TELEMEDICINE Thyroid Health Practice with a Functional Medicine Approach

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All Posts in Category: Thyroid

Vitamin B-12

Vitamin B12 plays an important role in the body and if you are feeling tired or weak it could be a sign you are deficient.

There are two types of vitamin B12 in the body, these are active B12 and inactive B12, both make up Total B12. The simple difference between the two forms is that active B12 is the form used by the body.

WHAT IS ACTIVE B12?

Active B12 is when B12 binds to transcobalamin protein (known as Holotranscobalamin or HoloCT) and is made available to cells for use in the body, hence being called active B12. 

The most widely used B12 test on the NHS checks total levels of B12. Active B12 typically makes up 10% - 30% of the total B12 in the body, so being in the “normal,” range of the total B12 might hide a B12 deficiency. It’s the levels of active B12 you really need to be concerned with if you are worried about thyroid issues, fatigue or any other symptoms associated with a vitamin B12 deficiency.

WHY TEST YOUR B12 LEVELS?

The two main reasons to check your Vitamin B12 levels are:

  • You’re concerned about a thyroid disorder
  • You are experiencing unexplained fatigue

WHAT ARE THE SYMPTOMS OF VITAMIN B12 DEFICIENCY?

Some of the symptoms of vitamin B12 deficiency include:

  • Fatigue
  • Anaemia
  • Neurological features
  • Sore tongue
  • Bone marrow suppression
  • Cardiomyopathy

Low vitamin B12 levels

B12 as a key co-factor in metabolic methylation is involved in several vital biological processes. Therefore, the increase of food sources high in vitamin B12 (see picture) and supplementation - ideally with a methylated form of B12 - are important for rapid restoration of the B12 status, which is indicated by low serum levels.

High vitamin B12 serum concentrations without supplementation: the pitfalls of interpretation

High active B12 concentrations may be due to excessive levels of the vitamin, increased levels of its transport proteins [1] or related to autoimmune or haematological disorders [2].

High or supraphysiological serum B12 levels without supplementation have been associated with many health problems kidney failure, blood disorders, cancer, and liver or autoimmune diseases. [2,3]  All conditions may show elevated concentrations of B12 transport proteins.

Elevated serum B12 levels may also be associated with a functional deficiency of the vitamin. Functional deficiency is caused by a failure of uptake into processing within the cells, Uptake can be reduced due to abnormal increases of B12-binding proteins or the formation of immunoglobulin-B12-complexes.It is unknown, whether B12 should be supplemented in these conditions.

Recent findings in diseases associated with oxidative stress have revealed that intracellular oxidative stress results in local functional B12 deficiency [4]. Treatment with glutathione and/or vitamin C, a key  regenerator of intracellular glutathione, may provide therapeutic benefit.

As supraphysiological levels may serve as a new important diagnostic marker in serious conditions unrelated to the individual patient’s B12 status, further investigations to rule out an underlying health condition need to be initiated, if supplementing with glutathione and vitamin C fails to improve levels.

References:

[1] Jeffery J, Millar H, Mackenzie P, Fahie-Wilson M, Hamilton M, Ayling RM. An IgG complexed form of vitamin B12 is a common cause of elevated serum concentrations. Clin Biochem 2010; 43:82–8.

[2] Remacha AF, Zapico E, Sarda MP, Rojas E, Simo M, Remacha J, et al. Immune complexes and persistent high levels of serum vitamin B12. Int J Lab Hematol 2014; 36:92–7.

[3] Andres E, Serraj K, Zhu J, Vermorken AJ. The pathophysiology of elevated vitamin B12 in clinical practice. QJM 2013; 106:505–15.

[4] Solomon LR. Functional cobalamin (vitamin B12) deficiency: role of advanced age and disorders associated with increased oxidative stress. Eur J Clin Nutr 2015; 69:687–92..

Picture source

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Your mouth and your thyroid

Optimise Thyroid function before Dental work!

 If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatment should be put on hold until a complete medical evaluation is performed.

Patients with history of thyroid diseases should be carefully evaluated to determine the level of medical management, and they should be treated in a way that limits stress and infection. 

Oral manifestations of hypothyroidism

The common oral findings in hypothyroidism include the characteristic enlarged tongue, distortion of the sense of taste, delayed eruption of teeth, poor periodontal health, altered tooth morphology and delayed wound healing.

Before treating a patient who has a history of thyroid disease, the dentist should obtain the correct diagnosis and etiology for the thyroid disorder, as well as past medical complications and medical therapy.

Dental Management of Hypothyroidism

Hemostasis - Patients with long standing hypothyroidism may have a decreased ability of small blood vessels to constrict when cut and may result in increased bleeding. Local pressure for an extended time will probably control the bleeding from the small vessels adequately.[10]

Susceptibility to infection - Patient with hypothyroidism may have delayed wound healing associated with an increased risk for infection because of the longer exposure of the unhealed tissue to pathogenic organisms. Hypothyroid patients are not considered to be immunocompromised.

Patients who have hypothyroidism are susceptible to cardiovascular disease from arteriosclerosis and elevated LDL.

Drug actions and interactions - Patients who have hypothyroidism are sensitive to central nervous system depressants and barbiturates, so these medications should be used sparingly.

It has been found that recent exposure to a surgical antiseptic that includes iodine (such as Povidone) can increase the risk of thyroiditis or hypothyroidism. Patients with underlying thyroid antibodies and a tendency toward autoimmunity appear to be at more risk.

Drug interactions of l-thyroxine include increased metabolism due to phenytoin, rifampicin and carbamazepine, as well as impaired absorption with iron sulfate, sucralfate and aluminum hydroxide. 

When l-thyroxine is used, it increases the effects of warfarin sodium and, because of its gluconeogenic effects; the use of oral hypoglycemic agents must be increased. Concomitant use of tricyclic antidepressants elevates l-thyroxine levels. Appropriate coagulation tests should be available when the patient is taking an oral anticoagulant and thyroid hormone replacement therapy.

Source

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The Unbelievably Long List of Hypothyroidism Symptoms

Every person will present with a different combination of symptoms. The severity of each person’s hypothyroidism will also determine the severity and number of symptoms they experience. Untreated hypothyroidism worsens with age with worsening symptoms. 

Are you being treated with thyroid replacement medication but still suffering symptoms? You might need a "fine-tuning" of your treatment.

Click on each tab and find out, how many symptoms apply to you.

  • Energy Level and Sleep
  • Weight
  • Body Temperature
  • Slowness
  • Infections
  • Related Autoimmune or Endocrine Diseases
  • Swelling and Thickened Skin of
  • Mouth and Throat
  • Ears
  • Eyes
  • Hair
  • Nails
  • Skin
  • Numbness and Tingling
  • pain
  • Digestion
  • Menstrual Disorders
  • Reproductive Disorders and Pregnancy
  • Emotional
  • Other Related Conditions
  • Brain
  • Kidney and Bladder
  • Gallbladder
  • Liver
  • Lungs
  • Heart
  • Cancer
  • Chronic fatigue
  • Less stamina than others
  • Long recovery period after any activity
  • Inability to concentrate
  • Sleep apnea
  • Snoring
  • Insomnia
  • Need naps in the afternoon
  • Weakness
  • Wake feeling tired
  • Frequently oversleep
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    Brain dysfunction and Thyroid function


    Thyroid dysfunction is frequently associated with functional disturbances of the brain such as cognitive impairment1, neurodegenerative disorders2, dementia3, depression, and anxiety4. Transient thyroid dysfunction may also induce neuropsychiatric changes5

    Functional neuroimaging studies suggest a direct association between thyroid and brain activity, therefore, these can provide some clues of underlying mechanisms of thyroid hormones on psychological and physiological effects on the brain.

    Specific thyroid hormone enzymes, transporters and receptors are believed to maintain thyroid hormone homeostasis in the brain2123. Therefore, current laboratory tests for thyroid dysfunction may not accurately measure thyroid hormone status in the brain8,2123

    Scientists from Korea used functional neuroimaging techniques of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) to study the underlying mechanisms of action of thyroid hormones, the use of sugar and blood flow in the brain. 8

    In hypothyroidism, significant decreases in blood sugar metabolism in the brain were identified in 3 parts of the brain [the blue dots]. In hyperthyroidism, a significant decrease was identified in 1 cluster [the red dot]:

    An external file that holds a picture, illustration, etc. Object name is 41598_2020_58255_Fig2_HTML.jpg

    They also found a reduced blood flow in one area in hypothyroidism. 

    An external file that holds a picture, illustration, etc. Object name is 41598_2020_58255_Fig3_HTML.jpg

    These areas play an important role in affective and cognitive regulation, involving attention, problem solving, motivation, error detection, decision making, and social behaviors24,25

    Metabolic and perfusion deficits in these area can affect working memory and attention, written word recognition, transient memory retrieval, awareness and imagery of visuospatial input, and priming processes, often compromised in patients with hypothyroidism28.

    In a small study thyroid hormone replacement therapy caused a reduction in the somatic complaints and depressive symptoms associated with a restoration of metabolic activity in the brain18.

    Another study demonstrated that the blood flow in affected brain areas can be normalised after treating hypothyroidism26

    In patients with hyperthyroidism treatment  increased regional activity in these regions and these changes significantly correlated with the anxiety and depressive symptoms13.

    These results suggest that thyroid hormones regulate the use of glucose and blood circulation in certain areas of the brain. These findings also demonstrate that the mechanism of neuropsychiatric disturbances in patients with hypothyroidism differs from those with hyperthyroidism.

    Source:

    Pak K, Kim M, Kim K, Kim BH, Kim SJ, Kim IJ. Cerebral glucose metabolism and Cerebral blood flow in thyroid dysfunction: An Activation Likelihood Estimation Meta-analysis. Sci Rep. 2020;10(1):1335. Published 2020 Jan 28. doi:10.1038/s41598-020-58255-5
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987231/

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    Thyroid Awareness week 20.-26.10.2018

    Thyroid Awareness Week is held to raise awareness of thyroid disease.

    Thyroid disorders are relatively rare in infants and children. Nevertheless, being aware of their symptoms is vital to allow early diagnosis and treatment.

    We found this very engaging child-friendly video from Thyroid Aware to look into thyroid problems in children:

     

    It is also available as a little e-book: Storybook for Children

    Resources: https://www.thyroidaware.com/en/resources/child_disorder.html

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    Thyroid Retreat Days

    For the first time everything required for a unique and bespoke residential program for clients with thyroid health problems will be available under one roof. Ours.

    The thyroid system plays a critical role in your metabolism. Along with insulin and cortisol, your thyroid hormone is one of the big three hormones that control your metabolism and weight.

    We have been running a successful Thyroid Clinic and learned that accurate testing, supplements and medication is often not enough.

    Lifestyle changes are paramount to improve chronic health conditions and cannot be taught in a report or a short consultation.

    This is why we created the Thyroid Retreat Days. We want to give our clients all the tools they need to make them feel better, after already implementing medication and supplements.

    Our motto is: learning with fun

    Cooking Workshops

    From healthy breakfasts to dinner party food – you will learn how to make delicious and thyroid friendly food – quickly.

    Seminars

    Learn in several very interactive workshops what makes you tired, the links between adrenal fatigue, thyroid health, Hashimotos’ and how to drum up your metabolism.

    Sleep Well

    Have a cosy night in a sumptuous room and wake up refreshed, ready for the next day.

    Relaxation

    From Mindfulness to Reflexology – a healthy mind makes a healthy body.

    Evening Entertainment

    Murder Mystery, Bingo and Rat Race are only a few events to keep you entertained.

    Download our brochure and call Dena on 01473 218 373 or 01449 833 833 NOW to book your slot.

    Only 6 places per event available!

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    Why you struggle to lose weight on a diet

    Successful weight loss is doomed to failure unless the reduced intracellular thyroid levels are addressed. Chronic and yo-yo dieting, frequently done by a large percentage of the population, is shown to be associated with reduced cellular T4 uptake of 25%-50% (2-7). Following repeated cycles of dieting, weight loss occurred at half the rate and weight gain occurred at three times the rate compared to controls with the same calorie intake (1). The reduced cellular thyroid level is generally not detected by standard laboratory testing unless a free T3/reverse T3 ratio is done.

    Finally a study explained why it is very difficult for obese patients to lose weight; as calories are decreased, thyroid utilisation is reduced and metabolism drops. Additionally, there are increased levels of free fatty acids in the serum with chronic dieting, which further suppresses T4 uptake into the cells and further cellular hypothyroidism (8-12).

    In a study published in the American Journal of Physiology-Endocrinology and Metabolism, Van der Heyden et al studied the effect of calorie restriction (dieting) on the transport of T4 and T3 into the cell (13). It was found that dieting obese individuals had a 50% reduction of T4 into the cell and a 25% reduction of T3 into the cell due to the reduced cellular energy stores, demonstrating that in such patients standard thyroid blood tests are not accurate indicators of intracellular thyroid levels.

    Many overweight individuals fail to lose weight with dieting. While it is always assumed they are doing a poor job of dieting, it has been shown, however, that chronic dieting in overweight individuals results in increased levels of NEFA, which suppresses T4 uptake into the cells (14). This suppressed T4 uptake results in reduced intracellular T4 levels and subsequent T4 to T3 conversion and a reduced metabolism (14-18).

    How you can find out, whether you are affected?

    Standard TSH, T4 and T3 testing will not detect this problem. Instead, a free T3/reverse T3 blood test can aid in the diagnosis of reduced uptake of thyroid hormones and intracellular hypothyroidism. It is proving to be the best physiologic marker of intracellular thyroid levels and supplementation with T3 should be considered.

    References:

    1. Brownell KD, Greenwood MR, Stellar E, Shrager EE. The effects of repeated cycles of weight loss and regain in rats. Physiol Behav 1986;38(4):459-64.
    2. Lim C-F, Docter R, Krenning EP, et al. Transport of thyroxine into cultured hepatocytes: effects of mild nonthyroidal illness and calorie restriction in obese subjects. Clin Endocrinol (Oxf) 1994;40:79-85.
    3. van der Heyden JT, Docter R, van Toor H, et al. Effects of caloric deprivation on thyroid hormone tissue uptake and generation of low-T3 syndrome. Am J Physiol Endocrinol Metab 1986;251(2):156-E163.
    4. Leibel RL, Jirsch J. Diminshed energy requirements in reduced-obese patients. Metabolism 1984;33(2):164-170.
    5. Elliot DL, Goldberg L, Kuehl KD, Bennett WM. Sustained depression of the resting metabolic rate after massive weight loss. Am J Clin Nutr 1989;49:93-6.
    6. Manore MM, Berry TE, Skinner JS, Carroll SS. Energy expenditure at rest and during exercise in nonobese female cyclical dieters and in nondieting control subjects. Am J Clin Nutr 1991;54:41-6.
    7. Croxson MS, Ibbertson HK, Low serum triiodothyronine (T3) and hypothyroidism in anorexia nervosa. J Clin Endorinol Metab 1977;44:167-174.
    8. Brehm A, Krssak M, Schmid AI, Nowothy P, et al. Increased Lipid Availability Impairs Insulin-Stimulated ATP Synthesis in Human Skeletal Muscle. Diabetes 2006;55:136-140.
    9. DeMarco NM, Beitz DC, Whitehurst GB. Effect of fasting on free fatty acid, glycerol and cholesterol concentrations in blood plasma and lipoprotein lipase activity in adipose tissue of cattle. J Anim Sci 1981;52:75-82.
    10. Lim C-F, Bernard BF, De Jong M, et al. A furan fatty acid and indoxyl sulfate are the putative inhibitors of thyroxine hepatocyte transport in uremia. J Clin Endocrinol Metab 1993;76:318-324.
    11. Lim C-F, Docter R, Visser TJ, Krenning EP, Bernard B, et al. Inhibition of thyroxine transport into cultured rat hepatocytes by serum of non-uremic critically ill patients: Effects of bilirubin and nonesterified fatty acids. J Clin Endocrinol Metab 1993;76:1165-1172.
    12. Elliot DL, Goldberg L, Kuehl KD, Bennett WM. Sustained depression of the resting metabolic rate after massive weight loss. Am J Clin Nutr 1989;49:93-6.
    13. van der Heyden JT, Docter R, van Toor H, et al. Effects of caloric deprivation on thyroid hormone tissue uptake and generation of low-T3 syndrome. Am J Physiol Endocrinol Metab 1986;251(2):156-E163.
    14. Lim C-F, Docter R, Krenning EP, et al. Transport of thyroxine into cultured hepatocytes: effects of mild nonthyroidal illness and calorie restriction in obese subjects. Clin Endocrinol (Oxf) 1994;40:79-85.
    15. Leibel RL, Jirsch J. Diminshed energy requirements in reduced-obese patients. Metabolism 1984;33(2):164-170.
    16. Elliot DL, Goldberg L, Kuehl KD, Bennett WM. Sustained depression of the resting metabolic rate after massive weight loss. Am J Clin Nutr 1989;49:93-6.
    17. Manore MM, Berry TE, Skinner JS, Carroll SS. Energy expenditure at rest and during exercise in nonobese female cyclical dieters and in nondieting control subjects. Am J Clin Nutr 1991;54:41-6.
    18. Croxson MS, Ibbertson HK, Low serum triiodothyronine (T3) and hypothyroidism in anorexia nervosa. J Clin Endorinol Metab 1977;44:167-174.
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    How Stress affects your Thyroid

    A study published in the Journal of Clinical Endocrinology and Metabolism found that significant physiologic stress inhibits the transport of the (inactive) T4 thyroid hormone into the cell while non-physiological stress had no effect. Serum T4 levels were artificially elevated in physiologically stressed individuals which confirms that serum T4 and TSH levels are poor markers for tissue thyroid levels in stressed individuals (1).

    One study found that with significant physiological stress, tissue levels of T4 and T3 were dramatically reduced by up to 79% without an increase in TSH. T4 and T3 levels in different tissues in different individuals showed a significant variation which was not reflected by TSH or serum T4 and T3 levels. This explains the wide range of symptoms that are due to tissue specific hypothyroidism not reflected or detected by standard blood tests, including TSH and T4 (2).

    A confirming study published in the Journal of Clinical Endocrinology and Metabolism has shown that the free T3/reverse T3 ratio was the most accurate marker for reduced cellular uptake of T4 (3).

    A number of substances have been identified that are produced in response to physiologic stress or calorie reduction. These include billirubin and fatty acids and can results in a 27%-42% reduction in cellular uptake of T4 but has no effect on T4 or T3 uptake into the pituitary (4,5,6,7,8) (see thyroid transport graph).

    What does this mean for you?

    If you are stressed, you enter a state of hypothyroidism which cannot be detected by routine NHS blood tests. Typical symptoms are fatigue, tiredness, weight gain.

    What you can do about it?

    It is important to get your stress under control. Our complementary therapists can help you with this. You might also want to have an in-depth thyroid laboratory test as you could benefit from (temporary) thyroid replacement medication with Nature-Thyroid.

    References:

    1. Sarne DH, Refetoff S. Measurement of thyroxine uptake from serum by cultured human hepatocytes as an index of thyroid status: Reduced thyroxine uptake from serum of patients with nonthyroidal illness. J Clin Endocrinol Metab 1985;61:1046–52.
    2. Arem R, Wiener GJ, Kaplan SG, Kim HS, et al. Reduced tissue thyroid hormone levels in fatal illness. Metabolism 1993;42(9):1102-8.
    3. Vos RA, de Jong M, Bernard BF, et al. Impaired thyroxine and 3,5,3′-triiodothyronine handling by rat hepatocytes in the presence of serum of patients with nonthyroidal illness. J Clin Endocrinol Metab 1995;80:2364-2370.
    4. Everts ME, De Jong M, Lim CF, Docter R, et al. Different regulation of thyroid hormone transport in liver and pituitary: Is possible role in the maintenance of low T3 production during nonthyroidal illness and fasting in man. Thyroid 1996;6(4):359-368
    5. Everts ME, Docter R, Moerings EP, van Koetsveld PM, Visser TJ, et al. Uptake of thyroxine in cultured anterior pituitary cells of euthyroid rats. Endocrinology 1994;134:2490–2497.
    6. Lim C-F, Bernard BF, De Jong M, et al. A furan fatty acid and indoxyl sulfate are the putative inhibitors of thyroxine hepatocyte transport in uremia. J Clin Endocrinol Metab 1993;76:318-324.
    7. Lim C-F, Docter R, Visser TJ, Krenning EP, Bernard B, et al. Inhibition of thyroxine transport into cultured rat hepatocytes by serum of non-uremic critically ill patients: Effects of bilirubin and nonesterified fatty acids. J Clin Endocrinol Metab 1993;76:1165-1172.
    8. Everts ME, Lim C-F, Moerings EPCM, Docter R, et al. Effects of a furan fatty acid and indoxyl sulfate on thyroid hormone uptake in cultured anterior pituitary cells. Am J Physiol 1995;268:E974-E979.

    Source: https://www.nahypothyroidism.org/thyroid-hormone-transport/

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    Is your Thyroid working with or against you?

    Hypothyroidism is one of the most common thyroid disorders. One recent analysis suggested that up to one in 10 women over age 60 has clinical or subclinical hypothyroidism. Hypothyroidism is characterised by mental slowing, depression, dementia, weight gain, constipation, dry skin, hair loss, cold intolerance, hoarse voice, irregular menstruation, infertility, muscle stiffness and pain, and a wide range of other unpleasant symptoms. In fact, every cell in the body has receptors for thyroid hormone.

    Though not as common as hypothyroidism, hyperthyroidism is often a more serious condition, because it is associated with an increased risk of heart attack, stroke, and death. Symptoms of hyperthyroidism include palpitations, rapid heartbeat, excessive sweating, weight loss, diarrhoea, anxiety, feeling warm even when others are not, increased appetite, and insomnia.

    Should you identify a problem, we are happy to help!

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