Thank you for following up on this case here. Although hypothyroidism is one possible aetiology of hair loss, there are many things which can lead to loss of hair and the pattern of loss is important to consider. Hair loss can be due to a variety of things, which include issues such as autoimmunity, hormonal imbalance, thyroid, or cortisol abnormalities. Other things such as oxidative stress and nutritional deficiencies also may play a role. The factors at play with male pattern hair loss, known as androgenic alopecia, are quite different than alopecia areata, which begins with patches of hair loss which may encompass the full head (and body) and is associated with autoimmunity. Generalized hair thinning yet is another variant, which may be associated with thyroid, hormones, nutritional deficiencies, and toxicity.
I do agree that some of the nutritional markers for this man are tending towards insufficiency and may benefit from supplementation. Adequacy of both zinc and iron are important for healthy thyroid function, and conversion of thyroid precursors to the active hormone. Iodine deficiency is quite common, both in the US (more midland) and the UK. His antibodies are within a normal range and do not suggest autoimmunity, so I would not be concerned with iodine supplementation. B vitamins and vitamin A are important for healthy thyroid function, and he also appears to be on the lower end of normal for his serum vitamin B.
Of note, the concern of iodine supplementation with autoimmunity is with the use of high doses (far in excess of the RDA). Iodine is an essential nutrient for everyone, and iodine deficiency can co-exist with thyroid autoimmunity. However, when supplementing iodine in individuals with thyroid autoimmunity it also is important to supplement other essential thyroid supportive nutrients in particular selenium, as this reduces the likelihood of an inflammatory response to iodine.
Selenium plays a critical role in reducing iodine-induced autoimmune thyroiditis, and supports the conversion of T4 into T3. In an animal model of iodine-induced autoimmune thyroiditis, supplementation of selenium was found to upregulate regulatory T cells, reduced lymphocytic infiltration, and lower serum thyroglobulin antibody (TgAb) titres compared to untreated mice. Other studies have found similar effects of reduced TgAbs and lymphocytic invasion with selenium in addition to iodine supplementation in animal models of spontaneous autoimmune thyroiditis.
Xue H, et al. Selenium upregulates CD4(+)CD25(+) regulatory T cells in iodine-induced autoimmune thyroiditis model of NOD.H-2(h4) mice. Endocr J. 2010;57(7):595-601. Epub 2010 Apr 27. http://tinyurl.com/jklucat
Wang W, et al. Effects of Selenium Supplementation on Spontaneous Autoimmune Thyroiditis in NOD.H-2h4 Mice. Thyroid. 2015 Oct;25(10):1137-44. http://tinyurl.com/z67xrc7
You may want to perform a test to evaluate for iodine sufficiency to determine if this is an issue. Iodine status should not be determined via a blood test, but should be assessed via urine. The most accurate measurement of iodine status is a median 24-hour urinary iodine concentration (UIC) test as levels vary with intake of both iodine and fluid. If a spot measurement is made rather than a 24-hour collection, expressing the urinary iodide concentration as a function of urinary creatinine is necessary to correct for the variable influence of fluid intake. It is worthy to note that as the kidneys excrete approximately 90% of ingested iodine this number primarily reflects adequacy of intake and is relative consumption in recent days.
WHO, UNICEF, International Council for the Control of Iodine Deficiency Disorders. Assessment of iodine deficiency disorders and monitoring their elimination, 3rd Ed. Geneva, Switzerland: World Health Organization, 2007.
Vejbjerg P, et al. Estimation of iodine intake from various urinary iodine measurements in population studies. Thyroid. 2009 Nov;19(11):1281-6. http://tinyurl.com/jmsyfu2
I agree that stress and lifestyle also may play a role in this man’s hair loss, and that his blood sugar measurements are a bit on the high side. Oxidative stress can impact hair growth (and loss), which is not surprising when we consider the very small hair follicle from which growth must continuously occur. Evaluation of this man’s history for potential environmental exposure to both heavy metals and other sources of toxicity may help direct further testing and therapies. The hair is one of the things in which we see the excretion of heavy (and essential) metals, as they are present in the follicle and come out with the new hair growth.
A garum armoricum Ling-fish-based food concentrate has been shown to balance adrenal function or dysregulated HPA function under stress as well as supporting mood and sleep. This food concentrate (http://tinyurl.com/pntrrf4) contains polypeptides that act as precursors to neurotransmitters such GABA, encephalins and endorphins. They can exert a regulatory effect on the nervous system, potentially enabling the organism to adapt to stressful conditions. It also contains the essential omega-3 fatty acids, DHA and EPA. These are precursors of the prostaglandins and prostacyclins, cellular chemical mediators which help regulate the main biological functions of the body, including the noradrenergic functions of the central nervous system.
You also may want to consider supporting this man’s endocrine function as a whole, as his testosterone levels, although normal, are on the lower end especially for his age. Support for hypothalamic function, which sends a signal to the thyroid and other hormonal axis in the body to in essence turn on (or off in a state of excess), may also be helpful. I would question how his cortisol response is as well, given the lower levels of testosterone in addition to thyroid. An adrenal stress index can be used to evaluate this.
Zinc may support reduction of hair loss, and has been shown to be helpful in alopecia areata when low zinc levels are present. Essential fatty acids in combination with antioxidants have been shown in human studies to support the reduction of hair loss. Epigallocatechin-3-gallate (EGCG) from green tea has been shown to enhance hair growth in vitro as well.
Park H, et al. The therapeutic effect and the changed serum zinc level after zinc supplementation in alopecia areata patients who had a low serum zinc level. Ann Dermatol. 2009 May;21(2):142-6. http://tinyurl.com/q8og2l8
Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002 Jul;27(5):396-404. http://tinyurl.com/mje4exf
Le Floc’h C, et al. Effect of a nutritional supplement on hair loss in women. J Cosmet Dermatol. 2015 Mar;14(1):76-82. http://tinyurl.com/ovza8cf
Kwon OS, et al. Human hair growth enhancement in vitro by green tea epigallocatechin-3-gallate (EGCG). Phytomedicine. 2007 Aug;14(7-8):551-5. http://tinyurl.com/oh6w2cc
The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Meda-Stim (BRC): 2 caps with breakfast. http://tinyurl.com/cwt6gwh Thyroid supportive nutrients and botanicals.
Selenium Solution Liquid (ARG): 1/2 teaspoon (100mcg) daily with food. http://tinyurl.com/kqmmbdo
Fe-Zyme (BRC): 1 tablet daily with food. https://tinyurl.com/ycmbnbg8 Also contains additional zinc.
ProOmega™ (NN): 2 softgels twice daily with meals (2000 mg total combined EPA/DHA). http://tinyurl.com/7t9myqe
ThioDox (ARG): 1-2 capsules twice daily. https://tinyurl.com/yd69w9dl
Nrf2 Renew (ARG): 1-2 capsules twice daily. http://tinyurl.com/jkvywwg
Also consider for stress response/cortisol balance:
Stabilium® 200 (ARG): 4 capsules once daily on an empty stomach for 4 weeks, decreasing to 2 -3 capsules after this. http://tinyurl.com/pm5ou44 Garum armoricum concentrate that supports balanced HPA axis response to stress.
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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