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Medical Preparedness – Diabetes

Do you have an extra glucometer in your supplies?

A chronic condition such as diabetes can be life threatening if our fragile medical supply chain is disrupted and medication or supplies to test are not available. Having adequate supplies- an extra glucometer with test trips, batteries, and solution should be in every diabetic’s medical kit. Whether you are type 1, 2 or gestational diabetic having the extra glucometer and supplies is vital. Nowadays, glucometers there are so many high-tech glucometers- ones that use a thin needle under the skin and read glucose levels every few minutes and alert user if levels are out of range, to blood free sensors that use flashing light to take glucose readings- and even more. Even though technology is wonderful, relying on it can be dangerous. Glucometers can fail by giving incorrect readings or stop working altogether. It is important to have another glucometer, preferably one that isn’t as high tech to measure the reading against or in case of altogether failure. In addition, make sure you have an adequate supply of medication- both oral and injectable insulin (along with supplies) in case these drugs aren’t available for an extended period of time. Aim for at least 6-month supply of drugs and supplies. Even more would be better.

Always check with the diabetic and observe for symptoms of hypo/hyperglycemia. If glucose readings are within normal limits established by their care provider but they exhibit symptoms of poor glucose control, retake glucose with alternate glucometer. Contact primary care provider or healthcare professional if needed.

Diabetes testing and lab values

The following are excerpts from the CDC website:

Tests for Type 1 Diabetes, Type 2 Diabetes, and Prediabetes

A1C Test

The A1C test measures your average blood sugar level over the past 2 or 3 months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes.

Fasting Blood Sugar Test

This measures your blood sugar after an overnight fast (not eating). A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.

Random Blood Sugar Test

This measures your blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast (not eat) first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.

5 things you can do to improve blood sugar – prediabetic or diabetic

  1. Get moving

Exercise of any form contributes to overall health and is a valuable tool in managing glucose levels. Even a brisk walk has benefits. If you haven’t been exercising, take it slow and easy. The key is to be consistent. If walking, aim for at least 30 minutes a day 5 days a week. Studies reveled that walking 30 minutes a day reduced blood sugar readings by 25 percent. Once you have mastered this, consider HIIT- high intensity interval training-short bursts of intense exercise alternated with low intensity recovery periods. Studies show that this form of exercise has the more powerful effect on glucose control than other forms of exercise. Consult with your primary care provider before embarking on any new exercise regimen.

  1. Reduce stress

High stress hormones prevent the pancreas from producing insulin. When under stress, stress hormones such as glucagon and epinephrine are released and reduce glucose uptake in the muscle. When this happens, more glucose is circulating in the blood, causing hyperglycemia. Ways to manage and reduce stress include journaling, exercise, meditate, connect with others, and my personal favorite, deep breathing. Johns Hopkins Medicine has a good video on deep breathing and stress reduction.

  1. Follow diabetic diet and consider intermittent fasting (IF)- only under the supervision of a healthcare professional

If you are prediabetic or type 2 diabetic intermittent fasting- when you eat in a restricted time frame- for example eat 8 hours and fast 16- has proven health benefits, including the ability to lower blood sugar and in some cases reverse diabetes and insulin resistance (Insulin resistance is when muscles, fat, and liver cells don’t respond well to insulin and can’t easily take up glucose from your blood.)

There are downsides to intermittent fasting. If you are taking medication to lower blood glucose IF could potentially cause a hypoglycemic episode. In addition, with type 1 diabetics, IF can cause hyperglycemia and hypoglycemia.

  1. Get good quality sleep- at least 7 hours a night

Too little sleep can affect glucose levels by:

  • Increasing insulin resistance.
  • Make you hungrier the next day and reduce how full you feel after eating and causes the hunger hormone grehlin to increase
  • Make you more likely to reach for junk foods—those that are high in carbs and sugar.
  1. Stay hydrated and don’t get overheated

Dehydration can lead to an increase in blood glucose because the blood is more concentrated.

Also, extreme heat can cause blood vessels to widen, which in turn causes insulin to absorb more quickly, leading to low blood sugar.

- Brooke Lounsbury, RN

Medical Content Writer

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The Ongoing Adderall Shortage

The ongoing Adderall shortage seems to have no end. Teva, the largest manufacturer of Adderall, is experiencing “ongoing intermittent manufacturing delays” due to increased demand. Every year, the DEA sets a quota — a limit on the amount of raw materials for many controlled substances, like Adderall. This is based in part on the Food and Drug Administration’s estimate of the need for the drug: For 2023, the FDA estimated just over 38,000 kilograms of amphetamine would be sufficient to meet the demand for Adderall and its generics – and the DEA set the quota at 42,400 kilograms, according to a DEA spokesman.

What is Adderall?

Adderall is a combination medication of Amphetamine/dextroamphetamine, used to treat attention deficit hyperactivity disorder – ADHD (attention deficit hyperactive disorder) and narcolepsy, a sleep disorder that makes one drowsy and unable to stay awake during the day.

Adderall is classified as schedule ll drug because its potential for abuse is high, due to its addictive nature. Other drugs that fall in this category are Vicodin, cocaine, fentanyl, oxycodone and Ritalin.

The Adderall shortage is affecting a large part of the U.S. population

According to the CDC:

CDC scientists found that, as of 2016, 6.1 million children aged 2-17 years living in the U.S. had been diagnosed with attention-deficit/hyperactivity disorder (ADHD), which is similar to previous estimates. Researchers also found that children living in rural areas were more likely to have been diagnosed with ADHD and less likely to receive behavioral treatment in the past year compared with children living in urban or suburban areas.

Among all children 2-17 years of age with ADHD, researchers also found:

  • 6 out of 10 (62%) were taking medication for their ADHD, and represent 1 out of 20 of all U.S. children;
  • Just under half (47%) received any behavioral treatment for their ADHD in the past year. Among the youngest children (2-5 years of age), the number increased to over half (60%);
  • Nearly two-thirds (64%) also had another mental, emotional, or behavioral disorder, such as conduct disorder, anxiety, depression, autism, and Tourette syndrome.

During the pandemic, prescriptions for ADHD medications increased significantly

Relative annual percent change in percentage of persons aged 5–64 years with at least one stimulant prescription fill, by sex and age group — MarketScan commercial databases, United States, 2016–2021

How Adderall works

It is a stimulant that works by increasing the amounts of dopamine and norepinephrine in the brain. Dopamine is a neurotransmitter that plays a role in the “reward” center of the brain. It is released during pleasurable activities such as eating, sex, regular exercise and any activity that involves expectation of reward.

Norepinephrine affects how the brain responds to events, particularly how it pays attention and the speed with which it reacts to outside stimuli., belongs to a class of drugs known as stimulants. It can help increase your ability to pay attention, stay focused on an activity, and control behavior problems. High levels of norepinephrine activate the “fight or flight” part of the sympathetic nervous system, leading to fear and anger responses.

What non pharmaceutical interventions you can do to increase dopamine and norepinephrine

There are a wide variety of treatments available for ADHD, including medication, counseling and behavior therapy, and lifestyle changes.

  • Eat tyrosine rich foods

Tyrosine is a non-essential amino acid, meaning the body can synthesize it, and is a precursor to norepinephrine and increases dopamine availability. Tyrosine rich foods include:

Beef, pork, fish chicke4n, firm tofu, milk, low fat ricotta cheese, large white beans, squash and pumpkin seeds and wild rice

  • Regular exercise

Regular, consistent exercise has been proven to increase dopamine levels in the brain. In addition, regular exercise is widely known to improve mood.

  • Balance gut health

Recent research is proving the important role your digestive system has in producing many neurotransmitters, including dopamine. Healthy microbiota in the gut leads to dopamine, serotonin and other neurotransmitters increase. Fermented foods which are rich in probiotics, kefir,yogurt with active cultures and fiber rich fruits and vegetables contribute to overall health.

  • Get good quality sleep

Sleep allows the body to repair and rejuvenate. Sleep is one of the most important and underrated activities we engage in. When rested, your body is able to hand stressors and remain more alert and focused.

  • Practice meditation or prayer

 According to a study “Increased dopamine tone during meditation-induced change of consciousness” two sets of participants were evaluated. One  set had eyes closed, and not instructed to do anything. The other set practiced focused meditation. The focused meditation group had a  65% increase in endogenous dopamine release. An increase in dopamine also occurred during a 7-day spiritual retreat.

- Brooke Lounsbury, RN

Medical Content Writer

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Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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What is Discontinuation Syndrome?

You may have heard or been told by your care provider to never stop taking your antidepressant medication abruptly and wondered why. The side effects of suddenly stopping your antidepressant can be severe and last for months or even years.

What are antidepressants?

Antidepressants are prescription drugs used to treat clinical depression. They are one of the most commonly used medications on the market. 11% of Americans over the age of 12 take antidepressant medication.

They also are used to treat:

  • Anxiety disorders
  • Obsessive compulsive disorder (OCD)
  • Panic disorders
  • Serious phobias, such as agoraphobia and social anxiety (social phobia)
  • Bulimia
  • Post-traumatic stress disorder (PTSD)
  • Help ease symptoms associated with nicotine or methamphetamine withdrawal

How antidepressants work

It’s thought that antidepressants work by increasing neurotransmitters. These are chemicals in the brain like serotonin and noradrenaline. They can improve mood and emotion, although this process isn’t fully understood.

Types of antidepressants

Selective serotonin reuptake inhibitors (SSRI)

SSRIs are the most widely prescribed antidepressant. SSRIs work by increasing serotonin levels in the brain. Serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). It’s thought to have a good influence on mood, emotion and sleep.

After carrying a message, serotonin is usually reabsorbed by the nerve cells (known as “reuptake”). SSRIs work by blocking (“inhibiting”) reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells.

A few examples are:

  • citalopram (Celexa)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • fluoxetine (Prozac)

Serotonin and norepinephrine reuptake inhibitors (SNRI)

SNRIs are similar to SSRIs. Evidence suggests that some people respond better to SSRIs, while others respond better to SNRIs. They are sometimes used to treat anxiety disorders and long-term (chronic) pain, especially nerve pain.

Examples of SNRIs include:

  • duloxetine (Cymbalta)
  • venlafaxine (Effexor)
  • desvenlafaxine (Pristiq)

Tricyclic antidepressant (TCA)

TCAs are an older type of antidepressant. They’re no longer usually recommended as a first-line treatment for depression. This is because they can be more dangerous if an overdose is taken. They also cause more unpleasant side effects than SSRIs and SNRIs.

People with severe depression who fail to respond to other treatments may be prescribed TCAs. TCAs may also be recommended for other mental health conditions, like OCD and bipolar disorder.

Examples of TCAs include:

  • amitriptyline
  • imipramine
  • nortriptyline
  • Some types of TCAs, like amitriptyline, can also be used to treat chronic nerve pain.

Atypical antidepressants

Atypical antidepressants work in a manner different than other antidepressants. They change the levels of one or more neurotransmitters, such as dopamine, serotonin or norepinephrine.

Examples of atypical antidepressants include:

  • Bupropion (Wellbutrin SR, Wellbutrin XL, others)
  • Mirtazapine (Remeron)

What is half life?

A half-life is the time it takes for a drug in your body to reduce by half. Half-life does not change depending on the dosage a person is taking or the amount of time they have been on medication. Half-life can vary from person to person according to their overall health and other factors.

Every drug has its own unique half-life. For instance,

SSRIs

 Most SSRIs have a half life or a day or so, except Prozac

  • Prozac (fluoxetine) has a longer half life than many other antidepressants. Depending on individual metabolism and health, it can take 1-4 days to reach half-life, and up to 30 days to be completely removed from the body.
  • Sertraline(Zoloft)-22 to 36 hours
  • Citalopram (Celexa)-36 hours
  • Paroxetine (Paxil)-24 hours

SNRIs

  • Duloxetine (Cymbalta)- 8 to 17 hours
  • Venlafaxine (Effexor)-4 to 7 hours
  • Desvenlafaxine (Pristiq)-about 11 hours

TCAs   

  • Amitriptyline- 9-25 hours
  • Imipramine- 19 hours
  • Nortriptyline-36 hours

Atypical antidepressants

  • Bupropion (Wellbutrin SR, Wellbutrin XL, others)- 33-37 hours
  • Mirtazapine (Remeron)- 20-40 hours

Discontinuation syndrome

Never go off or change the dose of your antidepressant without the guidance of your care provider.

Discontinuation syndrome occurs when an antidepressant is stopped suddenly. Depending on the half life of the drug, the symptoms can be more severe and longer lasting. Withdrawal symptoms usually come on within a few days of stopping the medicine and can last from 1 week to several months or more. Some people have severe withdrawal symptoms that last for years.

Withdrawal symptoms

Neurotransmitters are not only active in the brain but the entire body. Abruptly stopping antidepressants causes changes to neurotransmitter levels that can be felt throughout the body.

There are many mental and physical symptoms when coming off /abruptly stopping antidepressants including:

  • Mood swings, agitation, manic feelings, depression, irritability, confusion, paranoid, suicidal
  • Irritable, anxious, confused
  • Balance: dizziness, light-headedness, vertigo
  • Unusual sensations: numbness, sound hypersensitivity, “brain-zap”, which is a feeling of an electric shock to the head
  • Stomach cramps, loss of appetite, nausea, vomiting
  • Insomnia, vivid dreams or nightmares
  • Restless legs, uneven gait
  • Slurred speech
  • Heat sensitivity, sweating

Given the severity of symptoms from abruptly stopping antidepressants, be sure you have enough in case of supply chain disruption. Review your medications with your care provider and have a plan in place for enough medication in the event your medication is in short supply.

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

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Hashimotos Thyroiditis Part 2

Tips to manage Hashimoto’s

  • Health risks of not treating Hashimoto’s adequately
  • Lifestyle/stress reduction tips to manage energy and emotional ups and downs
  • How to naturally increase biologically active T3
  • Diet strategies to help heal
  • Nutritional supplements that can aid in recovery and optimal health
  • How to advocate for yourself in the healthcare field when dealing with Hashimoto’s

Health risks of not treating Hashimoto’s adequately

  • May cause impaired carbohydrate metabolism leading to an increase in type 1 and type 2 diabetes- A study that examined hospitalized patients between the years of 2001 and 2010, the Endocrinology and Diabetology Department in Bydgoszcz concluded : “Conclusions: Carbohydrate metabolism disorders in the form of type 1 diabetes connected with an autoimmune process, as well as type 2 diabetes connected with the increase of the insulin resistance, occurred in average of half of the patients with Hashimoto’s thyroiditis.”
  • Cognitive decline/brain fog, inability to focus, – Hashimoto’s thyroiditis is an inflammatory disease (hence the “itis” at the ending of thyroiditis) This extends to brain tissue, where brain inflammation can cause a multitude of problems.
  • Fertility issuesAn unregulated thyroid condition of any kind can lead to lack of or incomplete implantation or early miscarriage. Thyroid disorders in men can affect sperm quality and motility
  • Higher risk of heart disease and high cholesterol

A large study in Demark over a period of 7 years revealed that   individuals with mild hypothyroidism who were not treated had an 83% increased risk of developing heart problems as compared with individuals with normal thyroid function or hypothyroidism that was treated. 

High cholesterol – Low thyroid function negatively affects lipid metabolism, leading to an increase LDL, the “bad cholesterol.”

Lifestyle/stress reduction tips to manage energy and emotional ups and downs

Hashimoto’s disease can have you feeling great one day and totally exhausted the next. Even when optimally managed, excess stress, either emotional or physical can leave one feeling exhausted for days. It is important to maintain good diet, adequate exercise, avoid stress as much as possible and keep a consistent schedule.

  • Remove/reduce sugar from the diet as much as possible, replace with fiber rich fruits. Sugar can place a tremendous burden on the body, flooding cells with insulin to deal with excess glucose in the bloodstream. This can set off a cascade of reactions that challenge thyroid regulation and can affect fat cell receptors and metabolism.
  • Make time for exercise-Make sure you are getting at least 15 minutes of brisk walking in a day. However, don’t overdo any physical activity. This can cause adrenal fatigue, cortisol overload and other stressors that can create a cascading downward spiral resulting in an overload on thyroid function.
  • Plan your days, but don’t over plan. Make time in your schedule to eat a healthy diet, exercise and get good quality sleep. In addition, make relationships and community a priority. Healthy relationships help carry life’s burdens and reduce stress hormones.
  • Get adequate, good quality sleep- The body repairs, heals and detoxifies during sleep. Good quality sleep is vital for Hashimoto patients. Aim for at least 7 hours of shut eye.
  • Keep stress at a minimum. Overactive adrenals, cause by stress can lead to thyroid dysfunction, diabetes, heart disease and more. Nurture and maintain supportive relationships. Avoid news and media if it negatively affects you. Take up a hobby. Hobbies have proven to reduce stress and calm the mind.

How to naturally increase biologically active T3

T3, the biologically active thyroid form can be increased by:

  • Supplementing diet with selenium and zinc rich foods. A rich source of selenium can be found in Brazil nuts- you only need 1-2 a day, Zinc is found in shellfish, nuts, meats, legumes. If supplementing with either selenium or zinc consult your care provider. Selenium toxicity can cause kidney failure and heart attack or heart failure, zinc toxicity symptoms are nausea, dizziness, vomiting and can lead to copper deficiency and a decrease in HDL (good) cholesterol.
  • Adding healthy fats to your diet– flax, avocado, raw unsalted seeds, and nuts. These foods aid in helping cell receptors take up thyroid hormone.
  • Moderate exercise– Walking, jogging, swimming, tennis, biking, hiking in moderation helps overall thyroid function.
  • Liver detoxification– The liver is involved in the conversion of thyroid hormone and regulation. Some foods that can help detoxify the liver are onions, beetroot, apples, turmeric, leafy greens, tea and in moderation, coffee.
  • Add sea vegetables to your diet. Iodine is a key factor in thyroid function; however, iodine supplementation can be tricky. Too much or too little can negatively affect thyroid dysfunction. Sea salt and iodized salt in moderation along with adding kelp and seaweed powder to your meal can help provide iodine needed supplementation.
  • Drink plenty of good quality, fluoride free water- Filter your water, and if fluoridated use a filter that removes fluoride. Fluoride has an electrical affinity stronger than iodine and will bond to the tyrosine molecule (Thyroid hormone is comprised of tyrosine and iodine) This reduces the amount of thyroid hormone in the body.

 

Diet strategies to help heal

It is believed that impaired gastrointestinal tract (gut dysbiosis) and intestinal permeability are the main cause of Hashimotos. To learn more check out Dr Isabella Wentz book on Hashimotos Thyroiditis- the root cause. This book is a wealth of information to educate and empower anyone dealing with Hashimoto’s.

  • As stated above, avoid simple carbohydrates. Breakfast should include a quality high protein item and fruit or vegetable if desired. Some quality high protein foods are cold water fish (salmon, sardines, and tuna for example) grass fed and finished meats, eggs, and poultry.
  • Increase leafy greens and vegetables such as carrots, turnips,celery
  • Drink twice body weight in ounces of quality water.
  • Add healthy fats to your diet. Healthy fats include butter (no margarine) flax, raw, unsalted nuts and seeds, avocados, olive oil and cold-water fish such as salmon.
  • Add a digestive enzyme right before meals if you experience stomach issues.
  • Eat soy in moderation- Soy, if paired with iodine deficiency can inhibit thyroid function. Check ingredient labels on every packaged food item, including salad dressings, protein bars, ice cream etc. for added soy. Most nutritionists advise to limit soy, not cut it out completely.
  • Cruciferous vegetables- cabbage, broccoli, cauliflower, brussel sprouts etc. if eaten in excess can suppress thyroid function. These foods are packed with nutrition. Don’t cut them out completely, just don’t eat in excess.
  • Supplement with probiotics and fermented foods- Gut health-restoring the gut microbiome- is a large part of healing and managing Hashimoto’s
  • Do a trial run of going gluten free- It takes about 3 weeks for the body to adjust to a gluten free diet. Many report relief in digestive symptoms and less body aches after stopping gluten. In a select population, gluten consumption can trigger an immune reaction. This is because gluten contains a protein (gliadin) that resembles transglutaminase, an enzyme of the thyroid. In gluten sensitivity or celiac disease, the immune system mistakenly attacks the thyroid.
  • Some people react to casein which is found in cow milk, yogurt, some cheeses and supplements. Casein is very structurally similar to gluten(gliadin) and some people have a negative reaction to it, just like gluten.

Nutritional supplements that can aid in recovery and optimal health

Important-Check with your healthcare provider before taking supplements- many supplements can interact with medications you are currently taking

  • Selenium works in synergy with vitamin E to form active T3
  • Zinc- helps repair intestinal walls and stabilizes immune system.
  • Vitamin D with K2 (K2 aids calcium absorption to bones instead of going to arteries where calcium can build up, leading to heart attack and stroke.)
  • Vitamin C with bioflavonoids
  • Magnesium citrate
  • Iron in the form of ferritin- if iron deficient
  • Iodine
  • B complex (look for the methylated form of B12)
  • Probiotics
  • Betain with Pepsin- a natural gastric acid- many Hashimoto sufferers have low stomach acid
  • Digestive enzymes- hel break down fats, carbohydrates and protein. Many diagnosed with Hashimotos have problems digesting food.

 

How to advocate for yourself in the healthcare field when dealing with Hashimoto’s

Dealing with thyroid disorders can be a complicated and complex health issue. Many diseases mimic others- Some heart diseases may have undiagnosed thyroid function. This also is common with depression, anxiety, and other mental health disorders. Some medications can affect thyroid function. Diabetics have a higher incidence of thyroid disorders.

Educating yourself and seeking a health professional who understands  thyroid disorders is vital to overall wellbeing.

At the very minimum, request a TSH and free T4 lab if hypothyroid is suspected.

Keep a journal of food, activity, mood and physical symptoms that you have recorded for a week or so before your appointment. Include physical signs of hypothyroid you may be having. This will enable your care provider to provide the best care possible.  

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

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Hashimotos Thyroiditis Part 1

Part 1 will cover

  • Hashimoto’s description
  • Prevalence of Hashimoto’s
  • Symptoms of low thyroid (Is it Hashimotos?)
  • Other not as common hypothyroid conditions
  • Lab tests to diagnose Hashimoto’s
  • Medications to treat low thyroid/Hashimotos

Part 2 will cover:

Tips to manage Hashimoto’s along with medications such as

  • Health risks of not treating Hashimoto’s adequately
  • Lifestyle/stress reduction tips to manage energy and emotional ups and downs
  • How to naturally increase biologically active T3
  • Diet strategies to help heal
  • Nutritional supplements that can aid in recovery and optimal health
  • How to advocate for yourself in the healthcare field when dealing with Hashimoto’s

Description

Hashimoto’s thyroiditis is an autoimmune disease that affects the thyroid. An autoimmune disease is a condition in which the body’s immune system mistakes its own healthy tissues as foreign and attacks them. Most autoimmune diseases cause inflammation of the affected tissue. In the case of Hashimoto’s thyroiditis, the thyroid gland is inflamed and attacked by the body’s immune system.

Note: any word with “itis” at the end indicates inflammation. (Arthritis, bursitis, conjunctivitis for example)

Over 90% of hypothyroid cases are Hashimoto’s.

Other causes of low thyroid are:

 (Excerpt from American Thyroid Association)

  • Pituitary gland disorder/damage-The pituitary, the “master gland,” tells the thyroid how much hormone to make. When the pituitary is damaged by a tumor, radiation, or surgery, it may no longer be able to give the thyroid instructions, and the thyroid may stop making enough hormone.
  • Medicines-Medicines such as amiodarone, lithium, interferon alpha, and interleukin-2 can prevent the thyroid gland from being able to make hormone normally. These drugs are most likely to trigger hypothyroidism in patients who have a genetic tendency to autoimmune thyroid disease.
  • Too much or too little iodine. The thyroid gland must have iodine to make thyroid hormone. Iodine comes into the body in food and travels through the blood to the thyroid. Keeping thyroid hormone production in balance requires the right amount of iodine. Taking in too much iodine can cause or worsen hypothyroidism.
  • Surgical removal of part or all of the thyroid gland due to nodules or cancer
  • Radiation treatment-Patients with Hodgkin’s disease, lymphoma, or cancers of the head or neck are treated with radiation. All these patients can lose part or all of their thyroid function.
  • Congenital hypothyroidism (hypothyroidism that a baby is born with). A few babies are born without a thyroid or with only a partly formed one. A few have part or all their thyroid in the wrong place (ectopic thyroid). In some babies, the thyroid cells or their enzymes don’t work right.
  • Rare disorders that infiltrate the thyroid. In a few people, diseases deposit abnormal substances in the thyroid and impair its ability to function. For example, amyloidosis can deposit amyloid protein, sarcoidosis can deposit granulomas, and hemochromatosis can deposit iron.

Prevalence of Hashimoto’s

  • Most common in women– The American Thyroid Association (ATA) estimates that five to eight women are affected with Hashimoto’s for every one man. The ATA also estimates that one in eight women will be affected with Hashimoto’s or another thyroid disorder at some point in their lives.
  • Runs in families (genetic predisposition)
  • Affects about 5 percent of the US population
  • It is suspected that it is underdiagnosed

Symptoms

The onset of Hashimoto’s disease can be difficult to diagnose. As thyroid hormones are released in the bloodstream from  antibodies attacking the thyroid, transitory (temporary)hyperthyroidism (high thyroid) results.

Early symptoms can mimic hyperthyroid. This condition presents as an elevated T3 (the biologically active form of thyroid) and elevated T4, along with suppressed TSH. This condition is called thyrotoxicosis (Hashitoxicosis). This phase can last for 1-2 months, however in rare cases this phase can last for 2 or more years.

 Early-temporary symptoms can include

  • Anxiety
  • Nervousness
  • Diarrhea
  • Sleeplessness
  • Mood swings and muscle weakness.

 As the disease progresses (the autoimmune attack continues) thyroid production decreases, resulting in hypothyroidism (Hashimoto’s thyroiditis).

Symptoms of low thyroid are:

  • Dry skin,
  • Hair loss,
  • Constipation,
  • Depression,
  • Intolerance to cold,
  • Low energy
  • Brain fog,
  • Heavy menstruation,
  • Unexplained weight gain.
  • Muscle aches and cramps

Your care provider will take a thorough physical history (which includes checking for enlarged thyroid gland) and medical history along with a family history and your symptoms.

Lab tests for Hashimoto’s

TSH – The pituitary gland produces this hormone which stimulates the thyroid gland to produce thyroid hormone

Free T4– Free T4 is thyroid hormone not bound to protein, it is freely flowing in bloodstream.

Thyroid peroxidase antibodies (TPOAb) – Thyroid peroxidase (TPO) antibodies are a type of thyroid antibody. Thyroid peroxidase is an enzyme which helps to make thyroid hormones (T3, T4 and TSH). The body’s immune system makes antibodies in response to non-self proteins. These non-self proteins are called antigens.

Thyroglobulin antibodies (TGAb) Thyroglobulin antibodies (Tg Ab) are another type of thyroid antibody. Thyroglobulin is a protein made by thyroid cells. It helps to make thyroid hormones. Thyroglobulin antibodies (Tg Ab) are made when the body attacks it’s own thyroglobulin. Thyroglobulin antibodies can be raised in Hashimoto’s thyroiditis  They are also raised in 10-15% of the general population.

You may be diagnosed with Hashimoto’s disease if your TSH is high, your free T4 is low, and your TPO Ab is elevated. High TPO Ab is the key marker because it is present in over 90% of those with Hashimoto’s. TG Ab is present in about 60-80% of cases.

Total T3- as symptoms dictate

  • Low T3 levels may mean you have hypothyroidism,
  • T3 test results are often compared with T4 and TSH test results to help diagnose thyroid disease.

Reverse T3-as symptoms dictate

Reverse T3 is created by the body from T4. Your body can convert T4 into the ACTIVE thyroid hormone T3 or the inactive thyroid called reverse T3.  Reverse T3 slows metabolism to conserve energy during times of extreme stress and inflammation.

Treatment

Hashimoto’s requires a multi prong approach. Along with medication, and lifestyle/stress management, diet and supplements can go a long way to achieve optimum health.  Diet, lifestyle and supplements will be covered in part 2.

Medications

Note: A word about generic and label medications- Though the names are different, generic and brand-name drugs work the same. According to the FDA, generic drugs are just as effective as their branded counterparts. Drug makers must prove that generic medications can be substituted for brand-name drugs and offer the same benefits as their brand-name counterparts

Levothyroxine – also known as Synthroid Euthyrox, Unithroid,  Tirosint. and Levoxyl– These medications use only T4 hormone as primary ingredient.

One advantage to generic levothyroxine, unlike Synthroid is it does not contain corn. This is invaluable for anyone with an allergy or sensitivity to corn.

Armour thyroid- Desiccated thyroid- made from bovine thyroid hormone- contains both T4 and T3

  Cytomel – (generic name is liothyronine) – A manmade T3 hormone

There are many other brands of thyroid medications, however the above represents the majority of medications.

- Brooke Lounsbury, RN

Medical Content Writer

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