treatment of thyroid autoimmune disease · •week one: 12.5 mcg t3 •week two: 12.5 mcg t3 bid...
TRANSCRIPT
Treatment of Thyroid Autoimmune Disease
Michaël Friedman ND
Executive Director- AARM
Treatment Protocols
Can Maximize Thyroid Recovery Rates in Low Thyroid
1) Patients who currently are on T4
2) Patients who have autoimmune Hashimotos, recently diagnosed
3) Patients who have autoimmune Hashimotos, longstanding for over a year
4) Patients who have no primary thyroid disease, but hypothyroid symptoms
American Thyroid Association Guidelines (2014)
Guidelines for Treatment of HypothyroidismJonklaas, J. & Bianco, A.C., Bauer, A.J., Burman, K.D., Cappola, A.R., Celi, F.S., Cooper, D.S., Kim, B.W., Rosenthal, M.S., Sawka, A.M.
7b. Does levothyroxine therapy that returns the TSH levels of hypothyroid patients to the reference range also result in normalization of their T3 levels?
Summary statementPatients with hypothyroidism treated with levothyroxine to achieve normal TSH values often have T3 concentrations that are at the lower end of the reference range, or even below the reference range. The clinical significance of this is unknown.
© 2013 BLab
Patients who currently are on T4
• If not feeling well and body temp under 98.6, then switch to T3
• 75% patients need to stay around 25 MCG BID T3
• 25% need to go higher
• Different Dosing Strategies
-Cunningham MD
-Wilson MD
Cunningham’s Protocol
Cycle by taking:
• Week one: 12.5 mcg T3
• Week two: 12.5 mcg T3 BID
• Week three: 25 MCG T3 AM and 12.5 MCG PM
• Week Four: 25 MCG T3 BID
Wilson’s Protocol
• Increase 7.5 MCG SR –T3 BID daily
• Cycle until 75 MCG SR-T3 BID or temp reaches 98.6 F, then wean every two days until off for 2 days, and cycle again
Example of T4 Saturation
• In patients with destroyed Thyroid Tissue due to Ablation (RAI, Surgery in Graves Patients)
Friedman Protocol:
• Gradually Lower T4 by 25% a day, while increasing T3 by 7.5 MCG SR-T3 BID
• Plateau at a dose where patient feels well, typically 75 MCG SR T3 BID
Synergistic Supplements
Synergistic Hormones• Hydrocortisone• DHEA
Synergistic Nutritionals• Iodine/Diiodotyrosine• Selenium
Synergistic BotanicalsAdaptogens: Rhodiola, Ashwagandha, EtcAntiinflammatory Resins: Guggul, Boswellia
• Rosmarinic Acid Containing Herbs: Melissa officinalis, Lycopus spp
Integrating Restorative Protocols
In patients with and Fatigue and Normal TSH
Use Nutrition:
– Iodine/Dioiodotyrosine
– Adaptogens –( Help with mitochondria)
– Thyroid Herbs
– Low Dose Cortisol ( if blood pressure low)
– Licorice
• T3 (different dosing)
Conventional Treatment of Hypothyroidism
• 50-100 mcg of T4 irrespective of TSH level, and irrespective of patient response
• Disordered sleep
• Hormone Deficiencies
• Nutritional deficiencies
• Infections
• Mitochondrial dysfunction
• Coagulation defect
• Gastrointestinal dysfunction
10
Common Associated Dysfunctions/CFS
Conventional Treatment of Hyperthyroidim
• Thionamide methimazole is the primary drug used to treat Graves' hyperthyroidism at 10 mg a day
• Then RAI Ablation Therapy
• Treat the adrenergic response: 40 to 120 mg propanolol or 25 to 50 mg atenolol daily until their serum T3 and serum T4 concentrations are normal
Conventional Treatment of Hyperthyroidim
• The thionamide methimazole is the primary drug used to treat Graves' hyperthyroidism at 10 mg a day
• Then RAI Ablation Therapy
Treat the Adrenergic Reponse
40 to 120 mg propanolol or 25 to 50 mg atenolol
daily until their serum T3 and serum T4
concentrations are normal
• Reproductive cancers, especially breast cancer are associated with hypothyroidism.
• Iodine and Selenium are hypothesized to provide antioxidant and action and offer chemoprevention effect on the breasts and thyroid.
Biofactors. 2003;19(3-4):121-30. Role of iodine in antioxidant defence in thyroid and breast disease. Smyth PP.
Cancer Causes Control. 2000 Feb;11(2):121-7. Hypothesis: iodine, selenium and the development of breast cancer. Cann SA, van Netten JP, van Netten C.
IODINE, SELENIUM AND BREAST CANCER
14
Conventional Thoughts on AIT
• Don’t take iodine
– Will cause/worsen AIT
• Don’t take desiccated thyroid
– Will cause/worsen AIT
Leo Tolstoy
“I know that most men, including those at ease with problems of the
greatest complexity, can seldom accept even the simplest and most
obvious truth if it would oblige them to admit to the falsity of
conclusions they have delighted in explaining to their colleagues.”
How Much Iodine Stored In The Body?
• Approximately 1.5-2gm stored in body at sufficiency
– Fat tissue: 700mg
– Striated tissue: 650mg
– Thyroid: 50mg
Every organ and all tissues contain iodine
Iodine Transport
These numbers are impossible to reach at the RDA (150µg/day) for iodine!
To achieve the maximum transport of iodine ≈600µg/day across the cell membrane,
there must be sufficient iodine in the serum:
≈10-5-10-6 M
However, 50mg/day iodine/iodide can reach a 10-5 M!
Where is Iodine Found in the Body?
• Every cell in the body contains and utilizes iodine
– WBC’s cannot effectively guard against infection without adequate amounts of iodine
• Concentrated in the glandular system
– Thyroid gland contains the largest amount of iodine
– Breasts, ovaries, salivary glands, parotid glands, pancreas, cerebrospinal fluid, brain, stomach, skin, lacrimal glands, etc.
In Thyroid, What Happens to Iodine After Absorption?
I-NIS
I-
TSH
Oxidation (H202+
TPO) Organificatio
n
δ –Iodolactone
and other
iodinated lipids
Horm. Metab. Res. 1994;26:465
However, organification of lipids will only
occur with iodine intake in excess of the RDA.
100x
RDA
I2
MIT, DIT, T3, T4
RDATG
Iodolactone
Iodine + arachidonic acid δ-iodolactone
TPO
δ-iodolactone is a key regulator of apoptosis and cellular proliferation in the thyroid. It
inhibits Epidermal Growth Factor from thyroid follicles. δ-iodolactone is not detected in
human tissue when iodine deficiency is present, but is present with iodine administration
at 100x the RDA.
Eur. J. of Endocrin. 132. 735-43, 1995
Horm. Metab. Res. 26. 465-69. 1994
Hormnes. 2010. 9(1) 60-66
DHA and EPA- Iodolactone
Iodine + DHA (C22:6, ω-3) 5-iodo-γ-lactone (DHA-γ-IL)
Iodine + EPA (C20:5, ω-3) EPA-δ-IL
Without adequate iodine levels, it is impossible for EPA/DHA to be converted into IL. LP
is expressed in breast cancer cells.
Hormones. 2010. 9(1):60-66
J. Mammory Gland Biol. Neoplasia. 10. 189-96. 2005
Mol. Cell. Endocrinol. 31:49-57. 2005
LPO+H20
2
LPO+H20
2
Low Iodine and δ-Iodolactone
• Methyl-nitrosourea (MNU) induced tumors contain 4x more AA than normal mammary glands
– I2 supplementation is accompanied by a 10x higher δ-iodolactone content in tumors
– Same research shows that δ-iodolactone and iodine have antiproliferative and apoptotic properties.
Prostaglandins. Med. 1. 31-38. 1978
Endocr. Relat. Cancer. 13; 1147-58. 2006
Organified Iodine
• Regulates the cell cycle in thyroid gland by inducing apoptosis
G0,1: growth and preparation of the chromosomes for
replication
S:synthesis of DNA
G2: Preparation for Mitosis
(G1 and G2)
Endocrin. 126. 984-92
I-NIS
I-
TSH
Oxidation (H202+
TPO)
T
G
Organificatio
n
MIT, DIT, T3, T4
NADPH-Oxydase
SystemIodinated
LipidsCalciu
m
Basolateral membrane
δ -
Iodolactone
I2
In Thyroid, What Happens to Iodine After Absorption?(2)
In Thyroid, What May Happen If Iodine Levels Are Too Low? AIT
I-NIS
I-
TS
H
Oxidation H202+
TPO
T
G
Organificatio
n
MIT, DIT, T3, T4
NADPH-Oxydase
SystemIodinated
LipidsCalciu
m
Apical membrane
δ -
Iodolactone
I2
Anti TPO
Anti TG
Early
Treatment: Iodine, Magnesium, B2 and B3, Selenium, Vitamin C,
as well as Antioxidants
Does Iodine Cause Autoimmune Thyroiditis?
• Results of study:
– KI in solution of 30mM and higher found to inhibit the normal growth curve of thyroid cells
• Arrested cell cycle at G0/G1 and G2/M after 72 hours of treatment
• Did not induce apoptosis or necrosis of thyroid cells
Thyroid. Vol. 19. N.3. 2009
“
This study showed that iodine excess inhibited human primary thyroid proliferation…in
the presence of low dose IFN, KI…could induce lymphocytic infiltration in the thyroid
gland and secretion of proinflammatory cytokines. …{This} could explain the
development of hypothyroidism after adding iodide in a diet of persons that already have
lymphocytic infiltration and/or mild inflammation of the thyroid gland.”
Does Iodine Cause Autoimmune Thyroiditis?
• What amount of KI do you need to ingest to achieve a serum level of:
• 10uM KI:
• 100uM KI:
• 10mM KI:
• 30mM KI:
• 100mM KI:
Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
• 1mM of KI = 127mg/L
• The renal clearance of I is approx. 42.5L/day
• So:
– 1mM of KI=127mg/L x 42.5L/day =5,398mg/day
Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
• What amount of KI do you need to ingest to achieve a serum level of:
• 10uM KI: 54mg/day
• 100uM KI: 539mg/day
• 10mM KI: 54000mg/day
• 30mM KI: 161,000mg/day
• 100mM KI: 540,000mg/day
Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
Conclusions of article:
“Normal human thyroid cell proliferation is inhibited
in a dose-dependant manner by iodine
concentrations over 10mM
{REMEMBER: 161gm/day).”
MEDICAL
IODOPOBIA!Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
• Real conclusion:
• Iodine doses up to 161gm/day did not cause changes in normal human thyroid cell proliferation. Iodine is not associated with autoimmune thyroid illness unless it was given in large doses along with a goitrogen such as IFN.
Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
• In vitro studies with purified fractions of calf thyroid glands showed 10-5 molar I protects TPO against oxidative damage
To achieve 10-5 molar iodide, a human adult needs to take in
50-100mg I per day.
Endocrin. 1965;76:632-45
Does Iodine Prevent Autoimmune Thyroid Disorders?
• In-Vitro study of thyroid cells containing TSH receptor mutation
• Different amounts of NaI:
– Control
– 1mM NaI (5.4g/day)
– 10mM NaI (54g/day)
– 50mM NaI (270g/day)
Genomics. 97 (2011):94-100
Does Iodine Prevent Autoimmune Thyroid Disorders?
• 1mM NaI (5.4g/day) inhibited cell proliferation from 43-83%
• Iodine promoted apoptosis of mutant cells
Genomics. 97 (2011):94-100
“Importantly, despite a constitutive TSHR activation, iodide still causes down regulation
of proliferation and function in early stage autonomy.”
Alex 1.12
Alex 9.12
Alex 1.12 Alex 9.12
Iodine Deficiency
• Iodine deficiency was seen more in cases with hypothyroidism
• Iodine status was a strong predictor of the thyroid status
Ergür AT, Evliyaoğlu O, Şıklar Z, Bilir P, Öcal G, Berberoğlu M. Evaluation of thyroid functions with respect to iodine status and TRH test in chronic autoimmune thyroiditis. J Clin Res Pediatr Endocrinol. 2011;3(1):18-21. Epub 2011 Feb 23.
Iodine Therapy
• Six mg iodine or more is given daily to a person who has Graves' disease and is not already receiving iodine, within the succeeding 7 or 10 days there will be an amelioration in symptoms, and the FTI level will fall in parallel.
• If iodine administration is then stopped, the signs and symptoms quickly return to their previous state
• Iodine alone as a definitive form of treatment has been used in the past, but is not used today because its benefits may be transient or incomplete
• Saturated solution of KI (SSKI) is typically given orally in adult doses of about 250 mg iodide several times a day (5 drops of SSKI assumed to be ⅓ ml) for thyroid blockade (to prevent the thyroid from excreting thyroid hormone)
• As adjunctive therapy with antithyroid drug therapy in Graves’ disease – Low dose (50 mg) potassium iodide tablets added to methimazole results in normal free T4 levels by two weeks in 54 and 59 percent of patients treated with 15 or 30 mg methimazole, respectively, compared with 27 and 29 percent of patients treated with 15 or 30 mg methimazole alone.
“Small”doses are in the range of a few mg
“Large”doses are in the range of 500 mg
IODINE AND THYROID FUNCTION
• Usually small doses of Iodine :
• Stimulate thyroid function
• Induce the iodinase enzymes and
• Induce thyroxine synthesis
• Larger doses of Iodine:
• May Suppress Thyroid Function
• However larger doses of Iodine are not typically given to purposefully suppress thyroid function.
42
• Excess iodine can be more cytotoxic in the presence of selenium deficiency. Iodine supplementation in selenium-deficient populations is theoretically problematic, partly for this reason.
Smyth, PP (2003). "Role of iodine in antioxidant defence in thyroid and breast disease". BioFactors (Oxford, England) 19 (3–4): 121–30.doi:10.
Excess Iodine
Does Iodine Cause Autoimmune Thyroiditis?
• What amount of KI do you need to ingest to achieve a serum level of:
• 10uM KI: 54mg/day
• 100uM KI: 539mg/day
• 10mM KI: 54000mg/day
• 30mM KI: 161,000mg/day
• 100mM KI: 540,000mg/day
Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
Conclusions of article:
“Normal human thyroid cell proliferation is inhibited
in a dose-dependant manner by iodine
concentrations over 10mM
{REMEMBER: 161gm/day).”
MEDICAL
IODOPOBIA!Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
• Real conclusion:
• Iodine doses up to 161gm/day did not cause changes in normal human thyroid cell proliferation. Iodine is not associated with autoimmune thyroid illness unless it was given in large doses along with a goitrogen such as IFN.
Thyroid. Vol. 19. N.3. 2009
Does Iodine Cause Autoimmune Thyroiditis?
• In vitro studies with purified fractions of calf thyroid glands showed 10-5 molar I protects TPO against oxidative damage
To achieve 10-5 molar iodide, a human adult needs to take in
50-100mg I per day.
Endocrin. 1965;76:632-45
Does Iodine Prevent Autoimmune Thyroid Disorders?
• In-Vitro study of thyroid cells containing TSH receptor mutation
• Different amounts of NaI:
– Control
– 1mM NaI (5.4g/day)
– 10mM NaI (54g/day)
– 50mM NaI (270g/day)
Genomics. 97 (2011):94-100
Does Iodine Prevent Autoimmune Thyroid Disorders?
• 1mM NaI (5.4g/day) inhibited cell proliferation from 43-83%
• Iodine promoted apoptosis of mutant cells
Genomics. 97 (2011):94-100
“Importantly, despite a constitutive TSHR activation, iodide still causes down regulation
of proliferation and function in early stage autonomy.”
Suppression of thyroid-stimulating hormone (TSH) secretion in normal subjects by the administration of thyroid hormone results in thyroid atrophy.
Although the pathogenesis of thyroid nodules and sporadic nontoxic multinodulargoiters is poorly understood, TSH is presumed to be necessary if not sufficient and, therefore, suppression of TSH secretion might be expected to result in a decrease in nodule or goiter size or at least prevent further enlargement.
The clinical importance of the thyroid nodule evaluation is primarily related to the need to exclude thyroid cancer, which is present in 4.0 to 6.5 percent of thyroid nodules.
Thyroid Nodules
AUTOIMMUNE DISEASES:
•Offer Immune Modulating Herbs such as Adaptogens
•Eat a Hypoallergenic, Chemical Free Diet
•Make an Earnest Effort to Remove all Chemicals from the home, workplace, and places visited possible.
•Consider Detoxification Protocols
•Optimize Digestion and Gut Health
•Supplement Antioxidants, Fish Oils and Vitamin D
BASIC THERAPIES FOR AUTOIMMUNE DZ
51
1/3 of small molecules in human blood
• Metabolites produced by gut bacteria can enter the bloodstream by absorption,enterohepaticcirculation or impaired gut barrier function
• Up to one-third of the small molecules in human blood can be derived from gut bacteria
52
Wikoff, W. R. et al. Metabolomics analysis reveals large effects of gut microflora on mammalian blood metabolites. Proc.
Natl Acad. Sci. USA 106, 3698–3703 (2009).
Hood, L. Tackling the microbiome. Science 336, 1209 (2012).
Endotoxins Up-Regulate Inflammation, Etc.
53http://medical-dictionary.thefreedictionary.com/endotoxin
Selenium and Rosmarinic Acid
• Selenium– Thyroid Autoimmunity
– Hashimoto’s Thyroiditis
– Grave’s Disease
• Rosmarinic Acid– Thyroid Autoimmunity
– Hashimoto’s Thyroiditis
– Grave’s Disease
• Probiotics and prebiotics can be used to manipulate cytokines
• Some probiotics preferentially stimulate a Treg/Th3 cytokine profile
• Some probiotics stimulate a Th1 profile
Probiotics Can Suppress T Cells
Cytokines Probiotics
Increase Th1 (IFN gamma) Lactobacillus rhamnosus GG (LGG)
Increase Treg/Th3 (TGF beta and/or IL-10)
L. Reuteri DSM 17938Bifidobacterium infantisBifidobacterium adolescentisBifidobacterium lactisBifidobacterium breveLactobacillus rhamnosus GG
Decrease Th1 Lactobacillus plantarum Lactobacillus gasseri
Decrease Th2 Bifidobacterium lactisLactobacillus plantarumLactobacillus casei ShirotaLactobacillus reuteri
Decrease pro-inflammatory cytokines (IL-1, IL-6, IL-8, and TNFa)
Lactobacillus delbruekiiLactobacillus fermentumLactobacillus gasseri
Ther Adv Gastroenterol (2010) 3(5307319
Thyroid Autoimmunity
• Selenium deficiency confers increased risk.
• Selenium deficiency increases duration and severityof disease.
• Selenium supplementation decreases markers of autoimmune thyroid conditions, specifically anti-TPO and thyroglobulin levels.
Saranac L, Zivanovic S, Bjelakovic B, Stamenkovic H, Novak M, Kamenov B. Why is the thyroid so prone to autoimmune disease? Horm Res Paediatr. 2011;75(3):157–65.
Hashimoto’s and Selenium
• Selenium supplementation in individuals with Hashimoto’s reduces oxidative stress through glutathione peroxidase and lowers hydrogen peroxide levels.
• A study demonstrated a significant reduction in anti-TPO in the intervention group (n=36, 200 μg of selenium selenite and L-T(4)) versus those in a control group treated with L-T(4) only.
• Those with anti-TPO levels over 1200 IU/mL experienced a mean reduction of 40%, while those under 1200 IU/mLexperienced a mean reduction of 10%.
Gartner R, Gasnier BC, Dietrich J, Krebs B, Angstwurm M. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002;87(4):1687–91
Hashimoto’s and Selenium
• 4 studies included in a 2013 Cochrane Review demonstrated significant decreases in anti-TPO levels, with one study reporting subjective improvements in quality of life.
• Reviewers concluded insufficient evidence for clinical application due to unclear blinding strategies, and the absence of health-related quality of life scores.
Ej VZ, Ay A, Fedorowicz Z, Carter B, Pijl H. Seleniumsupplementation for Hashimoto’s thyroiditis (Review).Cochrane Database Syst Rev. 2014;3(1):25–31
Grave’s Disease and Selenium
• There are a number of possible mechanisms through which selenium may positively influence the course of Grave’s Disease. As an important component of both GPx , selenium may influence the regulation of T3 levels.
• Selenium helps to decrease inflammatory cytokines via NF-kappa-B inhibition, thereby attenuating the inflammatory
• there is an ongoing double-blind placebo controlled clinical trial, the Graves’ Disease Selenium Supplementation trial (GRASS), which aims to establish the clinical role of selenium in the treatment of Grave’s.
Watt T, Cramon P, Bjorner J, Bonnema S, Feldt- Rasmussen U, Gludd C. Selenium supplementation for patients with Graves’ hyperthyroidism (the GRASS trial): study protocol for a randomized controlled trial. Trials. 2013;14:119
Selenium and Graves Opthalmopathy
• Case-control data has demonstrated that selenium levels are significantly lower in GO patients that develop GO, compared to those with GO alone, suggesting selenium deficiency may be an independent risk factor for GO development in GO
• A 2011 double blind RCT demonstrated that supplementation with 200mcg of selenium per day significantly decreased GO, improved quality of life, and decreased worsening of disease
Marcocci C, Kahaly G, Krassas GE, et
al. Selenium and the Course of Mild
Graves’ Orbitopathy. N Engl J Med.
2011.
Emerging Research
• Currently, a multi-centred RCT is underway to assess the impact of 12 months of selenium supplementation in patients with autoimmune thyroiditis treated with levothyroxine.
• The CATALYST study (the chronic autoimmune thyroiditis quality of life selenium trial) is taking place across four clinic sites in Denmark involving 472 participants, and will be the first to assess quality of life as a primary outcome.
Winther KH, Watt T, Bjorner JB, Cramon P, Feldt- Rasmussen U, Gluud C, et al. The chronic autoimmune thyroiditis quality of life selenium trial (CATALYST): study protocol for a randomized controlled trial. Trials. 2014;15:115
Rosmarinic Acid and Thyroid Antibodies
• Botanicals containing Rosmarinic Acid– Lowers Thyroid Stimulating
Immunoglobulin levels
– Lowers Thyroid Antibodies
Pharmaceutical Biology 1986, Vol. 24, No. 2, Pages 53-63 , Effects of Lithospermum officinale and Related Plants on Hypophyseal and Thyroid Hormones in the Rat H.Sourgens,H.Winterhoff,HG. Gumbinger and FH. Kemper
Rosmarinus officinalis
Rosmarinic acid is a phenolic compound derived the following plants including:
Melissa officianalis (Lemon Balm)
Lycopus europeas (Gypsywort)
Lycopus virginia (Bugleweed)
Lithospermum officianalis (Stoneseed or Gromwell) • All have been traditionally used for thyroid
Rosmarinic Acid for Hyperthyroidism
64
Food Science and Technology, Volume 41, Issue 3, April 2008, Pages 391-400 Chemical composition and in vitro antioxidative activity of a lemon balm (Melissa officinalis L.) extract Keyvan Dastmalchi, H.J. Damien Dorman, Päivi P. Oinonen, Yusrida Darwis, Into Laakso, Raimo Hiltunen
Pharmaceutica Acta Helvetiae, Volume 72, Issue 5, January 1998, Pages 301-305 The aromatic and polyphenoliccomposition of lemon balm (Melissa officinalis L. subsp. officinalis) tea A. P. Carnat, A. Carnat, D. Fraisse, J. L. Lamaison
• Melissa has been shown to decrease TSI antibody to promote intracellular cyclic AMP responses
• Lycopus:• Binds with TSI, dose dependent• 905 patients, 87% improved
• No side effects noted • Officially recognized in Germany as a prescription
Harvey, R. Lycopus europaeus L. And Lycopus virginicus L.: A review of scientific research. British journal of Phytotherapy 4 (20, 55-65) 1995
ROSMARINIC ACID AND GRAVE’S ANTIBODIES
65
In Japan,
1.2 mg/day to as high as 13 mg/day from seaweed consumption
66
Thyroid. 2008 Jun;18(6):667-8. The average of dietary iodine intake due to the ingestion of seaweeds is 1.2 mg/day in Japan. Nagataki S.
Thyroid Research 2011 Oct 5:4(1):14 Assessment of Japaneses iodine intake based on seaweekconsumption in Japan: A literature-based analysis. Ava TT, Zava DT
SEAWEED
• Guggul and Boswellia tree resins that are anti inflammatory
Commiphora mukulGuggul Burseraceae Family
67
Beta Blockers
• hyperthyroidism is associated with an increased number of beta-adrenergic receptors
• decreases serum triiodothyronine (T3) concentrations by as much as 30 percent , via inhibition of the 5'-monodeiodinase
Rauwolfia
• Depletes tissue stores of catecholamines (EPI, NE)
Rand MJ, Jurevics H. The pharmacology of rauwolfia alkaloids. In: gross F, ed. Antihypertensive agents new York, Springer-Verlag, 1977, 77-159
Vitamin D 3 and Hashimoto’s Disease
• 1,25 Vitamin D levels are lower in individuals with Hashimoto’s disease
• Supplementation with Vitamin D 3 in animal models prevents the development of autoimmune thyroiditis
Iodine Transport Problems
• When problems develop with iodine use, think detoxification– Vitamin C
– Salt
– Water
– Liver and kidney support
– Exercise
– Clean Diet
Hashimoto’s Disease
• Impossible to experimentally induce Hashimoto’s disease in laboratory animals by administering iodine
• Only by the use of anti-thyroid drugs (i.e., goitrogens) can you induce Hashimoto’s disease in laboratory animals
Goitrogens induce not only hyperplasia they cause iodine deficiency!
Radioactive Iodine
• Half-life of 131I:
– Graves’ disease: 5.4 days
– Nontoxic goiter: 6.4 days
– Uninodular adenoma: 5.7 days
Nuclear Medicine Comm. 2010;31:201-5
Where Does Radioactive Iodine Go?
10-32% Thyroid– Ovaries
– Testicles
– Parathyroids
– Adrenals
– Breasts
– Eyes
– Intestine
• Salivary glands
• Pituitary glands
• Muscles
• Bones
• Skin
• Gallbladder
• Kidneys.
68-90% Extra-Thyroidal
Radioactive Iodine
“Radioactive iodine is effective, safe and relatively inexpensive.”
Werner and Ingbar’s The Thyroid. 2000
Radioactive Iodine: Effective?
• If the goal is to destroy the thyroid, then it is effective
– Only if the cause of autoimmune thyroid disorders is too much thyroid tissue that needs to be destroyed
HOWEVER: Excess thyroid tissue is not the cause; it is the consequence of the illness.
Radioactive Iodine: Safe?
• Radioactive iodine will bind to all tissues where iodine is bound
– Glands• Breasts, prostate, ovaries, etc
All tissues of the body utilize iodine.
Radioactive Iodine: Safe?
• 6,841 patients with thyroid cancer
• Received an average dose of 162mCi of *I
• Dose dependant increase in cancer of:
– Salivary gland, bone, soft tissue and colorectum
• Increased risk of primary malignancy of 27%
Br. J. Ca. 2003:89:1638-44
FP News: 2.1.07
Iodine Transport Problems
• When problems develop with iodine use, think detoxification– Vitamin C
– Salt
– Water
– Liver and kidney support
– Exercise
– Clean Diet
Radioactive Iodine
• Half-life of 131I:
– Graves’ disease: 5.4 days
– Nontoxic goiter: 6.4 days
– Uninodular adenoma: 5.7 days
Nuclear Medicine Comm. 2010;31:201-5
Hashimoto’s Disease
• Initial
15 year old boy
TSH
After 5 years
0
20
40
60
80
Initial After 5 years
TPO AB
0
5
10
15
20
Hashimoto’s Thyroiditis
• Initial
0
5
10
15
20
After 3 months
0
50
100
150
200
Initial After 3 months
27 year old female
TSH T3
TSH: 5.1
Tx: Nt 1/2gn
Iodine
25mg/d
Tx: Nt 1gn
Iodine
37.5mg/d
Tx: Nt 1gn
Iodine
37.5mg/d
Tx: Nt 1.5gn
Iodoral
50mg/d
Case Study-2
• 55 Year Old woman with severe Hyperthyroidism, anxiety, heart palpitations, temp 99 for over 3 years, BP 160/100
• MD ‘I need something which will work within 5 days or she will need to get irradiated’
Botanicals Prescribed
• Symptoms normalized within 5 days
Case Study-3
• 50 Year Old woman with severe Hyperthyroidism, anxiety, heart palpitations, temp 99 for over 4 years, BP 230/110
• Refused conventional treatment
• Total T3 levels 350 ng/dl (ref 60 -181 ng/dl)
Case Study-3 cont’d.
• One month later 160/100, loose stools,
Total T3 350 ng/dl no change
• 3 months later
BP 150/90, loose stools, no heart palpitations
Total T3 360 ng/dl
Case Study-3 cont’d.
– 6 months later-BP 160/90, diarrhea, dizziness-Total T3 300 ng/dl
– 9 months later-BP 160/90-Total T3 300 ng/dl
– 12 months later-BP 160/90, diarrhea, dizziness-Total T3 250 ng/dl (ref 60 -181 ng/dl)
Case Study-3 cont’d.
– 16 months later
-BP 120/90, got divorced
-Total T3 200 ng/dl (ref 60 -181 ng/dl)
– Since then Total T3 fluctuates, no palpitations, BP fluctuates between mild to moderate hypertension. Does not need irradiation.
Hyperthyroid Lab Report
Hyperthyroid Lab Report
Hyperthyroid Lab Report
Hyperthyroid Lab Report
Case Study-1
• Jan 2004, 12 year old with DM type 1
• diagnosed with Graves’
• Recommended Thyroidectomy or Irradiation
• Instead took Botanicals, symptoms normalized within three months blood tests improved but not cured
• No longer needed irradiation
Toxic Multi Nodular Goiter
After 3 months
TSH Reference Values (.35-5 mIU/ml)
Total T3 Reference Values (60-181 ng/dl)
Total T3
0
50
100
150
200
250
37 year old male
Initial
Graves Disease
Initial
TSI Reference Values (under 130)
TSI
0
50
100
150
200
250
40 year old woman
After 2 months
Hyperthyroid FAQ’s
• Dosage
• Drug Interaction
• Blood test monitoring
• Interpreting low TSH values, when all other blood tests normalized, and symptoms normalized
• Cases in which it doesn’t work well
In Summary, safe, natural remedies for Hyperthyroidism include:
• Iodine 2-5 mg/day
• Selenium 200 mcg twice a day
• Rosmarinic Acid containing plants (200-400 mg of RM daily)
• Adaptogens and Adrenal Supportive Herbs
• Herbal Specifics for Individual Presentations
• Higher the dose, the better the result with herbs and Hyperthyroidism.
• However even at a low dose, its is possible to have complete normalization of TSI levels.
HYPERTHYROIDISM SUMMARY
101
*Jillian Stansbury, ND*Joseph Pizzorno, ND
David Brownstein MDEdwin Cunningham MD
• Acknowledgements