Saul Marcus, ND
New York City
Naturopathic Doctor

Hypothyroidism Guide Page 4

These pages originally written in 2010 for my first website. I have posted them here for educational purposes. For general information on how natural health can help with thyroid conditions please follow this link to the main hypothyroidism page.

13. Heavy metals, toxins and the liver

The modern world is full of toxic chemicals that don’t belong in our bodies. These include heavy metals such as mercury, cadmium and lead, persistent organic pollutants (POPs) such as PCB, dioxins, pharmaceutical drugs and other toxins. Although avoidance is always the best way to protect oneself, at this point our environment is polluted with so many toxins, everyone is effected. For examples, over 80,000 POPs that have been released into the environment. For many of these we lack of information on how they affect human health. [66]. Therefore detoxification is an essential part of maintaining health in the 21st century.

The total effect of such toxicity is beyond the scope of this article. We will only discuss the effect of toxins on thyroid functions, but this is only a small part of total toxic load we all are under.

What are persistent organic pollutants?

According to the EPA:

Many people are familiar with some of the most well-known POPs, such as PCBs, DDT, and dioxins. POPs include a range of substances that include:

Intentionally produced chemicals currently or once used in agriculture, disease control, manufacturing, or industrial processes. Examples include PCBs, which have been useful in a variety of industrial applications (e.g., in electrical transformers and large capacitors, as hydraulic and heat exchange fluids, and as additives to paints and lubricants) and DDT, which is still used to control mosquitoes that carry malaria in some parts of the world.
Unintentionally produced chemicals, such as dioxins, that result from industrial processes and from combustion (for example, municipal and medical waste incineration and backyard burning of trash). [67]

Persistent organic pollutants decrease both the production and conversion thyroid hormone. Dioxins, PCB’s and oregano compounds have also been shown to interfere with the action of thyroid hormone. Therefore, even if you have the right amount of active T3, toxins may prevent T3 from doing anything. This may produce symptoms of hypothyroidism as well, despite perfect thyroid hormone levels. [68][69]

So if we go back to the thyroid hormone family chart we can see that POP’s interfere with thyroid hormone production, conversion, and usage.

14. Adrenal fatigue, stress, cortisol and hypothyroidism

Fight or flight

Imagine one of those old movies where the cavemen are get attacked by a saber toothed tiger, or even a dinosaur. In that prehistoric moment, the caveman has only two options, life or death

There is no other possible outcome.

In a life or death situation the body will do anything it can do to live, even at the expense of it’s own health. Therefore, in that moment, profound changes take place that change individual biochemistry to maximize chance of immediate survival. This is called the “fight or flight,” response.

The fight or flight response includes the following changes:

Increased blood sugar. Over years this may contribute to diabetes, cardiovascular disease and other health problems. But, in the moment, increased blood sugar is needed to fuel the heart, lungs and brain.
Increased blood pressure. There are many long term negatives effects of high blood pressure (hypertension). However, in the short term it gets more blood, oxygen and nutrients to the muscles needed for fight or flight.
The body will break down, or digest it’s own proteins, and convert it into sugar in order to fuel the fight or flight. In other words, under stress the body will eat itself alive for quick energy.
Decreased immune function. The body will not put its energy to fighting off viruses/bacteria, if it’s energy is needed for immediate survival.
Digestive function slows down. The body won’t put energy to digesting food if it thinks it immediate survival is in danger.

For long term health and vitality, all these changes are bad. But In terms of surviving a short term life or death, this response allows people to perform much more strenuous activity then would otherwise be possible. The fight or flight response is not bad. It helps protects us in emergency situations. [80]

The danger is when we live under stress for prolonged periods. High blood sugar, blood pressure, diabetes, poor immune function, and poor digestion are common problems millions of people live with, and are directly caused by the fight or flight response.

This fight or flight response is otherwise known as the stress response. It is triggered by the adrenal hormone cortisol.

The stress response and cortisol is not only triggered by life and death situations. In fact, stress simply means, the nonspecific response of the body to any demand. [81]

Some other examples of stressors are:

Anger, such as road rage or getting into a fight.
Depressed moods and extreme sadness.
Long days of working a job you don’t like.
Any illness such as the flu.
Poor digestion and inflammation in the GI system.
Improper exercise.
Eating junk food such as ice cream.
Exposure to toxins in the air and water.

Cortisol and thyroid hormone

In addition to the above negative effects of cortisol (increased blood sugar, high blood pressure, poor digestion, poor immune function), it also lowers thyroid hormone. As discussed in section 10, when the body is pushed too hard, thyroid hormone and the metabolic rate goes down. This is the body’s way of protecting itself, like putting on the emergency brakes in a car out of control.

15. Blood sugar, estrogen and hormonal balance

The thyroid and hormonal balance

Hormones are chemical messengers produced by one part of the body to tell some other part what to do. Thyroid hormone, is just one of many others including insulin, cortisol, estrogen, progesterone and testosterone. There are many other hormones, but these are amongst the most important.

Usually, we only think of one hormone at a time. Thyroid symptoms indicate a thyroid problem. Blood sugar symptoms means there is an insulin problem. Symptoms around sexual function indicate a sex hormone problem. And high stress means a cortisol problem. This simple model may help medical students learn about hormones, and is good for books that convince you that if just your thyroid hormone, or if just your testosterone was normalized, you would feel fine, but the hormonal system really does not work like this.

In real life each these four systems affects the other three in a complex balance game. Basically, when one hormone goes up, another goes down to compensate. This continues until a patient becomes so sick, that almost all of these hormones go down.

The pancreas, insulin and blood sugar

Junk food, or foods high in sugar stimulate the pancreas to release insulin. Insulin’s job is to lower blood sugar, by moving it into cells to be used for energy, or stored for later use. We store sugar for energy in two ways. Sugar can be converted to fat, or in the liver as glycogen. Fat is a long term energy reserve. Glycogen is more easily used, and is the first place we our body goes for energy when we have not eaten for a few hours. [84] Cortisol is insulin’s counterpart. Among many other functions, cortisol takes sugar stored in the liver (glycogen) and puts it into the blood stream. To keep things simple, insulin lowers blood sugar, and cortisol raises blood sugar. This is what may sound confusing at first. When insulin goes up to lower blood sugar, cortisol goes up as well. It may sound odd. Why would the body raise cortisol, which increases blood sugar, at the same time insulin is going up to lower blood sugar? The answer is in the very complex way the body precisely regulates itself. Too much insulin will lower blood sugar too much. This is called hypoglycemia (low blood sugar) . So when insulin goes up, cortisol goes up a little also. This is not to raise blood sugar, but to make sure insulin does not drop blood sugar too much. As reviewed in section 14, high cortisol decreases thyroid hormone. In a healthy diet, the moderate ups and downs of cortisol as it helps regulate blood sugar is not going to effect thyroid function. However, high carb, high sugar diets send insulin and blood sugar surging up and down all day. This affects both cortisol and ultimately thyroid hormone as well. [85] Therefore, as part of normalizing thyroid hormone function naturally, it’s essential to have a good diet and keep blood sugar in an acceptable range.

The sex hormones

The three most well known sex hormone are estrogen, progesterone, and testosterone. Although we often think that estrogen and progesterone are female hormones and testosterone is a male hormone, women and men have both. Of these three hormones, it is estrogen that has a profound effect on thyroid hormone. Estrogen is carried in the blood by a protein called “sex hormone binding globulin.” Higher levels of estrogen will increase binding protein and this is associated with less active thyroid hormone. [86]

Excessive levels of estrogens in women and men are epidemic in our society.

Three common causes of high estrogens are: 1) Xeno-estrogens. Many synthetic chemicals, (especially plastics) mimic estrogen. These synthetic xeno-estorgens are much more powerful than the estrogen made in the body, and there are currently no tests for them. The best way to eliminate xeno-estrogens is to avoid them, by reducing exposure to toxins, and never heating food in plastic. Plastics are full of these compounds, which when heated, will leak into food. 2) Poor liver function. If the liver is sluggish, and unable to get detoxify estrogens out of the body, estrogens will accumulate. This is true for both estrogens made by our own body (endogenous estrogens) and estrogens we have made outside of our bodies (xeno-estrogens). 3) Weight gain. Fat cells have an enzymes called aromatase. Aromatase converts testosterone into estrogen. Therefore, obesity can contribute to high estrogen, low thyroid hormone and low testosterone.

Sleep

Sleep deprivation has been shown to decrease T4 and T3, but not TSH. Therefore, sleep problems may contribute to symptoms of hypothyroidism, yet not change TSH labs. [88] There are various reasons why people don’t sleep well, but one major reason is related to stress and cortisol. Normally cortisol is highest in the morning, and goes down during the day until it’s lowest point when we go to bed. Under high stress cortisol may remain high until the evening, preventing sleep. Long term stress may cause insomnia through a slightly different way. Often people are tired all day long, get energy at night, or wake about 2-3AM. Instead of having high cortisol all day long, they have a deregulation of cortisol. It is too low during the day making them tired, but goes up late or night, preventing them from sleeping. This kind of insomnia can be helped by taking supplements during that day that help raise cortisol, and supplements at night that keep cortisol down. In my practice I use seri-phos (phosphoralated serine) to help people sleep if their cortisol is too high. The supplement phosphatidyl serine can also help as well, but is unfortunately very expensive. in addition to taking supplements for sleep, it’s important to look at the diet, lifestyle and the overall hormonal picture to get to the root cause of the problem. Is insomnia caused by cortisol deregulation, anxiety, neurotransmitter imbalance or something else. And depending on what is causing insomnia some supplements are going to work and others wont.

16. Grave disease
(this section not copied for archive pages – see main Graves disease section for up to date information)

17. Thyroid supplements

Before getting into the specifics of nutritional supplementation I hope it is clear at this point that treatment plans need to be individualized. Holistic medicine works best when treating the whole body. If the primary problem is coming from the adrenal glands, or digestive system, you are not going to see much benefit from taking some “thyroid supplements.”

Hypothyroidism supplements

Iodine

In depth information of supplementing with iodine for hypothyroidism is found in section 6.

Iodine can be taken in pill form, and as a liquid. Lugol’s iodine solution is probably the most well know. High amounts of iodine are in sea vegetables such as kelp, dulse, hijiki, nori, wakame and kombu.

Selenium

Selenium is perhaps the most well thyroid supplement after iodine. It is essential for the proper conversion of thyroid hormone to T3. It has also been shown to decrease thyroid antibodies. Therefore selenium is often added to thyroid supplements, although by itself it is not a miracle cure for hypothyroidism. The thyroid gland uses selenium with iodine, so if iodine supplements are used, it may be best to include selenium as well.

Zinc

Zinc is used in the manufacture of thyroid hormone, and the conversion from T4 to T3. [93]

A simple way to test for zinc deficiency is the zinc taste test. All you do is take about a teaspoon of zinc mixed into water, and taste it for about 10 seconds. If it has a strong metallic taste, you don’t need zinc. If there is no taste at all, or it tastes good, then there is a need for zinc. I do this test on all my new clients. Low levels of zinc are also associated with poor wound healing.

Since the body uses zinc for hundreds of different reactions, including production of hydrochloric acid for digestion, I consider adequate zinc to be foundation for good health.

Zinc supplementation can potentially be harmful because zinc needs to be in proper balance with copper. Therefore it is only best to supplement with zinc if there is a need for it.

Vitamins A, D, K and essential fatty acids

Vitamins A, D and essential fatty acids (such as the omega-3 fats in fish oil) plays an important part in in making T3 effective. Therefore, even with adequate thyroid hormone, there still may be symptoms of hypothyroidism if the body does not have the nutrients it needs to make T3 work. [94].

Vitamin A deficiency is associated with acne and lots of raised bumps, or “chicken skin,” on the back of the upper arms. This is an called of hyperkeratosis. Vitamin A supplements can be used to treat this, but sometimes the body has enough vitamin A, it just can’t use it. The liver uses zinc to convert much of dietary vitamin A (beta-carotene) to it’s active form. So the real cause of vitamin A deficiency symptoms may really be zinc deficiency.

Hypothyroid patients may also have a yellow orange coloring to their skin, because without zinc, the liver can not convert beta-carotene into the active form of vitamin A. So the carotene goes to the skin and turns it yellow. [95]

Vitamin A is sometimes said to be dangerous due to potentially teratogenic (harmful to the developing fetus) effects in pregnant women. Therefore if a women has a chance of getting pregnant, she can not supplement with that much vitamin A.

Vitamin D is important for thyroid health in two ways. First, Vitamin D is needed to regulated the expression of T3. [96]. Secondly, low levels of vitamin D are associated with autoimmune disease. Conventional lab ranges range from 30.0 to 74.0 (ng/mL). [97] However, many holistic practitioners like to see vitamin D at at least 60 to 80 (ng/mL). In autoimmune some practitioners get best results when vitamin D is up to 80 – 100 (ng/mL).

Vitamin D increases calcium absorption from the digestive system. At first this sounds like a good thing. But calcium depends on Vitamin K to work properly. Without vitamin K, calcium can get stuck in the wrong places, such as the arteries and contribute to arteriosclerosis. [98] Therefore, in my practice I only use combined vitamin D/K products. What it comes down to is the fat soluble vitamins: A, D and K all seem to work together. So a deficiency of one, can cause deficiency of all three. Since these vitamins are essential for proper thyroid hormone function, all three should be considered together. [99]

Other vitamins

Vitamins E, B2, B3 and B6 are also used in the production of thyroid hormone. [100]

Tyrosine

Tyrosine is an amino acid (a building block of protein) that along with iodine is what thyroid hormone is mostly made of. Tyrosine is included in many thyroid supplements. If someone if not consuming enough protein in their diet, then production of thyroid hormone can be affected (along with many other symptoms). However, there does not seem to be much evidence that supplementing with extra tyrosine, on top of a diet that supplies enough protein will help hypothyroidism. [101] However, as stated in previous sections, some hypothyroid patients may not be eating enough calories. If someone happens to be malnourished, and in need of protein, I would supplement with additional protein by using a protein powder, or amino acid supplement that contains all the essential amino acids. I would not only give tyrosine.

Thyrotropin pmg

This is a supplement from the company standard process which is made from cow thyroid gland. It contains no thyroid hormone. I’m unsure exactly how it works, since it’s a specialty product made by just one supplement company. I’ve heard that it acts as a decoy in auto immune disease so the immune system goes after the supplement and not the thyroid gland. I have also heard that it helps to actually repair the the thyroid. However, many practitioners have had good results using it on clients, not matter how exactly it does work. This is only available through health care professionals who use Standard Process supplements.

Other supplements

Proper supplementation for hypothyroidism needs to go beyond just giving “thyroid supplements.” Other systems related to thyroid function such as the liver, digestive system, and adrenal glands must also be supported.

Hyperthyroidism supplements

Since hyperthyroidism may also indicated deeper problems with auto immune disease and toxicity, other systems must also be supported with supplements. These would most likely be the liver, digestive system and detoxification in general. However, there are some supplements that are specific to hyperthyroidism.

Although these supplements may be helpful in controlling symptoms, and limiting need for medications, this would be only a small part, of a comprehensive plan for someone with graves disease. Refer to section 16 hyperthyroidism, for more detail on what a full plan does entail

Iodine

Medical doctors use iodine in acute hyperthyroidism crisis. Iodine is not used in natural health for hyperthyroidism.

Carnitine

L-carnitine is a supplement usually used to improve energy. For hyperthyroidism, it has been shown to decrease symptoms, most notably nervousness and palpitations. The results where the same at 2 – 4 grams per day. It seems to do this by inhibiting the action of thyroid hormone on cell. It does not inhibit production of thyroid hormone. [102]

Herbs for hyperthyroidism

Lycopus virginicus (Bungleweed), Mellissa officinalis (lemon balm) and Iris versicolor (blue flag) have traditionally been used to treat hyperthyroidism. [103]

Minerals

Selenium, and low dose lithium may be helpful. Often people are scarred of lithium, because of its reputation as a psychiatric drug. In psychiatry a starting dose of 600 is typical, compared to less than 5mg as a nutritional dose. The effects of a low, nutritional dose of lithium, therefore, can not be compared to that used in psychiatry. However, if someone still does not feel comfortable with lithium, carnitine and botanicals can be used instead.

The best use of supplements in graves disease

Supplements are best used, as a way to control symptoms and lower need of medications, while other work is done on the underlining cause of graves disease. Supplements can be used as a long term substitute for drugs. However, natural health has a lot more to offer people with graves disease, by working on the root cause of immune system dysfunction.

18. Putting it all together

If you have read all the information in this guide it may seem overwhelming. We have seen that hypothyroidism (and hyperthyroidism) is not only about the thyroid gland. It is rather a symptom of a deeper issue that is effecting the entire body. There are also multiple factors that can limit thyroid hormone production and conversion. This may make it difficult to know where to start.

Although sometimes it’s important to understand the complex factors that cause ill health, it’s also important to pull back and go back to basics: diet, lifestyle, digestion, and detoxification.

Diet and lifestyle

Start with basic questions:

What is the diet like? Is someone eating a special diet that is depriving them of nutrition? Are there enough calories and high quality protein?

What about allergenic foods? Gluten is the top offender and I would recommend that anyone with a history of hypothyroidism as least go on a trial gluten free diet. This means no wheat, spelt, rye, barley or oats. Other common allergenic foods include soy, eggs, dairy and corn.

Is there and excessive amount of sugar, processed carbs, fructose or artificial sweeteners in the diet? When blood sugar is off, it starts a series of hormonal changes that starts with insulin, but effects the other hormones as well.

Does the diet contain many high nutrient foods? Are vegetables being eaten at all?

Are there lifestyle factor causing stress such as anger, fear, a poor job situation, or family problems? Stress increases cortisol and that lowers thyroid hormone.

Digestion and toxicity

Good digestion is essential to health. Especially in case of auto-immune disease. Is there a history of irritable bowel disease, pain, or discomfort after eating. And particular foods that just can’t be eaten?

It has also been my experience that most people do not digest their food well, even if they do not actively have gastrointestinal symptoms. The 4R program outlined in section 7 and detoxification as discussed in section 13 are often good places to start, in addition to making lifestyle and dietary modifications. I believe those are the core, foundational issues people need to fix. There are many supplements to help the adrenals and low cortisol, but those work a lot better if the stress from toxins, poor diet, poor nutrition, and emotional stress and relieved.

Sometimes it’s necessary to do lab tests for digestive function, toxicity and hormonal imbalances. Most blood tests are designed to look for diseases, and not these foundational issues that lead to poor health. However, there are some companies that do have good tests, which most medical doctors do not usually use. The two labs I use in my practice are:

http://www.diagnostechs.com/ and http://www.metametrix.com/

The real leaders in natural health

Health gurus, popular health books, fancy web sites and doctors on TV may get the most attention, but I believe the real leaders in natural health are my colleagues. These are the naturopathic doctors, chiropractors, nutritionists, chinese medicine doctors, holistic MD’s and people with other credentials who day in and day out help people get better using natural therapies.

No, we don’t always have the biggest web sites, TV credentials, infomercial’s, or health guru status. In fact, most of my colleagues are just plain bad at marketing. I still have to explain to most people I meet just what a naturopathic doctor is. So we may not be well known, but we are out there, helping people in small practices, and I believe we offer clients the best that natural health has to offer.

Nothing I presented in this guide is based upon original research. It came from my education in naturopathic school, professional seminars, things I learned from other practitioners, conventional and functional medicine texts There are many other people who know the same information, working all over the country.

So while I would like my guide to be useful to people with hypothyroidism, and maybe bring some clients my way, I am by no means the only person who can help clients find natural solutions to hypothyroidism. Although I am a naturopathic doctor, I don’t think ND’s have a monopoly in holistic and natural health.

So if your medical doctor has not been helpful (or if you just don’t like bothering with most MD’s) and you need help, I strongly suggest seeking out a professional who can help you. Before making an appointment with someone, I would recommend doing some research, and at least asking the practitioner’s office if they can help someone in your situation and what sorts of therapies they use. Also, don’t assume the fanciest web site, or highest fees makes the best practitioner.

These are a few sites that may help people find a practitioner near them. This is not meant to me an all inclusive directly:

http://www.naturopathic.org

The American Association of Naturopathic Physicians

http://www.diagnostechs.com/providers.php

http://www.metametrix.com/

These are two lab companies I use in my own practice. Their directories can be useful if looking for a practitioner who does “functional tests,” such as hormone testing, digestive function, nutritional status and more. Often when all (or most) of the conventional labs come back normal, function tests are able to give the answers people need.

19. References

Section 1. Introduction

[1] Gardner, David G., Dolores M. Shoback, and Francis S. Greenspan. Greenspan’s Basic & Clinical Endocrinology. New York: McGraw-Hill Medical, 2007. 243-44. Print.

[2] Guyton, Arthur C., and John E. Hall. “Thyroid Metabolic Hormones.” Pocket Companion to Textbook of Medical Physiology. Philadelphia: W.B. Saunders, 2001. 590. Print.

Section 2. Thyroid stimulating hormone (TSH)

[3] Shier, David, Jackie Butler, and Ricki Lewis. Hole’s Human Anatomy & Physiology. Boston, MA: McGraw-Hill Higher Education, 2004. 482. Print.

[4] Kumar, Vinay, and Ramzi S. Cotran. Robbins Basic Pathology: With Studentconsult Access. Elsevier Saunders, 2004. 728. Print.

[5] Kumar, Vinay, and Ramzi S. Cotran. Robbins Basic Pathology: With Studentconsult Access. Elsevier Saunders, 2004. 727. Print.

[6] Blanchard, Kenneth H., and Marietta Abrams-Brill. What Your Doctor May Not Tell You about Hypothyroidism: a Simple Plan for Extraordinary Results. New York: Warner, 2004. 12. Print.

[7] Eckman, Ari S. “TSH Test: MedlinePlus Medical Encyclopedia.” National Library of Medicine – National Institutes of Health. 19 May 2010. Web. 18 Aug. 2010.

Section 3. Beyond TSH

[8] Andersen, Stig, Klaus M. Pedersen, Niels Henrik Bruun, and Peter Laurberg. “Narrow Individual Variations in Serum T(4) and T(3) in Normal Subjects: a Clued to the Understanding of Subclinical Thyroid Disease.” The Journal of Clinical Endocrinology & Metabolism 87.3 (2002): 1068-072. Print.

[9] Guyton, Arthur C., and John E. Hall. “Thyroid Metabolic Hormones.” Pocket Companion to Textbook of Medical Physiology. Philadelphia: W.B. Saunders, 2001. 586-587. Print.

[10] Arafah, Baha M. “Increased Need for Thyroxine in Women with Hypothyroidism during Estrogen Therapy.” The New England Journal of Medicine 344.23 (2001): 1743-749. Print.

[11] McPhee, Stephen J., and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2010. New York: McGraw-Hill Medical, 2010. 1005. Print.

[12] Fischbach, Frances Talaska. Manual of Laboratory and Diagnostic Tests for PDA. Philadelphia: Lippincott Williams & Wilkins, 2005. 441-451. Print.

[13] Brady, David M. “Thyroid and Adrenal Disorders.” Lecture. The Role of Thyroid, Adrenal and Othe Endocrine Dysfunctions in Chronic Illness. Boston. 29 Oct. 2005. The Role of Thyroid, Adrenal and Other Endocrine Dysfunctions in Chronic Illness. Moss Nutrition. 94-100. Print.

[14] Ibid., 94-100.

[15] Fischbach, Frances Talaska. Manual of Laboratory and Diagnostic Tests for PDA. Philadelphia: Lippincott Williams & Wilkins, 2005. 453. Print.

[16] Pizzorno, Lara, and William Ferril. “Chapter 32, Thyroid.” Textbook of Functional Medicine. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 644. Print.

[17] Guyton, Arthur C., and John E. Hall. “Thyroid Metabolic Hormones.” Pocket Companion to Textbook of Medical Physiology. Philadelphia: W.B. Saunders, 2001. 561. Print.

Section 4. Not all doctors treat hypothyroidism the same way

[19] Gardner, David G., Dolores M. Shoback, and Francis S. Greenspan. Greenspan’s Basic & Clinical Endocrinology. New York: McGraw-Hill Medical, 2007. 243-44. Print.

Section 5. Low TSH induced hypothyroidism

[20] Miller, Marcus N., Cheryl K. Burdette, and Richard S. Lord. “Chapter 10 Hormones.” Laboratory Evaluations for Integrative and Functional Medicine. Ed. Richard S. Lord and J. Alexander. Bralley. Duluth, GA: Metametrix Institute, 2008. 552. Print.

Section 6. Iodine deficiency

[21] Guyton, Arthur C., and John E. Hall. “Thyroid Metabolic Hormones.” Pocket Companion to Textbook of Medical Physiology. Philadelphia: W.B. Saunders, 2001. 590. Print.

[22] Fitzgerald KN, Nelson-Dooley C, and Richard S. Lord. “Chapter 3 Nutrient and Toxic Elements.” Laboratory Evaluations for Integrative and Functional Medicine. Ed. Richard S. Lord and J. Alexander. Bralley. Duluth, GA: Metametrix Institute, 2008. 104. Print.

[23] Meletis, Chris D., and Nieske Zabriskie. “Iodine, a Critially Overlooked Nutrient.” Alternative and Complementary Therapies 13.3 (2007): 132-36. Print.

[24] Smyth, Peter P.A. “Role of Iodine in Antioxidant Defence in Thyroid and Breast Disease.” Biofactors 19.3-4 (2003): 121-30. Print.

[25] Kessler, Jack H. “The Effect of Supraphsiologic Levels of Iodien on Patients with Cyclic Mastalgia.” The Breast Journal 10.4 (2004): 328-36. Print.

[26] Ristic-Medic, Danijela, Zlata Piskackova, Lee Hooper, Jiri Ruprich, Amelie Casgrain, Kate Ashton, Mirjana Pavlovic, and Maria Glibetic. “Methods of Assessment of Iodine Status in Humans: a Systematic Review.” American J of Clin Nutr 89.6 (2009): 2052s-069s. Print.

[27] Christianson, Alan. “Iodine’s New Paradigm: More…or Less?” Naturopathic Doctor News & Review 6.8 (2010): 8-10. Print.

[28] Moss, Jeff. “A Perspective on High Dose Iodine Supplementation – Part V – The Japanese Experience with Dietary Iodine.” Moss Nutrition Report 218 (1 Dec. 2007). Print.

[29] Konno, K., H. Makita, K. Yuri, and K. Kawasaki. “Association between Dietary Iodine Intake and Prevalence of Subclinical Hypothyroidism in the Coastal Regions of Japan.” The Journal of Clinical Endocrinology & Metabolism 78 (1994): 393-97. Print.

[30] Anguiano B et al. Uptake and gene expression with antitumoral doses of iodine in thyroid and mammary gland: Evidence that chronic administration has not harmful effects. Thyroid. 2007;17(9):851-859.

[31] Ibid.,

[32] Moss, Jeff. “A Perspective on High Dose Iodine Supplementation – Part VII – Can High Dose Iodine Suppress Iodine Uptake Into the Thyroid?” Moss Nutrition Report 221 (1 Apr. 2008). Print.

[33] Moss, Jeff. “A Perspective on High Dose Iodine Supplementation – Part VIII – Some “Big Picture” Thoughts on All That I Have Written in This Series So Far” Moss Nutrition Report 221 (1 Jun. 2008). Print.

[34] Moss, Jeff. “A Perspective on High Dose Iodine Supplementation – Part XII – Laboratory Analysis To Determine Need And Overall Series Conclusions Moss Nutrition Report 228 (1 Aug. 2009). Print.

Section 7. Auto immune hypothyroidism (Hashimoto’s thyroiditis)

[35] Tomer, Yaron, and Terry F. Davies. “Infection, Thyroid Disease, and Autoimmunity.” Endocrine Reviews 14.1 (1993): 107-20. Print.

[36] Brady, David M., Alexander Bralley, and Richard S. Lord. “Chapter 7 Hormones.” Laboratory Evaluations for Integrative and Functional Medicine. Ed. Richard S. Lord and J. Alexander. Bralley. Duluth, GA: Metametrix Institute, 2008. 426-29. Print.

[37] Petru, G., D. Stuenzner, P. Lind, O. Eber, and JR Moese. “Antibodies against Yersinia Enterocolitica in Immunogenic Thyroid Diseases.” Acta Medica Austriaca 14.1 (1987): 11. Print.

[38] Hanaway, Patrick. “Chapter 26 Clinical Approaches to Gastrointestinal Imbalance: Balance of Flora, GALT, and Mucosal Integrity.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 444-53. Print.

[39] Brady, David M., Alexander Bralley, and Richard S. Lord. “Chapter 7 Hormones.” Laboratory Evaluations for Integrative and Functional Medicine. Ed. Richard S. Lord and J. Alexander. Bralley. Duluth, GA: Metametrix Institute, 2008. 413-466. Print.

[40] Ibid.,

[41] Ibid.,

[42] Ibid.,

[43] Ibid.,

[44] Ibid.,

[45] Ibid.,

[46] Nichols, Trent W., and Nancy Faass. Optimal Digestion: New Strategies for Achieving Digestive Health. New York, NY: WholeCare, 1999. 62-63. Print.

[47] Lukaczer, Dan. Textbook of Functional Medicine. By David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 462-68. Print.

Section 8. Celiac disease

[48] Purcell, Gretchen P. “What Makes a Good Clinical Decision Support System.” BMJ 330 (2005): 740-41. Print.

[49] Fasano, Alessio. “Celiac Disease- How to Handle a Clinical Chameleon.” The New England Journal of Medicine 348.25 (2003): 2568-570. Print.

[50] get from celiac notes – every perosn dxed w/ celia 14 others have not, or just cite whole seminar

[51] Fasano, Alessio, and Carlo Catassi. “Current Approaches to Diagnosis and Treatment of Celiac Disease: An Evolving Spectrum.” Gastroenterology 120 (2001): 636-51. Print.

[52] Nicoletta, Ansaldi, Tiziana Palmas, Andrea Corrias, Maria Barbatto, Rocco Mario D’Altglia, Angelo Campanozzi, et al. “Autoimmune Thyroid Disease and Celiac Disease in Children.” J Pediatr Gastroenterol Nutr 37.1 (2003): 63-66. Print.

[53] Brady, David M. “Thyroid and Adrenal Disorders.” Lecture. The Role of Thyroid, Adrenal and Othe Endocrine Dysfunctions in Chronic Illness. Boston. 29 Oct. 2005. The Role of Thyroid, Adrenal and Other Endocrine Dysfunctions in Chronic Illness. Moss Nutrition. 125. Print.

[54] Hyman, Mark. “Chapter 26, Clinical Approaches to Environmental Inputs.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 370. Print.

[55] Corrao, Giovanni, Gino Roberto Corrazza, Vincenzo Bagnardi, Giovanna Brusco, Carolina Ciacci, and Mario Cottone. “Découvrir / Discover Refdoc INIST Diffusion 2, Allée Du Parc De Brabois F-54514 Vandoeuvre-lès-Nancy Cedex France Phone: +33 (0)3 83 50 46 64 Fax: +33 (0)3 83 50 46 66 Nous Contacter Contact Us Faire Une Nouvelle Recherche Make a New Search Lancer La Recherche Commander Ce Document Ok Order This Document Ok Titre Du Document / Document Title Mortality in Patients with Coeliac Disease and Their Relatives: a Cohort Study.” Lancet 358 (2001): 356-61. Print.

[56] Hyman, Mark. “Chapter 26, Clinical Approaches to Environmental Inputs.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 369. Print.

[57] Ibid,.

Section 9. Autoimmune polyendocrine syndrome (APS)

[58] Betterle, Corrado, and Renato Zanchetta. “Update on Autoimmune Polyendocrine Syndromes (APS).” Acta Bio Medica 74 (2003): 9-33. Print.

Section 10. Why the body may want to make less thyroid hormone

[59] Werner, Sidney C., Sidney H. Ingbar, Lewis E. Braverman, and Robert D. Utiger. Werner & Ingbar’s the Thyroid: a Fundamental and Clinical Text. Philadelphia: Lippincott Williams & Wilkins, 2000. 281-295. Print.

Section 11. Euthyroid sick syndrome and low T3 syndrome

[60] Berkow, Robert, and Mark H. Beers. The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck &, 1999. 86. Print.

[61] Ibid.,

[62] Ober, K. Patrick. Endocrinology of Critical Disease. Totowa, NJ: Humana, 1997. 155-73. Print.

[63] Brady, David M. “Thyroid and Adrenal Disorders.” Lecture. The Role of Thyroid, Adrenal and Othe Endocrine Dysfunctions in Chronic Illness. Boston. 29 Oct. 2005. The Role of Thyroid, Adrenal and Other Endocrine Dysfunctions in Chronic Illness. Moss Nutrition. 96. Print.

Section 12. Anti-thyroid diets

[64] Bland, Jeffrye S., and David S. Jones. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Cellular Messaging, Part II- Tissue Sensitivity and Intracellular Response.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 590-609. Print.

[65] Felig, PF. “The Thyroid: Physiology, Thyrotoxicosis, Hypothyroidism, and the Painful Thyroid,.” Endocrinology and Metabolism, Third Edition. Ed. RD Utiger. New York: McGraw-Hill, 1995. 435-519. Print.

Section 13. Heavy metals, toxins and the liver

[66] txt fxn med pg 150

[67] “Persistent Organic Pollutants: A Global Issue, A Global Response | International Programs | USEPA.” US Environmental Protection Agency. 27 May 2010. Web. 23 Aug. 2010. <http://www.epa.gov/international/toxics/pop.html#pops>.

[68] txt fxn med ref 270, pg 601]

[69] ref 269, txt pfxn med 601 – think it is 269, typo was 379

[70] Sauvage, Marie-Frederique, Pierre Marquet, Annick Rousseau, Claude Raby, Jacques Buxeraud, and Gerad Lachatre. “Relationship between Psychotropic Drugs and Thyroid Function: A Review.” Toxicology and Applied Pharmacology 149.2 (1998): 127-35. Print.

[71] Ibid.,

[72] Felig, PF. “The Thyroid: Physiology, Thyrotoxicosis, Hypothyroidism, and the Painful Thyroid,.” Endocrinology and Metabolism, Third Edition. Ed. RD Utiger. New York: McGraw-Hill, 1995. 435-519. Print.

[73] Ibid.,

[74] Ibid.,

[75] Ibid.,

[76] Pizzorno, Lara, and William Ferril. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Thyroid.” Ed. David S. Jones. Textbook of Functional Medicine. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 647. Print.

[77] Bland, Jeffrye S., and David S. Jones. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Cellular Messaging, Part II- Tissue Sensitivity and Intracellular Response.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 590-609. Print.

[78] “How Your Thyroid Works – “A Delicate Feedback Mechanism”” Endocrine Diseases: Thyroid, Parathyroid Adrenal and Diabetes. – EndocrineWeb. Web. 23 Aug. 2010. <http://www.endocrineweb.com/thyfunction.html>.

[79] Pelletier, Catherine, Eric Doucet, Pascal Imbeault, and Angelo Tremblay. “Associations between Weight Loss-Induced Changes in Plasma Organochlorine Concentrations, Serum T3 Concentration, and Resting Metabolic Rate.” Toxicological Sciences 67 (2002): 56-51. Print.

Section 14. The adrenals, stress, cortisol and low T3

[80] Guyton, Arthur C., and John E. Hall. “Thyroid Metabolic Hormones.” Pocket Companion to Textbook of Medical Physiology. Philadelphia: W.B. Saunders, 2001. 473. Print.

[81] Selye, Hans. The Stress of Life. New York: McGraw-Hill, 1976. 74-78. Print.

[82] Stratakis, CA, and GP Chrousos. “Neuroendocrinology and Pathophysiology of the Stress System.” Ann N Y Acad Sci. 771 (1995): 1-18. Print.

[83] Wilson, James L. Adrenal Fatigue: the 21st Century Stress Syndrome. Petaluma, CA: Smart Publications, 2001. 27-44. Print.

Section 15. Blood sugar, estrogen and hormonal balance

[84] Guyton, Arthur C., and John E. Hall. “Thyroid Metabolic Hormones.” Pocket Companion to Textbook of Medical Physiology. Philadelphia: W.B. Saunders, 2001. 523-524. Print.

[85] Felig, PF. “The Thyroid: Physiology, Thyrotoxicosis, Hypothyroidism, and the Painful Thyroid,.” Endocrinology and Metabolism, Third Edition. Ed. RD Utiger. New York: McGraw-Hill, 1995. 435-519. Print.

[86] Ibid.,

[87] Lang, Janet R. “Balancing Femail Hormones Naturally (part 1).” Lecture.

[88] Obal F., and Kruegar, JM. “Hormones, cytokines, and sleep.” Coping with the Environment: Neural and Endocrine Mechanisms. New York: Oxford University Press, 2001. 331-349. Print.

Section 16. Graves disease and Hyperthyroidism

[89] Gardner, David G., Dolores M. Shoback, and Francis S. Greenspan. Greenspan’s Basic & Clinical Endocrinology. New York: McGraw-Hill Medical, 2007. 248-55. Print.

[90] Ibid.,

[91] Ibid.,

[92] Hull, Janet Starr. Sweet Poison: How the World’s Most Popular Artificial Sweetener Is Killing Us– My Story. Far Hills, NJ: New Horizon, 2001. Print.

Section 17.

[93] Pizzorno, Lara, and William Ferril. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Thyroid.” Ed. David S. Jones. Textbook of Functional Medicine. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 644-47. Print.

[94] Bland, Jeffrye S., and David S. Jones. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Cellular Messaging, Part II- Tissue Sensitivity and Intracellular Response.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 590-609. Print.

[95] Aktuna, D., W. Buchinger, W. Langsteger, E. Meister, H. Sternad, O. Lorenz, and O. Eber. “Beta-carotene, Vitamin A and Carrier Proteins in Thyroid Diseases.” Acta Med Austriaca 20 (1993): 17-20. Print.

[96] Bland, Jeffrye S., and David S. Jones. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Cellular Messaging, Part II- Tissue Sensitivity and Intracellular Response.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 590-609. Print.

[97] “25-hydroxy Vitamin D Test: MedlinePlus Medical Encyclopedia.” National Library of Medicine – National Institutes of Health. Web. 25 Aug. 2010. <http://www.nlm.nih.gov/medlineplus/ency/article/003569.htm>.

[98] Schurgers, LJ, HM Spronk, BA Soute, PM Schiffers, JG Demey, and C. Vermeer. “Ion of Warfarin-induced Medial Elastocalcinosis by High Intake of Vitamin K in Rats.” Blood 109.7 (2007): 2823-831. Print.

[99] Masterjohn, C. “Vitamin D Toxicity Redefined: Vitamin K and the Molecular Mechanism.” Med Hypotheses 68.5 (2006): 1026-034. Print.

[100] Pizzorno, Lara, and William Ferril. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Thyroid.” Ed. David S. Jones. Textbook of Functional Medicine. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 644-47. Print.

[101] Bland, Jeffrye S., and David S. Jones. “Chapter 32 Clinical Approaches to Hormonal and Neuroendocrine Imbalances: Cellular Messaging, Part II- Tissue Sensitivity and Intracellular Response.” Textbook of Functional Medicine. Ed. David S. Jones. Gig Harbor, WA.: Institute for Functional Medicine, 2005. 590-609. Print.

[102] Benvenga, Salvatore, Antonino Amato, Menotti Calvani, and Francesco Trimarchi. “Effects of Carnitine on Thyroid Hormone Action.” Annals of the New York Academy of Sciences 1033.1 (2004): 158-67. Print.

[103] Friedman, Michael. Fundamentals of Naturopathic Endocrinology: Complementary and Alternative Medicine Guide. Toronto, ON: CCNM, 2005. 94. Print.

Made with ❤ with Elementor

Hypothyroidism Guide Page 4

13. Heavy metals, toxins and the liver

What are persistent organic pollutants?

According to the EPA:

14. Adrenal fatigue, stress, cortisol and hypothyroidism

Fight or flight

The fight or flight response includes the following changes:

Cortisol and thyroid hormone

15. Blood sugar, estrogen and hormonal balance

The thyroid and hormonal balance

The pancreas, insulin and blood sugar

The sex hormones

Excessive levels of estrogens in women and men are epidemic in our society.

Sleep

16. Grave disease(this section not copied for archive pages – see main Graves disease section for up to date information)

17. Thyroid supplements

Hypothyroidism supplements

Iodine

Selenium

Zinc

Vitamins A, D, K and essential fatty acids

Other vitamins

Tyrosine

Thyrotropin pmg

Other supplements

Hyperthyroidism supplements

Iodine

Carnitine

Herbs for hyperthyroidism

Minerals

The best use of supplements in graves disease

18. Putting it all together

Diet and lifestyle

Digestion and toxicity

Recommended reading :

The real leaders in natural health

19. References

16. Grave disease
(this section not copied for archive pages – see main Graves disease section for up to date information)