Hashimotos, Hypothyroid, Symptoms, Signs, Correlations

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The most common cause of Hypothyroidism is Hashimotos disease, with the association of anti-thyroid peroxidase (aniTPO) antibodies and the development of autoimmune hypothyroidism present  (Duere 2008, p.805). The progression of subclinical hypothyroidism often presents with elevated TSH alongside in range thyroid hormone levels (Duere 2008, p.805). Prevalence of antiTPO is often higher in a TSH range of above 2.5 (Sofia 2016, p.111). Those with upper-normal TSH show the prevalence of antiTPO, with a high-normal TSH having more clinical relevance in women (Sofia 2016, p.111).

Autoimmune thyroid disease causes altered thyroid gland function by cell-mediated and humoral actions as well as causing cellular damage. Cellular damage results in sensitized T-lymphocytes or autoantibodies that bind to thyroid cell membranes causing cell death and inflammatory reactions (Spencer 2016). The action of the stimulating or blocking affect this has on cell membrane receptors leads to alterations in thyroid gland function (Spencer 2016). Three auto antigens become involved in autoimmune thyroid disease, Thyroperoxidase (TPO), the TSH receptor and Thyroglobulin and are often used in the diagnosis of autoimmune thyroid disorders (Spencer 2016). TSH receptor autoantibodies are heterogeneous and mimic TSH action.  When this action antagonises the action of TSH, this causes hypothyroidism (Spencer 2016). TPOAb are involved in the destructive process of the tissues associated with hypothyroidism as seen in Hashimotos disease (Spencer 2016). Hence the appearance of TPOAb correlating with the development of thyroid dysfunction (Spencer 2016)

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Analysis

Fatigue is a common aetiology of endocrine dysfunction, hormone interactions, releasing factors and regulation of inflammation (Kaltsas p.393). Clients can commonly present in clinic with anxiety disorder and an increased prevalence of mood disorder is seen in patients with overt thyroid disease. Adequate levels of thyroid hormone are critical for normal brain function (Shinkov 2016, p.25). Proper function of the brain involves transport and metabolism of T4, 2 deiodinase being one of the enzymes responsible for regulating T3 and T4 in the brain (Hage 2012). All T4 in the brain is derived from serum, therefore thyroid hormones are transported across the blood brain barrier and are crucial for thyroid action in the brain (Shinkov 2016, p.25).

There are several proteins capable of transporting thyroid hormone such as Organic anion transporting polypeptide (OATP) and Monocarboxylate (MCT8), MCT8 has been characterised as an active thyroid hormone transporter with its mutations leading to brain disorders and irregularities in mood, brain development, cognitive impairment and depression (Shinkov 2016, p.25). OATP also plays a significant role in delivering serum T4 to the brain. OATP1C1 is seen to up-regulate hypothyroid and down-regulate hyperthyroid, hence any changes in the transporters function will directly influence thyroid hormone transport and cause a shift in regularities of the brain (Deure 2016, p.805), (Shinkov 2016, p.26). This could explain fatigue, depression and changes in mood as are often presented in thyroid disease.

The association of Hashimoto symptoms are linked to autoimmune processes such as inflammatory bowel disease, anaemia, celiac disease and diabetes (Ebert 2010). Symptos such as fatigue, dry skin and hair, intolerance to cold, inflammatory bowel symptoms, excessive thirst and deficiency in iron. Iron playing an important role in thyroid hormone metabolism (Khatiwada 2016).

Secretion of acid within the Gastrointestinal Tract can often be reduced in hypothyroidism, this often is correlated to the changes that take place within the gastric mucosa. Hashimotos disease is associated with reduced acid output relating to a high incidence of parietal cell antibodies, the epithelial cells that secrete hydrochloric acid and intrinsic factor. This reduced output linking to autoimmune conditions such as gastritis or reduction of gastrin levels that affect gastric emptying because of the damage to smooth muscle (Ebert 2010, p.403).

Small intestinal bacterial overgrowth can be seen in a majority of patients with hypothyroidism. Thyroid hormone dysregulation can also result in diminished motility of the oesophagus, stomach, colon and small intestine (Ebert 2010, p.403). This can explain abdominal discomfort, flatulence and bloating in some cases!

A Decrease in stool frequency, often constipation  can be noted in hypothyroidism sometimes due to the layers of the GIT separating and causing muscle degeneration (Ebert 2010, p.403).

The thyroid is responsible for regulating energy expenditure and metabolism with the production of thyroid hormone being regulated via the hypothalamic-pituitary-thyroid (Mebis 2009). The activation of thyrotrophic-releasing hormone (TRH) within the hypothalamus increases thyroid hormone (T4/T3) (Munzberg 2016, p.173). Thyroid hormone acts on many tissues to promote cellular metabolism and energy expenditure and as such is an important regulator of Basal metabolic rate  (Munzberg 2016, p. 174). The changes that occur in nutritional state or temperature lead to the activity of TRH neurons within the hypothalamus. This results in release of thyroid hormones from the gland making TRH neurons and HPT axis directly involved in the regulation of energy expenditure within the body and its response to changes both internally and externally (Munzberg 2016, p. 175).

In regards to fluid retention and persistent thirst, it is seen that the anterior hypothalamus contains the primary hormone Arginine vasopressin (AVP) that controls renal water clearance, synthesized within cell bodies of the paraventricular nuclei (PVN). Axons created from these nuclei project inside the posterior pituitary where it is stored and released in response to stimulation of the central osmoreceptors, detecting change in osmotic pressure (Stanchenfield 2010, p.2011).

Within the anterior hypothalamus, it is indication that thirst stimulation is regulated here (Stanchenfield 2010, p.2011). Any changes in central volume such as inflammation, stress and thyroid hormone irregularities, can initiate a response including thirst sensation, sympathetic nervous system activity, sodium appetite and renin-angiotensin-aldosterone system activity, thus affecting body fluid regulation and thirst mechanisms (Stanchenfield 2010, p.2011).

Age, Menorrhagia and irregular menses can also be considered in patients of  post menopausal age, oestrogen-related osmotic AVP threshold can be linked with water and sodium retention and urine output can become reduced, resulting in greater overall fluid retention (Stanchenfield 2010, p.2011)

Frequent dosages of antibiotics can also be the cause of lowered immunity and an imbalance of microflora. All immune cells have receptor sites for thyroid hormone. In a thyroid deficient state, the immune response becomes affected because of the thyroid hormones influence on the activity of immunity and modulation of immune cell cytokine release (Popko 2015, p.473). Immune cells require thyroid hormone for regulation and maturation of T and B Cells (Popko 2015, p.473). Thyroid hormones dampen cytokine load, causing the receptor sites to stop responding effecting the conversion of T4 to T3 and the receptor sites response leading to systemic inflammation (Popko 2015, p.474).  This cycle creates autoimmune responses that result in an increase of cytokine load, directly impacting on thyroid metabolism (Popko 2015, p.473). The impact on thyroid metabolism suppresses TSH, making the receptors less responsive by decreasing the conversion of thyroid hormones, this explaining the in some client why low immunity is common (Popko 2015, p.473).

Naturopathy can help support the body through its natural healing abilities through herbs, nutrition and lifestyle.

Below are some simple herbal aims that we can naturopaths can help with to name a few

Herbal Treatment Aims

  • Improve fatigue, brain function, anxiety, depression, and forgetfulness.
  • Help client adapt to stress
  • Modulate Thyroid hormones by helping up-regulate T4
  • Improve energy and sleep
  • Improve GIT symptoms and gastric motility

<3Like what you are reading? want to know more or intrigued how Naturopathy can help? Contact me, I’d love to hear from you!

In health and with love

Sarah Whitworth

sarah@forevernatural.com.au

 

 

 

 

 

 

 

 

 

 

 

 

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