2. Proesmans_Natural treatments for thyroid dysfunction

Natural treatments for
thyroid dysfunction
Dr Rudy Proesmans
Iodine
There are 4 Iodine atoms in one thyroxine molecule
Iodine
• Iodine source: fish and seaweed
• Vit D and Iodine deficiency are very
common, supplementation is advisable
for everybody
• Fear for toxicity is not scientifically
based. Too much iodine is excreted by the
kidney’s
• Minimal versus optimal
• www.jodiumtekort.nl
Iodine
• Worldwide deficiency
• In 2008 two billion of the
worldpopulation was iodine deficient
• Daily intake has to be min. 150µg.
Pregnant women and breastfeeding
women need min. 250 µg
• Our food supply is only +/- 50-70 µg
Iodine deficiency and the foetus
• Iodine requirements are increased ≥ 50%
during pregnancy.
• Miscarriage
• Stillbirths
• Congenital anomalies-cretinism
Brain Damage-mental retardation
• Increased perinatal morbidity
and mortality
Zimmermann MB. The effects of iodine deficiency in
pregnancy and infancy.
Paediatr Perinat Epidemiol. 2012 Jul
• .... Two meta-analyses have estimated
that iodine-deficient populations
experience a mean reduction in IQ of 1213.5 points.
Iodine deficiency and the neonatus
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Endemic cretinism
Neonatal Goiter
Neonatal hypothyrodism
Endemic mental retardation
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Effect of inadequate iodine status in UK pregnant women on
Cognitive outcomes in their children: results from the Avon
Longitudinal Study of Parents and Children (ALSPAC)
Bath ea
Lancet , 2013
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Iodine deficiency and the adolescent
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Goiter
(Subclinical) Hypothyroidism
School performance and IQ impaired
Retarded growth, hearing, speech
ADHD
Taylor PN, et al. Therapy of endocrine disease:
Impact of iodine supplementation in mild-to-moderate iodine deficiency:
systematic review and meta-analysis. Eur J Endocrinol. 2013 Nov 22;
• Iodine supplementation improves some
maternal thyroid indices and may benefit
aspects of cognitive function in school-age
children, even in marginally iodinedeficient areas
Iodine deficiency
• WHO : iodine deficiency is the most
important ‘single cause’ of mental
retardation which is preventable.
• WHO: 300.000.000 school age children
are iodine deficient
Iodine deficiency and the adult
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Goiter
Apathy
Hypothyroidism (low T4, high TSH)
Suboptimal brain function (sluggish thinking)
Low capacity for initiative and decision making
Spontaneous Hyperthyroidism
Which nutrients are important in the
production of T3?
• Tyrosine
• Iodine
(enzyme deiodinase)
• Selenium
• Zinc
• Iron
• Magnesium
• Vit B 12
• (cortisol)
Deiodinase polymorfisme
• SNP of the deiodinase gene
• polymorphism in the D2 gene, Thr92Ala, is
associated with reduced T4 to T3 activation in
skeletal muscle and thyroid, linked to obesity and
alterations in thyroid-pituitary feedback, and in
responses to thyroid hormone treatment.
T3-T4
• A suggestive clue to the presence of this
polymorphism could be a higher than
normal free T4/free T3 ratio. Clinicians
could consider adding T3 as a
therapeutic trial in selected patients.
• Wartofsky L. Combination L-T3 and L-T4 therapy for
hypothyroidism. Curr Opin Endocrinol Diabetes Obes. 2013 Oct;
Symptoms of hypothyroidism
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Fatigue
Increased sensitivity to cold
Constipation
Dry skin
Unexplained weight gain
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Causes
• Autoimmune disease. Hashimoto's
thyroiditis
• Radiation therapy. Radiation used to treat
cancers of the head and neck can affect
• Pituitary disorder
• Pregnancy. Some women develop
hypothyroidism during or after pregnancy
(postpartum hypothyroidism)
• Iodine deficiency.
Diagnosis
• TSH alone is not a reliable test. One can
miss subclinical hypothyroidism
• TSH 0,4 - 4,0 mU/l standard range
• TSH 0,15 – 2 mU/l optimal range
T3/T4 in 24 hour urine
• The elevation of thyroid hormone levels in urine, assesses
tissue exposure to thyroid hormones over a 24-hour period.
The urine thyroid test therefore serves as a valuable tool
for detecting those patients that are suffering from thyroid
dysfunction, particularly low grade hypothyroidism who
might otherwise go undetected through standard blood
tests. It is important to use this test as an adjunct to other
indicators of thyroid function, such as body temperature,
symptomology and standard blood thyroid tests.
Treat the patient not the lab test !
Iodine intake via bread
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Ann Endocrinol . 2011 Apr;72(2):158-61. Epub 2011 Apr 21. Optimization of
iodine intake in Belgium. Moreno-Reyes R, Van Oyen H, Vandevijvere S.
• Mild iodine deficiency (MID) is a long-standing problem in
Belgium and was recognized only recently as public health issue
by the Ministry of Health (MOH). The main MID-related health
problems in Belgium are a high prevalence of thyroid nodules
and multinodular goiter. The economic cost of thyroid nodular
disease only in Belgium was estimated at about €40 millions per
year. The Belgian health authorities adopted a selective strategy
to optimize iodine intake through the fortification of bread with
iodized salt.
• 75% of the Belgian people have a mild to severe iodine
deficiency !
Uptake of iodine in
non-thyroid tissue
• Salivary glands ( iodine dissolves parotis
stones, SSKI 5 drops/day )
• Kidneys
• Prostate
• Breast tissue
• Pancreas
• Skin
• Ovaria
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Iodine and breast cancer
• Biofactors. 2003;19(3-4):121-30.
• Role of iodine in antioxidant defence in
thyroid and breast disease. Smyth PP.
• “the Japanese experience may indicate
a protective effect against breast cancer
for an iodine rich seaweed containing
diet”.
Iodine and breast cancer
• There is a clear relationship between low
iodine intake and the incidence of breast
cancer
• Intake of iodine in Japanese women is 25x
more than the intake of western women
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Funahashi H, et al. Seaweed prevents breast cancer? Jpn J Cancer Res. 2001
May;92(5):483-7.
Aceves C, Anguiano B, Delgado G. Is iodine a gatekeeper of the integrity of
the mammary gland? J Mammary Gland Biol Neoplasia. 2005 Apr;10(2):18996.
Mol Cancer. 2009 Jun 6;8:33. doi: 10.1186/1476-4598-8-33.
Antineoplastic effect of iodine in mammary cancer:
participation of 6-iodolactone (6-IL) and peroxisome
proliferator-activated receptors (PPAR).
Aceves C et al
‘studies in mammary cancer demonstrated that moderately
high concentrations of molecular iodine (I2) have a
antiproliferative and apoptotic effect either in vivo as in
vitro, however the cellular intermediated involved in these
effects has not been elucidated.’
Prostate. 2013 Jan;73(1):31-41.
Uptake and antitumoral effects of iodine and 6iodolactone in differentiated and undifferentiated
human prostate cancer cell lines.
• Normal and cancerous prostate cells can take
up iodine, and depending on the chemical
form, it exerts antiproliferative and apoptotic
effects both in vitro and in vivo.
Breast J. 2004 Jul-Aug;10(4):328-36.
The effect of supraphysiologic levels of iodine on patients with cyclic
mastalgia.
Kessler JH
• 111 patients; 4 groups . Placebo, 1,5 mg
iodine, 3 mg iodine en 6 mg iodine
• After 3 months significant reduction in pain
in the group with 3 and 6 mg, not in the 1,5
mg group and placebo
• 6 mg group : > 50 % pain reduction
• No side effects
Cancer Causes Control. 2000 Feb;11(2):121-7.
Hypothesis: iodine, selenium and the development of breast cancer.
Cann S, van Netten JP, van Netten C.Source
• Iodine, in addition to its incorporation into
thyroid hormones, is organified into antiproliferative iodolipids in the thyroid; such
compounds may also play a role in the
proliferative control of extrathyroidal tissues.
Selenium acts synergistically with iodine.
Iodine deficiency summary
• Suboptimal brain development (MBD)
• ADD , autisme ( Zimmerman, 2009)
• Iodine def. during pregnancy increases risk for ADHD in
childhood .
• Cholesterol profile of children improves after iodine
supplementation (Zhao ,2010)
• Iodine is an anti-oxidant. It is important for the immune
system , it helps in the prevention of bacterial and viral
infections.
• Infertility (Stewart, 1991)
• Increased risk for breast, ovarium and prostate cancer
• Breast and ovaria cysts
Iodine for general prevention
Iodine 250 -500 mcg per day
( Kelp )
Iodine is not been absorbed through lung
tissue only orally
Treatment and prevention of fibrocystic breast disease
( Reclus)
• Lugol drops ( 1 drop = 6 mg iodine and
iodide)
• 2dr per day
• After 3 weeks , 2 drops , 2-3 x per week
• Lugol tabletten ( 1 tabl = 12 mg iodine en
iodide) (Nutrined)
Prevention of breast cancer
• Lugol 2 drops , 2 x per week
• Lugol tabl , 1 tablet 2 x per week
• Check for thyroid hormones
• Vit D 5000 – 10.000 iu per dag !
• Note: Amiodarone: the iodine content is 75 mg in a 200-mg tablet
Approximately 10% of the iodine content of oral amiodarone is
released into the circulatory system
Treatment of hyperthyroïdism
• SSKI (Saturated Solution of Kalium Iodide): 2 x
10 dr , 1 w , 2 x 5 dr , 1 week, 5 dr a few weeks
according to the respons
• 1 dr SSKI= 35 mg iodine in the form of
potassium iodine
• Wolff-Chaikoff effect: high concentration of
iodine blocks the production of T4
(amiodarone, Cordarone)
Jod-Basedow effect
• The Jod-Basedow effect typically occurs with
comparatively small increases in iodine intake, in people
who have thyryoid abnormalities that cause the gland to
function without the control of the pituitary . In some ways
the Jod-Basedow phenomenon is the opposite of the
Wolff-Chaikoff effect. However, unlike the WolffChaikoff effect, the Jod-Basedow effect does not occur in
persons with normal thyroid glands, as thyroid hormone
synthesis and release in normal persons is controlled by
pituitary TSH secretion, which does not allow
hyperthyroidism when extra iodine is ingested.
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Emerson CH, Anderson AJ, Howard WJ, Utiger RD. Serum thyroxine and
triiodothyronine concentrations during iodide treatment of hyperthyroidism. J
Clin Endocrinol Metab 1975; 40:33.
WOLFF J, CHAIKOFF IL. The temporary nature of the inhibitory action of
excess iodine on organic iodine synthesis in the normal thyroid. Endocrinology
1949; 45:504.
Philippou G, Koutras DA, Piperingos G, et al. The effect of iodide on serum
thyroid hormone levels in normal persons, in hyperthyroid patients, and in
hypothyroid patients on thyroxine replacement. Clin Endocrinol (Oxf) 1992;
36:573.
Marigold JH, Morgan AK, Earle DJ, et al. Lugol's iodine: its effect on
thyroid blood flow in patients with thyrotoxicosis. Br J Surg 1985; 72:45.
Erbil Y, Ozluk Y, Giriş M, et al. Effect of lugol solution on thyroid gland
blood flow and microvessel density in the patients with Graves' disease. J Clin
Endocrinol Metab 2007; 92:2182.
Ross DS, Daniels GH, De Stefano P, et al. Use of adjunctive potassium
iodide after radioactive iodine (131I) treatment of Graves' hyperthyroidism. J
Clin Endocrinol Metab 1983; 57:250.
Takata K, Amino N, Kubota S, et al. Benefit of short-term iodide
supplementation to antithyroid drug treatment of thyrotoxicosis due to Graves'
disease. Clin Endocrinol (Oxf) 2010; 72:845.
Benua RS, Becker DV, Hurley JR. Thyroid storm. Curr Ther Endocrinol
Metab 1994; 5:75.
lithium
• Lithium causes a suppresion of the
production of T4
• Lithium can cause a goiter and
hypothyroidism in the treatment of
bipolar disorders (lithiumcarbonaat 400
1200 mg per day)
• Lithiumcarbonaat 300 mg/dag
• Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol
Metab. 2009 Dec;23(6):723-33
Herbal treatment
• Lycopus europaeus MT , 3 x 30 – 50 dr
Beer AM, Wiebelitz KR, Schmidt-Gayk H. Lycopus europaeus (Gypsywort): effects on
the thyroidal parameters and symptoms associated with thyroid function.
Phytomedicine. 2008 Jan;15(1-2):16-22.
Radioactive iodine therapy
• Increased risk for cancer ( breast cancer)
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Metso S, Auvinen A, Huhtala H, Salmi J, Oksala H, Jaatinen P. Increased
cancer incidence after radioiodine treatment for hyperthyroidism. Cancer.
2007
Goldman MB, et al. Radioactive iodine therapy and breast cancer. A
follow-up study of hyperthyroid women. Am J Epidemiol. 1988 May
Lithium : an essential element
• Lithium helps people with alcohol
addiction
• Lithium protects brain cells against the
toxic effects of alcohol
• In the combination with zinc , it is very
effective for stubborn warts ( lithium 10
mg + zink 50 mg)
• Li is neuroprotective
• Li stimulates the angiogenesis after a
stroke
• Engel T, Lithium, a potential protective drug in Alzheimer's
disease. Neurodegener Dis. 2008;5(3-4):247-9.
• Zhong J, Lee WH, Lithium: a novel treatment for Alzheimer's
disease? Expert Opin Drug Saf. 2007 Jul;6(4):375-83
• Schrauzer GN, Shrestha KP, Lithium in drinking water and the
incidences of crimes, suicides, and arrests related to drug
addictions. Biol Trace Elem Res. 1990 May;25(2):105-13
• Feng HL et al. Combined lithium and valproate treatment
delays disease onset, reduces neurological deficits and
prolongs survival in an amyotrophic lateral sclerosis mouse
model. Neuroscience. 2008 Aug 26;155
• Guo S, Arai K, Stins MF, Chuang DM, Lo EH. Lithium
Upregulates Vascular Endothelial Growth Factor in Brain
Endothelial Cells and Astrocytes. Stroke. 2008 Oct 30.
• Chiu CT, Chuang DM. Neuroprotective action of lithium in
disorders of the central nervous system. Zhong Nan Da Xue
Xue Bao Yi Xue Ban. 2011 Jun;36(6):461-76
• Luo J. Lithium-mediated protection against ethanol
neurotoxicity. Front Neurosci. 2010 Jun 28;4:41
Mol Med Rep. 2012 Mar
Effects of lithium on oxidative stress parameters in
healthy subjects. Khairova R et all
….This reduction in the SOD/CAT ratio may lead to lower
OxS, indicated primarily by a decrease in the
concentration of cell hydrogen peroxide.
Overall, the present findings indicate a potential role for
the antioxidant effects of lithium in healthy subjects,
supporting its neuroprotective profile in bipolar
disorder (BD) and, possibly, in neurodegenerative
processes.
Take home message
• Worldwide Iodine deficiency
• Food supply is too low ( bread , seaweed )
• Iodine deficiency is the main cause of non
optimal brain development
• Supplementation: 0,5 mg per day
• High risk breast cancer : 2-3 x/ week 12 mg (+
vit D)
• Lithium is neuroprotective
• Think of high dosage I in the treatment of
hyperthyroidism