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.