Understanding the Nuances of Thyroid Disorders Flashcards
(103 cards)
1
Q
The two primary thyroid hormones that the body depends upon to support pretty much each and every metabolic process within the body are BLANK and BLANK?
A
T4 (thyroxine) and T3 (triiodothyronine)
2
Q
Where is T4 primarily made and then stored?
A
Within the colloid of the thyroid gland cell.
Once we have T4, it is then converted into its active form, T3.
3
Q
Where does the conversion of T4 to T3 happen?
A
Primarily within the thyroid gland, the liver, the kidneys, as well as every other cell within the body on an as-needed basis.
4
Q
T3 is considered “active” because ?
A
It is the form of thyroid hormone that is the most preferred and utilized across all body tissues.
5
Q
Where is the Colloid?
A
The space that rests in between the follicular cells
6
Q
Where do the follicular cells rest?
A
These cells rest on the outside of the thyroid gland
7
Q
Where can you find the Parafollicular cells?
A
In between the cellular structure of the thyroid gland.
8
Q
True or False: Thyroid hormones are necessary for pretty much every single metabolic process within the body.
A
True
9
Q
Thyroid hormones play a role in increasing BLANK activity and energy BLANK within the body.
A
Cellular metabolic; production
10
Q
Thyroid hormones aid in BLANK, which is important for things such as human growth and development, especially in primary development stages of life such as fetal development, adolescence, and pregnancy
A
Protein synthesis
11
Q
Thryoid hormones are BLANK, and play a role in increasing our body temperature, such as with basal body temperature.
A
thermogenic
12
Q
Why does basal body temperature rise post-ovulation?
A
Because progesterone promotes thyroid hormone production, which results in thermogenesis and a rise in BBT.
13
Q
Thyroid hormones also support erythrocyte production, which do what?
A
Help with oxygen and nutrient delivery across the body.
14
Q
Why is thyroid health important for digestive function?
A
They support the production of gastric secretions and facilitate gut motility. This is also why hypothyroidism often results in constipation.
15
Q
Thryoid hormones play integral role in BLANK hormone production, which is necessary for facilitating ovulation and promoting healthy reproductive function.
A
steroid
16
Q
Thyroid hormone promotes a healthy BLANK function and detoxification, which is important for what?
A
Liver; This important for helping to promote the metabolism and the detoxification of certain hormones like estrogen, as well as cholesterol within the body.
17
Q
Thyroid hormone plays a role in influencing BLANK expression.
A
Gene
18
Q
Thyroid rhomrones maintain our brain health, memory, and our ability to stay cognizant and focused by promoting brain BLANK.
A
neurogenesis
The growth and development of nervous tissue
19
Q
What is TRH?
A
Thyrotropin-releasing hormone, which is released from the hypothalamus in the brain.
20
Q
Where is TRH (thyrotropin-releasing hormone) released from?
A
From the hypothalamus in the brain.
21
Q
After TRH is released from the hypothalamus in the brain, it is delivered to BLANK, which triggers what?
thyrotropin-releasing hormone
A
To the pituitary, triggering the production and release of TSH (thyroid-stimulating hormone), which is then delivered to the thyroid-stimulating hormone receptor (TSHr) site on the thyroid.
22
Q
What is TSH?
A
Thyroid-stimulating hormone
23
Q
What is TSHr? Where is it found?
A
Thryoid-stimulating hormone receptor; it is found on the follicular cells of the thyroid.
24
Q
The response to TSH on the receptor is going to stimulate which three different actions within the thyroid?
TSH = thyroid-stimulating hormone, the receptor is found on the follicular cells
A
- Thyroglobulin (TG)
- Thyroid Peroxidase (TPO)
- and it is also going to stimulate iodide uptake.
Iodide does not equal iodine. Iodine is found in the foods we consume
25
When we consume foods with iodine in them, such as kelp, seaweed, and iodized salt, the iodine within those foods gets reduced into the component, BLANK, within the small intestine.
iodide
26
After we consume foods with iodine in them and the iodine in those foods gets reduced into the component iodide within the small intestine, it is then absored into the bloodstream as BLANK, not as BLANK.
Iodide, not iodine.
27
The body still needs iodine in the BLANK form, not the BLANK form, in order to produce thyroid hormone. So this means the body has to reconvert BLANK back into BLANK in order for it to be utilized.
iodine; iodide
Iodide back into iodine.
28
What is iodide oxidation?
The body then has to reconvert iodide back into iodine in order for it to be utilized
29
What is the first step of iodide oxidation?
When iodide reaches the thyroid.
First, it has to pass through the follicular cell membrane of the thyroid, which requires the support of the sodium-iodide symporter.
From there, it enters into the colloid of the cell, a process known as “iodide uptake”, which requires TSH stimulation on the TSH receptor.
30
What is iodide uptake?
When iodide reaches the thyroid, passing through the follicular cell membrane of the thyroid, and enters into the colloid of the cell, which requires TSH stimulation on the TSH receptor.
31
Once iodide is successfully in the colloid of the cell, this is where BLANK comes in.
TPO
| Thyroid Peroxidase, an enzyme produced by the thyroid gland.
32
TPO works alongside BLANK, which is going to also be produced by the thyroid gland to help facilitate iodide oxidation.
hydrogen peroxide (H2O2)
33
Together, BLANK and BLANK break off electrons from the iodide, transforming iodide back into iodine.
TPO and H2O2
34
Once iodide oxidation is complete and we have usable iodine within the colloid of th thyroid cells, the next step is where BLANK and BLANK — also produced from TSH receptor stimulation — work together, with the help of iodine and tyrosine to produce MIT (Monoiodotyrosine) and DIT (Diiodotyrosine).
TPO and thyroglobulin
35
Thyroglobulin is BLANK dependent
Tyrosine
## Footnote
Tyrosine is an amino acid found in foods such as chicken, turkey, fish, peanuts, pumpkin seeds, sesame seeds, lima beans, avocados, banana, and dairy.
36
What is Tyrosine?
Tyrosine is an amino acid found in foods such as chicken, turkey, fish, peanuts, pumpkin seeds, sesame seeds, lima beans, avocados, banana, and dairy.
37
What role does TPO play in the process of converted iodide back into iodine?
To take the freshly converted iodine and place it on top of the tyrosine of the thyroglobulin. Depending on how many iodine molecules were placed on top of tyrosine, this leads to the production of MIT (Monoiodotyrosine) — one iodine molecule — or DIT (Diiodotyrosine) — two iodine molecules15.
38
Whta do MIT and DIT do when they work together?
To produce the end product of thyroid hormone.
39
40
With MIT, or Monoiodotyrosine, there is BLANK iodine molecule present.
One
## Footnote
Hence the term “mono” which equates to “one”
41
DIT, or Diiodotyrosine, contains BLANK iodine molecules.
Two
## Footnote
Hence the term “di” which equates to “two”.
42
What is T4?
Thyroxine, the main hormone produced by the thyroid gland.
43
MIT & DIT together produce what?
T3, with 3 iodine moledules; 1 plus 2 = 3
44
If we are producing T4, we need X BLANK to produce T4?
Two DIT which has four iodine molecules on it. So we have 2 _ 2 =4.
45
When we have DIT plus MIT in this specific sequence, what happens?
Which is 2 plus 1, should equal 3 right? Not necessarily.
DIT plus MIT, that specific sequence, creates Reverse T3.
46
With With reverse T3, the primary difference is the reverse placement of BLANK?
Iodine, hence the name "reverse" T3
47
With T3 and reverse T3, technically both contain the same amount of BLANK molecules, but the BLANK placement on the hormone itself is different.
iodine; iodine
Although the placement of the iodine seems benign, it actually causes the hormone to have a complete opposite physiological effect.
## Footnote
For example, if T3 is stimulatory, helping to promote metabolic activity, reverse T3 is the opposite, where it turns off metabolic activity within the cells.
48
Wher does most of the thyroid hormone production occur?
Some of it happens with the thyroid itself, but most of it actually happens outside of the thyroid.
49
Within the thyroid, only about X% of T4 is produced and about X% of T3 and reverse T3 are produced.
90%; 10%
## Footnote
As far as reverse T3 and T3 go, the majority of this is synthesized within cellular tissues from the conversion of T4.
50
What is the primary reason why most T3 conversion happens on a cellular level?
T4 transports better within the bloodstream, with the help of thyroxine-binding globulin (TBG), which can then be delivered to cellular tissues and converted into T3 for metabolic purposes on an as-needed basis.
51
Why do we need to be thinking about cellular helath when it comes to considering issues with T3?
The primary reason why most T3 conversion happens on a cellular level is that T4 transports better within the bloodstream, with the help of thyroxine-binding globulin (TBG), which can then be delivered to cellular tissues and converted into T3 for metabolic purposes on an as-needed basis.
52
What is T2?
The completely inactivated form of thyroid hormone
53
What are Deiodinases?
Enzymes that play a big role in the conversion of T4 to T3 and Reverse T3 on a cellular level.
A deiodinase is an enzyme that works to remove iodines from the T4 molecule to produce T3, RT3, and T2 within the cells.
## Footnote
“de” which means remove, we have “iodin”, which stands for iodine, and then “ase”, which means enzyme.
54
What are D1, D2, and D3?
Three primary forms of deiodinases. D2 plus D1 together convert T4 into T3.
Whereas D3 and D1 together convert T4 into Reverse T3.
Finally, D2 and D1 convert Reverse T3 into T2, and D3 converts T3 into T2.
T2 is the completely bound and unusable form of thyroid hormone.
55
What is the final metabolite that is produced, and one of the primary ways that the body eliminates thyroid hormone from the body?
T2
56
What is hyperthyroidism?
The excess production or too much production of thyroid hormone
57
What is hypothyroidism?
The deficiency, or too little production of thyroid hormone
58
For most, what is the primary cause of thyroiditis?
Some form of autoimmunity or adenomas of the thyroid gland. Such as growths or nodules of the thyroid gland or with conditions such as postpartum thyroiditis
59
True or False: ometimes thyroid issues can be related to the thyroid itself, such as thyroiditis, which is inflammation of the thyroid gland. Although, in the greater scheme of things, we need to take a step back and look at where is the thyroiditis coming from.
True
60
What are the common types of thyroid conditions associated with hyperthyroidism?
* Graves Disease
* Plummer Disease
* Postpartum Thyroiditis
61
What are the common types of thyroid conditions associated with hypothyroidism?
* Autoimmune Hashimotos Thyroiditis
* Hypopituitary-Driven Hypothyroidism (Secondary Hypothyroidism)
* Nutrient-Deficiency Hypothyroidism
* Cellular Hypothyroidism
* Postpartum Thyroiditis
62
Hyperthyroidism is commonly induced by the BLANK stimulation of the thyroid which then leads to the overproduction of thyroid hormone.
autoimmune
63
What is Graves Disease?
Graves disease is one of the more common hyperthyroidism dysfunctions and is caused by an antibody that increases TSI (thyroid-stimulating immunoglobulin).
In this case, TSI is going to have a very similar effect to TSH, mimicking its action on the TSH receptor of the follicular cells, which then triggers the whole series of events that lead to more production of thyroid hormone itself.
64
What is Plummer Disease?
Plummer disease is caused by the overproduction of thyroid hormone as a result of thyroid nodule adenomas.
A thyroid nodule is a benign growth of the thyroid gland and is usually not cancerous. When these nodules are present on the thyroid, they have the potential to up regulate the MIT and DIT process, causing more T4 production, and resulting in symptoms of hyperthyroidism.
65
Why do you typically Goiter with hyerthyroid cases?
Both Plummer and Graves disease can cause inflammation and enlargement of the thyroid.
In many cases, we can actually see the enlargement of the person’s thyroid gland from their throat, where it'll be a little bit more expanded.
66
What is Thyroid Eye Disease and why does it occur?
A symptom of Graves disease, which is where a persons'e eys appear to pop slightly out of their sockets.
This occurs due to an autoimmune response by the body causing degradation of the tissues surrounding the eye, resulting in inflammation and swelling, causing the eyes to protrude from their sockets.
67
Which antibodies are typically present in order for there to be a Hashimoto's diagnosis?
TPO and TG antibodies
68
What roles does TPO play?
TPO plays a really big role in iodide oxidation, with TPO antibodies present this can impact the body’s ability to convert iodide into iodine.
Beyond that, because TPO plays a role in placing iodine on tyrosine, we can see it having an impact there as well, impeding the ability to produce MIT and DIT.
## Footnote
These antibodies are present in a Hashimoto's diagnosis = hypothyroidism (low thyroid hormone)
69
What role does TG (thyroglobulin) antibody play?
It's going to have an impact on thyroglobulin production within the thyroid. We need thyroglobulin for thyroid hormone production as well, so without that, thyroid hormone production is hindered.
## Footnote
This causes low thyroid hormone production, which results in hypothyroidism
70
When it comes to Hashimoto's Thyroiditis, what do we need to be considering?
Ways to balance the immune system and the up-regulation of those antibodies because it is not always a dsyfunction or disease of the thyroid itself but rather an overproduction of antibodies, which is a byproduct of an overactive immune system.
71
What is secondary hypothyroidism?
Hypopituitary-driven hypothyroidism
We call it secondary hypothyroidism because the hypothyroidism is caused as an aftermath effect of poor pituitary and/or hypothalamic function
72
What is happening in the case of secondary hypothyroidism?
We have a dysfunction within the HP axis of the brain, which impacts the brain’s ability to produce TRH and TSH properly.
73
Oftentimes HP issues are paired with other hypopituitary issues, such as WHAT?
Adrenal insufficiency or anovulation, and of course, hypothyroidism.
## Footnote
Essentially, when hypothalamic-pituitary dysfunction occurs, this can have an impact on thyroid health and thyroid hormone production further down the line.
74
Glucocorticoids produced by the adrenals play a role in the function of the BLANK, so adrenal health is important as well when it comes to BLANK uptake and conversion to BLANK.
sodium-iodide symporter; iodide uptake and conversion to iodine.
75
Why do we want to consider things like HPA dysregulation and adrenal health when observing hypothyroid issues?
Glucocorticoids produced by the adrenals play a role in the function of the sodium-iodide symporter, so adrenal health is important as well when it comes to iodide uptake and conversion to iodine.
This could having an impact on thyroid hormone production in various areas.
76
When considering secondary hypothyroidism, you may also consider whether or not the individual is prone to BLANK or BLANK, as that could be another indication that they are unable to produce sufficient sex hormones in general as a result of overall HP axis dysfunction.
anovulation or amenorrhea
77
BLANK is really important for the production and function of TRH and TSH
Zinc
## Footnote
In addition, zinc is a necessary for precursor deiodinase production and function
78
We need BLANK in our diet so that we have BLANK available to support the iodide oxidation process to make thyroid hormone.
iodine; iodine
79
Not only do we need iodine to support the iodide oxidation process to make thyroid homrone, but in order for iodide to get into the cells properly, we also need BLANK, as this is an important factor in the sodium-iodide symporter.
sodium
80
BLANK, which is necessary for converting iodide into iodine alongside H2O2, is heme dependent and heme requires the nutrients B9, B12, Zinc, Copper, and Iron to be produced.
TPO
81
In order for TPO to do its job properly, it needs H2O2, which requires SOD (Superoxide Dismutase), which requires the minerals BLANK & BLANK as cofactors.
zinc & copper
82
We need BLANK to continue the process of thyroid hormone production. So we need to have an adequate protein intake and BLANK intake in the diet in order for thyroglobulin to be produced properly.
tyrosine; tyrosine
| Tyrosine is a type of amino acid, which are the building blocks of prote
83
With the very last step in thyroid hormone conversion, deiodinases are BLANK and BLANK dependent.
selenium and cystine dependent
84
With cellular hypothyroidism, what we see is that the D3 deiodinase can be up-regulated by BLANK.
Cellular inflammation
85
D3 plays a role in reverse T3 and T2 conversion, meaning when cellular stress and inflammation are present, this can result in lowered BLANK and higher BLANK values.
T3; Reverse T3
86
When cellular inflammation is chronic, this can lead to the chronic deactivation of BLANK to BLANK, resulting in lower BLANK levels and symptoms of BLANK.
T3 to Reverse T3; T3; hypothyroidism.
87
Why do we need to be running reverse T3 on a thyroid panel?
When observing bloodwork ranges, reverse T3 is often elevated in the cases of cellular hypothyroidism.
When cellular inflammation is chronic, this can lead to the chronic deactivation of T3 to Reverse T3.
88
What causes cellular inflammation?
When considering cellular inflammation, we need to be looking at cellular health.
A few considerations:
* Fatty acid balance, which forms the structure and permeability of the cell’s lipid bilayer
* Dehydration, as water plays a big role in facilitating cellular communication and nutrient delivery
* Blood sugar imbalances, and high insulin levels
* Toxin overload, especially from gut and pathogenic infections
* Immune system up-regulation
* Oxidative stress and systemic inflammation
* Estrogen excess, as improper estrogen metabolism can lead to depurating adducts and the production of reactive oxygen species
* Nutrient deficiencies can play a big role in the cells being able to work properly as they should
* and so much more!
89
With postpartum thyroiditis, it contains aspects of both BLANK and BLANK?
Hyperthyroidism and hypothyroidism;In many cases, we may first see a hyperthyroid pattern, which then declines and eventually results in hypothyroidism patterns over the course of about 12 months.
90
True or False: postpartum thyroiditis usually lasts forever
False; it's usually temporary.
Although, in some cases, it can cause damage to the thyroid, and of course, when we have cellular damage to the thyroid, that has the potential to turn into primary hypothyroidism as the thyroid gland itself is unable to produce efficient thyroid hormone.
91
When can postpartum thyroiditis turn into primary hypothyroidism?
When it causes damage to the thyroid, and of course, when we have cellular damage to the thyroid, that has the potential to turn into primary hypothyroidism as the thyroid gland itself is unable to produce efficient thyroid hormone.
92
When it comes to the immune system, pregnancy is BLANK dominant state?
TH2
93
TH1 dominance induces more of a BLANK response that is often associated with organ-specific autoimmune diseases
pro inflammatory
94
TH2 dominance, we often see a lowered BLANK function, which is important for maintaining a healthy pregnancy.
Immune
95
After birth, once that BLANK dominance of the immune system is released, BLANK dominance may take over, which sometimes causes a rebound effect to occur. When this happens, it can result in more thyroid hormone production, TPO antibody production, and temporary symptoms of hyperthyroidism due to inflammation of the thyroid gland.
TH2; TH1
Over time, the thyroiditis that occurs in this situation can cause inflammation and degradation of the thyroid tissue resulting in thyroid hormone decreasing over a period of time, and thus, resulting in hypothyroid patterns.
96
What are some of the contributing factors to thyroiditis?
* Excess stress and cortisol
* Blood sugar dysregulation and insulin resistance
* Sex hormone imbalances
* Estrogen as excess estrogen can increase sex hormone binding globulin, which may influence TBG, causing an increase in bound and unusable thyroid hormone
* Androgen excess and PCOS are other hormone imbalances heavily associated with hypothyroidism
* Infections, such as intestinal dysbiosis, parasites, Epstein Barr virus, and Lyme disease. All of these infections can up-regulate the immune system and contribute more to autoimmune-related issues
* Oxidative stress and inflammation
* Heavy metal exposure, especially with halogens, which are within the family of fluoride, chlorine, and bromide which can displace iodine within the thyroid, having an impact on thyroid hormone production
* Certain medications, such as hormonal birth control, chemotherapy drugs, lithium, glucocorticoids, and dopamine antagonists38. These medications may either suppress thyroid hormone production, increase TSH, impair thyroid hormone metabolism, and/ or cause liver burden which can increase inflammation
* Thyroid hormone resistance, which is an issue that can cause thyroiditis when thyroid hormone medication is improperly taken, or if a person’s cells aren’t able to uptake their medication properly, typically as a result of cellular inflammation
97
What should you do to get to the root of your client's thyroid health?
* Get both a full thyroid panel as well as a full metabolic and nutrient panel
* Cycle charts, specifically when looking at basal body temp shifts, as thyroid hormone plays a role in regulatin body temp. and basal body temp.
* Symptom assesment and discussion.
## Footnote
When we have symptom assessment, we can look at… what is their nutrition quality, what is their digestive health, what are their energy levels like? Do they have any abnormal cyclical or menstrual patterns to observe?
98
What is step 1 for helping support our clients with their thyroid health?
We want to be looking at addressing the foundations.
What is their quality of nutrition? What are their dietary habits? What is their mineral balance like within their body? You may consider something like an HTMA to help you to assess their mineral balance. You also want to look at things like their lifestyle habits. How do they manage their stress? Do they have cortisol issues due to stress? Do they have really bad sleep and waking patterns that need to be addressed? What is their hydration like? Do they have a lot of toxic load influence in their life? Do they use conventional products? How is their digestive health and how is their blood sugar balance?
99
Once the foundations are in place, this is where we begin to identify the root of the thyroid dysfunction. So with autoimmune thyroid disorders, we talked about how this can have a big association with the BLANK.
Immune system
100
Roughly X% of the immune system is within the
gut.
70%; So whenever we have up-regulated immune system issues, I am always wanting to consider the state of the individual’s digestive health. In many ways, addressing gut health is fundamental when it comes to working with thyroid disorders, specifically those that are autoimmune.
101
You might want to look at avoiding gluten and soy because?
Gluten can demonstrate molecular mimicry to thyroid tissue. So when there is already an autoimmune response present, specifically with Hashimoto’s Thyroiditis, gluten may trigger further thyroid tissue damage.
Soy can also be a little bit more problematic for people with thyroid issues, as well as uncooked goitrogenic foods. Goitrogens are antinutrients found within uncooked cruciferous vegetables such as broccoli, cauliflower, cabbage, and kale and may contribute to inflammation of the thyroid when consumed uncooked and in excess.
102
When it comes to nutrient-deficiency-driven hypothyroidism, we want to look at addressing what?
Nutrient quality, as well as protein intake, digestive function, mineral balance, and cellular communication.
103
With hypopituitary-driven hypothyroidism, we primarily want to be looking at what?
The pituitary and considering what's causing inflammation of the brain and contributing to HP dysfunction.
For example, addressing stress, inflammation, and cortisol imbalances, as well as making sure they are consuming enough calories and emphasizing nutrient density in their diet.
