The importance of regular thyroid function testing and working with a healthcare professional to manage hypothyroidism.
|The thyroid is a small, butterfly-shaped gland located at the base of the throat. This gland plays a very important role in controlling the body's metabolism. It does this by producing thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), substances that travel through the blood to every part of the body. These thyroid hormones tell the cells in the body how fast to use energy and produce proteins. The thyroid gland also makes calcitonin, a hormone that helps to regulate calcium levels in the blood by inhibiting the breakdown (reabsorption) of bone and increasing calcium elimination from the kidneys.|
|The body has an elaborate feedback system to control the amount of T4 and T3 in the blood. When blood levels of the hormones decrease, the hypothalamus releases thyrotropin-releasing hormone, which in turn causes the pituitary gland to release thyroid- stimulating hormone (TSH). TSH stimulates the thyroid gland to produce and secrete T4 (primarily) and T3. When the system is functioning normally, thyroid production turns on and off to maintain relatively stable levels of thyroid hormones.
Hypothyroidism: too little thyroid hormone; slowing of body functions; symptoms include weight gain, dry skin, constipation, cold intolerance, puffy skin, hair loss, fatigue, and menstrual irregularity in women. Severe untreated hypothyroidism, called myxedema, can lead to heart failure, seizures, and coma. Specific types of hypothyroidism include:
• Congenital hypothyroidism: this condition affects infants from birth; it is caused by inadequate thyroid hormone and is most commonly due to a thyroid gland that is missing, only partially developed, or located in an abnormal part of the body. The rest of the cases are due to a normal-sized or enlarged thyroid that does not function properly or produce sufficient thyroid hormone. Left untreated, this condition can cause delays in physical and intellectual development. In children, hypothyroidism can stunt growth and delay sexual development.
• Hashimoto thyroiditis: the most common cause of hypothyroidism. It is a chronic autoimmune condition in which the immune system targets the thyroid, causing inflammation and damage and the production of autoantibodies. With Hashimoto thyroiditis, the thyroid produces low amounts of thyroid hormone.
• Iodine deficiency: lack of this element (as iodide) diminishes the ability of the thyroid gland to make enough thyroid hormone. T4 has four iodides and T3 has three. Iodide is present throughout the environment, but most iodide is in sea water and seaweed. People who live in countries with little access to the sea often have iodide deficiency unless their sources of food are supplemented
|with iodide. Fortunately, iodide is used to fight bacterial growth in many foods (such as iodized salt) and is also in many dietary
|Blood test||What it is ?||Why is it tested ?||What it means||Nutritional intervention|
|TSH||Thyroid stimulating hormone||High TSH levels with normal T3 &/ or T4 indicates sub clinical hypothyroidism.
High TSH with low T3 &/ or T4 indicates hypothyroidism.
|• Goitogen containing foods negatively impact thyroid function by impairing thyroid peroxidase. Cruciferous vegetables such as broccoli, cauliflower , soya , Brussels sprouts should be taken in small amounts.
• Flavanoids such as apigenin, luteolin, kaempferol and vitexin found in soya based foods, millets such as bajra, ragi, and proso. These impair thyroid function.
• Coffee, green tea and alcohol — these beverages may irritate the thyroid gland
• Processed food and sugary food should be avoided as it contributes to weight gain.
|T3||Triiodothyron ine||T3 bound to protein||High TSH levels with normal T3 &/ or T4 indicates sub clinical hypothyroidism.
High TSH with low T3 &/ or T4 indicates hypothyroidism.
|T4||Thyroxine||T4 bound to protein||High TSH levels with normal T3 &/ or T4 indicates sub clinical hypothyroidism.
High TSH with low T3 &/ or T4 indicates hypothyroidism.
|Free T3||T3 is unbound in the blood & is biologically active||Low free T3 indicates hypothyroidism|
|Free T4||T4 is unbound in the blood & is biologically active||• Low free T4 results may indicate an underactive thyroid gland (hypothyroidism)
• When people are iodine- deficient, the thyroid makes much more T3 than T4.
|Thyroid peroxidase (TPO)
&Thyroglobul in (TG) antibody
|Thyroid antibody markers||To detect Grave’s disease or Hoshimotos thyroiditis.||Positive results indicate auto immune form of hypothyroidism.||• Test for allergies and intolerances.|
|Urinary iodine concentration|
|Vitamin D||Vitamin||• Vitamin D is associated with autoimmune thyroid deficiency - especially hoshimottos disease.
• Regulates insulin secretion.
|• Correcting this deficiency shows a marked improvement on thyroid function.
• Deficiency can lead to rapid excretion of calcium.
• Helps in weight management.
|• Supplementation and regular monitoring.
• Vitamin D rich food - cod liver oil, fatty fish (salmon , herring, trout, sardines, tuna), egg yolk, milk
• Ensure adequate healthy fat intake to retain Vitamin D.
|Calcium||Mineral||When the calcium level is high in the bloodstream, the thyroid gland releases calcitonin. Calcitonin slows down the activity of the osteoclasts found in bone.
This decreases blood calcium levels.
|• Calcium deficiency could be caused by thyroid issues.
• However, calcium supplementation or antacid intake can interfere with thyroid medication.
• Calcium is best given in the form of food.
|• Calcium source should be taken only 90 mins after taking thyroid medication.
• Natural sources of calcium are better than supplementation.
|Vitamin A||Vitamin||An underactive thyroid gland cannot efficiently convert carotene to usable Vitamin A||• Protein intake may also low. Vitamin A binds to retinol binding protein to be circulated in the body.||• Ensure adequate protein levels. Good quality proteins should be focused on.
• Ensure adequate consumption of healthy fats.
• Zinc deficiency impairs absorption, transport and metabolism of Vitamin A.
• Vitamin A sources are sweet potatoes, carrots, dark green leafy vegetables, dried apricots, capsicum, fish , liver etc.
|Vitamin B12||Vitamin||People with an underactive thyroid or people with low thyroid cannot absorb this vitamin effectively.||Muscle weakness, lethargy, tiredness and prickly feet is a result of Vitamin B deficiency.||• Vitamin B12 has a large range. Make sure your client is at least in the middle of that range.|
|Vitamin E||Vitamin||Vitamin E promotes healthy thyroid function.||Low Vitamin E levels causes deregulation of thyroid production.||• Consume healthy fats on a regular basis.
• Ensure adequate HDL levels to ensure adequate absorption.
|Selenium||Mineral||Selenium is present in the thyroid gland.
It helps convert T4 ( inactive form) to T3 (active form) in the body.
|Deficiency causes hypothyroidism.||• Increase consumption of brazil nuts. sea food, seeds, lamb, chicken, egg, spinach.|
|Zinc||Mineral||• Hypothyroidsm causes zinc deficiency||• Low zinc levels are seen in obese individuals.
• Low immune levels are caused by Zinc
• Zinc is needed to convert T4 to T3
|• Increase intake of dietary proteins. Animal proteins enhances absorption of zinc.
• Phytates in cereals , whole grains & soy inhibit absorption of zinc by binding to it.
• Calcium rich foods should not be taken with Zinc rich food as Calcium inhibits Zinc absorption.
|Gluten intolerance - genetic test||Protein present in wheat||Most people who have auto immune versions of thyroid usually have gluten intolerance. Sometimes intolerance is so mild that it cannot be recognised.||Patients with gluten intolerance , their symptoms of thyroid generally decrease when gluten is avoided,||• Gluten free foods are recommended ONLY if the person is gluten intolerant.
• A genetic test is important to know if a person is gluten intolerant.
• Check for hidden sources of gluten.
|Creatinine phosphokinas e||Enzyme||An enzyme in the body. It is found mainly in the heart, brain, and skeletal muscle.||Serum creatine phosphokinase levels thus show an inverse relation with serum T3, T4 levels.
Indicates low muscle mass.
|• Ensure adequate protein and carb consumption.|
|Somatomedin C||Protein||protein produced in the liver and muscles that's known as a growth factor||It is reduced in hypothyroidism, Somatomedin C promotes cell growth and division.||• Ensure adequate protein and carb consumption.|
|GFR||Glomerular filteration rates||This is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute.||Hypothyroidism is associated with reduced GFR.||• Low sodium diet
• Moderate amounts of proteins.
• DASH diets.
• Reduce consumption of processed foods.
|Uric acid||hyperthyroidism can cause a significant increase in serum uric acid||Uric acid is a chemical created when the body breaks down substances called purines.
A significant correlation between thyroid function and purine nucleotide metabolism has been established in hypothyroidism
|• Maintain the right weight.
• Ensure adequate water consumption.
• Avoid organ meats.
• Decrease beer and distilled liquor.
• Moderate coffee consumption reduces gout.
• Cherries are associated with reduced gout.
• Focus on complex carbs.
|Carotenoids||C a r o t e n e m i a i n hypothyroidism is due to a decrease in the conversion of carotene into vitamin A, as well as associated h y p e r l i p i d e m i a a n d hypercholesterolemia.||Carotenemia is a clinical condition characterized by yellow pigmentation of the skin (xanthoderma) and increased beta-carotene levels in the blood.||Carotenemia is harmless and a reversible condition. Reduce intake of carotenoids and control thyroid hormones.|
|ALP||Alkaline phosphatase||It is an enzyme that helps break down proteins. The body uses ALP for a wide range of processes, and it plays a particularly important role in liver function and bone development.||Hypothyroidism, particularly Grave’s disease can cause elevated ALP levels.
Not only does the liver play a role in the chemical process that develops thyroid hormones, but untreated hypothyroidism can cause problems in liver function over time.
|• Ensure adequate zinc, vitamin B12, Vitamin A, copper levels. Zinc and Magnesium supplementation can increase ALP levels.
• Reduce Zinc levels to reduce ALP levels.
• Foods rich in copper help to reduce ALP levels.
• Vitamin D deficiency leads to high ALP levels.
|Serum copper||Metal||Copper, along with other minerals like zinc, helps m a i n t a i n optimal thyroid gland function.||T3 and T4 levels of thyroid hormones are c l o s e l y l i n k e d to copper levels.
Many people have copper deficiency, but some might have copper toxicity (copperiedus).
|• Excess estrogen can cause copper retention.
• Cooking acidic foods in copper cookware can increase toxicity.
• IUDs (intrauterine devices) made up of copper can cause copper toxicity.
|Homocysteine||Protein||Thyroid levels influence heart rates||Risk of heart disease||• MTHFR gene test. The risk alleles are more common in people with hypothyroidism.
• Increase consumption of
• Ensure adequate Vitamin B12 levels.
|Genetic Markers||Genetic tests||Asses congenital hypothyroidism||DUOX2, PAX8, SLC5A5,TG,TPO,TSHB, TSHR genes.|