hyperthyroidism

Hyperthyroidism, A Nutritional Therapy Approach

1.  The thyroid and its function

Simply put, an overactive thyroid secretes too much T3 and T4, causing Hyperthyroidism. The thyroid is a small, butterfly-shaped gland located at the front of a neck. It regulates metabolism through the release of hormones and plays a major role in growth and development of the human body. These hormones are constantly released in steady amounts into the bloodstream. If the body needs more energy, for instance if it is growing or during pregnancy, the thyroid produces more hormones.

Tetraiodothyronine (T4) and triiodothyronine (T3) are two primary hormones that control how body’s cells use energy. The thyroid produces a less known hormone, called calcitonin, involved in calcium and bone metabolism. An increase in blood calcium concentration stimulate its production, to protect against the development of hypercalcemia. Some gastrointestinal hormones, such as gastrin also promote its release. 

Iodine is one of the main building blocks of both hormones T4 and T3. Our bodies can’t produce this trace element, so it needs to be provided from the diet. Dietary iodine is absorbed into our blood stream and then carried to the thyroid gland. Here, it will serve to make thyroid hormones.

To make the exact number of hormones, the thyroid gland needs help of another gland called pituitary. The pituitary gland, located in the brain, signals the thyroid gland whether to release more or less hormones, by producing a thyroid stimulating hormone (TSH). Also, a certain amount of thyroid hormones travel in the bloodstream bound to carrier proteins. If the body needs more hormones, T3 and T4 can be freed from these proteins and perform their tasks.

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The thyroid tissue consists of a lot of small individual lobules, which contain a tremendous number of small follicles which store thyroid hormones in the form of little droplets. Hormones secreted by the thyroid interact with cells mitochondria, causing an increased production of ATP, which is our energy currency. Almost 90% of thyroid hormone production is in the form of T4, which is less active and only 10% is T3, which is the active hormone.

Whenever your body needs it, T4 will arrive to the liver and kidneys, where, via a process called deiodination, which removes a molecule of iodine, is converted into T3.

The body converts T4 to T3, but many people have difficulty with this conversion. The causes are mostly due to stress, poor liver and kidneys function, gut and hormonal imbalances, and nutritional deficiencies. The fact that these hormones play important roles throughout the body explains why impaired thyroid function is associated with many widespread symptoms and diseases.

2.  Hyperthyroidism and its symptoms

An overactive thyroid secretes too much T4, T3 or both, causing some of the bodily functions to accelerate. This condition is hyperthyroidism. According to a 2016 study published in “The Lancet”, women are more susceptible to this condition. Potential reasons are female sex hormones imbalance, when there is too much oestrogen production and not enough progesterone. Excess oestrogen production causes the liver to produce high levels of thyroid binding globulins (TBG). These bind to the thyroid hormone and decreases the amount of thyroid hormone that can be assimilated and utilised by the cells. For many women, thyroid problems may arise during times of hormonal unrest. For exmple during childbearing, menopause and periods of prolonged or intense emotional, physical and mental stress.

As mentioned before, over production of T4 and T3 can cause an excessively high metabolic rate. When the body is in this state, it may experience rapid heart rate, elevated blood pressure, hand tremors, increase sweat and develop low tolerance to heat. Increased appetite, nervousness, restlessness, hair loss, itching, inability to concentrate are also signs of overactive thyroid. Hyperthyroidism can also cause more frequent bowel movements, weight loss and, in women, irregular menstrual cycles. Visibly, the thyroid gland itself can swell into a goiter, which can be either symmetrical or one-sided.

Eyes may also appear quite prominent, which is a sign of exophtalmos, a condition that’s related to Graves’ disease. This happens when the muscles in eyes and surrounding tissue swell up, giving the eyes a bulging appearance. Eyes may become red and puffy and sometimes it can lead to double vision or limited eyeball movement. Thyroid eye disease doesn’t always develop at exactly the same time as Graves’ disease, it can develop before or after.

3.  Graves’ disease

A variety of conditions can cause hyperthyroidism. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. In autoimmune disorders, the immune system begins to fight against healthy tissues and cells of the body. Our immune system usually produces proteins known as antibodies in order to fight foreign invaders such as viruses and bacteria. In Graves’ disease, the immune system mistakenly produces antibodies called thyroid-stimulating immunoglobulins that target our own healthy thyroid cells. This may stimulate an over production of thyroid hormones.

Graves’ disease tends to run in families, which suggests a potential genetic link.

4.  Diagnosis

To have a deep understanding of thyroid problems, blood tests should include the following markers: TSH, total T4, free T4, total T3, free T3, and reverse T3. Very important may also be testing for thyroid antibodies, to exclude an auto immune condition.

The thyroid is responsible for thermoregulation. Performing a “basal body temperature check”, using a normal thermometer first thing in the morning, might indicate thyroid issues depending if body temperature is high (hyperthyroidism) or low (hypothyroidism). Women in their childbearing age should avoid checking body temperature on days leading up to menstruation as that can alter results.

Unfortunately, the conventional approach only tests for TSH levels, which doesn’t paint the full picture. In fact, Dr. John O’Reilly, an expert in thyroid health at the University of Scotland, has shown in his studies, that the TSH test virtually never correlates with the clinical condition of his patients.

5.  Conventional treatment

  • Anti-thyroid medications – may gradually reduce symptoms of hyperthyroidism by preventing thyroid gland from producing excess amounts of hormones. Methimazole, and to a lesser extend propylthiouracil, are most commonly prescribed drugs. Treatment with anti-thyroid medications usually continues at least a year and sometimes longer. After that, people may experience a relapse. Both drugs can cause serious liver damage, sometimes leading to dangerous health complications.
  • Radioactive iodine – taken by mouth, radioactive iodine will penetrate the thyroid gland, where it causes the gland to shrink and permanently damage the glad. This treatment may cause thyroid activity to slow enough to become underactive (hypothyroidism), and people may eventually need to take medication every day to replace thyroid hormones.
  • Beta blockers – may treat symptoms of hyperthyroidism like rapid heart rate, palpitations and tremor. For that reason, doctors may prescribe them to help patient feel better until thyroid levels are closer to normal.
  • Surgery (thyroidectomy) – is not very much used. In a thyroidectomy, a doctor removes most of the thyroid gland. Risks of this surgery include damage to vocal cords and parathyroid glands, which are four tiny glands at the back of a thyroid. After surgery, your consultant may prescribe levothyroxine for a lifelong treatment, to supply the body with normal amounts of thyroid hormone.

6.  Natural approach

Selenium

Adequate levels of selenium are also important for optimal thyroid hormone metabolism. As said earlier, the thyroid gland produces T4 in generous amounts, but it is relatively biologically inactive. Therefore, the more biologically active T3 will be synthesize via a hormone conversion process, converting T4 to T3. The antioxidant selenium is key during this conversion process, which also neutralizes the toxic build-up of hydrogen peroxide, which is a by-product of the hormone conversion.

The thyroid contains the highest amount of selenium in the body, stored into proteins called selenoproteins. There are different types of selenoproteins that focus on different functions related to thyroid and immune system support. Some types of selenoproteins make the antioxidant glutathione peroxide, which protects cells from oxidative damage.

Selenium supplementation has resulted in thyroid improvements in few studies on Graves’, showing beneficial effect on Graves’ bulging of the eyes. One study found that 6 months supplemental selenium was associated with less eye involvement, improved quality of life, and delayed progression of Graves’. In another study, serum selenium levels in patients with remission and relapse of Graves’ disease were compared. The authors found that the highest serum selenium levels (>120 mg/L) were seen in the remission group, indicating a positive effect of selenium on the outcome of Graves’ disease.

Iodine

Although, increasing iodine intake via food or supplements may be considered not safe, some studies have proven just the opposite. Please always remember that I am not an advocate of self-diagnosing or self-prescribing, so whenever possible consult with a health care practitioner.

In 1920’s, Dr Plummer and his colleagues published reports of successful use of iodine for Graves’ Hyperthyroidism. In the 1930’s and 1940’s, other researchers also reported their successful use of iodine to treat Graves’ Hyperthyroidism. Starr, et al, in 1924, reported a success rate of 92% improvement with Lugol’s iodine (solution combining potassium iodide and elemental iodine in water) at a daily dose ranging from 6 to 90 mg. Redisch and Perloff reported that physicians used iodine alone for hyperthyroidism. Clinics in Europe and the US had very high success rates with supplemental iodine. “In Biedl’s clinic about 10% of the cases with favourable results were completely and permanently cured, 40% entirely symptom-free so long as iodine was administered, and 50% almost symptom-free but still showing some manifestations of the condition. The ‘toxic symptoms’ of acute Graves’ disease (diarrhoea, restlessness, insomnia) reacted especially favourably to iodine”.

Vitamin D

Recent evidence demonstrated an association between low vitamin D level and autoimmune thyroid diseases such as Hashimoto’s and Graves’. Also, impaired vitamin D signaling has been reported in thyroid cancers. Vitamin D plays a significant role in modulation of the immune system, enhancing congenital immune response while utilising an inhibitory action on the adaptive immune system.

Lithium

During a clinical trial at the Walter Reed Army Medical Centre, researchers found that those participants using Lugol’s iodine first and followed by lithium supplementation significantly and better recovered from hyperthyroidism compared to other groups using only iodine or lithium. Anyway, I have not used this product in my practice, because I believe that more research is needed to prove any possible benefits.

Diet and lifestyle

First and foremost, it is worth testing for any possible autoimmune conditions, to find out if there are other pathologies exacerbating hyperthyroidism, like Grave’s. Also, Coeliac disease and gluten sensitivity have demonstrated to have possible links to impaired thyroid function and Hashimoto’s. Simply removing gluten from diet for few months might improve symptoms of hyperthyroidism.

An experienced nutritionist will always bear in mind that disfunction of the hypothalamus or pituitary gland, as a consequence of past or present tumor, may negatively impact on thyroid function.

Beneficial results might occur by avoiding excitatory agents like coffees, alcohol, energy drinks, refined carbohydrates, like pizza, pasta, white bread and cakes.

Adopting an organic, wholefood, mainly plant-based diet, high in antioxidants, anti-inflammatory and other nutrients may support and protect the thyroid gland from further damage.

Avoid pro-inflammatory foods like red and cured meat, dairies and deep-fried food.

Avoid toxins overload, use natural toiletries and stop smoking.

Exercise may be very helpful, but start with lower intensity exercises, like walking, yoga or tai chi. 

Stress is known to take its toll on the body and mind in several ways, therefore it can aggravate symptoms of hyperthyroidism. If you are new to stress management, please read my article called Do you have an antidote to stress? Here’s mine.

More in the specific, a nutritional therapist may help modulating other symptoms present.

For how to deal with autoimmune disorders, please browse around the Autoimmunity section in the Clinical Nutrition folder.

7.  Final words

Hyperthyroidism is a disfunction of the thyroid gland, that sees an over production of the two thyroid hormones, T3 and T4, which are responsible for increasing the metabolic rate. Its symptoms may include rapid heart rate, elevated blood pressure, increased sweat, appetite, nervousness, restlessness, inability to concentrate, irregular menstrual cycles and many others. The reasons of hyperthyroidism may hide behind autoimmune disorders of the thyroid, like Graves’, tumors and other autoimmune conditions like Coeliac. To be diagnosed properly, a full spectrum thyroid test should be undertaken and not just TSH. Other tests are also available. Conventional treatments may be invasive or imply the use of drugs to modulate some of the symptoms or decrease T3, T4 production. From a nutritional point of view testing for autoimmunity markers is advisable and targeted supplementation might be implemented. Diet and lifestyle may also be taken into consideration, alongside stress management.

Author, Sylwia Wyrębek, Naturopathic Nutritionist

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References:

https://www.ncbi.nlm.nih.gov/pubmed/27038492

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127319/

https://www.ncbi.nlm.nih.gov/pubmed/25519493

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180687/

http://archinte.jamanetwork.com/article.aspx?articleid=534580

http://www.nejm.org/doi/pdf/10.1056/NEJM192509101931101

http://www.jstor.org/stable/25332878

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014602/

http://archinte.jamanetwork.com/article.aspx?articleid=536850

https://www.ncbi.nlm.nih.gov/pubmed/21278761/

https://yt.ax/watch/dr-mercola-interviews-dr-wright-on-hyperthyroidism-treatment-28684433/

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