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Hello everyone!

Hope you're having a good week! Here's a quick overview of Hypothyroidism - everyone presents differently and we treat every one differently. Of particular importance for us are our nutritional recommendations. Book a consult if you think you or someone you know needs care in that area. Functional medicine and TCM have great solutions! Thanks again to all those who left Google Reviewsyou help us heal more people in the area!

Hypothyroidism

The thyroid is a butterfly-shaped gland in the lower neck that makes thyroid hormones that help regulate growth and development, body temperature, heart rate, and weight.

Thyroxine (T4) is the main hormone secreted into the bloodstream by the thyroid gland.  The amount of thyroid hormones secreted is controlled by thyroid stimulating hormone (TSH), which is released from the pituitary gland in the brain. TSH stimulates the thyroid to secrete T3 and T4. When thyroid hormones are measured, the three most common markers are TSH, free T4, and free T3. 

Most of this conversion happens in the liver, but also take place in cells of the heart, muscle, gut, and nerves. These cells convert T4 to T3 with an enzyme, deiodinase which removes one molecule of iodine from T4. T4 has four iodine molecules and T3 has three iodine molecules. The majority of T4 is converted into T3 in the liver. About 20% of T4 is converted to T3 in the digestive tract. The rest of the T4 is converted into an inactive form, rT3 which the body cannot use. Levels of rT3 can become too high in times of major trauma, surgery, or severe chronic illness. 

Thyroxine (T4) is the main hormone secreted into the bloodstream by the thyroid gland and it accounts for about 94% and the remaining 6% is triiodothyronine (T3). T3 is the most active form the body can use. T4 must be converted to T3 before the body can use it. 

Hypothyroidism

Hypothyroidism, known as underactive thyroid, is a condition in which the thyroid gland is unable to produce sufficient thyroid hormones to fulfill the body’s needs. Approximately 5% of individuals aged 12 and older suffer from hypothyroidism. 

Primary hypothyroidism may occur due to dysfunction of the thyroid gland, which is commonly caused by an autoimmune condition called Hashimoto’s disease. Hypothyroidism is also caused by thyroiditis, congenital hypothyroidism, removal of thyroid and some medications. The cause of Hashimoto’s is not fully understood but researchers believe it is a combination of genetics and environmental factors. White blood cells called lymphocytes accumulate in the thyroid and produce antibodies that attack and destroy the cells in the thyroid gland. This lymphoid infiltration of the thyroid gland characterized in Hashimoto’s includes both B and T cells. These antibodies typically include thyroid peroxidase and/or thyroglobulin autoantibodies. Once enough cells have become damaged, the thyroid can no longer make enough hormones to regulate body functions. 

In a small number of cases, hypothyroidism results from dysfunction of the hypothalamus and/or pituitary gland in the brain, referred to as secondary hypothyroidism. 

Hypothyroidism and its symptoms develop slowly over time as the condition progresses. The symptoms vary from person to person but some symptoms are common. Decreased levels of thyroid hormones slow down the body’s metabolism causing unintentional weight gain, slowed heartbeat, fatigue, sensitivity to cold, joint/muscle pain, dry skin, fertility problems, depression, and a goiter. A goiter is an abnormal enlargement of the thyroid gland. In some goiter cases, thyroid hormones are not produced enough (hypothyroidism). However, in other goiter cases, thyroid hormones are overproduced (hyperthyroidism). 

Symptoms of Hypothyroidism 

When Untreated, Hypothyroidism May Result in: 

  • Cognitive impairment
  • Dyslipidemia (abnormal lipid levels)
  • Hypertension (elevated blood pressure) 

Causes and Risk Factors 

  • Age: increased risk with advancing age 
  • Autoimmune conditions (e.g., Hashimoto’s disease, type 1 diabetes) 
  • Certain medical procedures (e.g., thyroid surgery, radioiodine therapy, irradiation) 
  • Certain medications (e.g., amiodarone, antiepileptic drugs, lithium, some cancer treatments) 
  • Infertility
  • Neuromuscular dysfunction 
  • Certain nutrient deficiencies (e.g., iodine, selenium, vitamin D) 
  • Family history/genetic predisposition 
  • Gender: female at birth
  • Pregnancy 
  • Small stature at birth, low body mass index (BMI) during childhood 

Preventing and Addressing Hypothyroidism

Hypothyroidism treatment generally involves hormone replacement therapy with synthetic thyroid hormones. The following are general diet and lifestyle guidelines that may help support thyroid function. 

Diet 

Specific nutrients have been identified as essential to thyroid function and hormone production, including copper, iodine, iron, selenium, zinc, B vitamins, and vitamins A, C, and D. Additionally, certain dietary compounds, such as isoflavones from soy and glucosinolates from raw Brassica vegetables, may impair thyroid hormone production. The following table outlines foods and beverages to avoid, moderate, and enjoy for a thyroid-supportive diet. 

Thyroid Support: Foods to Avoid, Moderate, and Enjoy 

Physical Activity 

Regular physical activity may reduce the risk of hypothyroidism and improve thyroid hormone levels in individuals with the condition. Physical activity needs may vary based on age and other factors. Research suggests that three months of regular moderate-intensity exercise, such as jogging or aerobic circuit training, may be beneficial for individuals with hypothyroidism and subclinical hypothyroidism. 

Stress Management 

Chronic stress may play a role in the development of Hashimoto’s disease. Learn to recognize signs of stress in your body, such as low energy, changes in mood, and difficulty sleeping. Incorporate stress-reduction techniques, such as: 

  • Mindfulness practices (e.g.,breathing exercises, meditation, muscle relaxation)
  • Regular moderate-intensity exercise (e.g. 30 minutes of brisk walking daily)
  • Realistic goal-setting to reduce overwhelm
  • Social support from family, friends, colleagues, and community or religious associations 

Hypothyroidism & TCM 

In Traditional Chinese Medicine Hypothyroidism would be diagnosed as one or a combination of the following:

  • Spleen Yang Deficiency
  • Spleen & Kidney Yang Deficiency
  • Heart & Kidney Yang Deficiency
  • Devastated Yang
Because all patients are different with their constitution, age, medical history, there is no standard formula or treatment protocol. I would modify formulas such as Fu Zi Li Zhong Wan, You Gui Wan or Zhi Gan Cao Tan and Zhen Wu Tang and also consider prescribing supplements. Most patients are already taking medications to alleviate the deficiency. Acupuncture can also play a supporting role especially to treat symptoms such as constipation, edema, hair loss, palpitations and irregular menses. 

References 

  1. Bansal, A., Kaushik, A., Singh, C. M., Sharma, V., & Singh, H. (2015). The e ect of regular physical exercise on the thyroid function of treated hypothyroid patients: An interventional study
    at a tertiary care center in Bastar region of India. Archives of Medicine and Health Sciences, 3(2), 244. 
  2. Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. The Lancet, 390(10101), 1550–1562. 
  3. Gaitonde, D. Y., Rowley, K. D., & Sweeney, L. B. (2012). Hypothyroidism: An update. American Family Physician, 86(3), 244–251. 
  4. Garces-Arteaga, A., Nieto-Garcia, N., Suarez- Sanchez, F., Triana-Reina, H. R., & Ramírez- Vélez, R. (2013). Influence of a medium-impact exercise program on health-related quality  of life and cardiorespiratory fitness in females with subclinical hypothyroidism: An open-label pilot study. Journal of Thyroid Research,
    2013, 592801. 
  5. Huang, Y., Cai, L., Zheng, Y., Pan, J., Li, L., Zong, L., ... & Chen, G. (2019). Association between lifestyle and thyroid dysfunction: A cross- sectional epidemiological study in the She ethnic minority group of Fujian Province in China. BMC Endocrine Disorders, 19(1), 83. 
  6. Ihnatowicz, P., Drywień, M., Wątor, P., & Wojsiat, J. (2020). The importance of nutritional factors and dietary management of Hashimoto’s thyroiditis. Annals of Agricultural and Environmental Medicine: AAEM, 27(2), 184–193. 
  7. Mezzomo, T. R., & Nadal, J. (2016). E ect of nutrients and dietary substances on thyroid function and hypothyroidism. Demetra: Food, Nutrition & Health, 11, 427. 
  8. National Institute of Mental Health. (n.d.) 5 Things You Should Know About Stress. (n.d.). National Institutes of Health https://www.nimh. nih.gov/health/publications/stress/index.shtml 
  9. Patil, N., Rehman, A., & Jialal, I. (2021). Hypothyroidism. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/ books/NBK519536/ 
  10. Walter, K. N., Corwin, E. J., Ulbrecht, J., Demers, L. M., Bennett, J. M., Whetzel, C. A., & Klein,
    L. C. (2012). Elevated thyroid stimulating hormone is associated with elevated cortisol in healthy young men and women. Thyroid Research, 5(1), 13.
  11. Kresser C. Low T3 Syndrome I: It’s Not about the Thyroid! Chris Kresser. https://chriskresser.com/low-t3- syndrome-i-its-not-about-the-thyroid/. Published September 2011. Accessed May 17, 2019
  12. Peeters RP, Visser TJ. Metabolism of Thyroid Hormone. Nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK285545/. Published 2017. Accessed May 17, 2019.
  13. Tomino, S., Fujiwara, H., Kagimoto, T., Mitsuya, H., Nishimura, H., & Kishimoto, S. (1982). Decreased suppressor T cell activity in patients with hepatic cirrhosis (HC). Clinical and experimental immunology, 48(3), 625–632.
  14. Rydzewska, M., Jaromin, M., Pasierowska, I. E., Stożek, K., & Bossowski, A. (2018). Role of the T and B lymphocytes in pathogenesis of autoimmune thyroid diseases. Thyroid research, 11, 2. https://doi.org/10.1186/s13044-018-0046-9

Special thanks to my friend and colleague Dr Suzuki for proof reading these newsletters! 

Dr Arno Kroner
DAOM LAc Dipl.OM MTOM MBA
+1.323.459.6152
drkroner.com
arno.kroner@gmail.com

2001 South Barrington Suite 220
West LA CA 90025
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