons of pregnancy

DoufasAG,etal.AnnNYAcadSci.2000;900:65-76.GlinoerD.TrendsEndocrinolMetab.1998;9:403-411.

GlinoerD.EndocrRev.1997;18:404-433.

Additional Critical Activities of Thyroid Hormone

•  Regulates mitochondrial acOvity

•  Influences cardiovascular hemodynamicse

•  SOmulates metabolic acOviOes in most Ossues

•  Is criOcal for normal bone growth and development

•  SOmulates lipolysis and release of free faXy acids and glycerol

•  Effects cholesterol metabolism

•  SOmulates metabolism of cholesterol to bile acids

•  Facilitates rapid removal of LDL from plasma

•  Generally sOmulates all aspects of carbohydrate metabolism and the pathway for protein degradaOon

Chronic Autoimmune Thyroiditis (Hashimoto Thyroiditis)

Occurs when there is a defect in thyroid hormone synthesis

•  Is a chronic inflammatory autoimmune disease characterized by destrucOon of the thyroid gland by autoanObodies against thyroglobulin, thyroperoxidase, and other thyroid Ossue components

•  PaOents present with hypothyroidism, painless goiter, and other overt signs

Persons with autoimmune thyroid disease may have other concomitant autoimmune disorders

•  Most commonly associated with type 1 diabetes mellitus •  Celiac also common

THE ADRENAL-THYROID CONNTECTION

Honoring the Wisdom of the body

The body has an incredible capacity to heal, and symptoms are asking us to listen to what the body is saying.

Self-Preservation Theory

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HYPOTHYROID IMPACT

•  FaOgue

•  ConsOpaOon

•  Forge]ulness, slowed cogniOve funcOon

•  Moodiness/Irritability

•  Depression, Anxiety

•  Hair thinning/Hair loss

•  Dry skin

•  Weight gain

•  Cold intolerance

•  Elevated cholesterol

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•  Irregular/Heavy periods

•  Painful joints/carpal tunnel syndrome

•  FerOlity/miscarriage/difficulty with breast milk producOon

•  Mitochondrial dysfuncOon

•  Hoarseness/deepened voice

•  Dysphagia

•  Bradycardia

•  Puffy eyes

•  Goiter

ROOT CAUSE ASSESSMENT

FOOD TRIGGERS gluten, dairy, arOficial sweeteners, bromides, mercury 1

NUTRITIONAL INSUFFICIENCY, BLOOD SUGAR IMBALANCES

GUT IMBALANCES 2

SOS, STRESS, OVERWHELM 3

IMMUNE SYSTEM REGULATION, STEALTH (CHRONIC) INFECTION, CHRONIC INFLAMMATION, AI Dx 4

DETOXIFICATION BURDEN AND CAPACITY 5

OBTAINING THYROID LABS What to check & the controversies

Full thyroid panel vs. individual labs

Differences of opinion – but there is a right answer!

Treat women, not lab values

How often to recheck?

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Free Hormone Concept

Only unbound (free) hormone has metabolic acOvity and physiologic effects

•  Free hormone is a Ony percentage of total hormone in plasma (about 0.03% T4; 0.3% T3)

More than 99% of circulaOng T4 and T3 is bound to plasma carrier proteins

•  Thyroxine-binding globulin (TBG), binds about 75%

Total hormone concentraOon •  Normally is kept proporOonal to the concentraOon of carrier

proteins •  Is kept appropriate to maintain a constant free hormone level

Carrier proteins can be affected by physiologic changes, drugs, and disease

Thyroid Hormone Conversion (Low T3 Syndrome) & Resistance to Thyroid Hormone

Factors that inhibit thyroid hormone conversion: •  Stress/high corOsol, fasOng, alcohol, nutrient

depleOon, medicaOons, liver and kidney disease, chemotherapy, cigareXes, goiterogens, heavy metals, pesOcides, excess iodine, soy, low progesterone, surgery, obesity, aging

Factors that lead to peripheral hormone resistance: •  Receptor mutaOons, transmembrane receptor

defects, current data – inherited defect – but also consider other resistances that are acquired (i.e., insulin R)

Drugs and Conditions That Increase Serum T4 & T3 Levels by Increasing TBG

Drugs that increase TBG •  Oral contracepOves and other sources of

estrogen •  Methadone •  Clofibrate •  5-Fluorouracil •  Heroin •  Tamoxifen

CondiOons that increase TBG •  Pregnancy (and HcG mimics TBG) •  InfecOous/chronic acOve hepaOOs •  HIV infecOon •  Biliary cirrhosis •  Acute intermiXent porphyria •  GeneOc factors

Drugs and Conditions That Decrease Serum T4 and T3 by Decreasing TBG Levels or Binding of Hormone to TBG

Drugs that decrease serum T4 and T3 •  GlucocorOcoids •  Androgens •  L-Asparaginase •  Salicylates •  Mefenamic acid •  AnOseizure medicaOons, eg, phenytoin,

carbama-zepine •  Furosemide

CondiOons that decrease serum T4 and T3

•  GeneOc factors •  Acute and chronic illness

1. Prenatal Hypothyroidism 2. Postpartum Thyroiditis

Postpartum thyroidiOs is a destrucOve thyroidiOs induced by an autoimmune mechanism within one year ajer parturiOon. Postpartum thyroidiOs can also occur ajer spontaneous or induced aborOon. It usually presents in one of three ways:

3. Clinical Picture Transient hyperthyroidism alone

Transient hypothyroidism alone

Transient hyperthyroidism followed by hypothyroidism and then recovery

It is considered a variant form of chronic autoimmune thyroidiOs (Hashimoto's thyroidiOs).

Prenatally, hypothyroidism is associated with significant increased risks for pregnancy and baby •  FerOlity problems •  Miscarriage •  Severe hypothyroidism associated with increased

auOsm risk As many as 60% of women with hypothyroidism in pregnancy missed Symptoms overlooked because similar to pregnancy symptoms TesOng is not rouOne High TPO anObodies in pregnancy a major risk factor for postpartum thyroidiOs OpOmal TSH in pregnancy is trimester specific due to 1st trimester impact of bhCG, but ideal is max 2.5 in second and 3rd trimesters. Iodine requirements are increased in pregnancy

4. PP Thyroid Disease and PPD

Women with clinical manifestaOons of postpartum thyroidiOs should have laboratory assessment of thyroid funcOon. Because of the potenOal associaOon between postpartum depression and postpartum hypothyroidism, and because hypothyroidism is a reversible cause of depression, women with postpartum depression should also be assessed for hypothyroidism.

Women with symptomaOc hypothyroidism should be treated with levothyroxine (T4) (typically about 50 to 100 mcg/day although requirements may vary), irrespecOve of the degree of TSH elevaOon. In asymptomaOc women, we prefer to treat when the TSH exceeds 10 mU/L.

5. Monitor Thyroid Function

The majority of women with postpartum thyroidiOs need no treatment during either the hyperthyroid or the hypothyroid phases of their illness. However, thyroid funcOon (TSH, free T4, and T3) should be monitored every four to eight weeks to confirm resoluOon of biochemical abnormaliOes or to detect the development of more severe hypothyroidism, indicaOng possible permanent hypothyroidism.

6. Higher lifelong risk of developing Hashomoto’s

Most women recover and are euthyroid within one year postpartum. However, up to 30 percent of women never recover from the iniOal hypothyroid phase and have permanent hypothyroidism. Women with reversible hypothyroidism are also at increased risk for developing permanent hypothyroidism in the future, and therefore require yearly monitoring of TSH.

Thyroid Therapeutics

SHOULD YOU START MEDICATION?

Talking with women about medicaOon treatment:

•  Are medicaOons forever?

•  Is Hashimoto’s forever?

•  When should you start thyroid treatment with medicaOon?

•  What are the risks and side effects?

•  How do I know what dose I need?

…& WHICH?

The Main Menu of Op8ons •  Levothyroxine (Synthroid, Levoxyl): SyntheOc T4

•  Armour Thyroid, Nature-Throid: dessicated pork thyroid, T4/T3, mimics natural raOon of T4 (80%):T3 (20%)

•  Cytomel: SyntheOc T3

•  Liotrix T4/T3 in a 4:1 raOo

•  Compounded Thyroid: raOo is tailored to individual

•  Tirosint: Liquid gelcap T4 with only glycerin, gelaOn, and water – low allergenic

LIFESTYLE MEDICINE

•  Circadian Reset

•  Carb cycling

•  Self care

•  Self paOence and compassion

•  Reduce sympatheOc tone with mind-body and mindfulness pracOces

•  Time in nature

FOOD AS MEDICINE

•  EliminaOon diet

•  Avoid triggers

•  Balance blood sugar

•  Replete nutrients

Supplements Iodine:

•  Dietary sources

•  The recommended minimum intake is 150 µg/day

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Selenium •  The body turns selenium into the powerful

anOoxidant glutathione, protects the thyroid from the inflammaOon and oxidaOve stress that is suppressing funcOon and damaging thyroid Ossue, and several studies have shown that it can reduce TPO anObodies. It is also criOcal in the conversion

•  of T4 to T3. It decreases the risk of developing postpartum thyroidiOs in women who are posiOve for TPO anObodies, and can be started during

pregnancy and conOnued into the postpartum period to reduce risk. Amount in Brazil nuts variably, but 2/day ojen recommended.

•  I recommend other selenium-rich foods, including mushrooms, lamb, turkey, chicken, eggs, cod, and halibut, with the inclusion of Brazil nuts if you enjoy them, but not as a replacement for a supplement.

•  Up to 200 mcg/day (do not exceed)

•  Iron deficiency tells your thyroid to conserve energy, leading to decreased producOon of thyroid hormone.

•  Dietary sources of iron: red meat and dark-meat poultry have a highly absorbable form, and eaten several Omes weekly can quickly boost your iron; also helpful are leafy greens, red beans and dried apricots and raisins (though these are high in sugar).

•  If you test low, you might also want to supplement

with iron chelate, a form of iron that is non- consOpaOng, taken along with 500 mg of vitamin C to increase absorpOon.

•  PPIs should not be taken with iron because they block absorpOon, and iron should not be taken with your thyroid medicaOon because it blocks it; take iron and your thyroid medicaOon four hours apart.

•  30–60 mg iron amino chelate/day

Iron

Vitamin D •  CirculaOng levels of vitamin D3 have been

found to be low in those with Hashimoto’s and other autoimmune condiOons.

•  SupplemenOng with D3 at 4,000 IU daily (2,000 IU daily in pregnancy) may help prevent or reverse autoimmune thyroid disease. Levels can be rechecked every six

weeks to measure levels and indicate when to stay at a steady dose or decrease the dose. (I don’t recom- mend exceeding serum levels of 70 nM.)

•  2,000–4,000 IU/day

•  Involved in the conversion of T4 to T3; important if you appear to be having problems with thyroid hormone conversion.

•  30 mg/day; take with your meals to prevent nausea

Zinc

4R Gut Healing Heal Immunity, Treat Stealth Infection

Reduce stress/SOS Improve sleep Replete nutriOon Targeted anOviral and immune supporOng herbal & nutriOonal support

Support Detoxification Reduce toxin exposures Address body burden if necessary Improve/support natural hepaOc detoxificaOon

Remember the gut/microbiome for detoxificaOon-eliminaOon

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Botanical Treatment of Hypothyroidism

Curcumin

When there are elevated TPO anObodies, I always begin by reducing inflammaOon in the system and removing any triggers. NAC and Pycnogenol can be taken alternaOvely, or along with curcumin.

1,200–2,400 mg/day

Guggul

An herbal medicine, guggul has been shown to improve thyroid funcOon, increasing conversionof T4, the inacOve form of thyroid hormone, to T3, the acOve form. This herb should not be taken in pregnancy, but can be taken while breast-feeding. DisconOnue when thyroid levels normalize.

750 mg/day

Therapeu8c Goal Therapeu8c Ac8on

Botanical Name Common Name

SOmulate thyroid hormone producOon/thyroid acOvity

Thyroid sOmulaOng

Bauhinia purpurea Coleus forskohlii Commiphora mukul Fucus vesiculosus Withania somnifera

Bauhinia Coleus Guggul Bladderwrack Ashwagandha

Support metabolic funcOon, reduce damage from oxidaOve stress, improve energy and vitality

Adaptogens Withania somnifera

Ashwagandha

Supplement iodine in iodine- deficiency related cases

Iodine-rich Fucus vesiculosus

Bladderwrack

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