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  1. 1. HYPOTHYROIDISM PREPARED BY: MOHAMMED S. EL-LULU MASTER OF CLINICAL NUTRITION PALESTINE - GAZA……………………………………………………………………………..Botanical Medicine of Clinical Nutrition
  2. 2. Thyroid Gland (Generally)2  Thyroid is a small gland found in the middle of the lower neck (below the larynx or Adam’s apple).  Thyroid works with pituitary gland which produces thyroid stimulating hormone (TSH).  TSH stimulates the thyroid gland to produce the thyroid hormones, T3 and T4.
  3. 3. Thyroid system diagram3
  4. 4. Thyroxin Hormone4  Iodine, a trace mineral, is essential for the synthesis of the thyroid hormones: {thyroxine (T4) and triiodothyronine (T3)}.  T4:T3 = 10:1 (80-100µg of T4 & 10µg of T3/day).  20% of T3 derived directly from thyroid gland & 80% by conversion from T4.  Thyroid hormones regulate metabolism in every cell of the body and play a role in virtually all physiological functions.
  5. 5. Regulating thyroid hormones5  When the amount of thyroid hormone in blood drops, the pituitary gland secretes a hormone called thyroid- stimulating hormone (TSH).  TSH then stimulates the thyroid gland to increase its uptake of iodine from the blood, so that more thyroxine (T4) can be synthesized.  When necessary, thyroxine is then converted to the metabolically active triiodothyronine (T3), a process that involves removing one iodine atom from T4.
  6. 6. Regulating thyroid hormones6 Pharmacokinetics Mechanism  T3 t1/2 ≈ 24-36 hrs. Vd ≈ 40 L.  T4 t1/2 ≈ 6-7 days. Vd ≈ 10 L Iodine accounts for 65% of the molecular weight of T4 and 59% of the T3.
  7. 7. Physiological actions of Thyroxin hormones7  Potentiates brain development.  Increase heart rate.  Increase cardiac output.  Increase ventilation rate.  Thickens of endometrium in female.  Deficiency is the underlying problem responsible for the high rate of cancer (particularly breast, lung, prostate and ovary)
  8. 8. 8 Hypothyroidism  Symptoms  Complications  Classification  Goiter  Nutrients  Herbal remedies
  9. 9. Opera WinfreyOpera is a new guest to Hypothyroid community !!!
  10. 10. Hypothyroidism10  Hypothyroidism is a thyroid problem caused by an underactive thyroid gland that produces insufficient amounts of thyroid hormones.  May also develop from pituitary deficiency.  More likely due to inborn error of thyroid gland.  Hypothyroidism is seen in both sexes, but is more common in women.  In pregnant: new born is at risk of cretinism.
  11. 11. Basic symptoms of hypothyroidism11  weight gain, dry skin and hair,  hoarse voice, fatigue,  cold intolerance and puffy facial feature,  but these symptoms are minor compared to the effects thyroid deficiency can have on the body since every cell in the body needs thyroid hormone.  Because the symptoms may be varied and difficult to define, often simulate other conditions, many people with an underactive thyroid gland may be completely unaware of the problem.
  12. 12. Complications12 Untreated condition, patient is at risk for:  diabetes,  high blood pressure,  emphysema,  arthritis,  depression,  recurrent infections,  and migraine.
  13. 13. Classification of Hypothyroidism13  Primary (1ry): due to 3ry failure of the thyroid gland itself 2ry  Secondary (2ry): due to hypopituitarism 1ry  Tertiary (3ry): due to failure of hypothalamus  Quaternary (4ry): due to tissue insensitivity to 4ry action of thyroid hormone
  14. 14. Goitrus Hypothyroidism14  Excess stimulation by TSH due to decreased levels of circulating thyroid hormones, leads to enlargement of thyroid gland; due to: 1- Iodine deficiency. 2- Certain anti-thyroid drugs. 3- Hashimoto’s thyroiditis: Immunological disorder characterized by diffuse enlargement and lymphocytic infiltration of the gland.
  15. 15. Natural Diet for Hypothyroidism -115  Essential fatty acids are anti-inflammatory and necessary for hormone production. Take 1,000 to 1,500 mg flaxseed oil three times per day.  Seaweed, fish and algae should also be consumed frequently. They are rich in iodine and essential nutrients that maintain thyroid function balance.  Selenium rich foods as garlic and mushroom are important for peripheral conversion of T4 to T3, also regulate the amount of hormone produced.
  16. 16. Natural Diet for Hypothyroidism -216 Calcium & Magnesium:  Must be together. The optimal ratio is (3 Ca : 1 Mg).  Never supplement Ca without supplementing Mg, because the body will actually use its stored Mg to process the supplemented Ca. Daily actions:  Try to do regular physical activity or exercise.  Hormone levels should be monitored on a regular basis.  Perform a daily thyroid self-massage. Gently stroke up and down the sides of the trachea.
  17. 17. Avoid anti-thyroid foods17  Foods that depress thyroid activity are broccoli, cabbage, sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens.  These foods are rich in thiocyanates which have been shown to interfere with iodine utilization by the thyroid gland.  These foods should be included in the diet for hyperthyroid conditions and avoided for hypothyroid conditions.
  18. 18. Herbal remedies18 Herbal content of Thyroid Assist™ Thyroid Assist™  Fucus vesiculosis (Bladderwrack or kelp)  Avena sativa (Green Oats)  Coleus forskohlii (Makandi)
  19. 19. Thyroid Assist™ Benefits19  Supports pituitary gland production of the thyroid stimulating hormone (TSH).  Maintains T3 & T4 levels already within normal range.  Supports a balanced endocrine system.  Improves energy levels.  Maintains balanced metabolism and healthy weight.  Supports other functions of endocrine system for healthy emotions, fertility, growth, temperature & performance.
  20. 20. Fucus vesiculosis (Bladderwrack or kelp)20  Is a sea vegetable which is a prime source of iodine.  It has been used therapeutically for thousands of years, especially in Traditional Chinese Medicine.  Should be harvested from uncontaminated areas and screened for the presence of toxins and contamination.
  21. 21. Avena sativa (Green Oats)21  Is a general tonic traditionally.  Avena sativa can alleviate common nervous irritability.  It supports healthy sexual function.  Active ingredients are: saponins, flavonoids, minerals, alkaloids, steroidal compounds, Vitamins B1, B2, D, E, carotene and wheat protein.
  22. 22. Coleus forskohlii (Makandi)22  Is Ayurvedic (Indian) remedy. Forskolin support thyroid hormone secretion.  Thyrotropin & Forskolin increase the quantity of stimulatory guanine nucleotide-binding proteins in cultured thyroid follicles.
  23. 23. Case StudyHow to not save money? Just go to doctor.
  24. 24. Assessment (anthropometrics)24  Sex: Female  Age: 26  Height:1.62 m  Weight: 63 Kg  Body mass index: 24  Married and has 3 kids (normal birth).  Teacher, seasonally (Job creation)  Socio-economic status is growing slowly (satisfied)
  25. 25. Medical History25  Apparently healthy.  Before marriage, she suffered from acne for many years, but the case turned for the better.  At last year 2010, she suffered from sore throat more than 8 times.  She has a severe varicose veins in the 2 legs, with accumulation of fluids around the right ankle.  She is quite in his life, no bad ideas about life.
  26. 26. Nutritional facts (a while)26  Good, healthy, natural, fresh, and not frozen foods.  The best beverage is water.  Fishes: 1-2 meals weekly.  Diary products: 1 cup daily of whole milk or yogurt.  Beans: 2 meals weekly and one eggs daily.  Vegetables: the table is rich daily especially sweet pepper, where the salad is essential dish at least 3 times weekly.  Crazy in seeds, nuts, chocolates, chips, and biscuits.  Very bad intake of fruits except cantaloupe and melon.  Red meat and poultry: very little.  Rice and breads alternate daily with 3 or 2 essential meals.  Not salty foods are preferred.
  27. 27. Complain (doctor visits)27  She complained from hard movement of neck.  Inadequate swallowing action.  Three swelling spots at right, center, and left of neck.  At primary health care center, a severe sore throat diagnosed. And the treatment is Clarithromycin 500mg twice a day for 10 days, with Ibuprofen 400mg as need.  She encouraged to take thymus and chamomile as hot drink.  After 2 weeks the enlarged spots in left and center retained to normal size, while the right one had remained.  In Shifa hospital after 4 months, examination by Ultra-Sound radiation of neck, the 3 spots remain even unseen.
  28. 28. Complain (doctor visits)28  The primary diagnosis was Goiter and lymphadenopathy.  The think of that was hypothyroidism.  She advised to get blood analysis (Thyroid markers- T4 & TSH, Calcium level, CBC, and chemistry).  Lab worker notices:  Hypothyroidism: Elevated TSH & Reduced T4  Subclinical Hypothyroidism: Elevated TSH & Normal T4  Calcium Ionized: 1.02 (1.07- 1.28 mmol/L)  TSH: 3.3 (0.4- 5.0) US normal level (0.3- 3.0), so it’s overactive.  T4: 8.0 (4.5- 12.5)  After that, tests as CBC, Cholesterol, Liver enzymes, Kidney functions, Blood glucose level and Lactate dehydrogenase were normal.  By CT test of neck and chest: the result indicated mild enlargement of thyroid gland and inflamed lymph node at right position of neck.
  29. 29. Analysis of obtained data29  According to nutritional facts, she had a good dishes of food, but in fact she missed many nutrients due to very small serving and highly interesting in chips, chocolates, and biscuits.  Calcium level wasn’t sufficient so she needed Calcium supplements as effervescent form.  Bad immunity is important target to improve, while the recurrent infections of throats haven’t changed.  Reduced calorie empty food can result in increased amount of healthy foods, which supply essential nutrients as Iodine, calcium, magnesium, omega 3, Vit-C, Vit-E, selenium, and many others.
  30. 30. Recommendations30  According to CT, & Ultra-Sound, an enlarged lymph node at right neck should be removed by surgery.  According to the level of TSH which indicated high level according to new US scale, and normal level of T4, the case advised to get enough Iodine from food sources without medical intervention.  Also, the case reported to get other blood analysis for thyroid function after 3 to 4 months. **************** Thank you for paying attention