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highly\teducated\tparticipants\tand\tthose\twith\thigh\n\tnet\tfamily\tincomes.\tFrequency\tof\thyperthyroidism\ntreatment\twas\thigher\tin\tolder\tthan\tin\tyounger\tindividuals.\tSociodemographic\tfactors\tstrongly\ninfluenced\tthe\tdiagnosis\tand\ttreatment\tof\tthyroid\tdisorders,\tincluding\tthe\tuse\tof\tlevothyroxine\n(\nOlmos\tet\tal,\t2015\n).
|
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(\nOlmos\tet\tal,\t2015\n).\nThyroid-related\tdiseases\toften\tare\tpoorly\tdiagnosed,\tand\tmuch\tabout\ttheir\ttreatment\trequires\ngreater\tclarification\tand\tstudy.\tFor\texample,\n\tradiation\texposure\tof\tthe\tthyroid\tat\ta\tyoung\tage\tis\ta\nrisk\tfactor\tfor\tthe\tdevelopment\tof\tthyroid\tcancer,\tlasting\tfor\ta\tlifetime\tafter\texposure\t(\nSinnott\tet\tal,\n2010
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Sinnott\tet\tal,\n2010\n).\tEfforts\tto\treduce\texposure\tfrom\tmedical\tx-ray\texaminations\tcan\tprotect\tthe\tthyroid\tgland.\nGenetic\tfactors\tare\timplicated\tin\tendocrine\tautoimmune\tdiseases.\tRecent\tgenome-wide\tassociation\nstudies\t(GWAS)\thave\tenabled\tidentification\n\tof\trelevant\timmune\tresponse\tpathways;\tthe\tsame\tallele
|
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of\trelevant\timmune\tresponse\tpathways;\tthe\tsame\tallele\nthat\tpredisposes\tsomeone\tto\ta\tcertain\tautoimmune\tdisease\tcan\tbe\tprotective\tin\tanother\t(\nWiebolt\tet\nal,\t2010\n).\tThus\tendocrine\tGWAS\tare\tneeded,\tespecially\tfor\tGraves’\tdisease,\tHashimoto’s\tthyroiditis,
|
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] |
and\tAddison’s\tdisease.\tEach\tof\tthese\tdisorders\thas\tstages\tbeginning\twith\tgenetic\tsusceptibility,\nenvironmental\ttriggers,\tand\tactive\tautoimmunity,\n\tfollowed\tby\tmetabolic\tderangements\twith\tovert\nsymptoms\tof\tdisease\t(\nMichels\tand\tEisenbarth,\t2010\n).\tResearch\tis\tneeded\tto\tclarify\thow\tnutrients\ninteract\twith\tgenetics,\tespecially\tin\tthese
|
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interact\twith\tgenetics,\tespecially\tin\tthese\t\nautoimmune\tthyroid\tdisorders\t(AITDs)\n.\nThyroid\tphysiology\nThe\tthyroid\tgland\tis\ta\tsmall,\tbutterfly-shaped\tgland\tfound\tjust\tbelow\tthe\tAdam’s\tapple.\tAlthough\tit\nweighs\tless\tthan\tan\tounce,\tit\tproduces\thormones\tthat\n\tinfluence\tessentially\tevery\torgan,\ttissue,\tand
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thyroxine\t(T\n4\n)\n,\ta\tthyroid\thormone\tnamed\tfor\tits\tfour\nmolecules\tof\tiodine,\tand\t\ntriiodothyronine\t(T\n3\n)\n,\ta\tthyroid\thormone\n\tnamed\tfor\tits\tthree\tmolecules\tof\niodine.\tT\n3\n\tis\tthe\tmost\tpredominant\tand\tactive\tform\tof\tthyroid\thormone\tthat\tthe\tbody\tcan\tuse.\tThe
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0.012572100386023521
] |
thyroid\tgland\tregulates\tmany\tprocesses\tin\tthe\tbody,\tincluding\tfat\tand\tcarbohydrate\tmetabolism,\nbody\ttemperature,\tand\theart\trate.\tThe\tthyroid\talso\tproduces\t\ncalcitonin\n,\ta\thormone\tthat\thelps\nregulate\tthe\tamount\tof\tblood\tcalcium.\t\nReverse\tT\n3\n\t(rT\n3\n)\n,\tan\tisomer\tof\tT\n3\n,\tis\tderived\n\tfrom\tT\n4\n\tthrough
|
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] |
3\n\t(rT\n3\n)\n,\tan\tisomer\tof\tT\n3\n,\tis\tderived\n\tfrom\tT\n4\n\tthrough\nthe\taction\tof\tdeiodinase.\tAlthough\tthe\tbody\tcannot\tuse\trT\n3\n,\tit\tis\tnot\tsimply\tan\tinactive\tmetabolite\nwith\tno\tphysiologic\teffect\ton\tthe\tbody.\tThis\twill\tbe\tdiscussed\tmore\tlater\tin\tthe\tchapter.\tCommon\nreasons\tfor\televated\trT\n3
|
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] |
reasons\tfor\televated\trT\n3\n\tinclude\tinadequate\tiron\tlevels,\tchronic\tinflammation,\televated\tcortisol,\tand\nliver\tabnormalities\t(\nGomes-Lima\tand\tBurman,\t2018\n).\nThe\tsynthesis\tof\tthese\thormones\n\trequires\t\ntyrosine\n,\ta\tkey\tamino\tacid\tinvolved\tin\tthe\tproduction\tof
|
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] |
requires\t\ntyrosine\n,\ta\tkey\tamino\tacid\tinvolved\tin\tthe\tproduction\tof\nthyroid\thormone,\tand\tthe\ttrace\tmineral\tiodine.\tWithin\tthe\tcells\tof\tthe\tthyroid\tgland,\tiodide\tis\noxidized\tto\tiodine\tby\thydrogen\tperoxide,\ta\treaction\ttermed\tthe\t\norganification\n\tof\tiodide.\tTwo\nadditional\tmolecules\tof\tiodine\tbind\tto\tthe\ttyrosyl\tring\tin\ta\treaction\tthat\tinvolves
|
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] |
thyroid\tperoxidase\n(TPO)\n,\tan\tenzyme\tin\tthe\tthyroid\tresponsible\n\tfor\tthyroid\thormone\tproduction.\tCompleted\tthyroid\nhormones\tare\treleased\tinto\tthe\tcirculation;\thowever,\tmetabolic\teffects\tof\tthyroid\thormones\tresult\nwhen\tthe\thormones\tultimately\toccupy\tspecific\tthyroid\treceptors.\tIt\tis\testimated\tthat\ta\tcell\tneeds\tfive\nto\tseven\ttimes\tmore\tT\n4
|
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] |
to\tseven\ttimes\tmore\tT\n4\n\tto\tbind\tto\tthe\tnuclear\treceptors\tto\thave\ta\tphysiologic\teffect\tcompared\twith\nthe\tmore\tbiologically\tactive\tT\n3\n.\nThe\tbiosynthetic\n\tprocesses\tresulting\tin\tthe\tcreation\tof\tthyroid\thormones\twithin\tthe\tthyroid\tgland\nare\tcontrolled\tby\tfeedback\tmechanisms\twithin\tthe\t\nhypothalamic-pituitary-thyroid\taxis\t(HPT\naxis)
|
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hypothalamic-pituitary-thyroid\taxis\t(HPT\naxis)\n.\tThe\tHPT\taxis\tis\tpart\tof\tthe\tendocrine\tsystem\tresponsible\tfor\tthe\tregulation\tof\tmetabolism.\tAs\nits\tname\tsuggests,\tit\tdepends\ton\tthe\t\nhypothalamus\n\t(a\ttiny,\tcone-shaped\tstructure\tlocated\tin\tthe\nlower\tcenter\tof\tthe\tbrain\tthat\n\tcommunicates\tbetween\tthe\tnervous\tand\tendocrine\tsystems),\tthe\npituitary\tgland
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pituitary\tgland\n\t(the\tmaster\tgland\tof\tthe\tendocrine\tsystem\tlocated\tat\tthe\tbase\tof\tthe\tbrain),\tand\tthe\nthyroid\tgland\t(\nFig.\t30.1\n).
|
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0.027861861512064934,
0.05712755396962166,
0.014102311804890633,
-0.08219674974679947,
-0.015344354324042797,
0.07367296516895294,
-0.03677091374993324,
0.010361826047301292,
-0.02363406866788864,
0.03059246577322483,
-0.009411001577973366,
-0.042225707322359085,
-0.0699123740196228,
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0.02332715317606926,
0.06386461108922958,
0.0956985130906105,
0.03595981374382973
] |
FIG.\t30.1\nThe\thypothalamus-pituitary-thyroid\taxis.\t\nTRH,\n\tThyrotropin-releasing\thormone;\t\nTSH,\n\tthyroid-\nstimulating\thormone.\nThe\thypothalamus\tproduces\tand\tsecretes\t\nthyrotropin-releasing\thormone\t(TRH)\n,\twhich\ttravels\nto\tthe\tpituitary\tgland,\tstimulating\tit\tto\trelease\tTSH,\twhich\tsignals\tthe\tthyroid\tgland\tto\tupregulate\tits
|
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0.0037507102824747562
] |
synthetic\tmachinery.\tAlthough\tT\n4\n,\tT\n3\n,\tand\trT\n3\n\tare\tgenerated\twithin\tthe\tthyroid\n\tgland,\tT\n4\n\tis\nquantitatively\tthe\tmajor\tsecretory\tproduct.\tAll\tT\n4\n\tfound\tin\tcirculation\tis\tgenerated\tin\tthe\tthyroid\nunless\texogenously\tadministered\tvia\tthyroid\treplacement\tmedication\t(see\t\nTable\t30.2\n).\tProduction\tof\nT\n3\n\tand\trT\n3
|
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0.03927294909954071,
0.048339955508708954,
0.12610337138175964,
-0.004262132104486227
] |
Table\t30.2\n).\tProduction\tof\nT\n3\n\tand\trT\n3\n\twithin\tthe\tthyroid\tis\trelegated\tto\tvery\tsmall\tquantities\tand\tis\tnot\tconsidered\tsignificant\ncompared\twith\tperipheral\tproduction\tin\tother\tbody\ttissues\t(\nFig.\t30.2\n).\nFIG.\t30.2\nConstructing\tthyroid\thormones.\t(1)\tAccumulation\tof\tthe\traw\tmaterials\ttyrosine\tand\tiodide\t(I-),\t(2)
|
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] |
fabrication\tor\tsynthesis\tof\tthe\thormone,\tand\t(3)\tsecretion\tof\thormone\tinto\tthe\tblood\teither\tbound\tor\tas\tfree\tT\n4\n.\nWhen\tT\n4\n\tis\treleased\tfrom\tthe\tthyroid,\tit\tis\tprimarily\tin\ta\tbound\tform\twith\t\nthyroid-binding\nglobulin\t(TBG)\n,\ta\tprotein\tthat\ttransports\tthyroid\thormones\tthrough\tthe\tbloodstream,\n\twith\tlesser\namounts\tbound\tto\tT\n4
|
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with\tlesser\namounts\tbound\tto\tT\n4\n-binding\tprealbumin.\tIt\tis\testimated\tthat\tonly\t0.03%\tto\t0.05%\tof\tT\n4\n\twithin\tthe\ncirculatory\tsystem\tis\tin\ta\tfree\tor\tunbound\tform;\tthis\tunbound\tT\n4\n\tis\tcalled\t\nfree\tT\n4\n.\tIn\tperipheral\ntissues,\tapproximately\t70%\tof\tT\n4\n\tis\tconverted\tto\tT\n3\n\tor\trT\n3\n\tor\teliminated.\tAs\tmentioned,\tT\n3\n\tis
|
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] |
4\n\tis\tconverted\tto\tT\n3\n\tor\trT\n3\n\tor\teliminated.\tAs\tmentioned,\tT\n3\n\tis\nconsidered\tto\tbe\tthe\tmost\tmetabolically\tactive\tthyroid\thormone.\tAlthough\tsome\tT\n3\n\tis\tproduced\tin\n\tthe\nthyroid,\tapproximately\t80%\tto\t85%\tis\tgenerated\toutside\tthe\tthyroid\tgland,\tprimarily\tby\tconversion
|
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] |
via\ta\tdeiodinase\tenzyme\tfrom\tT\n4\n\tto\tT\n3\n\tin\tthe\tliver\tand\tkidneys.\tThe\tpituitary\tand\tnervous\tsystem\tare\nalso\tcapable\tof\tconverting\tT\n4\n\tto\tT\n3\n,\tand\tso\tare\tnot\treliant\ton\tT\n3\n\tproduced\tin\tthe\tliver\tor\tkidney.\nWithin\tthe\tliver\tand\tkidney,\tthe\tenzyme\tresponsible\tfor\tproduction\tof\tT\n3\n\tis\ta\tselenium-dependent\nenzyme\tcalled\t\n5-deiodinase
|
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] |
3\n\tis\ta\tselenium-dependent\nenzyme\tcalled\t\n5-deiodinase\n,\tan\tenzyme\tthat\tremoves\tone\tmolecule\tof\tiodine\tfrom\tT\n4\n\tto\tform\teither\nT\n3\n\tor\trT\n3\n\t(\nFig.\t30.3\n).\nFIG.\t30.3\nThyroid\tmetabolism.\nAssessment\tin\tthyroid\tdisorders\nAssessment\tbegins\twith\tan\tevaluation\tof\tthyroid\tstatus\tbased\ton\tlaboratory\tdata\tsuch\tas\ta\tfull
|
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thyroid\tpanel.\tIn\tthe\tabsence\tof\ta\tfull\tthyroid\tpanel,\ta\tserum\tthyrotropin\t(also\tknown\tas\tTSH)\tis\tthe\nsingle\tbest\tscreening\ttest\tfor\tprimary\tthyroid\tdysfunction\tfor\tthe\tvast\tmajority\tof\toutpatient\tclinical\nsituations\t(\nGarber\tet\tal,\t2012\n).\tA\tTSH\ttest\tdoes\tnot\tscreen\tfor\tautoimmune\tdisease.\tIf\tautoimmune
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] |
evaluation\tof\tcalorie\tand\tcarbohydrate\tintake.\tIn\taddition,\tan\tassessment\tof\tdietary\tintake\tof\ngoitrogenic\t(thyroid-inhibiting)\tfoods\n\tmay\tbe\twarranted.\nLaboratory\tnorms:\tFunctional\tversus\tpathologic\tranges\nA\ttypical\t(statistical)\treference\trange\tfor\tTSH\tin\tmany\tlaboratories\tis\tapproximately\t0.2\tto\t5.5
|
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] |
mIU/L.\tIndividuals\twith\tTSH\tvalues\tgreater\tthan\t2\tmIU/L\thave\tan\tincreased\trisk\tof\tdeveloping\tovert\nhypothyroidism\tduring\tthe\tnext\t20\tyears.\tSubclinical\tautoimmune\tthyroid\tdisease\tis\tso\tcommon\tin\nthe\tpopulation\tthat\tlaboratory\n\treference\tranges\tderived\tfrom\ttesting\tapparently\thealthy\tsubjects
|
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reference\tranges\tderived\tfrom\ttesting\tapparently\thealthy\tsubjects\neasily\tcould\tbe\tmisconstrued\tfor\tthose\twith\tdisease.\tImportantly,\tseveral\tstudies\thave\tdetected\tan\nincrease\tin\tthyroid\tantibody\tpositivity\twith\tTSH\tconcentrations\toutside\tthe\tnarrow\trange\tof\t0.2\tto\n1.9\tmIU/L\t(\nFjaellagaard\tet\tal,\t2015
|
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] |
1.9\tmIU/L\t(\nFjaellagaard\tet\tal,\t2015\n).\tThis\tfact\tprovides\tevidence\tthat\tTSH\tin\tthe\tupper\treference\nrange\toften\tis\tassociated\twith\tabnormal\n\tpathologic\tfindings\t(\nHak\tet\tal,\t2000\n;\t\nKhandelwal\tand\nTandon,\t2012\n;\t\nSaravanan\tet\tal,\t2002\n),\tmitochondrial\tdysfunction,\tand\tmorphologic\tskeletal\tmuscle
|
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] |
),\tmitochondrial\tdysfunction,\tand\tmorphologic\tskeletal\tmuscle\nalterations\tincluding\tmyalgia,\tmuscle\tcramps,\tand\tweakness\t(\nDunn\tet\tal,\t2009\n).\tAdditional\tevidence\nthat\tthyroid\tfunction\twithin\tthe\tlaboratory\treference\tranges\tcan\tbe\tassociated\twith\tadverse\noutcomes\tis\tshown\tin\t\nTable\t30.1\n.\tConversely,\tdecreased
|
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] |
outcomes\tis\tshown\tin\t\nTable\t30.1\n.\tConversely,\tdecreased\n\tTSH\tlevels\tcombined\twith\tnormal-to-high\tT\n4\nor\tT\n3\n\tlevels\tmay\tbe\tsuggestive\tof\thyperthyroidism\t(see\tThyroid\tFunction\tTests\tin\t\nAppendix\t13\n).
|
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0.07343120872974396,
-0.0013512878213077784,
-0.06874462962150574,
-0.019286664202809334,
0.06618223339319229,
-0.03540867939591408,
0.08655528724193573,
-0.043448127806186676,
0.027539623901247978,
0.09211501479148865,
-0.01531886775046587,
-0.032269492745399475,
-0.03481525182723999,
-0.038772158324718475,
0.06151142716407776,
0.02689855545759201,
0.03077399730682373,
0.0417855940759182,
0.05515582486987114,
0.012349845841526985,
0.01856384053826332,
-0.024716129526495934,
0.13564245402812958,
0.022772161290049553,
-0.03363680839538574,
-0.040634430944919586,
0.028192495927214622,
0.03895563259720802,
-0.04817361384630203,
-0.031200982630252838,
0.05260154977440834,
-0.04390750452876091,
-0.09983088821172714,
-0.021537072956562042,
0.06863050907850266,
0.06325593590736389,
0.013033521361649036,
-0.09946803748607635,
-0.039224348962306976,
0.11873061209917068,
0.12588727474212646,
0.08830161392688751,
-0.03949778527021408
] |
TABLE\t30.1\nVariation\tin\tThyroid\tFunction\tWithin\tReference\tRange\tand\tAdverse\tOutcomes\nTSH\t>2\tmIU/L\n*\nIncreased\t20-year\trisk\tof\thypothyroidism\nTSH\t>2\tmIU/L\n*\nIncreased\tfrequency\tof\tthyroid\tautoantibodies\nTSH\t>4\tmIU/L\n*\nIncreased\trisk\tof\theart\tdisease\nTSH\t2-4\tmIU/L\n*\nCholesterol\tvalues\trespond\tto\tthyroxine\treplacement\nFree\tT\n4\n\t<10.4\npmol/L\n†
|
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0.11352331191301346,
0.09663142263889313,
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0.03539907559752464,
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0.07462720572948456,
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0.08328063040971756,
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0.04465459659695625,
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0.03540552034974098,
0.055559173226356506,
0.11513657867908478,
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] |
Free\tT\n4\n\t<10.4\npmol/L\n†\nImpaired\tpsychomotor\tdevelopment\tof\tinfant\tif\toccurs\tin\tfirst\ttrimester\tof\npregnancy\nT\n3\n,\tThyroxine;\t\nTSH,\n\tthyroid-stimulating\thormone.\n*\nTypical\treference\tranges:\tTSH\t0.2-5.5\tmIU/L\n†\nTypical\treference\tranges:\tfree\tT\n4\n\t9.8-25\tpmol/L\nChanges\tin\t5-deiodination\toccur\tin\ta\tnumber\tof\tsituations,\tsuch\tas\tstress,
|
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] |
poor\tnutrition,\tillness,\nselenium\tdeficiency,\tand\tcertain\tdrug\ttherapies.\tToxic\tmetals\tsuch\tas\tcadmium,\tmercury,\tand\tlead\nhave\tbeen\tassociated\twith\timpaired\thepatic\t5-deiodination\tin\tanimal\tmodels.\t(\nSoldin\tet\tal,\t2008\n).\nFree\tradicals\tare\talso\tinvolved\tin\tinhibition\tof\t5-deiodinase\tactivity.\tIn\tthe\tcourse\tof\tchronic\tliver
|
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] |
disease\tsuch\tas\thepatic\tcirrhosis,\talterations\tin\thepatic\tdeiodination\tresulting\n\tin\tincreased\trT\n3\n\tand\ta\nsimultaneous\tdecrease\tin\tT\n3\n\tlevels\talso\thave\tbeen\tobserved\t(\nBox\t30.1\n\tand\tsee\t\nChapter\t28\n).\nBOX\t30.1\n5-Deiodinase\tInhibitors\nSelenium\tdeficiency\nInadequate\tprotein,\texcess\tcarbohydrates\nHigh\tinsulin\nChronic\tillness\nStress\t(cortisol)
|
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High\tinsulin\nChronic\tillness\nStress\t(cortisol)\nCd,\tHg,\tPb,\tand\tother\theavy\tmetal\ttoxins\nCompromised\tliver\tor\tkidney\tfunction\nHypothyroidism\nOf\tthe\tdetected\tcases\tof\t\nhypothyroidism\n\t(underactive\tthyroid)\tmore\tthan\thalf\tare\tdue\tto\tan\nautoimmune\tdisorder\tcalled\t\nHashimoto’s\tthyroiditis\n,\tin\twhich\tthe\timmune\tsystem\tattacks\tand
|
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] |
Hashimoto’s\tthyroiditis\n,\tin\twhich\tthe\timmune\tsystem\tattacks\tand\ndestroys\tthyroid\tgland\ttissue.\tA\tcommon\tclinical\tpresentation\tof\tpatients\twith\tfunctional\tchanges\tof\nthe\tendocrine\tsystem\tis\taltered\tthyroid\tfunction.\tIndeed\t\nsubclinical\n\thypothyroidism\trepresents\tthe\nfirst\tsigns\tof\tthyroid\thormone\tdysfunction\tfor\tmany\tindividuals.
|
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] |
first\tsigns\tof\tthyroid\thormone\tdysfunction\tfor\tmany\tindividuals.\n\tTypical\tsymptoms\tinclude\tlow\nenergy,\tcold\thands\tand\tfeet,\tfatigue,\thypercholesterolemia,\tmuscle\tpain,\tdepression,\tand\tcognitive\ndeficits\t(\nBox\t30.2\n).\tEvaluation\tof\tthyroid\thormone\tmetabolism\tis\tneeded\tbefore\tthyroid\thormone\nreplacement\ttherapy.\nBOX\t30.2
|
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] |
replacement\ttherapy.\nBOX\t30.2\nCommon\tSymptoms\tof\tHypothyroidism\tand\tHyperthyroidism\nHypothyroidism\nHyperthyroidism\nFatigue\nHeat\tintolerance,\tsweating\nForgetfulness\nWeight\tloss\nDepression\nAlterations\tin\tappetite\nHeavy\tmenses\nFrequent\tbowel\tmovements\nDry,\tcoarse\thair\nChanges\tin\tvision\nMood\tswings\nFatigue\tand\tmuscle\tweakness\nWeight\tgain
|
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0.06981787085533142,
0.06426539272069931,
0.06687644124031067,
0.012450912036001682
] |
Changes\tin\tvision\nMood\tswings\nFatigue\tand\tmuscle\tweakness\nWeight\tgain\nMenstrual\tdisturbance\nHoarse\tvoice\nImpaired\tfertility\nDry,\tcoarse\tskin\nMental\tdisturbances\nConstipation\nSleep\tdisturbances\nTremors\nThyroid\tenlargement\nFrom\tShomon\tM:\t\nThyroid\tDisease\tSymptoms—Hypothyroidism\n\tand\tHyperthyroidism\n\t(website):
|
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] |
and\tHyperthyroidism\n\t(website):\nhttp://thyroid.about.com/cs/basics_starthere/a/symptoms.htm\n,\t2008.
|
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] |
Women\tare\tfive\tto\teight\ttimes\tmore\tlikely\tthan\tmen\tto\tsuffer\tfrom\thypothyroidism.\tIn\taddition,\nindividuals\twho\thave\tceliac\tdisease\tmay\tbe\tat\trisk\t(see\t\nClinical\tInsight:\n\tWas\tIt\tGluten\tThat\tCaused\nHer\tHypothyroidism?\n)\nCLINICAL\tINSIGHT\nGluten\tand\tHypothyroidism\nA\tcase\treport\tdescribed\ta\t23-year-old
|
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] |
Gluten\tand\tHypothyroidism\nA\tcase\treport\tdescribed\ta\t23-year-old\n\twoman\twith\ta\tdiagnosis\tof\thypothyroidism\tcaused\tby\nHashimoto’s\tthyroiditis\tand\tautoimmune\tAddison’s\tdisease\twho\twas\tfound\tin\tevaluation\tto\thave\nelevated\tantiendomysial\tantibody\tlevels\t(a\tmarker\tof\tceliac\tdisease\t[CD]).\tDuring\ta\t3-month
|
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] |
period\ton\ta\tgluten-free\tdiet,\tthe\tpatient\tdemonstrated\tremarkable\tclinical\timprovement\tin\ther\ngastrointestinal\t(GI)-related\tsymptoms\tand,\tmore\timportantly,\n\tin\ther\tthyroid\tfunction.\tShe\nrequired\tprogressively\tless\tthyroid\tand\tadrenal\treplacement\ttherapy.\tAfter\t6\tmonths,\ther
|
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endomysial\tantibody\tlevel\tbecame\tnegative,\ther\tantithyroid\tantibody\ttiter\tdecreased\tsignificantly,\nand\tthyroid\tmedication\twas\tdiscontinued.\tThis\tcase\treport\tpoints\tout\tthe\tpotential\timportant\neffect\tof\ta\tgluten-free\tdiet\ton\tthyroid\tfunction,\tespecially\tin\tthe\tpresence\tof\tCD.
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A\tnumber\tof\tstudies\tshow\tthe\timportance\tof\tgluten\tin\tthe\tinduction\tof\tendocrine\tautoantibodies\nand\torgan\tsystem\tdysfunction\tin\tadolescent\tceliac\tpatients\t(\nCassio\tet\tal,\t2010\n;\t\nMeloni\tet\tal,\n2009\n).\tFurthermore,\tthe\tgenetic\trisk\tfor\tCD\tis\tlargely\trelated\tto\thuman\tleukocyte\tantigen\ngenotypes,\twhich\tin\tturn\tis\tlinked\tto\tautoimmune\tthyroid\tdisease\t(
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] |
genotypes,\twhich\tin\tturn\tis\tlinked\tto\tautoimmune\tthyroid\tdisease\t(\nBarker\tand\tLiu,\t2008\n).\nAccording\tto\tthe\tinternational\n\tmedical\tbibliography,\tautoimmune\tHashimoto’s\tthyroiditis\tand\tCD\nare\tclearly\tassociated\t(\nFreeman,\t2016\n).\tThis\tmight\tbe\texplained\tpartly\tby\tthe\tincreased
|
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] |
Freeman,\t2016\n).\tThis\tmight\tbe\texplained\tpartly\tby\tthe\tincreased\nimmunosensitivity\tof\tCD\tpatients,\tas\tpart\tof\tan\tautoimmune\tpolyglandular\tsyndrome\t(APS),\tby\nthe\tdeficiency\tof\tkey\telements\tsuch\tas\tselenium\tand\tiodine\tdue\tto\tmalabsorption\t(\nStazi\tand\tTrinti,\n2010\n)\tor\tdue\tto\tantibodies\tthat\taffect\tboth\ttarget-tissues\n\t(\nNaiyer\tet\tal,\t2008
|
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] |
(\nNaiyer\tet\tal,\t2008\n).\tBased\ton\nrecommendations\tfrom\ta\trecent\tmeta-analysis,\tall\tpatients\twith\tautoimmune\tHashimoto’s\nthyroiditis\tshould\tbe\tscreened\tfor\tCD,\tgiven\tthe\tincreased\tprevalence\tof\tthe\tcoexistence\tof\tthese\ntwo\tdisorders\t(\nRoy\tet\tal,\t2016\n).\tThis\tstudy\tadvocates\tthat\tpatients\twith\tHashimoto’s\tthyroiditis
|
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] |
).\tThis\tstudy\tadvocates\tthat\tpatients\twith\tHashimoto’s\tthyroiditis\nundergo\tceliac\tserologic\ttests\t(serum\tIgA\tand\tIgG\tgliadin\tantibodies\t[AGA-IgA,\tAGA-IgG],\n\tIgA\ntransglutaminase\tantibodies\t[TGA],\tand\tserum\tIgA\tendomysium\tantibodies\t[EMA]),\tand\tthat\tif\tany\nof\tthe\tceliac\tserologic\ttests\tis\tpositive,\tthe\tpatients\tmust\tbe\tinvestigated\twith
|
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] |
gastroduodenoscopy\tand\tduodenal\tbiopsy.\tIt\tmust\tbe\tconsidered\tthat\tpositive\tthyroid\tand\tceliac\ntests\tmight\trepresent\tan\tepiphenomenon\tbecause\tserum\tautoantibodies\tgenerally\tdo\tnot\treflect\ta\nclinical\tautoimmune\tdisease\n\t(\nLiontiris\tand\tMazokopakis,\t2017\n).\tIt\thas\tbeen\treported\tthat\tgluten-
|
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Liontiris\tand\tMazokopakis,\t2017\n).\tIt\thas\tbeen\treported\tthat\tgluten-\ndependent\tdiabetes\tand\tthyroidal-related\tantibodies\twere\tfound\tin\tpatients\twith\tCD\tbut\twere\neliminated\tafter\tthe\timplementation\tof\ta\tgluten-free\tdiet\t(\nDuntas,\t2009\n).\tA\tgluten-free\tdiet\tmay\nbe\twarranted\tin\tcases\tof\tHashimoto’s\tthyroiditis,\tas\tthe\tmounting\tevidence\tshows\tthat\tthe
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] |
avoidance\tof\tgluten\tmay\treduce\tinflammation\tand\tauto-antibody\n\ttiters.\tSee\t\nChapter\t27\n\tfor\nadditional\tinformation\tabout\tCD.\nPathophysiology\nHashimoto’s\tthyroiditis\tis\tan\tautoimmune\tdisorder\tin\twhich\tthe\timmune\tsystem\tattacks\tand\tdestroys\nthe\tthyroid\tgland.\tIt\tis\tthe\tmost\tcommon\tform\tof\thypothyroidism.\tThe\tenlarged,\tchronically\tinflamed
|
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] |
thyroid\tgland\tbecomes\tnonfunctional,\twith\treactive\tparts\tof\tthe\tgland\tdeteriorating\tafter\tseveral\nyears.\tThyroid\tautoantibodies\n\tindicate\tthe\tbody’s\timmune\tsystem\tis\tattacking\titself\tand\twhether\tan\nautoimmune\tthyroid\tcondition\tis\tpresent,\tbe\tit\thypothyroidism\tor\thyperthyroidism,\tEpstein-Barr
|
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] |
virus\t(EBV)\thas\tbeen\timplicated\tas\ta\tcritical\tunderlying\tfactor\tin\tautoimmune\tthyroid\tdisease.\nJanegova\tet\tal\t(2015)\n\tdemonstrated\ta\thigh\tprevalence\tof\tEBV\tinfection\tin\tcases\tof\tHashimoto’s\nthyroiditis\t(80.7%)\tas\twell\tas\tin\tsamples\tof\n\tGraves’\tdisease\t(62.5%).\nSpecific\tantibody\ttests\tidentify\tHashimoto’s\tthyroiditis.
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] |
Specific\tantibody\ttests\tidentify\tHashimoto’s\tthyroiditis.\t\nThyroid\tperoxidase\tantibodies\t(TPO\nAb)\n\tare\timmune\tcells\tthat\tindicate\tthe\timmune\tsystem\tis\tattacking\tTPO\tin\tthe\tthyroid\tgland.\tThe\nTPO\tAb\ttest\tis\tthe\tmost\timportant\tbecause\tTPO\tis\tthe\tenzyme\tresponsible\tfor\tthe\tproduction\tof
|
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] |
thyroid\thormones,\tand\tthe\tmost\tfrequent\ttarget\tof\tattack\tin\tHashimoto’s.\t\nThyroglobulin\nantibodies\t(TGB\tAb)\n\tare\timmune\tcells\tthat\tindicate\tthe\timmune\tsystem\tis\tattacking\tthyroglobulin\nin\tthe\tthyroid\tgland.\tSometimes\tthis\ttest\tis\tnecessary\tas\twell\tbecause\tit\tis\tthe\tsecond\tmost\tcommon\ntarget\tfor\tHashimoto’s\tdisease.
|
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target\tfor\tHashimoto’s\tdisease.\nSchmidt’s\tsyndrome\trefers\tto\thypothyroidism\twith\tother\tendocrine\tdisorders,\tincluding\tAddison’s\ndisease\t(adrenal\tinsufficiency),\thypoparathyroidism,\tand\tdiabetes\tmellitus,\tall\tof\twhich\tmay\n\tbe\nautoimmune\tin\tnature.\t\nEuthyroid\tsick\tsyndrome\n\tis\thypothyroidism\tassociated\twith\ta\tsevere
|
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] |
Euthyroid\tsick\tsyndrome\n\tis\thypothyroidism\tassociated\twith\ta\tsevere\nsystemic\tillness\tthat\tcauses\tdecreased\tperipheral\tconversion\tof\tT\n4\n\tto\tT\n3\n,\tan\tincreased\tconversion\tof\nT\n3\n\tto\tthe\tinactive\trT\n3\n,\tand\tdecreased\tbinding\tof\tthyroid\thormones.\tConditions\tcommonly\tassociated
|
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] |
with\tthis\tsyndrome\tinclude\tprotein-calorie\tmalnutrition,\tsurgical\ttrauma,\tmyocardial\tinfarction,\nchronic\n\trenal\tfailure,\tdiabetic\tketoacidosis,\tanorexia\tnervosa,\tcirrhosis,\tthermal\tinjury,\tand\tsepsis.\nOnce\tthe\tunderlying\tcause\tis\ttreated,\tthe\tcondition\tusually\tis\tresolved\t(see\t\nPathophysiology\tand\nCare\tManagement\tAlgorithm:\n\tThyroid\tDysfunction\n).
|
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Triggers\nAdrenal\tdysfunction\tand\toxidative\tstress.\nLow\tthyroid\tfunction\tis\talmost\talways\tsecondary\tto\tsome\tother\tcondition,\toften\tadrenal\tdysfunction\n(\nKaltsas\tet\tal,\t2010\n)\t(see\t\nAdrenal\tDisorders\n\tlater\tin\tthis\tchapter).\nAging.\nMaintaining\tthyroid\thormone\tfunction\tthroughout\tthe\taging\tprocess\tappears\tto\tbe\tan\timportant
|
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hallmark\tof\thealthy\taging.\tThe\tincidence\tof\thypothyroidism\t(underactive\n\tthyroid)\tincreases\twith\tage.\nBy\tage\t60,\t9%\tto\t17%\tof\tmen\tand\twomen\thave\tan\tunderactive\tthyroid.\tThe\tabsence\tof\tcirculating\nthyroid\tautoantibodies\tin\thealthy\tcentenarians\tis\tnoted.\tBecause\tunhealthy\taging\tis\tassociated\twith
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a\tprogressively\tincreasing\tprevalence\tof\torgan-specific\tand\tnon-organ-specific\tautoantibodies,\tthe\nabsence\tof\tthese\tantibodies\tmay\trepresent\ta\tsignificantly\treduced\trisk\n\tfor\tcardiovascular\tdisease\nand\tother\tchronic\tage-related\tdisorders.\nMenopause.\nThe\trelationship\tbetween\tthyroid\thormone\tand\tthe\tgonadal\taxis\tis\twell\testablished;\thowever,\tthere
|
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are\tfew\tstudies\ton\tthe\trelationship\tbetween\tthyroid\tfunction\tand\tmenopause\tspecifically.\tIn\taddition,\nthey\tdo\tnot\tnecessarily\tclarify\twhether\tmenopause\thas\tan\teffect\ton\tthyroid\tregardless\tof\taging,\ndespite\tthe\tfact\n\tthat\thypothyroid\tsymptoms\tand\tmenopause\tsymptoms\t(such\tas\thot\tflashes,
|
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insomnia,\tirritability,\tand\tpalpitations)\tare\tcommonly\tconfused.\tAccording\tto\ta\treport\tfrom\tthe\nevaluation\tof\tthe\tStudy\tof\tWomen’s\tHealth\tAcross\tthe\tNation\t(SWAN),\tthyroid\tfunction\tdoes\tnot\nappear\tto\tbe\tdirectly\tinvolved\tin\tthe\tpathogenesis\tof\tmenopausal\tcomplications;\thowever,\nmenopause\tmay\tmodify\tthe\tclinical\texpression\tof\tAITDs
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menopause\tmay\tmodify\tthe\tclinical\texpression\tof\tAITDs\n\tsuch\tas\tHashimoto’s\tthyroiditis\t(\nDel\tGhianda\net\tal,\t2014\n).\nPregnancy.\nThyroid\tdysfunction\thas\tbeen\trelated\tto\tobstetric\tcomplications\tsuch\tas\tpremature\tdelivery,\ngestational\thypertension,\tpreeclampsia,\tand\tplacental\tabruption.\tNearly\t1\tout\tof\t50\twomen\tin\tthe
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0.08245987445116043,
0.10249832272529602,
0.09499185532331467,
0.001113122678361833
] |
United\tStates\tis\tdiagnosed\twith\thypothyroidism\tduring\tpregnancy.\tOut\tof\tevery\t100\tmiscarriages,\tsix\nare\tassociated\twith\tthyroid\thormone\n\tdeficiency\tduring\tpregnancy,\tup\tto\t18%\tof\twomen\tare\ndiagnosed\twith\tpostpartum\tthyroiditis,\tand\tapproximately\t25%\tof\twomen\tdevelop\tpermanent\nhypothyroidism\t(\nDe\tVivo\tet\tal,\t2010\n;\t\nYassa\tet\tal,\t2010\n).
|
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] |
hypothyroidism\t(\nDe\tVivo\tet\tal,\t2010\n;\t\nYassa\tet\tal,\t2010\n).\nGlobal\trecommendations\tfor\tiodine\tduring\tpregnancy\tare\t130-250\tmcg/d\tdepending\ton\tthe\ncountry.\tIn\tareas\tof\tsevere\tiodine\tdeficiency,\tmaternal\tand\tfetal\thypothyroxinemia\tcan\tcause\ncretinism\n\t(condition\n\tof\tstunted\tphysical\tgrowth\tand\tmental\tdevelopment).\tTo\tprevent\tfetal\tdamage,
|
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] |
dietary\tiodine\tadequacy\tis\tessential\tduring\tpregnancy\t(see\t\nChapter\t14\n\tand\t\nTable\t14.8\n)\n(\nZimmermann,\t2009\n).
|
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] |
Medical\tmanagement\nWhen\tthe\tthyroid\tis\tunderactive\t(hypothyroidism)\tbecause\tof\tautoimmune\tdisease\t(Hashimoto’s\ndisease),\tradioactive\tiodine\ttreatment,\tcongenital\tdefects,\tor\tsurgical\tremoval\t(thyroidectomy),\n\tthe\nconventional\tpharmacologic\tapproach\tfor\ttreatment\tis\tprescription\tthyroid\thormone\treplacement\nmedication.\t\nTable\t30.2
|
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] |
medication.\t\nTable\t30.2\n\tprovides\tan\toverview\tof\tkey\tforms\tof\tthyroid\thormone\treplacement.\tWith\tthe\nfurther\telucidation\tof\tthe\teffects\tof\tgenetics,\tnew\tagents\tare\tlikely\tto\tbecome\tavailable\tas\tadjunct\ntherapy.\nTABLE\t30.2\nPharmacologic\tTreatments\tfor\tHypothyroidism\nMedication\nBrand\nName\nMedication\nGeneric\tName\nUse\tand\tComments\nSynthroid,\nLevoxyl
|
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] |
Name\nMedication\nGeneric\tName\nUse\tand\tComments\nSynthroid,\nLevoxyl\nLevothyroxine—\n(synthetic\tT\n4\n)\nMost\tcommonly\tprescribed\tsynthetic\tform\tof\tthyroid\thormone\nreplacement\tdrug\t(thyroxine)\tthat\tprovides\ta\tsteady\tdose\tof\tT\n4\n\tfor\tthe\nbody\tto\tconvert\tto\tT\n3\n.\tAvailable\tin\ta\twide\trange\tof\tdoses.\tInactive\ningredients\tinclude\tlactose\tand\tcornstarch.
|
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] |
ingredients\tinclude\tlactose\tand\tcornstarch.\nTirosint\nLevothyroxine\nA\tsynthetic\tform\tof\treplacement\thormone\tthat\tincludes\n\tonly\tthree\ninactive\tingredients:\tgelatin,\tglycerin,\tand\twater.\nIs\tproduced\tin\ta\tdedicated\tfacility\tto\teliminate\tthe\trisk\tof\tcross-\nexposure.\nCytomel\nLiothyronine—\n(synthetic\tT\n3\n)\nSynthetic\tform\tof\tT\n3
|
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] |
Cytomel\nLiothyronine—\n(synthetic\tT\n3\n)\nSynthetic\tform\tof\tT\n3\n,\twhich\tcan\talso\tbe\tcompounded.\nSometimes\tprescribed\tin\taddition\tto\tT\n4\n.\tOnly\teffective\tfor\napproximately\t10\thours\tand\tmust\tbe\ttaken\ttwice\tdaily.\nArmour\nThyroid\nDesiccated\nnatural\nthyroid\nPrepared\n\tfrom\tdried\tor\tpowdered\tporcine\t(pig)\tor\tmixed\tbeef\tand\tpork
|
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-0.03381447121500969,
-0.10369760543107986,
-0.06854722648859024,
0.04220351576805115,
0.054740794003009796,
-0.014168545603752136,
-0.004131983499974012,
-0.05325210839509964,
-0.02139979414641857,
0.01724393665790558,
0.13507087528705597,
0.02998095192015171
] |
Prepared\n\tfrom\tdried\tor\tpowdered\tporcine\t(pig)\tor\tmixed\tbeef\tand\tpork\nthyroid\tgland\tfor\ttherapeutic\tuse.\nAvailable\tby\tprescription\tand\tfrequently\tused\tas\tan\talternative\tto\nsynthetic\tthyroid\tdrugs.\nAll\tbrands\tcontain\ta\tmixture\tof\tapproximately\t80%\tT\n4\n\tand\t20%\tT\n3\n.\nDifficult\tto\tstandardize.\nCompounded\tT\n3
|
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0.013414515182375908
] |
4\n\tand\t20%\tT\n3\n.\nDifficult\tto\tstandardize.\nCompounded\tT\n3\n\tmedication\tis\tavailable\tas\ta\ttime-released\tformula.\nCompounded\tmedications\tare\tfrequently\tnot\tinsurance\n\tcovered\tbut\nare\tless\texpensive\tthan\tstandard\tmedications.\nWP\tThyroid,\nNature-\nThroid\nDesiccated\nnatural\nthyroid\nProvides\tthe\tfull\trange\tof\tthyroid\thormones,\tincluding\tT\n4\n,\tT\n3\n,\tT\n2
|
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] |
4\n,\tT\n3\n,\tT\n2\n,\tand\tT\n1\n,\nwhich\tmay\tbe\tbeneficial\tfor\tthose\twho\thave\tdifficulty\twith\tT\n4\n-T\n3\nconversion.\nAvailable\tin\t8-13\tdifferent\tstrengths,\tranging\tfrom\tlow\tto\thigh\nconcentrations.\nThyrolar\nLiotrix—\n(synthetic\tT\n4\n-\nT\n3\ncombination)\nSynthetic\tcombination\tof\tT\n4\n\tand\tT\n3.\nSometimes\tused\tin\tlieu\tof\tArmour\tThyroid\tbecause\tof\tproblem\twith
|
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] |
3.\nSometimes\tused\tin\tlieu\tof\tArmour\tThyroid\tbecause\tof\tproblem\twith\nstandardization.\nT\n3\n,\tTriiodothyronine;\t\nT\n4\n,\tthyroxine.\nFrom\tShomon\tM:\t\nWhat\tis\tthe\tbest\tthyroid\tdrug?\n\t(website):\t\nhttp://thyroid.about.com/cs/thyroiddrugs/a/bestdrug.htm\n,\t2014.\nMedical\tnutrition\ttherapy
|
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,\t2014.\nMedical\tnutrition\ttherapy\nSeveral\tnutrients\tare\tinvolved\tin\tthyroid\thealth,\tparticularly\tiodine\tand\tselenium.\n\tBecause\tof\tthe\ncritical\trole\tof\tiodine\tin\tthe\tsynthesis\tof\tthyroid\thormone,\tthis\ttrace\tmineral\thas\treceived\tthe\tmost\nattention\thistorically\twith\trespect\tto\tthyroid\tdisorders.\tOther\tdeficiencies\tof\tmicronutrients\tsuch\tas
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] |
iron,\tselenium,\tvitamin\tA,\tand\tpossibly\tzinc\tmay\tinteract\twith\tiodine\tstatus\tand\tthyroid\tfunction\n(\nHess,\t2010\n;\t\nKöhrle,\t2013\n).\nFasting\tor\trestrictive\tdiets.\nCalorie\tand\tcarbohydrate\n\trestriction\tmay\treduce\tsubstantially\tthyroid\thormone\tactivity.\tThis\tvaries
|
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] |
widely\tbetween\tindividuals.\tGenetics,\tobesity,\tgender,\tand\tthe\tmacronutrient\tcontent\tof\tthe\nhypocaloric\tdiet\tinfluence\tthe\tresponse.\tNutritional\tstatus\tand\tenergy\texpenditure\tinfluence\tthyroid\nfunction\tcentrally\tat\tthe\tlevel\tof\tTSH\tsecretion,\tdeiodination,\tand\tpossibly\telsewhere.\tBecause\tan\nincrease\tof\trT\n3\n\tis\tfound\tat\tthe\n\texpense\tof\tT\n3
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] |
increase\tof\trT\n3\n\tis\tfound\tat\tthe\n\texpense\tof\tT\n3\n\tduring\tcaloric\trestriction,\tit\tis\tpossible\tthat\tthe\thepatic\npathways\tplay\ta\tsubstantial\trole\tin\tmetabolic\tcontrol\tduring\tenergy\tbalance.\tHowever,\twhen\tcaloric\nrestriction\tis\tlonger\tthan\t3\tweeks,\tT\n4\n\tand\trT\n3\n\tlevels\treturn\tto\tnormal\tvalues\t(\nDe\tVries\tet\tal,\t2015\n).
|
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0.03513825312256813,
0.05496431887149811,
0.0654197558760643,
0.06316125392913818,
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] |
4\n\tand\trT\n3\n\tlevels\treturn\tto\tnormal\tvalues\t(\nDe\tVries\tet\tal,\t2015\n).\nFasting\talso\texerts\ta\tpowerful\tinfluence\ton\tthe\tmetabolism\tof\tthyroid\thormones\tto\tsave\tenergy\tand\nlimit\tcatabolism.\tMild\n\televations\tin\tendogenous\tcortisol\tlevels\tmay\tbe\tpartly\tresponsible.\tFasting\ndecreases\tserum\tT\n3\n\tand\tT\n4
|
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] |
decreases\tserum\tT\n3\n\tand\tT\n4\n\tconcentrations,\twhereas\tintrahepatic\tthyroid\thormone\tconcentrations\nremain\tunchanged.\tHowever,\tketones\tgenerated\tfrom\tcalorie\tdeprivation\tdo\tnot\tappear\tto\tsuppress\nT\n3\n\tgeneration\tand\thepatic\t5-deiodinase\tactivity.\tIt\tappears\tthat\tfasting-induced\tchanges\tin\tliver\nthyroid\thormone\tmetabolism\tare\tnot
|
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|
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is\tassumed\tto\trepresent\tan\tenergy-saving\tmechanism,\tinstrumental\tin\ttimes\tof\tfood\tshortage\t(\nDe\nVries\tet\tal,\t2015\n).\nGoitrogens.\nCyanogenic\tplant\tfoods\t(cauliflower,\tbroccoli,\tcabbage,\tBrussels\tsprouts,\tmustard\tseed,\tturnip,\nradish,\tbamboo\tshoot,\tand\tcassava)\texert\tantithyroid\tactivity\tthrough\tinhibition\tof\tthe\tTPO\tenzyme.
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The\thydrolysis\tof\tbioactive\tcompounds\tcalled\tglucosinolates\tfound\tin\tcruciferous\tvegetables\tmay\nyield\t\ngoitrin\n,\ta\tcompound\tknown\tto\tinterfere\twith\tthyroid\thormone\tsynthesis.\tThe\thydrolysis\tof\nindole\tglucosinolates\n\tresults\tin\tthe\trelease\tof\tthiocyanate\tions,\twhich\tcan\tcompete\twith\tiodine\tfor
|
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] |
uptake\tby\tthe\tthyroid\tgland.\tIncreased\texposure\tto\tthiocyanate\tions\tfrom\tcruciferous\tvegetable\nconsumption,\thowever,\tdoes\tnot\tincrease\tthe\trisk\tof\thypothyroidism\tunless\taccompanied\tby\tiodine\ndeficiency.\tHowever,\tsteaming,\tcooking,\tor\tfermenting\tmay\treduce\tthe\tlevels\tof\tgoitrogens\tin\ngoitrogenic\tfoods\t(\nJagminder\tet\tal,\t2016\n).
|
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] |
goitrogenic\tfoods\t(\nJagminder\tet\tal,\t2016\n).\nSoybean,\tan\timportant\tsource\tof\tprotein\tin\tmany\tdeveloping\tcountries,\talso\thas\tgoitrogenic\nproperties\twhen\tiodine\tintake\tis\tlimited.\tThe\tisoflavones,\tgenistein\tand\tdaidzein,\tinhibit\tthe\tactivity\nof\tTPO\tand\tcan\tlower\tthyroid\thormone\tsynthesis.\tFurthermore,\texcessive\tintake\tof\tsoybeans\tmay
|
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interrupt\tthe\tenterohepatic\tcycle\tof\tthyroid\thormone\tmetabolism.\tHowever,\thigh\tintakes\tof\tsoy\nisoflavones\n\tdo\tnot\tappear\tto\tincrease\tthe\trisk\tof\thypothyroidism\twhen\tiodine\tconsumption\tis\nadequate.\nSince\tthe\taddition\tof\tiodine\tto\tsoy-based\tformulas\tin\tthe\t1960s,\tthere\thave\tbeen\tno\tfurther\treports
|
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of\thypothyroidism\tdeveloping\tin\tsoy\tformula–fed\tinfants.\tSoybeans\tare\tby\tfar\tthe\tmost\tconcentrated\nsource\tof\tisoflavones\tin\tthe\thuman\tdiet.\tSmall\tamounts\tare\tfound\tin\ta\tnumber\tof\tlegumes,\tgrains,\nand\tvegetables.\n\tAverage\tdietary\tisoflavone\tintakes\tin\tAsian\tcountries,\tin\tparticular\tin\tJapan\tand
|
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China,\trange\tfrom\t11\tto\t47\tmg/day\tbecause\tof\tintake\tof\tthe\ttraditional\tfoods\tmade\tfrom\tsoybeans,\nincluding\ttofu,\ttempeh,\tmiso,\tand\tmatte,\twhereas\tintakes\tare\tconsiderably\tlower\tin\tWestern\ncountries\t(2\tmg/day).\tSoy\tproducts\t(meat\tsubstitutes,\tsoy\tmilk,\tsoy\tcheese,\tand\tsoy\tyogurt),\nhowever,\tare\tgaining\tpopularity
|
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] |
however,\tare\tgaining\tpopularity\n\tin\tWestern\tcountries.\tAlthough\tresearch\thas\tnot\tdetermined\tthe\nexact\teffect\tof\tsoy\ton\tthe\tmetabolic\tfate\tof\tthyroid\thormones,\texcessive\tsoy\tconsumption\tis\tbest\napproached\tcautiously\tin\tthose\twith\tsuspected\timpairment\tof\tthyroid\tmetabolic\tpathways.\nIodine.
|
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] |
Iodine.\nAs\ta\ttrace\telement,\tiodine\tis\tpresent\tin\tthe\thuman\tbody\tin\tamounts\tof\t10\tto\t15\tmg,\tand\t70%\tto\t80%\nof\tit\tis\tlocated\tin\tthe\tthyroid\tgland.\n\tNinety\tpercent\tof\tit\tis\torganically\tbound\tto\ta\tprotein\tproduced\tin\nthe\tthyroid\tgland\tcalled\tthyroglobulin\t(Tg).\tIodide\tis\tactively\tabsorbed\tin\tthe\tthyroid\tgland\tto\thelp
|
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produce\tthe\tbiochemically\tactive\tthyroid\thormones\tT\n4\n\tand\tT\n3\n\t(see\t\nFig.\t30.2\n).\tThe\tthyroid\tgland\tmust\ncapture\tan\testimated\tminimum\tof\t60\tmcg\tof\tiodide\t(the\tionic\tform\tof\tiodine)\tdaily\tto\tensure\tan\nadequate\tsupply\tfor\tthe\tproduction\n\tof\tthyroid\thormone\t(\nGropper\tand\tSmith,\t2012\n).\tInadequate
|
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] |
of\tthyroid\thormone\t(\nGropper\tand\tSmith,\t2012\n).\tInadequate\nintake\tof\tiodine\timpairs\tthyroid\tfunction\tand\tresults\tin\ta\tspectrum\tof\tdisorders.\tRandomized\ncontrolled\tintervention\ttrials\tin\tiodine-deficient\tpopulations\thave\tshown\tthat\tproviding\tiron\talong\nwith\tiodine\tresults\tin\tgreater\timprovements\tin\tthyroid\tfunction\tand\tvolume\tthan\tproviding\tiodine
|
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] |
alone\t(\nHess,\t2010\n).\tIt\tis\talso\tvital\tto\tthyroid\tfunction,\n\tas\tit\tis\ta\tmajor\tcofactor\tand\tstimulator\tfor\tthe\nenzyme\tTPO.\nIn\tautoimmune\tHashimoto’s\tthyroiditis,\tsupplementing\twith\tiodine\tmay\texacerbate\tthe\tcondition.\nBecause\tiodine\tstimulates\tproduction\tof\tTPO,\tthis\tin\tturn\tincreases\tthe\tlevels\tof\tTPO\tAbs
|
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dramatically,\tindicating\tan\tautoimmune\tflare-up.\tSome\tpeople\tdevelop\tsymptoms\tof\tan\toveractive\nthyroid,\twhereas\tothers\thave\tno\tsymptoms\tdespite\ttests\n\tshowing\tan\televated\tlevel\tof\tTPO\tAbs.\nTherefore\tone\tmust\tbe\tcautious\tregarding\tthe\tuse\tof\thigh-dose\tiodine;\thowever,\ta\tclinical\tevaluation
|
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] |
and/or\tassessment\t(such\tas\tUI\texcretion\tlaboratories)\tmay\thelp\treveal\twhether\tiodine\nsupplementation\tis\twarranted.\tFurthermore,\talthough\tiodine\tdeficiency\tis\tthe\tmost\tcommon\tcause\tof\nhypothyroidism\tfor\tmost\tof\tthe\tworld’s\tpopulation\t(\nMelse-Boonstra\tand\tJaiswal,\t2010\n),\tin\tthe\tUnited
|
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] |
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