Definition:

Hypothyroidism can be defined as a condition in which the thyroid gland produces too little of its hormones, T3 and T4. The hypothalamus-pituitary master gland, through production of TRH and TSH, signals the thyroid gland to produce two main hormones, thyroxine (T-4) and triiodothyronine (T-3), that influence every cell in your body. The main functions of the thyroid hormones include regulating the body’s metabolism, growth and development, temperature and catecholamine levels, as well as influencing heart rate, amongst other things. 

• Highest levels of TSH secretions are between 10 pm and 4 am, and the lowest are between 10 am and 6 pm. The thyroid gland secretes thyroxine ( T4)  and Triiodothyronine (T3) hormones (as well as diiodotyrosine T2 and monoiodotyrosine T1), T3 being the more active hormone.  T4 constitutes 80-90% and T3 20-10% of the hormones produced by the thyroid gland.  Most of the circulating T3 is derived from the conversion of T4 to T3 in the peripheral tissues. T3  sends negative feedback to the pituitary to reduce TSH secretion.
• One μg of T3 is equivalent to 4 μg of levothyroxine. The use of T4-only preparations might alter the normal ratio of T4 to T3
• Studies suggest that each individual has a unique set-point for thyroid hormone levels, and that deviation from the set-point (even within the normal range for populations) may be undesirable.
• Hypothyroidism tends to run in families and is more common in women than in men.
• Primary hypothyroidism refers to the thyroid gland’s inability to produce enough thyroid hormones and ensuing hypothyroidism.
• Secondary hypothyroidism refers to pituitary dysfunction, caused by diseases such as pituitary adenomas, leading to the decreased production of TSH and ensuing hypothyroidism. (e.g., Low TSH, Low T4)
• Tertiary hypothyroidism refers to hypothalamic dysfunction, caused by diseases such as sarcoidosis or infections, leading to reduced production of thyrotropin-releasing factor and ensuing hypothyroidism.
• Transient hypothyroidism is referred to as hypothyroidism caused by subacute/silent thyroiditis or withdrawal of thyroid hormonal therapy.
• Subclinical hypothyroidism refers to elevated TSH with normal T4. It is estimated that 8% of women and 3% of men suffer from this condition, and the rates increase to 15-18% in women over 60 years of age.
• Sub-laboratory hypothyroidism refers to the syndrome of clinical hypothyroidism with normal laboratory tests. In such patients, the standard laboratory tests fail to detect hypothyroidism, but treatment with thyroid hormone improves their symptoms.   Most patients are urged to try weaning themselves from thyroid hormone after approximately 18 months. In one-half to two-thirds of these patients, symptoms do not return when the treatment is stopped.
• Consider thyroid hormone resistance/Refetoff syndrome, due to genetic mutations, in a clinically euthyroid person with elevated thyroid hormones, but TSH is not suppressed. 
• Consider Euthyroid Sick Syndrome (low FT3 and FT4 and normal TSH), due to acute and chronic illness, including trauma, infections, malignancy, stress, lung, kidney, and heart problems, etc.

Signs and symptoms of hypothyroidism:

Miscellaneous

• General appearance of pallor and dry, coarse skin, particularly on the lower legs.
• Asthma
• Carpal tunnel syndrome
• Cold extremities, intolerance to the cold
• Constipation
• Decreased libido
• Edema
• Erectile dysfunction
• Fatigue
• Headaches
• Muscle aches
• Reactive hypoglycemia
• Recurrent infections
• Sluggishness
• Weakness
• Weight gain

Psychiatric

• Depression
• Memory loss
• Poor mental concentration

Gynecological

• Fibrocystic breast changes
• Infertility
• Menstrual irregularities (amenorrhea, oligomenorrhea, menorrhagia)
• Polycystic ovary syndrome
• Postpartum depression
• Premenstrual syndrome

Ear, nose, and throat

• Allergic rhinitis
• Hoarseness
• Tinnitus
• Vasomotor rhinitis
• Vertigo

Dermatological

• Coarse, dry, or thinning hair
• Dry, rough skin
• Psoriasis
• Urticaria

Cardiovascular

• Angina pectoris
• Atherosclerosis
• Hypercholesterolemia
• Hyperhomocysteinemia
• Hypertension

Causes:

• The most common cause worldwide is iodine deficiency.
• In the developed world, destruction of the thyroid gland by autoimmune diseases such as Hashimoto’s is the leading cause of hypothyroidism.
• Medical treatments such as radiation therapy, surgery, radioactive iodine, and medications such as lithium and amiodarone.

Contributing factors:

• Genetic predisposition
• Leaky gut syndrome
• Food allergies
• Stress
• environmental toxins
• Other hormonal imbalance

Tests/Labs:

• TSH, T3, Free T3, T4, Free T4, Reverse T3, Thyroglobulin Antibody, Thyroperoxidase Antibodies (TPO), Thyroid-Stimulating Immunoglobulin (TSI), Thyrotropin Receptor Antibody (TRAb), etc.
• Adrenal function tests DHEA/Cortisol
• CBC/Hb/Hct, iron
• Lipid
• CK (CPK)
• Iodine testing
• Heavy metals
• Consider hypogonadism
• In 2003, the American Association of Clinical Endocrinologists proposed that the upper limit of normal for TSH be changed from 5.0 mU/L to 3.0 mU/L, raising further questions about the validity of the TSH test. If implemented, more than 4 times as many people as before would be classified as hypothyroid (20.0% vs. 4.64% of the population).

Treatment:

Lifestyle:

• Exercise: Maintain a regular aerobic and weight-bearing exercise routine.
• Yoga therapy, with an emphasis on thyroid-enhancing poses, may be beneficial.
• Implement stress reduction techniques.
• Avoid the following medications and toxins, if possible: lithium, thionamides, amiodarone, interferon-alpha, interleukin-2, cholestyramine, perchlorate, expectorants, aluminum hydroxide, raloxifene, heavy metals, chlorine, fluoride, and bromine.
• Avoid topical antiseptics (Betadine) and radiocontrast dyes when possible.

Diet:

• Calcium carbonate, iron, fiber, and some forms of magnesium (e.g., magnesium oxide) have been shown to inhibit the absorption of thyroid hormone and should not be taken within 2-4 hours of taking thyroid medicine.

 Other: Medications and supplements play a crucial role in the treatment of hypothyroidism.

For more information and to make an appointment, please contact Carolina Integrative Clinic at 919-869-6661 or email us at office@ciclinic.com.

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