Wednesday, 19 November 2014

(Preview) Most common diseases of 50 plus - Thyroid Disease - Hypothyroidism : Preventions, Managements and Treatments

 By Kyle J. Norton 
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Named 50 of the best health Tweeters Canada - Huffington Post
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                              Thyroid disease
                 Thyroid disease is defined as a condition of malfunction of thyroid gland

               Thyroid disease: Hypothyroidism

Hypothyroidism is a condition in which the thyroid gland is under active produced very little thyroid hormones.

A. Symptoms
Symptoms of the Hypothyroidism is depended to the severe stage of the disease, due to its progression slowly over years. Most common symptoms include
1. Weight gain and fatigue
Hyperthyroidism is associated to weight gain, especially in patients with co-existence of diabetes(1).
The comparable study of  patients with thyroid carcinoma (DTC) and 138 with autoimmune hypothyroidism (AIH), also indicated a significantly higher levels of fatigue in hypothyroidism patients(1b). Statistics of  study of  198 consecutive breast cancer patients receiving adjuvant chemotherapy, 22.2% of this patient population showed  a significant and progressive weight gain of 6.7 lbs, and 94% of all patients with  reported fatigue caused cytotoxic agents influence hypothyroidism in breast cancer patients(1a).

2. Vitiligo and alopecia areata
Vitiligo is associated with autoimmune endocrine disorders, especially with hypothyroidism(2). Primary hypothyroidism patients is at increased risk to develop vitiligo, depigmentation of parts of the skin and hair lost from some or all areas of the body, especially in the scalp(2a)

3. Chronic constipation(3a)
Hypothyroidism  may induce the  pathogenesis of constipation, according to the study by the University of California at Los Angele(3).

4.  Urticaria and puffiness of hands and feet, yellow ivory skin, coarse rough dry skin
Hypothyroid women showed a significantly higher frequency of urticaria and puffiness of hands and feet, yellow ivory skin, coarse rough dry skin(4).

5. Depression
Patients with hypothyroidism have a higher occurrence of depressive syndrome, caused by alterations in blood flow and glucose metabolism in the brain(5).

6. Mood and motor learning
Oral administration of  usual dose l-T(4) (euthyroid arm) vs. higher dose l-T(4) (subclinical thyrotoxicosis arm) , showed to improve confusion, mood and motor learning in patients with hypothyroidism(6).

B. Risk Factors and Causes
B.1. Risk factors
1. Family history
The risk of progression to overt hypothyroidism is related to number of factors including, family history(11a). Family members of patients with autoimmune thyroid disorder(AITD) are at increased risk for AITD, but not all will develop overt hypothyroidism or hyperthyroidism, according to the study by the Academic Medical Center, Netherlands(11).

2. Smoking
Smoking is a powerful risk factor for thyroid disease, especially in populations with a high smoking frequency, according to the study by the Aarhus University Hospital(12). Smoking reduced the risk of hypothyroidism but increased the risk of hypothyroidism in patients with Hashimoto's thyroiditis(13)(13a).

3. Age
Hypothyroidism is associated to increased age.  In the old rat,  the pituitary thyrotrophs increase hormonal secretion in response to decreased levels of thyroid hormones due to aging, even when the thyroid hormone levels are dramatically reduced, according to study of Dutch-Miranda and Wistar rats(14).

4. Autoimmune disorders, thyroid injury, post partum state, are common signs of patients with hypothyroidism, according to Dr. Zulewski H. at Universitätsspital Basel(15).

5. Radiation
  Light microscopy, electron microscopy and immunohistochemical methods, can cause pathological changes in the thyroid gland throuigh altering the gland structure and enhancing apoptosis(16).

6. Post pregnancy
Women with autoimmune thyroiditis are associated to increase risk of hypothyroidism at 3-6 months post-partum(17).

7. Partial thyroidectomy
Partial thyroidectomy, a removal of part of thyroid gland induces overall prevalence of 16% of hypothyroidism(18).

B.2. Causes
1. Autoimmune response
Autoimmune disease is an over reaction of immune response of the body against substances and tissues normally presented in the body. Primary overt autoimmune hypothyroidism is divided into primary idiopathic hypothyroidism with thyroid atrophy (Ord’s disease) and hypothyroidism with goitre (Hashimoto’s disease)(7).

2. Congenital Hypothyroidism(CH)
Baby with postdate delivery and macrosomia are associated to increased risk od congenital hypothyroidism(8a).The incidence of CH was greater in our population for 2007 to 2010, after an unexplained decline, according to the study by the Columbia University Medical Center(8).

3. Pituitary disorder
Pituitary disorders, is associated to reduce or increase secretion of hormones, affected growth and the functions of other glands in the body. A normal TSH does not exclude central hypothyroidism, but pituitary disease, with potential for deficiency of other anterior pituitary hormones, may contribute to correctly diagnosed hypothyroidism(9).

4. Pregnancy
  Women with TSH values at or above the 97.5th percentile for gestational age with free thyroxine more than 0.680 ng/dL at the time screening and were retrospectively identified with subclinical hypothyroidism, according to  University of Texas Southwestern Medical Center(10).

2. Iodine deficiency
Iodine is a key element in the synthesis of thyroid hormones, severe iodine deficiency is associated to risks of hypothyroidism, goiter, and cretinism due to biochemical alterations, according to  Verheesen RH and Schweitzer CM(11).

C. Complications
1. Coronary heart disease and mortality
Subclinical hypothyroidism is associated with an increased risk of the development of coronary heart disease (CHD).  CHD mortality is higher in patients with diagnosed elevated TSH levels, particularly in those TSH concentration of 10 mIU/L or greater(19).

2. Pre-eclampsia, perinatal mortality, and miscarriage
 Thyroid dysfunction interferes with women reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy outcome. According to the study by the MGM Medical College, pregnant women with subclinical hypothyroidism has an increased risk of complications, especially pre-eclampsia, perinatal mortality, and miscarriage(21).

3. Ovulatory dysfunction, pregnancy loss
Subclinical hypothyroidism may be associated with ovulatory dysfunction and adverse pregnancy outcome(22).

4. Increased susceptibility to inflammatory diseases
Hypothyroidism during gestation can influence the outcome of a CNS inflammatory disease, such as EAE, according to the study by the Universidad Andres Bello, Ciencias Biologicas(23).

5. Auditory function
 Iodine deficiency may contribute auditory function (deaf and hard of hearing) in process information. Hearing deficit, an invisible abnormality, has major consequences for educational and social skills if not detected, according to the study by the Wageningen University, Wageningen(24).

6. Hearing loss
Hearing loss contribute a significant problem, in adult patients with severe chronic hypothyroidism(25).

D. Diseases associated to hypothyroidism
1. Systemic Sclerosis
Systemic sclerosis (SSc) is a connective tissue disease of unknown etiology, and several studies reported its association with thyroid autoimmune disorders, including hypothyroidism and thyroid dysfunction(26).

2. Osteoarthritis and fibromyalgia
Thyroid dysfunction is seen at least three times more often in women with RA than in women with similar demographic features with non-inflammatory rheumatic diseases such as osteoarthritis and fibromyalgia(27).

3. Type 1 diabetes mellitus (T1DM)
8% of patients with T1DM had hypothyroidism, according to the data presented to department of Endocrinology from May 1997 to December 2011(28).

4. Adrenal insufficiency
According to study, long-term hypothyroidism is associated with adrenal insufficiency with abnormalities of hypothalamic–pituitary–adrenal(HPA) axis. Short-term hypothyroidism, on the other hand, is associated with increased pituitary corticotropic cells responsiveness to corticotropin-releasing hormone (CRH) produced by the hypothalamus(29).

5. Hyponatremia
Hypothyroidism is associated to 8% of patients with hyponatremia. Hyponatremia in hypothyroidism is due to a pure renal mechanism, and cannot be ascribed to inappropriate secretion of antidiuretic hormone(30) and severe primary hypothyroidism alone may not be enough to cause hyponatremia in the otherwise healthy individuals(30a).

6. Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis is the most common cause of hypothyroidism as a result of an autoimmune disease.

7. Solitary toxic thyroid nodules
Treatment of patients with solitary toxic thyroid adenomas with 131I (mean dose, 10.3 mCi) showed a possibility in  contribution to to late recurrent hyperthyroidism in patients at 4.5, 6, and 10 years after treatment(31).

8. Rhabdomyolysis
Although it is rare, rhabdomyolys, which is damaged skeletal muscle tissue breaks down rapidly, can be associated to hypothyroidism, according to the study by the Selcuk University(32).

9. Thyroid cancer
 Thyroid hormone withdrawal may induce acute hypothyroidism in patients with differentiated thyroid cancer and can impair quality of life, according to the study by the University of Athens(33).

10. Restless leg syndrome
 Restless leg syndrome may be a result of moderate hypothyroidism(34).

11. Myxedema coma
Myxedema coma, a state of decompensated hypothyroidism, is the extreme process of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism,, according to the study by the Prince Charles Hospital(35).

12. Tarsal Tunnel Syndrome
Tarsal tunnel syndrome, a compression neuropathy and painful foot condition is associated to hypothyroidism, according to the study by the Atkinson Morley’s Hospital, Wimbledon(36).

13. Carpal Tunnel Syndrome
Treatment with radioactive iodine may induce  hypothyroidism causes of developed symptoms of bilateral carpal tunnel syndrome(37).

14. Fatty liver
 Subclinical hypothyroidism may contribute to the development of non-alcoholic fatty liver disease(38) as a result of impaired liver enzyme levels, according to a cross-sectional study from Korean researchers(38a).

15. Sleep apnea and sleep disorders
Central, obstructive, and mixed patterns of sleep apnea and sleep disorder are commonly observed in hypothyroidism, according to the study by the Medical College of Georgia(39).

E. Misdiagnosis
1. Normal aging process
A diagnosis of hypothyroidism in the elderly can easily be overlooked, easily misdiagnosis due to the signs and symptoms of the disease are common to other diseases typical of old age(40).

2. Reversal deterioration of renal function
Ageing with the deterioration of renal function may delay the diagnosis of hypothyroidism,  according to the study by the Military Medical Academy, Clinic of Endocrinology(41).

3. Respiratory failure
 Hypothyroid may delay correct diagnosis, due to unexplained respiratory failure in effects of lower than normal thyroid hormone secretion, according to the study by the Servicio de Medicina del Hospital(42).

4. Brain stem infarct
 The diagnosis of myxedema coma with longstanding low level of thyroid hormone in the blood was often missed or delayed due to various clinical findings and concomitant medical conditions and precipitating factors, especially for patients with no medical history of hypothyroidism, according to the study by the Hallym University(43).

5. Statin intolerance
 Hypothyroidism  may be misdiagnosed as statin intolerance, according to the study by Krieger EV, and Knopp RH(44).

6. Hypercholesterolaemia
With no measurement of the concentration of thyroid-stimulating hormone and free hypothyroidism may be misdiagnosed as hypercholesterolaemia, thyroxine(45).

F.  Diagnosis
If you are experience certain symptoms of above and/or have had previous thyroid problems or goiter, your doctor may suspect that you have underactive thyroid. Blood test to measure the level of TSH and the level of the thyroid hormone thyroxine and triiodothyronine, depending to the stage of the diseases, are necessary(46).

G. Prevention
G.1. Diet to prevent Hypothyroidism

1. Seaweed, kelp or laver, seafood and seawater fish
Adequate consumption of Seaweed, kelp or laver, seafood and seawater fish may reduce risk for the development of hypothyroidism. According to a study, population inHong Kong, a coastal city in the southern part of China showed a high incidence of transient neonatal hypothyroidism and a relatively high mean cord blood thyrotropin (TSH) concentration(47).

2. Iodized salt
Regular consumption of iodized salt may reduce risk of hypothyroidism and enhance urine iodine concentration in iodine sufficiency areas(48).

3. Seaweed
Intake of seaweed regularly is associated to reduce risk of hypothyroidism through its function in  increased I/C concentrations (P < .0001) and serum TSH concentrations(49).

G.2. Antioxidants and phytochemicals to prevent Hypothyroidism
1. Iodine
Iodine, found abundantly in seaweed has been in Japanese diet for many centuries
 may induce a protective effect on hypothyroidism and improve prognosis of thyroid autoimmunity (50).

2. Resveratrol
Resveratrol influences thyroid function by enhancing iodide trapping and  increasing TSH secretion(51).

3. Polyphenolic flavonoids
 Green tea extract at 2.5 g% and 5.0 g% doses and black tea extract only at 5.0 g% dose have the potential to alter the thyroid gland physiology and architecture, through significant decrease in serum T3 and T4, and increase serum thyroid stimulating hormone (TSH)(52).

H. Treatments 
H.1. In conventional medicine perspective  
  Patients with hypothyroidism are treated by thyroid hormone therapy with doses depending to the stage and types of the diseases
1, Levothyroxine
The medication is a prohormone activated by deiodination(a peroxidase enzyme involved in the activation or deactivation of thyroid hormones) in the organs to triiodothyronine(T3 thyroid hormone) for treatment of overt hypothyroidism with low FT4 and elevated TSH or TSH > 10 mU/L, and subclinical hypothyroidism with a TSH between 4 and 10 mU/L and normal FT4, dependjng on the underlying disease and symptoms, according to the study by Medizinische Klinik IV der Universität München(52a).

2. Synthetic thyroxine
In patients with primary hypothyroidism, standard therapy synthetic thyroxine showed effectively in increased triiodothyronine through peripheral conversion(52b).

3. Combination levothyroxine plus liothyronine
Combination levothyroxine plus liothyronine produces same effect as of synthetic thyroxine  with no beneficial changes in body weight, serum lipid levels, hypothyroid symptoms, according to University College Dublin(53)(54).

H.2. In Herbal medicine perspective
1. Echinacea

a. Immune modulator
Ethanolic extract of fresh Echinacea purpurea exerts its immune modulator activity in regulation of  cell signalling for immune responses against threads, depending to exogenous stimuli,  viral infection and exposure to stress(55).

b. Anxiety
 Some extracts from Echinacea preparations shoed effectively in decreased anxiety, depending to doses manner(56).

2. Ashwagandha
Ashwagandha, also known as Withania somnifera, a Indian ginseng, used in Ayurvedic medicine over 3000 years to treat tumors and tubercular glands, carbuncles, memory loss and ulcers and considered as anti-stress, cognition-facilitating, anti-inflammatory and anti-aging,  is a nightshape plant in the genus of Withania, belonging to the family Solanaceae, native to the dry parts of India, North Africa, Middle East, and the Mediterranean. Ashwagandha enhanced immune function by increasing immunoglobulin production and regulating antibody production through cell signalling, according to the studd(57).

3. Fucus vesiculosus
Fucus vesiculosus, also known as Bladderwrack, has been used extensively to treat goitre, swelling of the thyroid gland related to iodine deficiency and thyroid disorders including underactive thyroid (myxedema), over-sized thyroid gland, according to the study by Unidad de Salud Mental Hospital de Laredois, is a source of iodine, discovered in 1811(57a).

4. Kelp
Kelp, containing high amount of iodine, showed to exert its protective effect on hypothyroidism through improvement of the prognosis of thyroid autoimmunity(50), but excessive intake of  iodine-rich seaweed (kelp) may induce hypothyroidism and chronic thyroiditis, according to the study of Japanese study(58).

H.3. In traditional Chinese medicine perspective
1. Yang tonifying herbs
Thyroidectomized rabbits treated by the Yang tonifying herbs showed to increase serum levels of thyroxine (T4) and triiodothyronine (T3), according to the study by the Department of Medicine, University of Western Australia, in a randomly study(59).

2. Baji Zibugao
Baji Zibugao (BJZBG), a medicinal plaster mainly consisting of Radix Morindae Officinalis), showed to maintain the levels of thyroxine (T4), triiodothyronine (T3) on total thyroidectomized rabbits(60).

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