Hypothyroidism

Hypothyroidism results from deficient production of thyroid hormone by the thyroid gland. Since the thyroid hormones regulate metabolism in every cell of the body, a deficiency can affect virtually all body functions. Deficiency of thyroid hormones can result from lack of stimulation by the pituitary gland, defective hormone synthesis or impaired cellular conversion of T4 to T3. No matter what the cause, symptoms such as low energy, fatigue, cold hands and feet, muscle pain, depression and cognitive deficits are common.

 Primary hypothyroidism is caused by an inherent inability of the thyroid gland to produce a sufficient amount of thyroid hormone. About 95% of overt hypothyroidism is primary. Iodine deficiency is the most common cause of primary hypothyroidism. The second most common cause is referred to as “post-theraputic hypothyroidism” due to surgery or radiation therapy for hyperthyroidism. However, primary hypothyroidism can also result from genetic defects, inhibition by drugs or chemicals, cancer, and iodine deficiency or excess.

In any case, the loss of functional tissue leads to a decrease production of TH to which the pituitary responds with an increased production of TSH which increases the synthesis of thyroglobulin, which may lead to thyroid enlargement and goiter results. Laboratory tests reveal elevated TSH with decreasing levels of TH reflective of the severity of the hypothyroidism. Maintenance of T3 levels until the late stages of hypothyroidism is accomplished by both increased secretion of T3 by the thyroid and increased conversion of T4 to T3 in the peripheral tissues.

Secondary hypothyroidism is due to inadequate stimulation of a normal thyroid gland by TSH from the pituitary. Most commonly, this is the result of pituitary tumors (or their treatment) or trauma but can also occur at the level of the hypothalamus. Lab tests will reveal very low TSH levels along with low levels of TH.

Cellular hypothyroidism is a third, less common. Symptoms of hormone deprivation result from a disorder in the peripheral tissues that reduce their responsiveness to TH (TH resistance) or that inactivate the hormone. Lab tests will reveal normal TSH and hormones but there will be low functional thyroid activity (low BMR, low temp)

Clinical symptoms: The characteristic sign of severe, chronic hypothyroidism is myxedema.  Myxedema is the result of the build-up of a protein-mucopolysaccharide complex that binds water and produces a non-pitting edema especially around the eyes, hands and feet. It also causes a thickening of the tongue and mucous membranes of the laryngeal and pharyngeal area causing hoarseness and slurred speech.

The symptoms of hypothyroidism usually have an insidious onset and the patient may be unaware of them for years before reaching the stage of myxedema.

Other Signs and Symptoms: Decreased levels of thyroid hormone leads to a general decrease in the metabolism of fats, proteins and carbohydrates and often result in weight gain, dyslipidemia and an increased risk of cardiovascular disease. Dry skin and hair, brittle nails and significant hair loss are common, and along with a poor tolerance to cold may be some of the first symptoms. Loss of libido, menstrual abnormalities, constipation, muscle weakness and joint stiffness are predominant features although depression, weakness and fatigue are usual.

Difficulty in losing weight is a common complaint of people with an underactive thyroid. Successful weight loss is usually a multi-step process, that includes the following steps:

Optimize Thyroid Treatment: For many patients, to lose weight, it’s not enough to have normal thyroid levels or in the reference range. They need to be optimal. That means a TSH typically below 2.0, Free T4 and T3 in the upper end of the reference range, and lower Reverse T3.

Optimize Blood Sugar: Your fasting glucose level should be balanced.

Balance Hormones: If sex hormones (estrogen, progesterone, testosterone), and adrenal hormones (cortisol, DHEA) are out of balance, this can make weight loss more difficult. Menopause as well as estrogen dominance, can make weight loss more difficult. Lack of testosterone in men and women can make it harder to build muscle. Adrenal imbalance can make you tired, less responsive to thyroid treatment, and less able to lose weight. Evaluating these hormones, and resolving imbalances may be a key step in helping you in your weight loss effort.

Optimize Thyroid Treatment: For many patients, to lose weight, it’s not enough to have normal thyroid levels or in the refence range. They need to be optimal. That means a TSH typically below 2.0, Free T4 and T3 in the upper end of the reference range, and lower Reverse T3.

Optimize Blood Sugar: Your fasting glucose level should be balanced.

Balance Hormones: If sex hormones (estrogen, progesterone, testosterone), and adrenal hormones (Cortisol, DHEA) are out of balance, this can make weight loss more difficult. Menopause as well as estrogen dominance, can make weight loss more difficult. Lack of testosterone in men and women can make it harder to build muscle. Adrenal imbalance can make you tired, less responsive to thyroid treatment, and less able to lose weight. Evaluating these hormones, and resolving imbalances may be a key step in helping you in your weight loss effort.

Food Selection: Eating two to three meals a day, no snacks, and avoiding food after 8 p.m. seem to help balance hunger hormones and blood sugar, and promote fat burning.

Iodine Deficiency: Iodine is a building block for thyroid hormone. Care should be taken so as to not deprive of iodine in daily diet. The best way to include iodine in your diet is with iodine-rich foods – seaweed, shrimp, dried prunes, lobster, cranberries – or use an iodine rich salt.

Goitrogens: Avoid excessive intake of goitrogens. Goitrogens are foods that can induce iodine deficiency by combining with iodine and making it unavailable for use by the thyroid. Foods such as broccoli, cabbage, cauliflower, Brussels sprouts, turnips, walnuts, almonds and soy are considered goitrogenic. Cooking usually neutralizes the goitrogens in these foods.

Nutrition for Hypothyroidism: Protein, Selenium, Magnesium, Iodine, Zinc, vitamin B-12, vitamin B2, vitamin A, vitamin D and vitamin C are important for thyroid function. Make sure your diet has enough of these nutrients or supplements for these vitamins are advisable.

Physical activity:  Encourage routine exercise. Exercise stimulates thyroid hormone synthesis, tissue sensitivity and decreases stress, which can interfere with the conversion to active T3.

Also, one should aim to sleep seven or more hours per night as lack of sleep contributes to weight gain and makes weight loss more difficult.

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Glycemic Index

Glycemic Index is the numerical index given to a carbohydrate-rich food that is based on the average increase in blood glucose level occurring in blood after the food is eaten. The higher the number, the greater the blood sugar response.

The Glycemic Index tells us how rapidly a particular carbohydrate turns into sugar.

Some factors that affect GI: 

Processing (puffed cereals have a much higher GI than the grain they came from), ripeness of fruit (unripe bananas can have a GI of 43, where overripe ones have been clocked at 74), protein content (soy beans have a lower GI than other beans), fat content (peanuts have a very low GI), fiber (orange juice has a higher GI than oranges), and how small the particles are (whole grains have a relatively low GI, but grinding them into flour shoots up the GI).

Glycemic index is the scale that was created on a standard amount of carbohydrate per food (50 grams), it doesn’t give people information about the amount of food they are actually eating. This information too is important if we want to assess the true impact of carbohydrate consumption. For this reason, the concept of the glycemic load was created, which takes serving size into account.

The glycemic load of a food is the glycemic index divided by hundred and multiplied by its available carbohydrate content (i.e. carbohydrate minus fibre) in grams.

For example, if we consider watermelon. Water melon has a high glycemic Index (about 72). However, a serving of 120g of watermelon has only about 6g of available carbohydrate per serving. So its glycemic load is pretty low i.e. 72/100 x 6 = 4.32.

Following is the list of some common food with their glycemic index.

Photo credit : myhealthandliving.com

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Nutrients (vitamins & minerals) deficiency

Human body requires many different vitamins and minerals that are crucial for both development and preventing disease. These vitamins are not produced naturally in the body, so you have to get them from your diet. Due to increase in stress levels, lifestyle related illnesses are on rise which also results in vitamin and mineral deficiencies. Among all, vitamin B12 and D3 deficiency is becoming more prevalent.

Vitamin D

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Vitamin D, also known as “sunshine vitamin”, is a fat soluble compound which acts like hormone. The two major forms are vitamin D2 and vitamin D3. Vitamin D3 is produced by the exposure to sunlight, specifically ultraviolet B radiation. Vitamin D3 plays a wide role in overall health however, worldwide, an estimated 1 billion people have inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. A simple course of Vitamin D3 could help you live longer. Vitamin D3 is critical for bone health. It helps in regulating the formation of bone and absorption of calcium and phosphorus. Symptoms of a vitamin D deficiency can be vague — fatigue and muscle aches or weakness. If it goes on long term, a vitamin D deficiency can lead to softening of the bones.

Calcium

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Calcium is important for maintaining strong bones and controlling muscle and nerve function. Signs of severely low calcium include fatigue, muscle cramps, abnormal heart rhythms, and a poor appetite, Patton says. Make sure you’re getting enough with at least three servings of milk or yogurt a day, she says. Other good sources of calcium are cheese, calcium-fortified orange juice, and dark, leafy greens.

Potassium

Potassium helps the kidneys, heart, and other organs work properly. You could become low in potassium in the short term because of diarrhea or vomiting, excessive sweating, or antibiotics, or because of chronic conditions such as eating disorders and kidney disease. Symptoms of a deficiency include weight loss, muscle weakness, constipation, and in severe cases, an abnormal heart rhythm.

Iron

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Iron is a trace element. It is very important because it helps your body to make hemoglobin. Hemoglobin is composed of heme + globin, where globin is protein, & hence it is necessary to have sufficient proteins in diet. Low protein diet may also cause Anaemia. Iron helps your body make red blood cells. Iron carries oxygen and removing carbon dioxide from muscles, helping them function properly. The body needs iron in order to make proper use of the B vitamins.

Vitamin B12

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Vitamin B12 is a member of the vitamin B complex. It can be stored in small amounts in liver, kidney & other body tissues. Vitamin B12 aids the production of DNA and helps make neurotransmitters in the brain. All the vegetarian sources are devoid of B12. With an increasing number of vegans and people who’ve had weight loss surgery, vitamin B12 deficiency is becoming more common.Symptoms of severe B12 deficiency include numbness in the legs, hands, or feet; problems with walking and balance; anemia; fatigue; weakness; a swollen, inflamed tongue; memory loss; paranoia; and hallucinations.

Folate

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Folate, or folic acid, is a particularly important vitamin for women of childbearing age, which is why prenatal vitamins contain such a hefty dose. A folate deficiency can cause a decrease in the total number of cells and large red blood cells as well as neural tube defects in an unborn child.

Magnesium

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Magnesium helps support bone health and assists in energy production. Although deficiency is fairly uncommon in otherwise healthy people, it can affect those who take certain medications, have certain health conditions, or consume too much alcohol, according to the National Institutes of Health’s Office of Dietary Supplements.

Magnesium deficiency can cause loss of appetite, nausea and vomiting, fatigue, and weakness. In more severe cases, it can lead to numbness, muscle cramps, seizures, abnormal heart rhythms, personality changes, or low potassium or calcium levels.

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