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Melse-Boonstra\tand\tJaiswal,\t2010\n),\tin\tthe\tUnited\nStates\tand\tother\tWesternized\tcountries,\tHashimoto’s\tthyroiditis\taccounts\tfor\tthe\tmajority\tof\tcases\n(\nEbert,\t2010\n).\nAlthough\tthe\trisk\tof\tiodine\tdeficiency\tfor\tpopulations\tliving\tin\tiodine-deficient\tareas\twithout
|
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adequate\tiodine\tfortification\tprograms\tis\twell\trecognized,\tconcerns\thave\tbeen\traised\tthat\tcertain\nsubpopulations\tmay\tnot\tconsume\tadequate\tiodine\tin\tcountries\tconsidered\n\tiodine\tsufficient.\nVegetarian\tand\tnonvegetarian\tdiets\tthat\texclude\tiodized\tsalt,\tfish,\tand\tseaweed\thave\tbeen\tfound\tto\ncontain\tvery\tlittle\tiodine.\nIron.
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] |
contain\tvery\tlittle\tiodine.\nIron.\nHistorically\tit\thas\tbeen\tthought\tthat\tlow\tthyroid\tfunction\tmay\tcontribute\tto\tanemia.\tRecent\tstudies\nsuggest\tthat\tlow\tthyroid\tfunction\tmay\tbe\tsecondary\tto\tlow\tiron\tstatus\tor\tanemia.\tThe\treason\tfor\tthis\nis\tbecause\tTPO\tis\ta\tglycosylated\theme\tenzyme\n\tthat\tis\tiron\tdependent.\tThe\tinsertion\tof\theme\tiron
|
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] |
that\tis\tiron\tdependent.\tThe\tinsertion\tof\theme\tiron\ninto\tTPO\tis\tnecessary\tfor\tthe\tenzyme\tto\ttranslocate\tto\tthe\tapical\tcell\tsurface\tof\tthyrocytes\t(or\nthyroid\tepithelial\tcells),\tthus\tassisting\tTPO\tto\tcatalyze\tthe\ttwo\tinitial\tsteps\tof\tthyroid\thormone\nsynthesis.\tA\tfull\tassessment\tof\tiron\tstatus\tcould\tlikely\thelp\tto\tidentify\tthe\tcause\tof\tmany\tcases\tof
|
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thyroid\tmalfunction.\tTreatment\tof\tanemic\twomen\n\twith\timpaired\tthyroid\tfunction\twith\tiron\timproves\nthyroid-hormone\tconcentrations,\twhile\tT\n4\n\t(hormone\treplacement\tmedication)\tand\tiron\ttogether\tare\nmore\teffective\tin\timproving\tiron\tstatus\t(\nHu\tand\tRayman,\t2017\n).\nSelenium.
|
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Hu\tand\tRayman,\t2017\n).\nSelenium.\nSelenium,\tas\tselenocysteine,\tis\ta\tcofactor\tfor\t5-deiodinase.\tIf\tselenium\tis\tdeficient,\tthe\tdeiodinase\nactivity\tis\timpaired,\tresulting\tin\ta\tdecreased\tability\tto\tdeiodinate\tT\n4\n\tto\tT\n3\n.\tIn\tanimals,\tdeficiencies\tof\nselenium\tare\tassociated\twith\timpaired\t5-deiodinase\tactivity\tin\tthe\tliver\tand\tkidney,\tas\twell\tas
|
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reduced\tT\n3\n\tlevels.\tEvidence\tsuggests\ta\tstrong\tlinear\tassociation\tbetween\tlower\tT\n3\n/T\n4\n\tratios\tand
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reduced\tselenium\tstatus,\teven\tamong\tindividuals\tconsidered\tto\tbe\teuthyroid\tbased\ton\tstandard\nlaboratory\tparameters.\tThis\tassociation\tis\tparticularly\tstrong\tin\tolder\tadults,\n\tpossibly\tas\tthe\tresult\tof\nimpaired\tperipheral\tconversion.\tAn\tinverse\trelationship\tbetween\tT\n3\n\tand\tbreast\tcancer\tis\tassociated
|
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0.07476608455181122,
0.037218011915683746,
0.07481097429990768,
0.006297605112195015
] |
3\n\tand\tbreast\tcancer\tis\tassociated\nwith\tdecreased\tselenium\tstatus,\teven\twhen\tplasma\tT\n4\n\tand\tTSH\tconcentrations\tmay\tbe\tsimilar.\tThis\ncombination\tof\tfactors\tstrongly\tsuggests\tthat\tlow\tT\n3\n\tmay\tbe\tdue\tto\tfaulty\tconversion\tof\tT\n4\n\tto\tT\n3\nexpected\tin\tselenium\tdeficiency\t(\nDe\tSibio\tet\tal,\t2014\n).\nSelenium\tparticipates
|
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] |
De\tSibio\tet\tal,\t2014\n).\nSelenium\tparticipates\n\tin\tthe\tantioxidant\tnetwork.\tIt\tis\ta\tcofactor\tfor\tglutathione\tperoxidase,\tan\nenzyme\twhose\tmain\tbiologic\trole\tis\tto\tprotect\tthe\torganism\tfrom\toxidative\tdamage.\tSeveral\tstudies\nreported\ton\tthe\tbenefit\tof\tselenium\ttreatment\tin\tHashimoto’s\tthyroiditis\tand\tGraves’\tdisease.
|
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] |
According\tto\ta\tsystematic\treview\tand\tmeta-analysis\tstudies,\tselenium\tsupplementation\treduced\nserum\tTPO\tAb\tlevels\tin\tpatients\twith\tchronic\n\tautoimmune\tthyroiditis\t(AIT)\t(\nWichman\tet\tal,\t2016\n).\nEvidence\talso\tsuggests\tthat\texcessive\tintakes\tof\tselenium\tmay\texert\ta\tdetrimental\tinfluence\ton
|
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] |
thyroid\thormone\tmetabolism.\tAlthough\tindividuals\texposed\tto\thigh\tdietary\tlevels\tof\tselenium\ntypically\thave\tnormal\tlevels\tof\tT\n4\n,\tT\n3\n,\tand\tTSH,\ta\tsignificant\tinverse\tcorrelation\thas\tbeen\tfound\nbetween\tT\n3\n\tand\tselenium.\tSome\tresearchers\thave\thypothesized\n\tthat\tthe\tactivity\tof\t5-deiodinase\tmay
|
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that\tthe\tactivity\tof\t5-deiodinase\tmay\nbecome\tdepressed\tafter\ta\thigh\tdietary\tintake\tof\tselenium,\tsuggesting\ta\tsafe\tlevel\tof\tdietary\tselenium\nat\tor\tbelow\t500\tmcg\tdaily.\tThere\tis\tevidence\tfrom\tobservational\tstudies\tand\trandomized\tcontrolled\ntrials\tthat\tselenium/selenoproteins\tcan\treduce\tTPO-antibody\ttiters,\thypothyroidism,\tand\tpostpartum
|
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] |
thyroiditis\t(\nHu\tand\tRayman,\t2017\n).\tIn\ta\t2016\tstudy\ton\tselenium\n\tsupplementation,\tauthors\tconclude\nthat\tselenium\tsupplementation\t(83\tmcg\tof\tselenomethionine\tper\tday\torally\tfor\t4\tmonths)\tcould\nrestore\teuthyroidism\t(healthy\tthyroid\thormone\tbalance)\tin\tone\tthird\tof\tsubclinical\thypothyroidism\npatients\twith\tAIT\t(\nPirola\tet\tal,\t2016\n).\nMagnesium.
|
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] |
patients\twith\tAIT\t(\nPirola\tet\tal,\t2016\n).\nMagnesium.\nMagnesium\tis\tthe\tfourth\tmost\tabundant\tmineral\tin\tthe\tbody.\tIt\thas\tbeen\trecognized\tas\ta\tcofactor\tfor\nmore\tthan\t300\tenzymatic\n\treactions,\twhere\tit\tis\tcrucial\tfor\tadenosine\ttriphosphate\t(ATP)\tmetabolism\nand\tcellular\tenergy\tproduction.\tLow\tserum\tmagnesium\tis\tassociated\twith\tseveral\tchronic\tdiseases
|
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including\tthyroid\tdisease.\tA\tcross-sectional\tstudy\tof\tover\t1200\tChinese\tparticipants\trevealed\tthat\nseverely\tlow\tserum\tmagnesium\twas\tassociated\twith\tincreased\trisks\tof\tpositive\tantithyroglobulin\nantibody\tand\thypothyroidism.\n\tThe\trisks\tof\tHashimoto’s\tthyroiditis\tdiagnosed\tusing\tultrasonography
|
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0.06837654113769531,
0.09145226329565048,
0.043606095016002655
] |
The\trisks\tof\tHashimoto’s\tthyroiditis\tdiagnosed\tusing\tultrasonography\nin\tthe\tlowest\tquartile\tgroup\twere\thigher\tthan\tthose\tin\tthe\tadequate\tmagnesium\tgroup\t(0.851\tto\n1.15mmol/L)\t(\np\n<0.01,\todds\tratios\t[ORs]\t=\t2.748\tto\t3.236).\tThe\trisks\tof\ttotal\tand\tsubclinical-only
|
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] |
hypothyroidism\tin\tthe\tlowest\tquartile\tgroup\twere\thigher\tthan\tthose\tin\tthe\tadequate\tmagnesium\ngroup\t(0.851\tto\t1.15mmol/L)\t(\np\n\t<\t0.01,\tORs\n\t=\t4.482\tto\t4.971)\t(\nWang\tet\tal,\t2018\n).\nIdeal\tintake\tfor\tmagnesium\tshould\tbe\tbased\ton\tthe\tDRI.\tMagnesium\tsupplements\tare\tavailable\tas
|
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] |
magnesium\toxide,\tmagnesium\tchloride,\tmagnesium\tcitrate,\tmagnesium\ttaurate,\tmagnesium\torotate,\nas\twell\tas\tother\tamino\tacid\tchelates.\tIn\tthe\ttreatment\tof\tmagnesium\tdeficiency,\torganic\tbound\nmagnesium\tsalts,\tsuch\tas\tmagnesium\tcitrate,\tgluconate,\torotate,\tor\taspartate\n\trecommendations\nwere\tmade\tdue\tto\ttheir\thigh\tbioavailability\t(\nKisters,\t2013\n).
|
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] |
were\tmade\tdue\tto\ttheir\thigh\tbioavailability\t(\nKisters,\t2013\n).\nVitamin\tD.\nLower\tvitamin\tD\tstatus\thas\tbeen\tfound\tin\tHashimoto’s\tthyroiditis\tpatients\tthan\tin\tcontrols,\tand\ninverse\trelationships\tof\tserum\tvitamin\tD\twith\tTPO/TGB\tAb\thave\tbeen\treported.\tHowever,\tother\tdata
|
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and\tthe\tlack\tof\ttrial\tevidence\tsuggest\tthat\tlow\tvitamin\tD\tstatus\tis\tmore\tlikely\tthe\tresult\tof\nautoimmune\tdisease\n\tprocesses\tthat\tinclude\tvitamin\tD\treceptor\tdysfunction\t(\nHu\tand\tRayman,\t2017\n).\nOral\tvitamin\tD\tsupplementation\twas\tfound\tto\treduce\ttiters\tof\tthyroid\tantibodies\tin\tlevothyroxine-
|
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] |
treated\twomen\twith\tpostpartum\tthyroiditis\tand\tlow\tvitamin\tD\tstatus.\tVitamin\tD\tincreased\tserum\nlevels\tof\t25-hydroxy\tvitamin\tD,\tas\twell\tas\treduced\ttiters\tof\tthyroid\tantibodies.\tThis\teffect\twas\tmore\npronounced\tfor\tTPO\tthan\tfor\n\tTGB\tAb\tand\tcorrelated\twith\ttheir\tbaseline\ttiters.\tAuthors\tconcluded
|
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] |
TGB\tAb\tand\tcorrelated\twith\ttheir\tbaseline\ttiters.\tAuthors\tconcluded\nthat\tvitamin\tD\tpreparations\tmay\treduce\tthyroid\tautoimmunity\tin\tlevothyroxine-treated\twomen\twith\nHashimoto’s\tthyroiditis\tand\tnormal\tvitamin\tD\tstatus\t(\nKrysiak\tet\tal,\t2017\n).\tTaking\tinto\tconsideration
|
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] |
Krysiak\tet\tal,\t2017\n).\tTaking\tinto\tconsideration\nthe\tlow\tcost\tand\tthe\tminimal\tside\teffects\tof\tvitamin\tD\tsupplementation,\tscreening\tfor\tvitamin\tD\ndeficiency\tand\tcareful\tvitamin\tD\tsupplementation\n\twith\tmonthly\tmonitoring\tcalcium\tand\t25-hydroxy\nvitamin\tD\tlevels,\twhen\trequired,\tmay\tbe\trecommended\tfor\tpatients\twith\tHashimoto’s\tthyroiditis\n(
|
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0.07541957497596741,
0.069036103785038,
0.014866615645587444
] |
(\nLiontiris\tand\tMazokopakis,\t2017\n).\nManagement\tof\tthyroid\tdisorders\tduring\tpregnancy\nThe\tAmerican\tThyroid\tAssociation\trecommendations\ton\tdiagnosis\tand\tmanagement\tof\tthyroid\ndisease\tduring\tpregnancy\tand\tthe\tpostpartum\tperiod\twere\treported\tin\ta\treview\tarticle\n\tin\t2017\twith\nthe\tfollowing\tguidelines\t(\nKalra\tet\tal,\t2017\n).\nHypothyroidism\tand\tpregnancy
|
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] |
Kalra\tet\tal,\t2017\n).\nHypothyroidism\tand\tpregnancy\nLaboratory\tassessment\n1.\t\nTSH\tassessment\tshould\tbe\tbased\ton\tpopulation-based\ttrimester\tspecific\treference\tranges,\ncalculated\tfrom\tdata\tof\thealthy\tpregnant\twomen\twithout\thistory\tof\tthyroid\tdisease,\twith\noptimal\tiodine\tintake,\tand\tnegative\tTPO\tAb\tstatus.\n2.
|
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] |
optimal\tiodine\tintake,\tand\tnegative\tTPO\tAb\tstatus.\n2.\t\nIf\tpregnancy\tspecific\tpopulation-based\tdata\n\tis\tnot\tavailable,\tupper\treference\tlimit\t(URL)\tof\n4.0\tmU/L\tmay\tbe\tused.\n3.\t\nA\tlevel\t0.5mU/L\tlower\tthan\tnonpregnant\tURL\tcan\talso\tbe\ttaken\tas\tURL\tfor\tTSH\tin\npregnancy.\n4.\t\nSerum\tT\n4
|
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0.02185683138668537
] |
pregnancy.\n4.\t\nSerum\tT\n4\n\t(thyroxin)\tis\ta\thighly\treliable\tmarker\tfor\tthyroid\tfunction\tin\tlast\ttrimester\tof\npregnancy.
|
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] |
Preconception\tinvestigations\n1.\t\nTest\tTSH\tin\tall\twomen\tpresenting\twith\tinfertility.\n2.\t\nTest\tTSH\teither\tbefore,\tor\t1\n\tto\t2\tweeks\tafter,\tcontrolled\tovarian\thyper\tstimulation\t(COHS).\n3.\t\nNonpregnant\twomen\twith\tmild\tTSH\televation\tfollowing\tCOHS\tshould\tundergo\trepeat\ntesting\tafter\t2\tto\t4\tweeks.\n4.
|
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0.09110979735851288,
0.09519405663013458,
0.04355725273489952,
0.0024897775147110224
] |
testing\tafter\t2\tto\t4\tweeks.\n4.\t\nTest\tTSH\tat\ttime\tof\tdiagnosis\tof\tpregnancy,\tin\teuthyroid,\tantibody\tpositive\twomen.\nIodine\tintake\n1.\t\nEnsure\tiodine\tintake\tof\t250\tmg/day,\tat\tleast\t3\tmonths\tbefore\tconception.\n2.\t\nSuch\tintake\tis\tnot\trequired\tin\n\twomen\twho\tare\ton\ttreatment\tfor\teither\thypo-\tor\thyper-\nthyroidism.\n3.\t\nAvoid\tiodine\tintake\t>500\tmg/day.\n4.
|
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0.0072959414683282375
] |
thyroidism.\n3.\t\nAvoid\tiodine\tintake\t>500\tmg/day.\n4.\t\nAvoid\tiodine\tcontaining\tsupplements\tin\texcess.\nAdditional\ttherapies\n1.\t\nSelenium\tsupplementation\tis\tnot\trecommended\tfor\ttreatment\tof\tantibody\tpositive\tpregnant\nwomen.\n2.\t\nT\n3\n\tor\tdesiccated\tthyroid\tis\tnot\trecommended\tduring\tpregnancy.\nPolycystic\tovary\tsyndrome\nPolycystic\tovary\tsyndrome\t(PCOS)
|
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] |
Polycystic\tovary\tsyndrome\nPolycystic\tovary\tsyndrome\t(PCOS)\n\tis\ta\tcommon\tendocrine\tdisorder\tof\tunknown\tcause\tthat\taffects\nan\testimated\t3%\tto\t12%\tof\twomen\tof\treproductive\tage\tin\tWestern\tsocieties\t(\nMoran\tet\tal,\t2010\n;\t\nVelez\nand\tMotta,\t2014\n).\tThe\tcondition\tis\tcharacterized\tby\treproductive\tissues\tsuch\tas\tamenorrhea\tor
|
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0.08007476478815079,
0.07914495468139648,
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0.03228706121444702,
0.041767947375774384,
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0.02715984918177128,
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0.051440246403217316,
0.09439264237880707,
0.03692246973514557,
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0.05949629098176956,
0.04459357261657715,
0.14466969668865204,
0.09603247791528702,
-0.005920300725847483
] |
other\tmenstrual\tirregularities,\tanovulation,\tenlarged\tovaries\twith\tmultiple\tcysts,\tand\tinfertility.\tMore\ngeneralized\tsymptoms\tinclude\tinsulin\n\tresistance,\tacne,\thirsutism\t(excessive\tor\tabnormal\tdistribution\nof\thair\tgrowth),\tmale-pattern\tbaldness,\tweight\tgain,\tand\tsleep\tapnea\t(\nTable\t30.3\n).\nTABLE\t30.3
|
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0.06799541413784027,
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0.02967776544392109,
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0.10106146335601807,
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0.10105741769075394,
0.08652472496032715,
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0.044939711689949036,
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0.01127652544528246,
0.11006389558315277,
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0.0028454328421503305,
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0.07241620123386383,
0.1278049349784851,
0.016741057857871056,
0.015067320317029953,
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0.05409801006317139,
0.042192138731479645,
0.07828143239021301,
0.02148648537695408
] |
Table\t30.3\n).\nTABLE\t30.3\nNutrition\tTreatment\tfor\tPolycystic\tOvary\tSyndrome\nObesity\nInstitute\tweight\tmanagement\tprogram\tof\tdiet\tand\texercise.\nInsulin\tresistance\nRestrict\trefined\tcarbohydrates\t(low–glycemic\tindex\tdiet)\tand\ttotal\ncalories.\nIncrease\thigh-fiber\n\tfoods.\nRecommend\tsmall,\tfrequent\tmeals.
|
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] |
Increase\thigh-fiber\n\tfoods.\nRecommend\tsmall,\tfrequent\tmeals.\nMonitor\tcarefully\tto\tascertain\tbenefit\tfrom\thigh-\tversus\tlow-\ncarbohydrate\tdiet.\nConsider\tsupplementation\twith\tchromium\tpicolinate.\nLow\tserum\t25\thydroxy\tvitamin\tD\nAdminister\tvitamin\tD\n3\n\t(cholecalciferol).\nClomiphene-citrate\tresistant\tinfertility\nUse\tshort-term\tNAC\tas\tadjunct.
|
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] |
Use\tshort-term\tNAC\tas\tadjunct.\nLaboratory\tor\tclinical\tevidence\tof\nhypothyroidism\nInstitute\tthyroid\thormone\n\treplacement.\nUse\tfoods\tor\tsupplements\twith\tselenium\tand\tiodine.\nNAC,\tN\n-acetylcysteine.\nPathophysiology\nBiochemical\tand\tendocrine\tabnormalities\tin\twomen\twith\tPCOS\tinclude\ta\thyperandrogenic\tstate\tin
|
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] |
which\tthere\tis\ta\thigher\tconcentration\tof\tfree\tandrogens\t(dehydroepiandrosterone,\ttestosterone,\tand\nandrostenedione)\tand\tdecreased\thepatic\tproduction\tof\tsex\thormone\tbinding\tglobulin\t(\nSirmans\tand\nPate,\t2013\n).\tIn\taddition\tto\tthe\televated\tlevels\tof\tandrogens,\thyperinsulinemia\t(which\tresults\tfrom
|
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] |
insulin\tresistance),\timpaired\tglucose\ttolerance,\tand\thyperlipidemia\tare\tseen.\tHyperandrogenism\tis\nresponsible\tfor\tmany\tof\tthe\tsymptoms\tof\tPCOS,\tsuch\tas\treproductive\tand\tmenstrual\tabnormalities,\nhirsutism,\tand\tacne.\tElevated\tandrogen\tlevels,\tin\tturn,\tappear\tto\tbe\tdue\tin\tpart\tto\thyperinsulinemia,\nwhich
|
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] |
which\n\ttriggers\tthe\tincrease\tin\tandrogen\tproduction.\tThus\tinterventions\tthat\timprove\tinsulin\nresistance\tand\thyperinsulinemia\tmay\treverse\tsome\tof\tthe\tmanifestations\tof\tPCOS.\nThe\tinsulin\tresistance\tseen\tin\t50%\tto\t70%\tof\twomen\twith\tPCOS\tis\tunique\tin\tthat\tit\toccurs
|
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independent\tof\tbody\tweight\tto\tsome\textent\tand\tis\tnot\talways\tcorrected\tby\tweight\tloss.\tIt\tappears\tto\nresult\tfrom\tinsulin\treceptor\tphosphorylation\n\tabnormalities\tin\tan\tinsulin-mediated\tsignaling\tpathway\n(\nSirmans\tand\tPate,\t2013\n).\tConventional\ttreatment\tof\tPCOS\tincludes\tdiet\tand\texercise\tto\tpromote
|
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improvements\tin\thealth,\tincluding\timproved\tinsulin\tsensitivity,\timproved\tmenstrual\n\tregularity,\tbetter\nemotion\tscores\t(on\ta\tquestionnaire\tdesigned\tto\tdetect\tchanges\tin\tquality\tof\tlife),\tand\tdecreased\nmarkers\tof\tinflammation\tcompared\twith\ta\tconventional\tlow-fat\tdiet\twhen\tmatched\tclosely\tfor
|
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macronutrient\tand\tfiber\tcontent\t(\nMarsh\tet\tal,\t2010\n).\nMedical\tmanagement\nHypothyroidism\toccurs\tin\tsome\tcases\tof\tPCOS.\tLaboratory\ttests\tfor\tthyroid\tfunction\tare\tfrequently\nnormal\tin\tpatients\n\twith\tclinical\tevidence\tof\thypothyroidism,\tand\ttreatment\twith\tthyroid\thormone
|
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] |
results\tin\tclinical\timprovement\tin\tmany\tpatients.\tTherefore\tan\tempirical\ttrial\tof\tthyroid\thormone\nshould\tbe\tconsidered\tfor\tpatients\twith\tPCOS\twho\thave\tclinical\tevidence\tof\thypothyroidism.\nThyroid\tantibody\tstatus\tshould\tbe\ttaken\tinto\taccount\twhen\tconsidering\ttreatment\twith\tthyroid\nhormone\tin\twomen\twith\tPCOS.\tMetformin
|
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hormone\tin\twomen\twith\tPCOS.\tMetformin\n\tfrequently\tis\tprescribed\tto\timprove\tinsulin\tresistance,\tand\ntreatment\twith\tthis\tdrug\tmay\tlead\tto\tresumption\tof\tovulation.\tOther\ttherapies\tinclude\tthe\tdrugs\nclomiphene\tcitrate\t(to\tinduce\tovulation)\tand\tspironolactone\t(an\tantiandrogen),\tas\twell\tas\toral
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contraceptives\t(to\ttreat\tmenstrual\tirregularities\tand\thirsutism).\nMedical\tnutrition\ttherapy\nNutritional\tinterventions\tthat\tmay\tbe\tbeneficial\tfor\n\twomen\twith\tPCOS\tinclude\tdietary\tmodifications\ndesigned\tto\tenhance\tinsulin\tsensitivity.\tThis\tincludes\trecommending\ta\tlow-glycemic\tload\tdiet,
|
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consuming\thigh-fiber\tfoods,\tand\tpreventing\texcess\tweight\tgain\tvia\tcalorie\tawareness\tand\tpromotion\nof\tphysical\tactivity.\tEating\ta\tdiet\tthat\tkeeps\tblood\tsugar\tbalanced,\tincluding\tcombining\tlow-glycemic\ncarbohydrates\twith\tprotein\tand\teating\tsmaller\tmeals\tmay\talso\n\tbe\tof\tbenefit.\tIt\tis\timportant\tto\tensure
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] |
be\tof\tbenefit.\tIt\tis\timportant\tto\tensure\noptimal\tnutrient\tstatus\tfor\tvitamin\tD\tand\tto\tscreen\tfor\tsub\toptimal\tthyroid\tfunction\t(see\t\nTable\t30.3\n).\nComplementary\tand\tintegrative\tapproaches\nA\tcritical\treview\tof\tthe\t12\trandomized\tcontrolled\ttrials\t(RCTs)\thighlights\tthat\toral\tadministration\tof
|
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] |
myoinositol,\talone\tor\tin\tcombination\twith\tD-chiro-inositol,\ttwo\tstereoisomers\tof\tinositol\t(an\nintracellular\n\tmessenger\tmolecule),\tis\tcapable\tof\trestoring\tinsulin\tsensitivity\tand\tspontaneous\novulation\tand\timproving\tfertility\tin\twomen\twith\tPCOS.\tThese\tRCT\tstudies\tsupport\tthe\thypothesis\tof
|
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] |
a\tprimary\trole\tof\tinositol\tphosphoglycans\t(IPGs)\tas\tsecond\tmessengers\tof\tinsulin\tsignaling\tand\ndemonstrate\tthat\tmyoinositol\tsupplementation\tbeneficially\taffects\tthe\thormonal\tmilieu\tof\tPCOS\npatients.\tIndeed,\tthese\ttrials\n\tprovide\tevidence\tthat\tmyoinositol\treduces\tinsulin\tlevels,\tprobably
|
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0.14840304851531982,
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] |
provide\tevidence\tthat\tmyoinositol\treduces\tinsulin\tlevels,\tprobably\neither\tby\tconversion\tto\tD-chiro-inositol\t(via\tthe\tepimerase\tenzyme)\tor\tby\tserving\tas\tsubstrate\tfor\tthe\nformation\tof\tIPGs\tand\tD-chiro-inositol-containing\tIPGs,\twhich\twould\tin\tturn\tamplify\tinsulin\tsignaling\n(\nUnfer\tet\tal,\t2016\n).
|
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(\nUnfer\tet\tal,\t2016\n).\nN-Acetylcysteine\t(NAC)\tis\tan\tamino\tacid–derived\tsupplement\tthat\tmay\thelp\timprove\tinsulin\nreceptor\tactivity,\n\treduce\ttestosterone,\tand\tincrease\tspontaneous\tovulation\tin\tPCOS.\tIn\ta\trecent\nreview\tof\teight\tRCTs\tthat\tcompared\tmetformin\tor\tplacebo\tand\tNAC,\twomen\twho\ttook\tNAC\twere
|
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] |
more\tlikely\tto\tachieve\tpregnancy\tand\tto\tdeliver\ta\tlive\tbaby,\tespecially\tif\tresistant\tto\tthe\tfertility\tdrug\nclomiphene\tcitrate.\tThere\twas\tno\tbenefit\tfrom\tNAC\tfor\timproving\tmenstrual\tregularity,\tacne,\nhirsutism,\tbody\tmass\tindex\t(BMI),\n\tfasting\tinsulin,\tor\tfasting\tglucose.\tThe\ttypical\tdose\tof\tNAC\twas\n1200\tto\t1800\tmg/day\t(\nThakker\tet\tal,\t2015\n).
|
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] |
1200\tto\t1800\tmg/day\t(\nThakker\tet\tal,\t2015\n).\nHyperthyroidism\nGraves’\tdisease\n\tis\tan\tautoimmune\tdisease\tin\twhich\tthe\tthyroid\tis\tdiffusely\tenlarged\t(goiter)\tand\noveractive,\tproducing\tan\texcessive\tamount\tof\tthyroid\thormones.\tIt\tis\tthe\tmost\tcommon\tcause\tof\nhyperthyroidism\n\t(overactive\tthyroid)\tin\tthe\tUnited\tStates.\tPhysical\tsymptoms
|
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] |
(overactive\tthyroid)\tin\tthe\tUnited\tStates.\tPhysical\tsymptoms\n\tfrequently\tinclude\nred,\tdry,\tswollen,\tpuffy,\tand\tbulging\teyes\t(exophthalmos),\theat\tintolerance,\tdifficulty\tsleeping,\tand\nanxiety\t(see\t\nBox\t30.2\n).\tHowever,\tthe\tmost\tcommon\tsign\tof\tGraves’\tdisease\tis\tgoiter\tor\tthyroid\nenlargement\t(\nFig.\t30.4
|
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0.03526090085506439,
0.05958927050232887,
0.08641933649778366,
0.03998171165585518
] |
enlargement\t(\nFig.\t30.4\n).\tThe\texcessive\tthyroid\thormones\tmay\tcause\ta\tserious\tmetabolic\timbalance\ncalled\t\nthyrotoxicosis\n.\tThe\tprevalence\tof\tmaternal\tthyrotoxicosis\tis\tapproximately\t1\tcase\n\tper\t1500\npersons,\twith\tmaternal\tGraves’\tdisease\tbeing\tthe\tmost\tcommon\tcause\t(80%\tto\t85%)\t(\nAmerican\nThyroid\tAssociation,\t2019\n).
|
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] |
FIG.\t30.4\nA,\n\tExophthalmos.\t(From\tSPL/Photo\tResearchers,\tInc.)\t\nB,\n\tThyroid\tenlargement.\n\t\nSource:\n\t(From\tBuck\tC:\n2011\tICD-9-CM,\tfor\tHospitals\n,\tvols\t1-3,\tSt\tLouis,\t2011,\tWB\tSaunders.)\nPathophysiology\nCommonly,\tpatients\thave\ta\tfamily\thistory\tinvolving\ta\twide\tspectrum\tof\tautoimmune\tthyroid\tdiseases,
|
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] |
such\tas\tGraves’\tdisease,\tHashimoto’s\tthyroiditis,\tor\tpostpartum\tthyroiditis.\tIn\tGraves’\tdisease,\n\tthe\nTRH\treceptor\titself\tis\tthe\tprimary\tautoantigen\tand\tis\tresponsible\tfor\tthe\tmanifestation\tof\nhyperthyroidism.\tThe\tthyroid\tgland\tis\tunder\tcontinuous\tstimulation\tby\tcirculating\tautoantibodies
|
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] |
against\tthe\tTRH\treceptor,\tand\tpituitary\tTSH\tsecretion\tis\tsuppressed\tbecause\tof\tthe\tincreased\nproduction\tof\tthyroid\thormones.\tThese\tthyroid-stimulating\tantibodies\tcause\trelease\tof\tthyroid\nhormone\tand\tTg,\tand\n\tthey\talso\tstimulate\tiodine\tuptake,\tprotein\tsynthesis,\tand\tthyroid\tgland\tgrowth.
|
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The\tTg\tand\tTPO\tAbs\tappear\tto\thave\tlittle\trole\tin\tGraves’\tdisease.\tHowever,\tas\tmentioned\tearlier,\nthey\tare\tmarkers\tof\tHashimoto’s\tthyroiditis\tautoimmune\tdisease\tagainst\tthe\tthyroid.\tA\tTSH\tantibody\n—typically\treferred\tto\tas\tthyroid-stimulating\timmunoglobulin—test\tis\tused\tto\tidentify\nhyperthyroidism,\tor\tGraves’\tdisease.\nTriggers
|
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] |
hyperthyroidism,\tor\tGraves’\tdisease.\nTriggers\nGraves’\tdisease\tis\tan\tautoimmune\tdisorder,\tinfluenced\tby\ta\tcombination\tof\tenvironmental\tand\ngenetic\tfactors.\tGenetic\tfactors\tcontribute\tto\tapproximately\t20%\tto\t30%\tof\toverall\tsusceptibility.\nOther\tfactors\tinclude\tinfection,\texcessive\tiodide\tintake,\tstress,\tfemale\tgender,\tsteroids,\tand\ttoxins.
|
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] |
Smoking\thas\tbeen\timplicated\tin\tthe\tworsening\tof\tGraves’\tophthalmopathy\t(eye\tdisease)\t(\nWiersinga,\n2016\n).\tGraves’\tdisease\talso\thas\tbeen\tassociated\twith\tinfectious\tagents\tsuch\tas\t\nYersinia\nenterocolitica\n\tand\t\nBorrelia\tburgdorferi\n,\tas\tthese\tbacteria\thave\tbeen\tshown\tto\tcontain\thigh-affinity\nbinding\tsites\tfor\tthe\thormone\tTSH\t(\nHargreaves\tet\tal,\t2013
|
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binding\tsites\tfor\tthe\thormone\tTSH\t(\nHargreaves\tet\tal,\t2013\n).\nGenetics.\nSeveral\tautoimmune\tthyroid\tdisease\tsusceptibility\tgenes\thave\tbeen\tidentified\tand\tappear\tto\tbe\nspecific\tto\teither\tGraves’\tdisease\tor\tHashimoto’s\n\tthyroiditis,\twhereas\tothers\tconfer\tsusceptibility\tto
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] |
thyroiditis,\twhereas\tothers\tconfer\tsusceptibility\tto\nboth\tconditions.\tThe\tgenetic\tpredisposition\tto\tthyroid\tautoimmunity\tmay\tinteract\twith\tenvironmental\nfactors\tor\tevents\tto\tprecipitate\tthe\tonset\tof\tGraves’\tdisease.\tHLA-DRB1\tand\tHLA-DQB1\tappear\tto\tbe\nassociated\twith\tGraves’\tdisease\tsusceptibility.\nStress.
|
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] |
associated\twith\tGraves’\tdisease\tsusceptibility.\nStress.\nStress\tcan\tbe\ta\tfactor\tfor\tthyroid\tautoimmunity.\tAcute\tstress-induced\timmunosuppression\n\tmay\tbe\nfollowed\tby\timmune\tsystem\thyperactivity,\twhich\tcould\tprecipitate\tautoimmune\tthyroid\tdisease.\tThis\nmay\toccur\tduring\tthe\tpostpartum\tperiod,\tin\twhich\tGraves’\tdisease\tmay\toccur\t3\tto\t9\tmonths\tafter
|
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] |
delivery.\tEstrogen\tmay\tinfluence\tthe\timmune\tsystem,\tparticularly\tthe\tbeta-cells.\tTrauma\tto\tthe\nthyroid\talso\thas\tbeen\treported\tto\tbe\tassociated\twith\tGraves’\tdisease.\tThis\tmay\tinclude\tsurgery\tof\nthe\n\tthyroid\tgland,\tpercutaneous\tinjection\tof\tethanol,\tand\tinfarction\tof\ta\tthyroid\tadenoma.\nMedical\tmanagement
|
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0.039649598300457
] |
Medical\tmanagement\nFor\tpatients\twith\tsustained\tforms\tof\thyperthyroidism,\tsuch\tas\tGraves’\tdisease\tor\ttoxic\tnodular\ngoiter,\tantithyroid\tmedications\tcan\tbe\tused.\tThe\tgoal\twith\tthis\tform\tof\tdrug\ttherapy\tis\tto\tprevent\tthe\nthyroid\tfrom\tproducing\thormones\t(\nTable\t30.4\n).
|
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] |
TABLE\t30.4\nTreatments\tfor\tHyperthyroidism\nMedication\nBrand\tName\nMedication\nGeneric\tName\nUse\tand\tComments\nTapazole\nMethimazole\n(MMI)\nBoth\tdrugs\tinterfere\twith\tthe\tthyroid\tgland’s\tproduction\tof\thormones.\nBoth\thave\tside\teffects,\twhich\tinclude\trash,\titching,\tjoint\tpain,\tand\nfever.\nNorthyx\nPropylthiouracil\n(PTU)
|
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fever.\nNorthyx\nPropylthiouracil\n(PTU)\nLiver\tinflammation\tor\treduction\tin\twhite\tblood\tcells\tmay\toccur.\nUnderlying\thyperthyroidism\tcan\treturn\twhen\tpatient\n\tis\tno\tlonger\ntaking\tthe\tmedication.\nRadioactive\niodine\nThis\tis\tthe\tmost\twidely\trecommended\tpermanent\ttreatment\tof\nhyperthyroidism.\nThyroid\tcells\tabsorb\tradioactive\tiodine,\twhich\tdamages\tor\tkills
|
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Thyroid\tcells\tabsorb\tradioactive\tiodine,\twhich\tdamages\tor\tkills\nthem.\nIf\ttoo\tmany\tof\tthe\tthyroid\tcells\tare\tdamaged,\tremaining\tthyroid\ndoes\tnot\tproduce\tenough\thormone,\tresulting\tin\thypothyroidism,\nand\tsupplemental\tthyroid\thormone\tmay\tbe\tnecessary.\nSurgical\tTreatment\n•\t\nPartial\tor\tcomplete\tremoval\tof\tthe\tthyroid\n•
|
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Surgical\tTreatment\n•\t\nPartial\tor\tcomplete\tremoval\tof\tthe\tthyroid\n•\t\nNot\tas\tcommon\tas\tpharmacologic\tmodes\tof\ttreatment\nThe\teffects\tof\timmunotherapy\tdrugs\tare\talso\tbeing\tevaluated\t(\nSalvi,\t2014\n)\t(see\t\nPathophysiology\nand\tCare\tManagement\tAlgorithm:\n\tThyroid\tDysfunction\n).\nManaging\timbalances\tof\tthe\thypothalamus-pituitary-thyroid\taxis
|
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).\nManaging\timbalances\tof\tthe\thypothalamus-pituitary-thyroid\taxis\nThe\tthyroid\thas\ta\trelationship\tto\thypothalamic,\tpituitary,\timmune,\tadrenal,\n\tand\tcardiovascular\nfunctions\tthat\taffect\tclinical,\tcellular,\tand\tmolecular\toutcomes.\tA\tchecklist\tof\tconsiderations\tis\tfound\nin\t\nBox\t30.3\n\tand\tis\tdiscussed\there.\nBOX\t30.3
|
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] |
in\t\nBox\t30.3\n\tand\tis\tdiscussed\there.\nBOX\t30.3\nFactors\tPromoting\tThyroid\tHealth\tin\tAdults\nConsider\nProtein:\t0.8\tg/kg/day\nIodine\t(once\tautoimmune\tdisease\thas\tbeen\truled\tout):\t150\tmcg/day\nSelenium\t(as\tL-selenomethionine):\t75-200\tmcg/day\nZinc\t(as\tzinc\tcitrate):\n\t10\tmg/day\nVitamin\tD\t(as\tD\n3\n\tor\tcholecalciferol):\t1000\tIU/day
|
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] |
10\tmg/day\nVitamin\tD\t(as\tD\n3\n\tor\tcholecalciferol):\t1000\tIU/day\nVitamin\tE\t(as\tD-alpha\ttocopherol\tsuccinate):\t100\tIU/day\nVitamin\tC\t(as\tascorbic\tacid):\t100-500\tmg/day\nGuggulsterones\t(from\tguggul\textract):100\tmg/day\nAshwaganda:\t100\tmg/day\nReduce\tor\teliminate\nGluten\t(found\tin\twheat,\trye,\toats,\tand\tbarley)\nProcessed\tsoy
|
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] |
Gluten\t(found\tin\twheat,\trye,\toats,\tand\tbarley)\nProcessed\tsoy\nExcessive\tuncooked\tgoitrogenic\tfoods\nStress\nProvide\tadequate\n\tprecursors\tfor\tthe\tformation\tof\tT\n4\n.\nIodide\tis\ta\tlimiting\tnutrient\tin\tmany\tindividuals\tfor\tthe\tproduction\tof\tT\n4\n.\tAdequate\tlevels\tof\torganic
|
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] |
4\n.\tAdequate\tlevels\tof\torganic\niodide,\twhich\tcan\tcome\tfrom\tsea\tvegetables,\tiodized\tsalt,\tand\tseafood,\tare\timportant\tin\tT\n4\nproduction.\tAdequate\tdietary\tprotein\tintake\tis\timportant\tin\testablishing\tproper\tprotein\tcalorie\nnutrition.\tSupplementation\twith\ttyrosine\tdoes\tnot\tappear\tto\thave\ta\tbeneficial\n\teffect\ton\televating\nthyroid\thormones.
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] |
effect\ton\televating\nthyroid\thormones.\nReduce\tantithyroidal\tantibodies.\nA\tvariety\tof\tfood\tantigens\tcould\tinduce\tantibodies\tthat\tcross-react\twith\tthe\tthyroid\tgland.\tA\tfood\nelimination\tdiet\tusing\tgluten-free\tgrains\tand\tpossible\telimination\tof\tcasein,\tthe\tpredominant\tmilk
|
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] |
protein,\tmay\tbe\tconsidered\tfor\thypothyroidism\tof\tunexplained\torigin.\tIt\talso\thas\tbeen\tsuggested\tthat\nenvironmental\ttoxins\tsuch\n\tas\tcadmium\tand\tlead\tmay\tplay\ta\trole\tin\tinducing\tAIT\tand\tthyroid\ndysfunction\t(\nBajaj\tet\tal,\t2016\n).\tImplementing\tnutritional\tsupport\tand\tproviding\tadequate\tlevels\tof
|
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).\tImplementing\tnutritional\tsupport\tand\tproviding\tadequate\tlevels\tof\nvitamin\tD\tand\tselenium\tto\tsupport\tthe\timmune\tsystem\tmay\tbe\tbeneficial.\nImprove\tthe\tconversion\tof\tT\n4\n\tto\tT\n3\n.\nNutritional\tagents\tthat\thelp\tsupport\tproper\tdeiodination\tby\tthe\ttype\t1,\t5-deiodinase\tenzyme\tinclude\nselenium\t(as\tL-selenomethionine)
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selenium\t(as\tL-selenomethionine)\n\tand\tzinc\t(as\tzinc\tglycinate\tor\tzinc\tcitrate).\tHuman\tstudies\nrepeatedly\thave\tdemonstrated\tconsequent\treduced\tconcentrations\tof\tthyroid\thormones\twhen\ta\tzinc
|
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] |
deficiency\tis\tpresent\t(\nBlazewicz\tet\tal,\t2010\n).\tIn\tchildren\twith\tDown’s\tsyndrome,\tzinc\tsulfate\tmay\nreduce\tthyroidal\tantibodies,\timprove\tthyroid\tfunction,\tand\treduce\tthe\tincidence\tof\tsubclinical\nhypothyroidism\t(\nMazurek\tand\tWyka,\t2016\n).\nZinc\tsupplementation\n\twas\talso\tshown\tto\tameliorate\thazards\tof\tradiation\ton\tthyroid\thormone\nindices\t(
|
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] |
indices\t(\nAl\tet\tal,\t2016\n).\nEnhance\tT\n3\n\tinfluence\ton\tmitochondrial\tfunction.\nA\tnumber\tof\timportant\tnutritional\trelationships\timprove\tthyroid\thormones’\teffects\ton\tthe\nmitochondria,\tthe\torganelles\tresponsible\tfor\tthe\tmajority\tof\tcellular\tenergy\tproduction\t(\nLanni\tet\tal,\n2016\n).\tSelenium\tsupplementation\tin\tanimals\tcan\timprove\tthe\n\tproduction\tof\tT\n3
|
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] |
production\tof\tT\n3\n\tand\tlower\nautoantibodies\tto\tthyroid\thormones\twhile\timproving\tenergy\tproduction.\tSupplementation\twith\nselenomethionine\tresults\tin\timproved\tdeiodination\tof\tT\n4\n,\twhich\tmay\timprove\tATP\tformation\tby\nsupporting\timproved\tmitochondrial\tactivity.\tFood\tsources\tof\tselenium\tinclude\tthe\tBrazil\tnut,
|
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] |
snapper,\tcod,\thalibut,\tyellowfin\ttuna,\tsalmon,\tsardines,\tshrimp,\tmushrooms,\tand\tbarley.\nMonitor\tuse\tof\tbotanical\tproducts.\nBased\ton\tanimal\tstudies,\tit\tappears\tthat\tcertain\tbotanical\tpreparations\tinfluence\tthyroid\tactivity.\tThe\nmost\tsignificant\tproducts\tinclude\t\nCommiphora\tmukul\n\t(guggulsterones,\tfrom\tguggul\textract)\tand\nWithania\tsomnifera
|
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] |
(guggulsterones,\tfrom\tguggul\textract)\tand\nWithania\tsomnifera\n\t(ashwagandha).\t\nC.\tmukul\n\tdemonstrates\tstrong\tthyroid\tstimulatory\taction.\tIts\nadministration\t(1\tmg/100\tg\tbody\tweight)\tincreases\tiodine\tuptake\tby\tthe\n\tthyroid,\tincreases\tTPO\nactivity,\tand\tdecreases\tlipid\tperoxidation,\tsuggesting\tthat\tincreased\tperipheral\tgeneration\tof\tT\n3
|
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] |
3\nmight\tbe\tmediated\tby\tthis\tplant’s\tantioxidant\teffects.\t\nW.\tsomnifera\n\t(ashwagandha)\troot\textract\t(1.4\ng/kg)\tmay\tincrease\tT\n3\n\tand\tT\n4\n\tconcentrations\twithout\tchanging\t5-deiodinase\tactivity\t(\nSharma\tet\tal,\n2018\n).\nAvoid\tdisruption\tof\tthyroid\thormone\tmetabolism\tfrom\tflavonoids.\nFlavonoids,
|
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] |
Flavonoids,\n\tnatural\tand\tsynthetic,\thave\tthe\tpotential\tto\tdisrupt\tthyroid\thormone\tmetabolism.\nSynthetic\tflavonoid\tderivatives\tcan\tdecrease\tserum\tT\n4\n\tconcentrations\tand\tinhibit\tthe\tconversion\tof\nT\n4\n\tto\tT\n3\n\tand\tthe\tmetabolic\tclearance\tof\trT\n3\n\tby\tthe\tselenium-dependent\t5-deiodinase.\tNaturally
|
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3\n\tby\tthe\tselenium-dependent\t5-deiodinase.\tNaturally\noccurring\tflavonoids\tappear\tto\thave\ta\tsimilar\tinhibitory\teffect.\tOf\tthe\tnaturally\toccurring\tflavonoids,\nluteolin\t(most\toften\n\tfound\tin\tleaves,\tbut\talso\tseen\tin\tcelery,\tthyme,\tdandelion,\tgreen\tpepper,\tthyme,
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perilla,\tchamomile\ttea,\tcarrots,\tolive\toil,\tpeppermint,\trosemary,\tand\toregano)\tis\tthe\tmost\tactive\ninhibitor\tof\t5-deiodinase\tactivity.\tBecause\tisolated\tor\tconcentrated\tflavonoids\tare\tincreasingly\tused\nas\ttherapeutic\tinterventions,\tmore\tresearch\ton\tthe\tpotential\tinfluence\tof\tthese\tsubstances\ton\tthyroid\nhormone\tmetabolism\n\tis\tdesirable\t(
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hormone\tmetabolism\n\tis\tdesirable\t(\nGonçalves\tet\tal,\t2013\n).\tHowever,\tin\tpatients\twith\tthyroid\tcancer\nwho\thave\treduced\tability\tto\tuptake\tiodide,\tflavonoids\tsuch\tas\trutin\tand\tapigenin\t(found\tin\nasparagus,\tfigs,\tand\tgreen\tand\tunpeeled\tapples)\tare\table\tto\tincrease\tiodide\tuptake\tand\tmay\tbe
|
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useful\tand\tadjuvant\tin\tradioiodine\ttherapy\tsince\tthis\tflavonoid\tincreased\tthyroid\tuptake\twithout\naffecting\tadversely\taffecting\tthyroid\n\tfunction\t(\nGonçalves\tet\tal,\t2013\n;\t\nGonçalves\tet\tal,\t2017\n).\nUse\tcaution\twith\tsupplements.\nLipoic\tacid\treduces\tthe\tconversion\tof\tT\n4\n\tto\tT\n3\n.\tBecause\tit\tis\tusually\tnot\ta\ttherapeutic\tadvantage\tto
|
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] |
4\n\tto\tT\n3\n.\tBecause\tit\tis\tusually\tnot\ta\ttherapeutic\tadvantage\tto\ndecrease\tperipheral\tactivation\tof\tT\n3\n\tsubsequent\tto\tT\n4\n\ttherapy,\tuse\tof\tlipoic\tacid\tsupplements\tin\nhypothyroid\tpatients\treceiving\texogenous\thormone\ttherapy\tshould\tbe\tapproached\twith\tcaution.\nHowever,\tlipoic
|
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] |
However,\tlipoic\n\tacid\thas\tbeen\tmore\trecently\tshown\tto\tbe\ta\tpotential\tadjuvant\ttherapy\tfor\tadvanced\nthyroid\tcancer\tbecause\tit\tcould\tactivate\tadenosine\tmonophosphate\tactivated\tprotein\tkinase\t(AMPK)\nand\tinhibit\ttransforming\tgrowth\tfactor\tβ-TGFβ\tpathway\tby\treducing\tcancer\tcell\tmigration\tand\nsuppressing\ttumor\tgrowth\t(\nJeon\tet\tal,\t2016\n).
|
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] |
suppressing\ttumor\tgrowth\t(\nJeon\tet\tal,\t2016\n).\nMaintain\tvitamin\tsufficiency.\nOne\tnutrient\tthat\tis\tcritically\timportant\tfor\n\testablishing\timmune\tbalance\tand\tpreventing\tthe\nproduction\tof\tautoantibodies\tis\tvitamin\tD.\tVitamin\tD\tis\tconsidered\ta\tprohormone\twith
|
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] |
antiproliferative,\tdifferentiating,\tand\timmunosuppressive\tactivities.\tVitamin\tD\tis\tan\teffective\timmune\nmodulator\tand\tmay\tsuppress\tthe\tdevelopment\tof\tautoimmune\tdiseases,\tsuch\tas\tarthritis\tand\nmultiple\tsclerosis\t(\nBaeke\tet\tal,\t2010\n).\tConversely,\ta\tvitamin\tD\tdeficiency\n\tis\tassociated\twith
|
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] |
).\tConversely,\ta\tvitamin\tD\tdeficiency\n\tis\tassociated\twith\nnumerous\tautoimmune\tconditions,\tincluding\tHashimoto’s\tthyroiditis.\tMore\tthan\t90%\tof\tpeople\twith\nautoimmune\tthyroid\tdisease\thave\ta\tgenetic\tdefect\taffecting\ttheir\tability\tto\tmetabolize\tvitamin\tD\n(\nFeng\tet\tal,\t2013\n;\t\nKivity\tet\tal,\t2011
|
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] |
(\nFeng\tet\tal,\t2013\n;\t\nKivity\tet\tal,\t2011\n).\tVitamin\tD\talso\tappears\tto\twork\twith\tother\tnutritional\tfactors\tto\nhelp\tregulate\timmune\tsensitivity\tand\tmay\tprotect\tagainst\tdevelopment\tof\tautoantibodies.\n\tAfter\nexposure\tto\theavy\tmetals,\tdecreases\tin\ta\tvariety\tof\thepatic\tantioxidant\tlipid\tperoxidation\t(the
|
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oxidative\tdegradation\tof\tlipids)\tsystems\thave\tbeen\tobserved.\tAscorbic\tacid\thas\tbeen\tshown\tto\tbe\neffective\tin\tpreventing\tlead-induced\tdecreases\tin\tT\n3\n\tand\thepatic\t5-deiodination\tin\tan\tanimal\tmodel\n(\nAmbali\tet\tal,\t2011\n).\nAdrenal\tdisorders\nCushing’s\tsyndrome\nIn\tCushing’s\tsyndrome,\ttoo\tmuch
|
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0.08626903593540192,
0.12084038555622101,
0.09531185775995255,
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] |
Adrenal\tdisorders\nCushing’s\tsyndrome\nIn\tCushing’s\tsyndrome,\ttoo\tmuch\n\tcortisol\tremains\tin\tthe\tbloodstream\tover\ta\tlong\tperiod.\tThe\nexogenous\tform\toccurs\twhen\tindividuals\ttake\tsteroids\tor\tother\tsimilar\tmedications\tand\tceases\twhen\nthe\tmedication\tis\tstopped.\tEndogenous\tCushing’s\tsyndrome\tis\trare\tand\toccurs\tas\tthe\tresult\tof\ta
|
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] |
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