Compounding for Managing Thyroid Conditions

Zoom Heaton PharmD., Women’s Health Clinical Liaison for Revelation Pharma

Hashimoto’s disease, also known as Hashimoto’s thyroiditis and chronic lymphocytic thyroiditis, is a severe autoimmune disorder in which the immune system attacks the thyroid gland, affecting more women than men. If left alone, especially over an extended period of time, individuals can fall victim to serious complications that can lead to life-threatening hypothyroidism.

With this, it’s crucial the medical community fosters a deep understanding of management options available to patients, specifically between conventional approaches and integrative functional approaches, and how a strategic blend between the two can result in a more substantial positive impact on patient outcomes.

Conventional: Medication, Monitoring, Symptoms Management

Diagnosis:

• Thyroid Function Tests: Check levels of TSH (Thyroid Stimulating Hormone), Free T4, and Free T3.
• Autoantibodies: Anti-thyroid peroxidase (TPO) antibodies and anti-thyroglobulin antibodies are usually elevated in Hashimoto’s disease.

Pharmacotherapy:

• Levothyroxine (Synthroid, Levoxyl): The standard approach. It’s a synthetic form of the thyroid hormone thyroxine (T4), taken orally, designed to normalize thyroid levels.
• Liothyronine (Cytomel): In some cases, doctors may prescribe T3 alone or in combination with T4.
• Desiccated Thyroid Extracts: Some practitioners use animal-derived combinations of T3 and T4 as an alternative.

Addressing Symptoms:

Symptom management for issues like fatigue, weight gain, and depression is also part of the conventional approach, often including diet, exercise, and sometimes antidepressants or other therapies.

Monitoring:

Regularly monitoring thyroid hormone levels is essential to adjust medication as needed as thyroid function changes over time.

Integrative: Root Causes, Lifestyle Changes, Holistic Approach

Diagnosis:

Functional medicine emphasizes assessing root causes, including detailed patient history and comprehensive lab tests beyond typical thyroid panels, to identify contributing factors like gut health, adrenal function, and nutrient deficiencies, leaning into a holistic approach.

Nutrition and Lifestyle Modifications:

• Anti-Inflammatory Diets: Emphasizes whole foods and may restrict gluten, dairy, soy, and other potential triggers. The Autoimmune Protocol (AIP) diet is often recommended.
• Nutritional Supplements: Important nutrients can be supplemented based on individual needs:
  • Selenium: Studies show it can reduce TPO antibody levels.
  • Vitamin D: Vital for immune modulation.
  • Zinc and Magnesium: Essential for thyroid function and overall metabolic health.
  • Probiotics: Support gut health, which plays a role in autoimmunity.

Addressing Root Causes of Disease:

• Gut Health: Leaky gut syndrome (intestinal permeability) is often addressed using strategies to remove irritants, replace digestive support, repair the gut lining, and rebalance the gut flora.
• Adrenal Function: Chronic stress and adrenal dysfunction can exacerbate thyroid issues.
• Detoxification Support: Reducing the body’s toxic load through liver support, reducing exposure to environmental toxins, and promoting healthy detoxification pathways.

Stress Management:

Integrative and functional approaches often include stress reduction techniques such as mindfulness, yoga, deep breathing exercises, and other mind-body practices to improve resilience and overall well-being.

Herbal and Alternative Therapies:

Adaptogenic herbs like Ashwagandha and Rhodiola are sometimes recommended to support stress management and thyroid function. Acupuncture and other alternative therapies can benefit a comprehensive strategy.

LDN in Hashimoto’s:

Low Dose Naltrexone (LDN) involves using a much lower dose (typically 1.5 to 4.5 mg) of naltrexone, originally developed to address opioid addiction at higher doses. LDN has been found to have beneficial effects on the immune system.

LDN works by modulating the immune system, potentially balancing the overall immune response and reducing autoimmune activity in conditions such as Hashimoto’s thyroiditis.

Benefits of LDN:

• Reduction in Autoantibodies: LDN can reduce thyroid autoantibodies (TPO and anti-thyroglobulin) levels in Hashimoto’s patients.
• Symptom Reduction: Patients may experience improvements in fatigue, pain, and other symptoms associated with hypothyroidism.
• Anti-inflammatory Effects: LDN’s effect on modulating inflammatory processes can benefit overall thyroid health.

Combining conventional and integrative functional approaches, along with innovative options like Low Dose Naltrexone (LDN), offers a comprehensive care plan for managing conditions like Hashimoto’s disease. This blend addresses hormone replacement needs while tackling autoimmune roots, contributing lifestyle factors, and optimizing patient well-being. This approach can lead to a more personalized, holistic care plan that addresses both the symptoms and root causes of the condition to improve patient health and boost quality of life.

Listen to Dr. Heaton’s webinar series on Hashimoto’s disease here.

References:

• Caturegli, P., De Remigis, A., & Rose, N. R. (2014). Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmunity Reviews, 13(4-5), 391-397.
• Woeber, K. A. (2002). Levothyroxine therapy and serum-free thyroxine and free triiodothyronine concentrations. The Journal of Endocrinology & Metabolism, 87(11), 4840-4842.
• Dayan, C. M., & Panicker, V. (2013). Hypothyroidism and depression. European Thyroid Journal, 2(3), 168-179.
• Virili, C., et al. (2015). Gut microbiota and Hashimoto's thyroiditis. Reviews in Endocrine & Metabolic Disorders, 16(4), 319-324.
• Pizzorno, J., Murray, M., & Joiner-Bey, H. (2002). The Clinician's Handbook of Natural Medicine, 2nd Ed. St. Louis: Churchill Livingstone.
• Xia, Y., et al. (2018). Dietary patterns are associated with serum levels of thyroid autoantibodies in individuals with autoimmune thyroid disease. Nutrients, 10(10), 1243.