Hypothyroidism is caused by an underactive thyroid gland that produces insufficient thyroid hormones. The document summarizes the symptoms, complications, classifications, and treatments for hypothyroidism. It provides details on the thyroid gland, hormones, and regulating system. Treatment recommendations include dietary changes like increasing iodine, calcium and magnesium intake. Herbal supplements like bladderwrack, oats and makandi are also suggested to support thyroid function.

1. HYPOTHYROIDISM
PREPARED BY: MOHAMMED S. EL-LULU
MASTER OF CLINICAL NUTRITION
PALESTINE - GAZA
……………………………………………………………………………..
Botanical Medicine of Clinical Nutrition

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. Thyroid system diagram
3

4. Thyroxin Hormone
4
 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. Regulating thyroid hormones
5
 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. Regulating thyroid hormones
6
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. Physiological actions of Thyroxin hormones
7
 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 Hypothyroidism
 Symptoms
 Complications
 Classification
 Goiter
 Nutrients
 Herbal remedies

9. Opera Winfrey
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10. Hypothyroidism
10
 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. Basic symptoms of hypothyroidism
11
 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. Complications
12
Untreated condition, patient is at risk for:
 diabetes,
 high blood pressure,
 emphysema,
 arthritis,
 depression,
 recurrent infections,
 and migraine.

13. Classification of Hypothyroidism
13
 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. Goitrus Hypothyroidism
14
 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. Natural Diet for Hypothyroidism -1
15
 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. Natural Diet for Hypothyroidism -2
16
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. Avoid anti-thyroid foods
17
 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. Herbal remedies
18
Herbal content of Thyroid Assist™ Thyroid Assist™
 Fucus vesiculosis
(Bladderwrack or kelp)
 Avena sativa
(Green Oats)
 Coleus forskohlii
(Makandi)

19. Thyroid Assist™ Benefits
19
 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. 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. 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. 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. Case Study
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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. Medical History
25
 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. 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. 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. 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. Analysis of obtained data
29
 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. Recommendations
30
 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.
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