Hypothyroidism

Gamma Oryzanol & formulations with Gamma Oryzanol on Hypothyroidism

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Title Of The Study: Effect of y-Oryzanol on Serum TSH Concentrations in Primary Hypothyroidism

A single oral dose (300mg) of y-oryzanol extracted from rice-bran oil produced a significant reduction on the elevated serum TSH levels in hypothyroid patients. Similarly, chronic treatment with y-oryzanol resulted in decreased serum TSH levels in 6 of 8 patients. In addition, there was no difference in the serum TSH response to TR in hypothyroid patients and normal subjects, These observations suggest that y-oryzanol inhibits serum TSH .levels in patients with primary hypothyroidism, possibly by a direct action at the hypothalamus rather than the pituitary.

For Study Link: Click Here

Vitamin C deficiency wreaks havoc on thyroid function

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With an estimated 30 million Americans having some form of thyroid disease, solutions are necessary as impaired thyroid function can lead to other chronic diseases if not treated. Because the thyroid is a hormone-producing gland that regulates the body’s metabolism, it also affects critical body functions.

Keep in mind, the rate at which your body produces energy from oxygen and nutrients can alter the way your heart, brain, muscles, liver, and other body parts work. If they work too fast or slow, you won’t feel well. Therefore, therapy is essential if you want to feel your best.

An important but neglected vitamin for healthy thyroid function

Numerous studies have confirmed the presence of excess oxidative stress and a deteriorated antioxidant defense system in thyroid conditions. In fact, a large experimental study published in the BMC Endocrine Disorders journal reported that all subjects with benign or malignant thyroid disease had low levels of antioxidants, particularly with selenium, zinc, and vitamin C.

While low levels of selenium and zinc were not found in all subjects, low levels of vitamin C were. This confirms an association with vitamin C deficiency and thyroid function. One reason why vitamin C may be deficient in all people with thyroid conditions could be a result of adrenal fatigue.

Physical, mental, and emotional stress takes its toll on the adrenal gland

The adrenal gland contains the highest concentration of vitamin C in the body. In fact, the vitamin plays a crucial role in both the adrenal cortex and adrenal medulla which are responsible for responding to stress.

According to the American Journal of Clinical Nutrition, vitamin C secretion is part of the body’s stress response. Excessive stress, along with the body’s insufficient intake of the vitamin, can create a deficiency that leads to adrenal stress.

Countless studies show chronic adrenal stress disrupts the hypothalamic-pituitary-adrenal (HPA) axis. Because thyroid hormone is directed by the hypothalamus and the pituitary glands, anything that disrupts the HPA axis will affect thyroid function.

With studies proving that vitamin C deficiency is a problem for all people who have a thyroid condition, it’s possible that adrenal fatigue could be the cause. Therefore, it’s imperative to include foods and/or supplements containing vitamin C, especially with extreme or ongoing stress.

How does vitamin C boost thyroid medication delivery

Many people who have been diagnosed with a form of thyroid disease often adopt pharmaceutical medication to regulate their thyroid. However, many patients still exhibit symptoms which indicate the medication may not fully work towards thyroid homeostasis. However, studies are showing that natural antioxidant therapy – such as with vitamin C – can reverse thyroid damage and even help those who don’t see improvement with their prescription medication.

The Journal of Clinical Endocrinology & Metabolism recently studied the effects of vitamin C on the absorption of a synthetic T4 hormone with 31 patients who either had autoimmune thyroiditis or idiopathic hypothyroidism. Prior to the study, all patients were not in good control when taking the synthetic T4. Serum concentrations of T3, T4, and TSH were measured at particular intervals after vitamin C therapy.

All three concentrations were improved while taking vitamin C. TSH decreased in all patients and normalized in nearly 55 percent of them. T4 was higher with 30 of the 31 patients, and T3 was increased with all patients tested. These findings are significant in the role of vitamin C and thyroid function.

Improving thyroid function with vitamin C

Every day is a challenge when it comes to protecting our bodies from damaging chemicals in the food we eat, the water we drink, and the air we breathe. As presented, vitamin C has proven to help prevent adverse effects to health by optimizing thyroid function.

If you suspect or have a thyroid condition, you may want to consider taking a vitamin C supplement. One of the leading experts on treating thyroid disease, the late Dr. John C. Lowe, recommended the highest doses of vitamin C to bowel tolerance for four weeks as therapy.

The supplement should be taken in divided doses throughout the day. Larger amounts taken are less absorbed into the blood. Therefore, you may want to consider 250 to 2,000 milligrams at one time. Absorption rate is 80 to 50 percent respectively.

What’s Behind Brain Fog in Treated Hypothyroidism?

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The phenomenon of brain fog, as described by some patients with hypothyroidism despite treatment, is often associated with fatigue and cognitive symptoms and may be relieved by a variety of pharmacologic and nonpharmacologic approaches, new research suggests.

The findings come from a survey of more than 700 patients with hypothyroidism due to thyroid surgery and/or radioactive iodine therapy (RAI) or Hashimoto’s, who reported having brain fog.

The survey results were presented May 29 at the American Association of Clinical Endocrinology (AACE) Virtual Annual Meeting 2021 by investigators Matthew D. Ettleson, MD, and Ava Raine, of the University of Chicago, Illinois.

Many patients with hypothyroidism continue to experience symptoms despite taking thyroid hormone replacement therapy and having normal thyroid function test results.

These symptoms can include quantifiable cognitive, quality of life, and metabolic abnormalities. However, “some patients also experience vague and difficult to quantify symptoms, which they describe as brain fog,” Raine said.

The brain fog phenomenon has been described with somewhat varying features in several different chronic conditions, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, post-menopausal syndrome, and recently, among people with “long haul” COVID-19 symptoms.

However, brain fog associated with treated hypothyroidism has not been explored in-depth, despite the fact that patients often report it, Raine noted.

Results Will Help Clinicians Assist Patients With Brain Fog

Fatigue was the most prominent brain fog symptom reported in the survey, followed by forgetfulness and difficulty focusing. On the other hand, rest and relaxation were the most reported factors that alleviated symptoms, followed by thyroid hormone adjustment.

“Hopefully these findings will help clinicians to recognize and treat the symptoms of brain fog and shed light on a condition which up until now has not been very well understood,” Ettleson said.

Asked to comment, session moderator Jad G. Sfeir, MD, of the Mayo Clinic, Rochester, Minnesota, told Medscape Medical News: “We do see patients complain a lot about this brain fog. The question is how can I help, and what has worked for them in the past?”

“When you have symptoms that are vague, like brain fog, you don’t have a lot of objective tools to [measure] so you can’t really develop a study to see how a certain medication affects the symptoms. Relying on subjective information from patients saying what worked for them and what did not, you can draw a lot of implications to clinical practice.”

The survey results, Sfeir said, “will help direct clinicians to know what type of questions to ask patients based on the survey responses and how to make some recommendations that may help.”

Fatigue, Memory Problems, Difficulty Focusing Characterize Brain Fog

The online survey was distributed to hypothyroidism support groups and through the American Thyroid Association. Of the 5282 respondents with hypothyroidism and symptoms of brain fog, 46% (2453) reported having experienced brain fog symptoms prior to their diagnosis of hypothyroidism.

The population analyzed for the study was the 17% (731) who reported experiencing brain fog weeks to months following a diagnosis of hypothyroidism. Of those, 33% had Hashimoto’s, 21% thyroid surgery, 11% RAI therapy, and 15.6% had both thyroid surgery and RAI.  

Brain fog symptoms were reported as occurring “frequently” by 44.5% and “all the time” by 37.0%. The composite symptom score was 22.9 out of 30.

Fatigue, or lack of energy, was the most commonly named symptom, reported by over 90% of both the thyroid surgery/RAI and Hashimoto’s groups, and as occurring “all the time” by about half in each group. Others reported by at least half of both groups included memory problems, difficulty focusing, sleep problems, and difficulties with decision-making. Other symptoms frequently cited included confusion, mood disturbance, and anxiety.

“Each…domain was reported with some frequency by at least 85% of respondents, regardless of etiology of hypothyroidism, so it really was a high symptom burden that we were seeing, even in those whose symptoms were the least frequent,” Raine noted.

Symptom scores generally correlated with patient satisfaction scores, particularly with those of cognitive signs and difficulty focusing.

Lifting the Fog: What Do Patients Say Helps Them?

The survey asked patients what factors improved or worsened their brain fog symptoms. By far, the most frequent answer was rest/relaxation, endorsed by 58.5%. Another 10.5% listed exercise/outdoor time, but 1.5% said exercise worsened their symptoms.

Unspecified adjustments of thyroid medications were said to improve symptoms for 13.9%. Specific thyroid hormones reported to improve symptoms were liothyronine in 8.8%, desiccated thyroid extract in 3.1%, and levothyroxine in 2.7%. However, another 4.2% said thyroxine worsened their symptoms.

Healthy/nutritious diets were reported to improve symptoms by 6.3%, while consuming gluten, a high-sugar diet, and consuming alcohol were reported to worsen symptoms for 1.3%, 3.2%, and 1.3%, respectively. Caffeine was said to help for 3.1% and to harm by 0.6%.

Small numbers of patients reported improvements in symptoms with vitamins B12 and D, Adderall, or other stimulant medications, antidepressants, naltrexone, sun exposure, and blood glucose stability.

Other factors reported to worsen symptoms included menstruation, infection or other acute illness, pain, and “loud noise.”   

Ettleson pointed out, “For many of these patients [the brain fog] may have nothing to do with their thyroid. We saw a large proportion of patients who said they had symptoms well before they were ever diagnosed with hypothyroidism, and yet many patients have linked these brain fog symptoms to their thyroid.”

Nonetheless, he said, “I think it’s imperative for the clinician to at least engage in these conversations and not just stop when the thyroid function tests are normal. We have many lifestyle suggestions that have emerged from this study that I think physicians can put forward to patients who are dealing with this…early in the process in addition to thyroid hormone adjustment, which may help some patients.”  

Debate Continues on Combination Therapy for Hypothyroidism

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It’s “critically important” for clinicians to recognize that not all patients with hypothyroidism are fully treated with levothyroxine (LT4) and some may need combination treatment with triiodothyronine (LT3) despite normal levels of thyroid stimulating hormone (TSH), according to thyroid expert Antonio C. Bianco, MD, PhD.

Speaking to a crowded room at the recent American Association of Clinical Endocrinology (AACE) Annual Meeting 2022, Bianco summarized the history of thyroid replacement treatment, the emerging data focusing on the subset of patients remaining symptomatic on levothyroxine, and how the clinical guidelines have evolved from stating that LT4 is the one and only treatment to now acknowledging that some patients may need combination therapy.

“Treatment with LT4 will leave residual symptoms in about 10%-20% of the patients. Before planning a thyroid surgery, this issue should be discussed with patients. We used to tell patients that LT4 treatment resolves all symptoms, but this is not true for all. For those…who remain symptomatic while on LT4, physicians should attempt combination therapy,” Bianco told Medscape Medical News.

The acknowledgement, he said, is “critically important because patients are greatly aggravated by the fact that physicians are satisfied with a normal serum TSH and yet they do not feel well. This comes out in every survey we and others have done.” Common residual symptoms include weight gain, fatigue, and “brain fog,” which clinicians sometimes dismiss as psychological, he noted.  

However, Bianco cautioned that before attempting combination therapy, it’s important to make sure that patients don’t have other comorbidities that could explain the residual symptoms, including perimenopause/menopause, obesity, vitamin B deficiency, anemia, or other autoimmune diseases.

Bianco is professor of medicine at the University of Chicago and author of more than 80 publications on the thyroid as well as an upcoming book.

Doctors Follow Guidelines…

Asked for comment, session moderator Alex Tessnow, MD, of the University of Texas Southwestern Medical Center, Southlake, told Medscape Medical News: “I agree with him entirely. I think the biggest challenge we have now is lack of data. It’s amazing how common hypothyroidism is. Almost 20% of women over age 65 have an elevated TSH.”

“Levothyroxine is the number one prescribed drug in the country. And of all those trials, only three have more than one hundred patients in them. That’s how unstudied this topic is. We really need to know more.”

Among the reasons the topic remains controversial, Tessnow said, are that “for years the guidelines said levothyroxine is the first choice. Doctors don’t want to deviate from the guidelines.”

And he noted that some doctors “may be fearful of LT3 being so potent and short-acting and potentially causing cardiac arrhythmias.”

“Levothyroxine is so long-acting it’s easy to give. Often patients have to take LT3 more than once a day on an empty stomach. There’s no combination pill as of now.”

Bianco noted that two investigational slow-release LT3 molecules are currently in the pipeline and could alleviate some of these concerns.

Trials Should Focus on Those Not Doing Well on Levothyroxine Alone

Tessnow and Bianco both noted that most of the studies that have failed to show a benefit of combination LT4+LT3 treatment have included overall populations with hypothyroidism rather than focusing just on those who remain asymptomatic with LT4.

“It is possible that those individuals most likely to benefit from combination therapy may not yet have been included in trials in sufficient numbers in order to provide adequate power for detecting a response,” Bianco said.

Tessnow agreed: “The sheer number of people who are doing fine on levothyroxine are going to cover up the potential benefit the combination would give those who are most symptomatic. We need to focus our studies on those patients”.  

In fact, this research gap was among the conclusions from an expert consensus statement published in March 2021, following a joint conference of the American Thyroid Association (ATA), the British Thyroid Association (BTA), and the European Thyroid Association (ETA). Bianco was one of the statement’s authors.

This “acknowledges that the previous clinical trials were not adequately designed,” says Bianco, adding, “there is a need for new clinical trials.”

Many Patient Reports Document Dissatisfaction With LT4 Treatment

Numerous patient-generated publications have documented residual symptoms with LT4 treatment alone, including higher levels of symptoms on questionnaires, deficits in neurocognitive functioning, impact on psychological well-being, and “brain fog,” as reported by Medscape Medical News and published in December 2021, and notably, a study from Bianco’s group in 2018, which found “prominent dissatisfaction” with their treatment and their physicians.  

“Some changed physicians five to ten times. We concluded there was a significant burden of unsuccessfully resolved symptoms among patients with hypothyroidism,” Bianco said during his talk.

“Some say patient preference isn’t a clinical outcome, but we have to consider it…To not listen to the patient in what they prefer is unfair and just gives them more reason to be mad at us,” he added.

History and Physiology: Why LT4 Is Used But May Not Be Enough for SomeTreatment of hypothyroidism using implantation of a sheep’s entire thyroid gland was first described in 1890, followed by subcutaneous injections of sheep’s thyroid extract. A short time later, thyroid extract by mouth was introduced. In 1965, a study demonstrated efficacy of a 3.5:1 mixture of synthetic LT4 and LT3.The shift to LT4 monotherapy happened in 1970, with a study published in the Journal of Clinical Investigation showing that T4 was converted to T3 in humans, “which all interpreted as ‘no need to use thyroid extract,’ then LT4 became the standard of care,” Bianco said.He then explained the physiologic basis for why some patients may not fare well with LT4 alone.TSH in the normal range doesn’t mean T3 and T4 are normal. “The thyroid is hard-wired to preserve serum T3,” he said.But once the patient develops hypothyroidism, the thyroid no longer responds to TSH, and serum T3 is only maintained via conversion of T4 to T3. Although LT4 is used to normalize serum TSH levels, that occurs before serum T3 is normalized, resulting in lower serum T3 levels and relatively higher serum T4 levels.The lower T3 level with normal serum TSH explains the residual symptoms, Bianco explained.  “Thus, by adding small amounts of LT3 to the regimen with LT4 we can normalize serum TSH but with normal serum T4 and T3 levels,” he said.So why do most patients report feeling fine with LT4 alone? “We do not have the answer to this question. Multiple factors could explain it, including genetics,” he told Medscape Medical News.    

How Can Combination Therapy Be Given Safely?

The 2012 guidance from the ETA provided specific information for how combination therapy should be prescribed by reducing LT4 and replacing a small amount with LT3 in order to keep TSH within normal range.

For example, if the patient is taking 100 µg/day of LT4, drop that to 87.5 µg/day and add 5 µg/day of LT3. Similarly, 200 µg/day of LT4 should be dropped to 175 µg/day and 10 µg/day of LT3 added.

Patients should undergo enhanced follow-up, with measurement of serum T3 at baseline and 3 hours after LT3.

This approach should be avoided in patients with cardiac conditions or concomitant use of other medications that could potentiate the effects.

Indeed, while there has been concern about cardiac effects of LT3, trials following nearly 1000 patients for as long as 1 year have shown that the addition of LT3 only minimally affects serum TSH, heart rate, or blood pressure. Bone turnover markers remained within normal range in two studies.

Another large study published in 2016 also showed no long-term effects of LT3 on cardiovascular disease outcomes or fractures, although there was increased use of antipsychotic medications.  

“Given the new safety data, physicians could be more liberal with this form of therapy as they treat patients with residual symptoms,” he concluded.  

Could It Be Hypothyroidism? Top 10 Symptoms

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The thyroid affects most of the systems dealing with metabolism. (Shutterstock)

The thyroid affects most of the systems dealing with metabolism.

Hypothyroidism is one of the most common diseases worldwide and has a direct impact on quality of life. Hypothyroidism occurs when the thyroid doesn’t produce enough hormones. This can result in heart disease, infertility, and poor brain development in children.

What is the thyroid?

The thyroid is a small, butterfly-shaped gland situated at the base of the front of your neck. Though this gland is small, it is extremely powerful. The hormones produced by the thyroid gland have a tremendous impact on your health, essentially affecting all aspects of your metabolism (energy). Metabolism is the process where the food you consume is transformed into energy. This energy is used throughout your entire body to keep many of your body’s systems working correctly.

The hormones created by the thyroid can affect:

  • Your heart rate
  • Weight control
  • Inflammation
  • Brain function
  • Heart health
  • Weight control
  • Mood
  • Immunity
  • Digestion

Hyperthyroidism vs. Hypothyroidism

When I was in nursing school and learning about the complex endocrine system, one of my most knowledgeable and educated professors, Dr. H, said that a simple way to start understanding the basic concept of the thyroid, whether that be hypothyroidism or hyperthyroidism, is to think of the work thyroid as “energy!”

  • Hypothyroidism means not enough metabolic energy.
  • Hyperthyroidism means too much metabolic energy.

Hypothyroidism can decrease or slow down your body’s functions like slow metabolism, tiredness, and weight gain. On the other hand, with hyperthyroidism, you may find yourself with more energy (as opposed to less) and anxiety instead of depression.

In the U.S., hypothyroidism is more common than hyperthyroidism. It is important to find a provider who specializes in hormones, to develop a customized treatment plan to balance your thyroid.

Top 10 Common Signs and Symptoms of Hypothyroidism

1. Fatigue

One of the most common symptoms of hypothyroidism is feeling completely worn out. The thyroid hormone controls energy balance and can influence whether you feel ready to take on the world or take a nap. A classic sign of low thyroid is “hitting the wall” in the afternoon.

2. Weight Gain

Hypothyroidism hits the trifecta in regard to weight gain. It signals the body to store more calories, burn fewer calories, and send signals to the brain to eat more. Not exactly the roadblock we need when trying to get ready for a big event, lose that baby weight, or drop those last stubborn pounds.

3. Constipation

In the most simple of explanations– it puts a brake on your colon. Constipation has numerous causes, and the majority of people who have constipation don’t have hypothyroidism. However, if you are noticing several of these signs and symptoms, it doesn’t hurt to get your hormones tested to rule out hypothyroidism.

4. Feeling Cold

This may be very noticeable or discrete at first and get worse as time goes on. Your basal metabolic rate (BMR) is the number of calories to keep your body functioning at rest (meaning how many calories we are burning at rest). With hypothyroidism, your BMR is lowered, therefore you produce less heat and are more sensitive to the cold.

5. Thinning Hair

Just when you thought this little gland couldn’t be responsible for anymore, it turns out your hair is affected by your thyroid, too.

Hair follicle cells are rapidly growing and these cells are regulated by the thyroid hormone. When the thyroid is under-active, it causes hair follicles to stop regenerating. What’s worse? Studies show many people with hair loss also developed coarse hair.

6. Pain/Swelling of the Joints & Puffy Eyes

Fluid retention, especially in regard to the face, is very common. So is pain and swelling of the joints—with no good explanation for the pain.

7. Feeling Depressed & Lack Motivation

Hormone fluctuations in postpartum women can be linked to be a common cause of hypothyroidism, which could be a contributing factor to postpartum depression experienced in many women.

Whether depression is caused, magnified, or unrelated to the thyroid is serious and a good reason to seek help from a friend, therapist, physician, or practitioner. The practice of yoga and mindfulness are great ways to help increase feelings of well-being and give yourself time to relax and restore the busy mind from the overload of stress, chaos, and the never-ending to-do list.

8. Dry Skin

Skin cells have a short lifespan and are sensitive to losing growth signals from the thyroid. Skin problems and sensitivities can be attributed to many things, including the dangerous rise in thousands of new products with toxic ingredients hitting the market every year. For this reason, blood work is crucial in hormone testing and treatment, and could also help you rule out an ongoing skin problem.

9. Muscle Weakness

Catabolism is a condition where your body starts to break down vital body tissues, such as muscle, to provide more energy for the body. When your metabolism is slowed down enough, like with hypothyroidism, your body panics and adjusts by switching from metabolism to catabolism. This process can be painful and cause muscle aches while decreasing your overall sense of physical well-being.

10. Brain Fog

Mental fog and poor concentration are common side effects of hypothyroidism. It’s important to remember difficulty concentrating can be attributed to countless things and can happen to everyone at certain times with no medical reason. That being said, it is an important and common presentation of thyroid problems and should be addressed.

It is important to understand the signs and symptoms vary widely on severity, progressions, and specific type of thyroid issue you may have. The down-regulation of the thyroid can develop slowly over several years and may not always be noticeable.

Many people may attribute these symptoms to stress in their life or part of the “normal aging process.” Oftentimes, intervention and medication are necessary to correct the root cause of these symptoms.

What can You do?

If you or someone you know experience any of the symptoms listed above, don’t shrug it off and think the symptoms are “just the way it is.” This imbalance in the thyroid can be easily detected with a simple blood test looking at the entire hormone profile to ensure all levels are in perfect balance.

At OnePeak Medical, we offer comprehensive hormone testing and analysis of symptoms. With this information, our medical providers will create a treatment program aimed at fixing deficiencies and re-establishing the correct balance between hormones, thyroid, brain chemicals, gut health, and adrenal-stress glands, using the most natural and individualized approach possible.

It’s our mission to help you resolve nagging symptoms and to help you age better, with fewer age-related problems. We’re dedicated to helping you live your best life and creating a personalized plan just for you. Let us help you save precious time and energy by giving you the tools to change your life—and most likely the lives of those around you. Good luck on your journey to wellness wherever it may take you. The best is really yet to come!

Hypothyroidism Diet: Foods for Underactive Thyroid

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Eating foods to help hypothyroidism can benefit your overall good health as well. Eating them daily can help boost the health of your thyroid and make living with hypothyroidism manageable and easier to live with. (Roman Samborskyi/Shutterstock)

Eating foods to help hypothyroidism can benefit your overall good health as well. Eating them daily can help boost the health of your thyroid and make living with hypothyroidism manageable and easier to live with. (Roman Samborskyi/Shutterstock)

Correct diet for your thyroid can offer many benefits like reducing the risk of hypothyroidism, which can lead to numerous health complications. But what foods should you be consuming for your thyroid? Well, we are about to tell you, but first it’s important to understand just how important the thyroid truly is.

Our thyroid is often overlooked unless a doctor raises concerns about it. Although you may not think about it much, it plays a major role in producing hormones and regulating our metabolism. When this process is thrown off, it can cause hypothyroidism (underactive thyroid).

The good news is, hypothyroidism is manageable and one way to do so is through diet.

Hypothyroidism and Diet

Just as our body requires nutrients for it to function properly, so does the thyroid. This is why diet is so important for proper management of hypothyroidism.

There are certain types of food that are best for hypothyroidism. They are iodine-rich and selenium-rich foods. Before we outline foods for hypothyroidism, let’s discuss the importance of iodine and selenium in your diet.

Iodine is required for the normal functioning of the thyroid, so when the thyroid is under-performing, boosting iodine can help it. Iodine-rich foods may aid in symptoms associated with hypothyroidism and assist your metabolism. Selenium is also highly beneficial for your thyroid as it aids in the production of hormones making your thyroid not have to work as hard.

Now that we understand the role of iodine and selenium in addressing hypothyroidism, let’s outline foods that you should eat if you have hypothyroidism.

Table: Hypothyroidism diet meal plan

Epoch Times Photo
Epoch Times Photo

Hypothyroidism diet meal plan chart. Download diet plan chart (JPG)

Iodine-rich foods for hypothyroidism

  • Iodized salt
  • Seaweeds and seafood
  • Salt water fish
  • Nori rolls
  • Celtic sea salt

Selenium-rich foods for hypothyroidism

  • Meat
  • Chicken
  • Salmon
  • Tuna
  • Whole unrefined grains
  • Brazil nuts
  • Dairy products
  • Garlic
  • Onions

Eating foods to help hypothyroidism can benefit your overall good health as well. Eating them daily can help boost the health of your thyroid and make living with hypothyroidism manageable and easier to live with.

On the other hand, there are foods you should avoid as they can worsen symptoms and the condition itself.

Foods to Avoid in a Hypothyroidism Diet

Many of the foods to avoid with hypothyroidism are common foods that should generally be avoided or limited as they do not contribute to good health. These items are:

Soy: Soy can interfere with hormones, especially in women.

Cruciferous vegetables: Generally food items like broccoli and cabbage are recommended for healthy eating, but not if you have hypothyroidism. This type of food can interfere with the production of thyroid hormones.

Gluten: Although commonly avoided by those with Celiac disease, gluten should also be avoided if you have hypothyroidism.

Fatty food: Fatty foods may interrupt the absorption of thyroid medications.

Sugary foods: With an already slower metabolism adding sugary foods will lead to greater weight gain.

Processed foods: Hypothyroidism can result in higher blood pressure, so the added salts from processed foods will only worsen this.

Too much fiber: Fiber is good to keep us regular, but not in the case of those with hypothyroidism.

Coffee: You may have to cut back on your morning coffee. Caffeine can limit the absorption of thyroid hormone replacement medications.

Alcohol: Alcohol can disrupt the production of thyroid hormones and reduce the body’s ability to utilize these hormones.

What Is Hypothyroidism (Underactive Thyroid)?

Hypothyroidism is a disruption in the normal processes carried out by the thyroid. Production of hormones reduces, which can lead to weight gain, constipation, changes in skin – becoming too dry – fatigue, and even depression.

Hypothyroidism can occur due to stress, if the thyroid is removed through surgery, or simply if it stops functioning normally.

Hypothyroidism Symptoms

If you’ve already been diagnosed with hypothyroidism, then you are now aware of the best foods for your condition. If you have concerns about your thyroid, but haven’t gotten it checked out yet, this is a list of the symptoms you may be experiencing:

  • Thinning hair
  • Depression
  • Weight gain
  • Constipation
  • Dry skin
  • Memory fog
  • Weakness of muscles
  • Elevated blood pressure
  • Pain, stiffness, or swelling of joints
  • Slowed heart rate
  • Changes in menstrual cycle
  • Elevated blood cholesterol
  • Sensitivity to cold

These symptoms, although part of hypothyroidism, are also quite common among other illnesses. Speak to your doctor and get your thyroid checked to know for sure.

Living With Hypothyroidism

Hypothyroidism is something you can live with. Along with medications, a hypothyroidism diet can greatly improve your everyday life and assist your thyroid. Enjoying these foods to help hypothyroidism is a great way to boost iodine and selenium – both essential for a healthy thyroid. Lastly, ensuring you’re not consuming the foods to avoid for hypothyroidism can help you feel better in the long run and make your thyroid hormone replacement that much more effective.

Hypothyroidism more prevalent during late perimenopause, postmenopause

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The prevalence of hypothyroidism — overt and subclinical — is higher among women during the late menopause transition and postmenopause compared with premenopause, according to study findings.

Mira Kang

Seungho Ryu

“Accumulated data on menopausal transition suggest that the late menopausal transition stage, among other stages, seems to be the most critical period during which various menopausal symptoms and measurable physiologic changes are likely to manifest,” Mira Kang, MD, PhD, associate professor and vice chief information officer of the data management committee at Samsung Medical Center in Seoul, South Korea, and Seungho Ryu, MD, PhD, professor at the Center for Cohort Studies, Total Healthcare Center at Kangbuk Samsung Hospital, told Healio. “Our findings add to the existing line of evidence, reflecting an increasing trend in the occurrence of abnormal thyroid function in the late menopausal stage. It would be of interest to find out what mechanisms or factors play into the increased prevalence of the hypothyroid state during the late transition period in future investigations.”

Overt hypothyroidism prevalence increases in late perimenopause and postmenopause
The prevalence of over hypothyroidism is significantly higher in women during late perimenopause and postmenopause compared with premenopause. Data were derived from Kim Y, et al. Thyroid. 2022;doi:10.1089/thy.2021.0544.

Kang, Ryu and colleagues collected data from 53,230 women aged 40 years or older (mean age, 47.1 years) who participated in the Kangbuk Samsung Health Study at the Kangbuk Samsung Hospital Total Healthcare Center in Seoul and Suwon, South Korea, and had a health examination performed between 2014 and 2018. The Stages of Reproductive Aging Workshop + 10 criteria were used to determine menopausal stages. Electroluminescence immunoassays were conducted to measure serum thyroid-stimulating hormone, free thyroxine and free triiodothyronine levels.

The findings were published in Thyroid.

Free T3 and TSH levels were highest in the study cohort during postmenopause. Free T4 levels were similar between premenopause and postmenopause.

In multivariable-adjusted analysis, the prevalence of overt hypothyroidism was higher in late perimenopause (adjusted prevalence ratio [aPR] = 1.61; 95% CI, 1.12-2.3) and postmenopause (aPR = 1.66; 95% CI, 1.16-2.37) compared with premenopause (P = .002). Similarly, the prevalence of subclinical hypothyroidism was higher during late perimenopause (aPR = 1.22; 95% CI, 1.06-1.4) and postmenopause (aPR = 1.24; 95% CI, 1.07-1.44) compared with premenopause (P = .001). No increased prevalence in overt and subclinical hyperthyroidism was observed during the different menopausal stages.

“There is substantial resemblance between symptoms of menopause and those of thyroid abnormalities, such as weight gain, fatigue, cold intolerance, mood swings and anxiety,” Kang and Ryu said. “Thus, existing thyroid problems may easily go overlooked, thereby delaying treatment. Thyroid dysfunction, if left untreated, may be associated with significant morbidity and impaired quality of life, and, in women approaching menopause, thyroid dysfunction may exacerbate certain menopausal symptoms. Therefore, it is critical that the prevalence and risk distributions of thyroid abnormalities across different stages of menopausal transition be clearly defined to facilitate timely intervention.”

More women had a serum TSH level of greater than 5 IU/mL during late menopause transition (aPR = 1.26; 95% CI, 1.11-1.43) and postmenopause (aPR = 1.29; 95% CI, 1.13-1.48) compared with premenopause (P < .001). A higher prevalence of low free T4 levels was observed during late perimenopause (aPR = 1.76; 95% CI, 1.24-2.51) and postmenopause (aPR = 1.9; 95% CI, 1.34-2.68) compared with premenopause (P < .001). Women were more likely to have low free T3 levels of less than 2 pg/mL during late perimenopause compared with premenopause (aPR = 2.4; 95% CI, 1.36-4.23; P =.014).

Kang and Ryu said longitudinal studies are needed to assess temporal associations between menopausal stages and thyroid function.

“In addition, the clinical and prognostic significance of thyroid dysfunction in women during the menopausal transition should also be explored.” Kang and Ryu said. “Lastly, since our population consisted of Korean women, our findings need to be extended to populations of other ethnicities.”

PERSPECTIVE

Arti Bhan, MD, FACE)

Arti Bhan, MD, FACE

Thyroid dysfunction is common in women and frequently manifests at the time of puberty, pregnancy and menopause. Symptoms related to menopause and thyroid disorders can overlap, leading to delayed diagnosis and treatment of underlying thyroid disease. There are data suggesting that adequate treatment of thyroid disorders can improve climacteric symptoms, thereby improving quality of life and possibly reducing the need for estrogen supplementation.

The authors conducted a cross-sectional study of 53,230 Korean women aged 40 years or older and stratified them by menopausal stages. Thyroid hormone levels were measured, and an increased prevalence of overt and subclinical hypothyroidism was observed in the late transition and postmenopausal stages. Subclinical and overt hyperthyroidism were not associated with menopause.

Current guidelines do not recommend routine screening for thyroid dysfunction in asymptomatic individuals. However, case-finding is recommended in women at increased risk for hypothyroidism or with symptoms. Diagnosis of thyroid disorders during menopause is important as thyroid hormone concentration can affect the intensity and frequency of menopausal symptoms. In addition, undiagnosed thyroid disease can affect cardiovascular health and increase long-term morbidity. This study suggests that screening women for thyroid dysfunction during the menopausal transition is prudent.

Arti Bhan, MD, FACE

Endocrine Today Editorial Board Member

Division Head, Endocrinology

Henry Ford Health System

does not alter thyroid function in adults with hypothyroidism

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COVID-19 vaccination is not associated with changes in thyroid function or an increased risk for adverse outcomes for people with hypothyroidism, according to data presented at ENDO 2022.

“Our current study represents the first to evaluate the safety of COVID-19 vaccination specifically among patients treated for hypothyroidism in a population-based cohort,” David T. W. Lui, MBBS, clinical assistant professor in the department of medicine at The University of Hong Kong, told Healio. “Although there were reports of thyroid dysfunction — such as thyroiditis and Graves’ disease — after COVID-19 vaccination, we showed that both inactivated and mRNA COVID-19 vaccines are not causing disturbances to thyroid function among patients treated for hypothyroidism.”

David T. W. Lui, MBBS
Lui is a clinical assistant professor in the department of medicine at The University of Hong Kong.

Lui and colleagues conducted a population-based cohort study using electronic health records from the Hong Kong Hospital Authority. Adults using levothyroxine were categorized as unvaccinated (n = 23,423) or having received one of two vaccines available in Hong Kong during the study period: BNT162b2 (Pfizer-BioNTech) mRNA vaccine (n = 12,310) and CoronaVac (Sinovac Life Sciences) inactivated vaccine (n = 11,353). Data was obtained between Feb. 23, 2021, and Sept. 9, 2021. Outcomes included dose reduction or escalation of levothyroxine, emergency department visits, unscheduled hospitalization, adverse events of special interest according to the WHO global advisory committee on vaccine safety, and all-cause mortality.

“The thyroid gland is a potential target of attack by SARS-CoV-2,” Lui said during a press conference. “Studies have found the expression of angiotensin-converting enzyme 2, the entry receptor for SARS-CoV-2, expressed in the thyroid cells. There were also cases of subacute thyroiditis and Graves’ disease among COVID-19 patients. Therefore, there were also similar concerns raised regarding the potential of COVID-19 vaccination in inducing thyroid dysfunction.”

Both COVID-19 vaccines were not associated with increased risks for levothyroxine dose changes, emergency department visits or unscheduled hospitalization. Sensitivity analyses according to age, gender and pre-vaccination thyroid status was consistent with the main analysis.

Of the study cohort, two who received the BNT162b2 vaccine died during the follow-up period and six had adverse events of special interests. Of those who received CoronaVac, one died and three had adverse events of special interest.

“These reassuring data should encourage patients treated for hypothyroidism to get vaccinated against COVID-19 for protection from potentially worse COVID-19-related outcomes,” Lui told Healio.

Vitamin D deficiency linked to higher risk for hypothyroidism

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Vitamin D deficiency may increase one’s risk for developing autoimmune hypothyroidism, according to study findings published in BMC Endocrine Disorders.

“Adequate vitamin D levels through sun exposure or dietary supplementations could prevent autoimmune hypothyroidism, where the body’s immune system attacks its own thyroid cells,” Peter McGranaghan, PhD, data analytics consultant at the Miami Cancer Institute of Baptist Health South Florida, told Healio. “Health care initiatives such as mass vitamin D deficiency screening among at-risk populations such as elderly, obese, indoor and sedentary individuals and prompt treatment with dietary supplementations could significantly decrease the risk for hypothyroidism in the long term.”

Lower levels of vitamin D increase risk for hypothyroidism.
Low and intermediate levels of vitamin D are associated with increased odds for hypothyroidism. Data were derived from Appunni S, et al. BMC Endocr Disord. 2021;doi:10.1186/s12902-021-00897-1.

McGranaghan and colleagues analyzed data from 7,943 adults aged 20 years or older who participated in the National Health and Nutrition Examination Survey from 2007 through 2012 (mean age, 47 years; 51.5% women). Participants were categorized based on serum 25-hydroxyvitamin D levels. Vitamin D deficiency was defined as a level of less than 20 ng/mL, intermediate levels were defined as 20 ng/mL to 30 ng/mL, and optimal vitamin D was defined as 30 ng/mL or more. Participants were considered to have hypothyroidism if they had a thyroid-stimulating hormone level of more than 5.6 mIU/L or were on levothyroxine. Those with a TSH between 0.34 mIU/L and 5.6 mIU/L and not taking any thyroid medication were categorized as normal controls.

Of the study cohort, 7.7% had hypothyroidism. About 80% of participants had health insurance, 58.1% said they engaged in some form of physical activity, 75.8% said they never smoked and 78.1% reported drinking alcohol.

“A surprising finding in our study was that majority of the participants had lower levels of physical activity and consumed alcohol,” McGranaghan said. “This was associated with compromised vitamin D status and thereby could have led to hypothyroidism.”

There was a significant association between vitamin D level and hypothyroidism, with 25.6% of hypothyroid patients being vitamin D deficient compared with 20.6% of normal controls. Those with hypothyroidism had a higher prevalence of obesity (40.5% vs. 33.4%), hypertension (47.1% vs. 29.5%), diabetes (19.7% vs. 10.7%), and dyslipidemia (54.9% vs. 44.7%; P < .001 for all) compared with those who did not have hypothyroidism.

After adjusting for variables, the odds for developing hypothyroidism were increased for people with intermediate vitamin D levels (adjusted OR = 1.7; 95% CI, 1.5-1.8) and deficient vitamin D levels (aOR= 1.6; 95% CI, 1.4-1.9).

“Future research should focus on early screening and prompt correction of vitamin D deficiency in susceptible populations such as elderly, obese, indoor and sedentary individuals,” McGranaghan said.

Does Hypothyroidism Explain Mona Lisa’s Smile?

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The unusual and enigmatic appearance of the Mona Lisa may be because she suffered from hypothyroidism, suggest two experts who cite not only the evidence visible in Leonardo da Vinci’s famous portrait, but also her natural history and dietary patterns at the time.

In a letter published in the September issue of Mayo Clinic Proceedings, Mandeep R. Mehra, MD, from Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and Hilary R. Campbell, BA, University of California, Santa Barbara, say the Mona Lisa may have developed the condition following a pregnancy.

In the painting, a portrait of Lisa Gherardini commissioned by her husband Francesco del Giocondo soon after the birth of their child Andrea in 1502, she shows numerous signs of hypothyroidism, even down to her famously inscrutable smile.

“We believe that the enigma of the Mona Lisa can be resolved by a simple medical diagnosis of a hypothyroidism-related illness that could have been the result of a peripartum thyroiditis accentuated by the living conditions of the Renaissance,” Mehra and Campbell write.

“In many ways, it is the allure of the imperfections of disease that give this masterpiece its mysterious reality and charm,” they add.

Did She Have Hyperlipidemia? More Likely, it Was Hypothyroidism

This is not the first time that the highly detailed yet mysterious portrait has been the subject of medical analysis.

In 2004, a team of rheumatologists and endocrinologists suggested that Gherardini had skin lesions on the left upper eyelid that were indicative of xanthelasma and the swelling on the upper dorsum of her right hand indicated a subcutaneous lipoma.

They therefore concluded that she may have suffered from familial hyperlipidemia and premature atherosclerosis, which could have caused her death.

Moreover, those authors posited that Gherardini’s mysterious smile may have been the result of Bell’s palsy.

However, in the current examination of the famous painting Mehra and Campbell say that, even if she had hyperlipidemia, it appears not to have been because of a familial or genetic cause as there are a lack of indicative factors.

Gherardini is also known to have lived to age 63 years. “It would have been unusual, if not impossible, to see her advance to that age in the presence of untreatable premature atherosclerosis from a genetically driven hyperlipidemia,” they observe.

Instead, Mehra and Campbell suggest the “more unifying” diagnosis of clinical hypothyroidism.

They point to the yellowish color of Gherardini’s skin, which can result from impaired hepatic conversion of carotene to vitamin A, and that her hair appears to be thinned.

“A complete lack of eyebrows or other hair throughout the pale skin further supports this diagnosis, and cascading hair down the side appears coarse in character,” they add.

Mehra and Campbell also believe that, on closer inspection, Gherardini’s neck “does insinuate the presence of a diffuse enlargement such as a goiter.”

They point out that people with advanced hypothyroidism often have systematic metabolic dyslipidemia, which could explain the supposition in the 2004 article that she suffered from a form of lipid disorder.

“In this circumstance, if Lisa Gherardini was indeed suffering from severe hypothyroidism or its consequences, the mysterious smile may at one level be representative of some psychomotor retardation and muscle weakness leading to a less than fully blossomed smile,” say Mehra and Campbell.

At the Time, Diet Was Poor and Iodine Deficiency Was Common

They add that dietary patterns in Renaissance Italy support the theory that she suffered from hypothyroidism, as people mostly ate a vegetarian diet of cereals, root vegetables, and legumes.

Furthermore, there were only 16 full harvests between 1375 and 1791, meaning that the diet in the region was often iodine deficient.

It is therefore not surprising, they note, that depictions of goiters are common in Italian Renaissance paintings and are the most prevalent condition in Byzantine artwork.

And given that Gherardini sat for the portrait shortly after giving birth, Mehra and Campbell suggest that she could, in fact, have been suffering from “a subclinical presentation of peripartum thyroiditis,” leading eventually to hypothyroidism.

They do note, however, that the loss of facial and body hair “may be an intentional depilation,” and the yellowish discoloration may be because of ageing of the pigments in the paint.

Finally, they suggest an alternative explanation: the enigmatic smile may have been Leonardo’s invention, resulting from his experimentation with novel techniques.