Thank you for posting this question here about supporting this woman with her thyroid health. I am glad her antibodies have improved, although given that they were high in the past she obviously has some autoimmune activity to consider as a part of long term support.
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. It is worthwhile to note that the medication Levothyroxine does contain iodine, and one iodine molecule is freed from each molecule of thyroxine in the conversion of T4 to T3.
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
Although the kidneys excrete approximately 90% of ingested iodine in a setting of iodine adequacy, they have a lower level of iodine excretion in a state of deficiency as the body attempts to replete iodine stores in the thyroid gland for the purpose of producing thyroid hormone. The thyroid gland in iodine-sufficient regions typically contains approximately 15mg of iodine.
Zimmerman MB. Iodine and Iodine Deficiency Disorders. Present Knowledge in Nutrition, 10th Edition. Ed. John W. Erdman, Jr., Ian A. MacDonald, Steven H. Zeisel. Wiley-Blackwell, 2012. 554-567.
Vought RL, et al. Iodine intake, excretion and thyroidal accumulation in healthy subjects. J Clin Endocrinol Metab. 1967 Jul;27(7):913-9. http://tinyurl.com/zbbvz4w
Selenium may play a critical role in reducing iodine-induced autoimmune thyroiditis, and supports the conversion of T4 into T3 which for this woman is somewhat low. 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
Additional nutrients which support thyroid function and healthy conversion from T4 to T3 include zinc, iron, the B vitamins, and vitamin A. Given her relatively high level (albeit normal) of reverse T3, support for stress and cortisol balance may be helpful. You may want to try supporting her with some of these nutrients and other things that support the body in producing thyroid hormone prior to having her increase the medication dosage further as her labs indicate may be helpful. However, this should be determined by how severe her symptoms are.
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. It is safe for use in individuals with autoimmune disease, and is not considered an adaptogen. 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.
The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client. 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
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 your client. 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.
- No Replies