Hyperthyroidism and Hypothyroidism PDF

Hyperthyroidism and Hypothyroidism Hyperthyroidism (WEIGHT LOSS→ higher TH→ higher metabolic rate→ burn more) Definition: overactive thyroid, excessive thyroid hormone (elevated metabolic rate) Most Common Cause: Grave’s Disease (enlarged thyroid, goiter, overactive, excess TH)...

Hyperthyroidism and Hypothyroidism Hyperthyroidism (WEIGHT LOSS→ higher TH→ higher metabolic rate→ burn more) Definition: overactive thyroid, excessive thyroid hormone (elevated metabolic rate) Most Common Cause: Grave’s Disease (enlarged thyroid, goiter, overactive, excess TH) ○ Risk Factors: autoimmune disorder/thyroiditis, excessive iodine intake, stress, gender (female), anemia, steroids, toxins Common Signs and Symptoms: Grave’s Disease (red, dry, puffy, bulging eyes- exophthalmos→ change in vision), heat intolerance and sweating, difficulty sleeping, anxiety (mental disturbances), weight loss, alterations in appetite, frequent bowel movement (higher metabolic rate→ higher GI motility), fatigue and muscle weakness, menstrual disturbance, thyroid enlargement, tremors, impaired fertility Treatment and Nutrition Considerations: antithyroid medication (Methimazole, Prophylthiouracil), radioactive iodine, surgery (thyroid removal) ○ Surgery: prevent malnutrition, unintentional weight loss, cachexia (wasting due to not getting enough energy), aspiration Promote adequate hydration, wound healing Monitor for dysphagia, difficulty chewing, mucositis, xerostomia, and dental caries after treatment, and adjust diet Avoid alcohol and tobacco Help with emotional effect of food fear Higher calorie and protein needs depending on treatment (chemo/radiation) Promote anticancer diet with foods rich in nutrients (vegetables, beans, whole grains, fish, citrus, antioxidants) ○ Nutrition: adequate protein and iodine from diet, limit processed foods, correct selenium and iron deficiency, vitamin D adequacy Limit gluten, dairy, uncooked goitrogenic foods (limited evidence) Hypothyroidism (WEIGHT GAIN) Definition: underactive thyroid, decreased thyroid hormone production (TH affect hair/skin) Most Common Cause: autoimmune disease/thyroiditis, surgery, radiation therapy, drugs like lithium, iodine deficiency, adrenal dysfunction, oxidative stress, aging, gender (female) ○ More than half due to Hasimotos’s thyroiditis (immune system attacks and destroys thyroid gland tissue) Common Signs and Symptoms: fatigue, forgetfulness, depression, heavy menses, dry/coarse hair/skin, mood swings, weight gain, hoarse voice, constipation Treatment and Nutrition Considerations: correct iodine deficiency or excess ○ May consider gluten avoidance and dairy avoidance with autoimmune thyroid conditions ○ Iodine Deficiency: limit soybean (soy isoflavones may inhibit TPO activity (used to make thyroid hormone), block med absorption) ○ Other: weight management, correct deficiencies (selenium, iron, magnesium, vit D), healthy balanced diet with limited processed foods (can worsen hypothyroidism) Synthroid (thyroid hormone replacement→ do not use with Hashimoto’s) Indication: hypothyroidism Hasimoto’s: can exacerbate condition (more TH, immune system will attack and cause flare up) Potential Interaction with Food  Take without food due to potential interaction with soy, fiber, iron and calcium supplement Using multivitamin with minerals together with levothyroxine may decrease effect of levothyroxine (separate by at least 4 hours) Should be taken on a consistent schedule with regard to time of day and relation to meals Hold continuous enteral nutrition (tube feedings) when given Goiter Definition: enlargement of thyroid gland (associated with hypothyroidism OR hyperthyroidism) Possible Causes: iodine deficiency (most common), thyroiditis, Grave’s Disease, congenital hypothyroidism Goitrogens: antithyroid activity through inhibition of TPO enzyme (limit raw vegetables) ○ Foods: cauliflower, broccoli, cabbage, brussel sprouts, mustard seed, turnip, radish, bamboo shoot, cassava, red wine, green tea, soy, sweet potato, millet Relationship with Iodine: size of thyroid decreases with higher iodine intake Iodine deficiency and toxicity can cause goiters Common Dietary Sources of Iodine and Selenium Iodine: animal protein foods and sea vegetables (adults= 150 mcg/day) Seaweed (nori, kelp, kombu, wakame) Fish, shellfish (cod, canned tuna, oysters, shrimp) Iodized table salt Dairy (milk yogurt, cheese), eggs, beef liver, chicken Selenium: cofactor for converting T4 to T3 (adults=55 mcg/day) Brazil nuts, seafood, meat, poultry, organ meats (liver) → PROTEIN RICH FOODS Polycystic Ovary Syndrome Definition: endocrine condition with set of symptoms related to hormonal imbalance (can affect metabolic, cardiovascular, inflammatory, reproductive, and other aspects of health) Reproductive Issues: amenorrhea, menstrual irregularities, anovulation, enlarged ovaries with multiple cysts, infertility General Symptoms: acne, hirsutism, male-pattern baldness, obesity, sleep apnea Causes: genetic and environmental factors (exact cause unknown) ○ High levels of male hormones and low estrogen ○ Insulin resistance (insulin receptor phosphorylation abnormalities) MNT: medications, cosmetic measures, lifestyle changes, management of blood sugar and complications Metformin for insulin resistance, clomiphene citrate (induces ovulation), oral contraceptives (treats menstrual irregularities, acne, hair growth), spironolactone (anti-androgen for hair growth and acne), thyroid hormone replacement for hypothyroidism Lifestyle changes for overweight/obesity (regular physical activity, low fat plant based diet) ○ Insulin Resistance: small frequent meals, restrict refined CHO, increase high fiber foods, low glycemic index/load ○ Hypothyroidism: adequate selenium and iodine intake ○ Vitamin D Supplementation: low vitamin D associated with PCOS development Healthy Eating Plan: ○ 4-5 meals or snacks daily, including breakfast (avoid skipping meals) ○ Variety of foods from all food groups (fruits, vegetables, grains, protein foods and dairy, healthy fat choices- canola and olive oil, walnuts, almonds, avocados)  ○ Protein at all meals and snacks (nut butters, lean meats, fish, tofu, beans, lentils, low fat dairy products) ○ Beverages (water, low fat or fat free milk, fortified soy beverage) Cushing’s Syndrome Definition: hypercortisolism, rare disorder caused by chronic exposure to excessive circulating cortisol Cortisol: stress hormone from adrenal gland (maintain BP, regulate blood glucose, reduce inflammation, participate in circadian rhythm and emotional memory) Common Causes: long term high dose use of steroids or cortisol like glucocorticoids, tumors (pituitary tumors), overproduction of adrenocorticotropic hormone (ACTH) → stimulate adrenal gland to overproduce cortisol Signs and Symptoms: more in females 30-50 Weight gain, thin arms and legs, moon/round face, increased fat around base of neck, fatty hump between shoulders, easy bruising, high BP, weak muscles Complications: osteoporosis, high BP, T2D, serious or multiple infections, loss of muscle mass and strength Management: manage complications Lower dosage of medications or use non-glucocorticoid medicine Treat tumor (surgery, radiation) Supporting with healthy diet rich in calcium and vitamin D (bone health, osteoporosis) Moderate low-impact physical activity (osteoporosis, high BP, T2D, muscle mass) Functions of Insulin and Glucagon Insulin: anabolic hormone (pancreatic beta cells), stimulates glycogen, triglyceride, and protein synthesis Most tissues in body depends on insulin for transportation of glucose from bloodstream into cells to be used for energy Secretion stimulated by an increased level of blood glucose, regulated by various hormones (growth hormone, melatonin, estrogen, leptin, etc.) Glucagon: catabolic hormone (pancreatic alpha cells), stimulate glycogenolysis, gluconeogenesis, lipolysis (additional energy production) Released in response to drop in blood glucose, prolonged fasting, exercise, protein rich meals Difference Between Type 1 and Type 2 Diabetes Type 1 Diabetes (5%): autoimmune condition, pancreatic beta cell destruction (insulin deficiency→ hyperglycemia) Highly related to autoimmune thyroid disease and celiac disease Type 2 Diabetes (90-95%): progressive defective insulin secretion with insulin resistance Risk Factors: obesity (increases insulin resistance), family history, age (>35), physical inactivity, prior history of gestational diabetes, prediabetes, hypertension, dyslipidemia, race/ethnicity ○ Medication conditions (Cushing’s Syndrome, PCOS, or medication like corticosteroids) ○ Insulin Resistance: compensatory effect (beta cells overworked and produce more insulin), body does not respond well to insulin, leading to hyperglycemia ○ Obesity: high abdominal fat distribution→ inflammation (inflammatory factors block insulin communication with cells) → more FFA leads to IR Higher resistin and cortisol, low adiponectin→ IR ○ Prediabetes: blood sugar levels higher than normal, but not high enough to be classified as T2D (no clear symptoms and undetected)→ can be reversed with lifestyle mods Common Signs and Symptoms for Uncontrolled Type 1 Diabetes Biochemical Tests Presence of ketones in urine, normal/low insulin and C-peptide levels, high autoantibodies against certain proteins found in pancreas Common Signs and Symptoms: Polyuria (excessive urination), polydipsia (excessive thirst), polyphagia (excessive hunger), unexpected weight loss and fatigue, dehydration and electrolyte imbalance, diabetic ketoacidosis (serious and life threatening) A1C and Fasting Glucose Levels for Healthy Adults and Diabetes Diagnosis Result A1C Fasting Plasma Glucose Oral Glucose Tolerance Random Blood (FPG) Test (OGTT) Sugar Test Normal