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
Disilgold.com Named 50 of the best health Tweeters Canada - Huffington
Post
Nominated for shorty award over last 4 years
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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