the link between sex hormones, hpa dysfunction and thyroid

YOUR LOGO

The Link Between Sex Hormones, HPA Dysfunction and Thyroid Disorders

1

Copyright© 2020. Health Training Associates, LLC. All rights reserved.

(Hormone Mastery Course Lecture for Module #4)

YOUR LOGO

Disclaimer

The material contained within this document/presentation and subsequent support documents for the Hormone Mastery Course (HMC) is not intended to replace the

services and/or medical advice of a licensed health care practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for health education purposes only based on the clinical experiences of its authors. Health Training Associates, LLC., Kurt N.

Woeller, D.O., Tracy Tranchitella, N.D. or any of its associates and members do not accept legal responsibility for any problems arising from your personal experimentation with the health education information described herein. Any application of suggestions

set forth in the following portions of this document/presentation and other support documents of the HMC (or other courses from Integrative Medicine Academy) is at the

reader/listener’s discretion and sole risk. As a health practitioner you are solely responsible for implementing treatment strategies for your patients or clients.

Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., discussed in this course, including support

documents and member forum, is done so at your sole risk. As an individual you accept full responsibility for using/implementing any health education information discussed in this course and understand that experimentation with supplements, medications,

herbs, dietary changes, etc. needs to be discussed with your (or your child’s) personal physician first.

2

YOUR LOGO

• ‘Chronic Stress Response’ revisited

• Thyroid dysfunction related to hypothyroidism

• Who’s at risk for hypothyroidism?

• Thyroid and hormonal imbalances

• What about hyperthyroidism?

Lecture Overview

3

YOUR LOGO

Lecture Overview

• HPA stress and the inhibition of thyroid metabolism.

• Oxalate and thyroid problems - introduction to the Organic Acids Test (OAT).

• Thyroid dysfunction and treatment options for hypothyroidism.

4

YOUR LOGO

Support Documents For Module #4

• Thyroid Support Supplements and Additional Recommendations (handout).

• Herbal Therapeutic Treatments for Hypothyroidism (pdf).

• Peripheral Metabolism of Thyroid Hormones: A Review (pdf).

• Lecture slides (pdf)

• Lecture slides: note taking (pdf)

5

YOUR LOGO6

YOUR LOGO7

Physiological Aspects of Cortisol & DHEAWhy We Must Assess Adrenal Function

YOUR LOGO8

Chronic Stress ResponsePotential Sources of Stress

Clinical Conditions

Chronic viral infections (EBV,CMV,Herpes I-II,etc.)Increased infectionsYeast overgrowthAllergiesFatigueHeadachesAutoimmune diseaseCancerCardiovascular disease

InsomniaHypoglycemiaHungerPMSDepressionIrritable bowelDigestive problemsADD/ADHD

Sympathetic System

HP

Stressor

Epinephrine

NE

NFL

Adrenal Cortex

TotalDHEA(s)

FreeDHEA(s)

ACTH

TotalCortisol

Free

Cortisol

Elevated Cortisolto DHEA Ratio*

Reduced HP Sensitivity to Negative Feedback

Energy Production• Insulin sensitivity• Glucose utilization• Blood sugar• Gluconeogenesis

Other Influences• Osteoporosis (bone loss) • Fat accumulation (waist)• Protein breakdown• Salt & water retention

Immune Activity• Secretory IgA• Antigen penetration • Circulating IgG• NK cell activity• Interleukin 2• T-Lymphocytes

KEYAssociationStimulusOutcomeInhibitionHP = Hypothalamus - PituitaryNFL = Negative Feedback LoopNE = Norepinephrine

* Abnormal Ratio ofCortisol to DHEA indicates

Pregnenolone Steal (Cortisol Escape)

Anger - FearWorry/Anxiety

DepressionGuilt

OverworkPhysical and Mental strain

Excessive exerciseSleep deprivation

Light-cycle disruptionLate hours

SurgeryTrauma/Injury

Whiplash – Head injuryInflammation

PainTemperature extremes

Toxic exposureInfections

Chemicals - Heavy metalsElectromagnetic fields

RadiationGeophysical

MalabsorptionMaldigestion

IllnessLow blood sugar - Poor diet

Nutritional deficienciesAllergiesFoods

Mold – Pollens

YOUR LOGO

HPA and HPT Axis

9

YOUR LOGO

Thyroid DysfunctionCommon Problems Leading To

Hypothyroidism

10

YOUR LOGO

Common Thyroid Disorders

• Hypothyroidism (underactive thyroid):• Primary – low thyroid levels, high TSH

• Secondary – low thyroid levels, normal or low TSH (pituitary disorder or cortisol inhibition).

• Peripheral disorder – low T3, normal T4, low or normal TSH (see article by Greg Kelly, N.D. – document section for Module #4 titled:“Peripheral Metabolism of Thyroid Hormones: A Review”

• Autoimmune cause = Hashimoto’s Thyroiditis

• Hyperthyroidism (overactive thyroid):• Most common cause is Grave’s Disease (autoimmune)

11

YOUR LOGO

Common Thyroid Disorders

• Thyroid Nodules:• Most are benign; approximately 4% are cancerous

• Sub-Clinical Hypothyroidism:• Elevated TSH, normal T4 and/or low normal T3

• Stress, Toxicity and Chronic Illness

12

YOUR LOGO

Who’s At Risk For Hypothyroidism?

• Family history of thyroid disorders

• Exposure to toxic substances such as excess chlorine, fluoride, PCBs.

• Presence of other pituitary, endocrine or autoimmune diseases.

• Complete or partial removal of thyroid gland

13

YOUR LOGO

Who’s At Risk For Hypothyroidism

• Treatment with radioactive iodine or anti-thyroid drugs, e.g. Tapazole for hyperthyroidism.

• Women, in general, seem to be more prone to hypothyroidism than men:

• Times of hormonal change: puberty, pregnancy, menopause.

14

YOUR LOGO

Hormone Use and Low Thyroid

• Use of oral estrogen and testosterone – both willincrease sex hormone binding globulin (SHGB) production from the liver that can also bind up thyroid hormone.

• Use of oral progesterone does not have this effect

15

YOUR LOGO

Thyroid Disorders and Hormonal Imbalances

• Hypothyroidism is commonly associated with ovulatory dysfunction.

• Thyroid hormone receptors are present on all human oocytes

• Increased production of TRH from the hypothalamus in response to low circulating thyroid hormone leads to elevated prolactin which suppresses ovulation.

• Thyroid hormone stimulates progesterone production by supporting the corpus luteum (also, placenta production of progesterone supported by thyroid too):

• Low thyroid hormone is associated with an increased chance of miscarriage.

16

YOUR LOGO

Thyroid Disorders and Hormonal Imbalances

• Low thyroid hormone decreases production of Sex Hormone Binding Globulin (SHBG) thereby altering the circulating levels of estrogen leading to abnormal feedback to the pituitary.

• Decreased SHBG = increased free estrogen = decreased pituitary stimulation of ovarian cycle.

• T3 modulates Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) action on steroid hormone biosynthesis.

17

YOUR LOGO

Thyroid Disorders and Hormonal Imbalances

• Low thyroid hormones are associated with menorrhagia (heavy flow) due to decreased production of coagulation factors.

• Adequate thyroid hormone normalizes prolactin and LH levels, reverses menstrual abnormalities and increases fertility.

• Steroid hormone synthesis is dependent on adequate levels of thyroid hormones.

18

YOUR LOGO19

Häggström M, Richfield D (2014). "Diagram of the pathways of human steroidogenesis”. Wikiversity Journal of Medicine

YOUR LOGO

Thyroid Hormone Influences Mitochondrial Activity

20

YOUR LOGO

Other Predisposing Factors in the Development of Hypothyroidism

• Stressful event(s) or chronic on-going

• Over consumption of goitrogenic foods such as soy, cruciferous vegetables, millet:

• Cooking these foods tends to limit the effect of the goitrogens.

• Chronic infections & high oxalates

21

YOUR LOGO

Shi WJ, et. al. Associations of Helicobacter pylori infection and cytotoxin-associated gene A status with

autoimmune thyroid diseases: a meta-analysis. Thyroid. 2013 Oct;23(10):1294-300

Helicobacter pylori infection is reportedly associated with extra-digestive diseases such as immune thrombocytopenic purpura and coronary heart disease. The risk factors for autoimmune thyroid diseases (ATDs) remain largely unknown, and whether H. pylori infection is associated with ATDs is still controversial. The aim of this meta-analysis was to determine the association between H. pylori infection and ATDs.

RESULTS:

Seven studies involving a total of 862 patients met the inclusion criteria and thus were included in our meta-analysis. Overall, H. pylori infection was associated with ATDs (OR 1.92 [CI 1.41-2.61]); the association was significant for Graves' disease (OR 4.35 [CI 2.48-7.64]), but not for Hashimoto's thyroiditis (OR 1.45 [CI 0.92-2.26], p=0.11). No association was observed in the subanalysis of studies using only enzyme-linked immunosorbent assay to detect H. pylori infection (OR 1.38 [CI 0.86-2.19], p=0.18). Five of the seven articles reported the association of CagA seroprevalence and ATDs. CagAseropositivity significantly increased the risk for ATDs by 2.24-fold [CI 1.06-4.75].

CONCLUSIONS:

Both the prevalence of H. pylori infection and the seroprevalence of CagA-positive strains are associated with ATDs. These findings suggest that H. pylori infection potentially plays a part in the development of ATDs.

22

YOUR LOGO

Helicobacter Pylori Stool Antigen –Doctors Data Laboratory

23

YOUR LOGO

Test available from Great Plains Laboratory –www.greatplainslaboratory.com or www.labstestsplus.com

24

YOUR LOGO

• Organic acids are compounds with acidic properties:• Carboxyl (-COOH)

• Alcohol (-OH)

• Thiol (-SH)

• An accurate assessment of what is going on metabolically in the body.

• Evaluates over 75 urinary metabolites that can be useful for discovering underlying causes of chronic illness.

• Treatment based on OAT findings often leads to improved energy, sleep and mental health conditions, as well as reduced attention and concentration problems, chronic pain and digestive problems.

What Is The OAT?

YOUR LOGO

• Yeast and Fungal Markers:• Evaluates for invasive candida and mold toxicity

• Bacterial Markers:• Evaluates for dysbiosis

• Clostridia Bacteria Markers:• Evaluates for various clostridia bacteria toxins

• Phenylalanine and Tyrosine Metabolites:• Evaluates for phenylalanine and tyrosine metabolism which

can lead to dopamine and norepinephrine imbalances.

GPL OAT Sections (examples)

26

YOUR LOGO

• Glycolytic and Mitochondrial Markers:• Evaluates for mitochondrial dysfunction

• Tryptophan Metabolites:• Evaluates for issues in tryptophan metabolism which

contributes to serotonin imbalance and excess quinolinicacid production.

• Oxalate Metabolites:• Evaluates for oxalic acid toxicity and endogenous oxalate

production problems.

GPL OAT Sections (examples)

27

YOUR LOGO28

Oxalate Metabolites

YOUR LOGO

What Are Oxalates?

• Oxalate, and its acid form, is an organic acid obtained from 3 primary sources:

• Diet

• Fungus, such as mold and candida

• Cell metabolism

• Oxalic acid is the most acidic organic acid in body fluids.

• Used to clean rust from radiators

• Ethylene glycol’s (antifreeze) primary toxicity is from oxalate crystal formation.

29

YOUR LOGO

‘X’ Mark

30

YOUR LOGO

Staghorn Oxalate Crystal in Kidney

31

YOUR LOGO

Oxalate Crystals In Brain

Oxalate crystal in meninges

32

YOUR LOGO

Oxalate Crystal In Nerve Tissue

33

YOUR LOGO

Thyroid Oxalate Accumulation

34

YOUR LOGO

GlyoxylateGlycerate

Glycolatehydroxypyruvate

GRHPRGlyoxylate reductaseHydroxypyruvic reductaseType II Hyperoxaluria

GlycolateOxidase (GO)

B-6Glycine

LDHLactatedehydrogenase

Oxalate AscorbateArabinose

YeastFungi

AGTAlanineGlyoxylateAminoTransferaseType IHyperoxaluria

Oxalates diet

dietEthylene glycol

Oxalate Metabolism

hydroxyproline

Protein,Gelatin

Protein

Collagen

Candidacollagenase

35

YOUR LOGO

Other Support

Vitamin B6

Probiotics

Calcium + Magnesium

Treat Yeast

Diet

36

YOUR LOGO

Signs and Symptoms of Hypothyroidism

37

YOUR LOGO

Signs & Symptoms of Hypothyroidism

• Absence of sweating

• Brittle nails

• Easy bruising

• Coarse, dry hair

• Dry skin and scalp

• Hair loss of the scalp, groin, outer eyebrows.

• Pale, cold, scaly and wrinkled skin.

• Poor wound healing

• Swelling of the hands, face and eyelids.

• Yellow/ivory skin color

• Itchy skin

• Immune system disruption

38

YOUR LOGO

Signs & Symptoms of Hypothyroidism

• Constipation

• Abdominal cramps and bloating.

• PMS

• Cold intolerance

• Muscle cramps and tenderness.

• Fibromyalgia

• Brain fog

• Depression

• Weight gain

• Seasonal exacerbation of symptoms.

• Infertility

• Miscarriage

• Frequent cold and flus

• Low libido

39

YOUR LOGO

Cellular Function of Thyroid Hormone

40

YOUR LOGO

How Does The Thyroid Work?

• Hypothalamus – in response to low levels of circulating thyroid hormone, the hypothalamus will excrete TRH (thyroid releasing hormone) to stimulate the pituitary gland.

• Pituitary Gland – in response to TRH, the pituitary will send TSH (thyroid stimulating hormone) to stimulate the thyroid gland.

• Thyroid Gland - in response to TSH, the thyroid will produce T4 and T3.

41

YOUR LOGO

How Does The Thyroid Work?

• Liver and Peripheral Tissues – converts T4 to the more active hormone, T3.

• Problems with Conversion of T4 to T3 – stress, elevated cortisol, acute and chronic illness, fasting, formation of RT3, selenium deficiency, zinc deficiency, heavy metal toxins.

42

YOUR LOGO43

YOUR LOGO44

YOUR LOGO45

www.slideshare.net/sos16/physiology-elective-presentation

YOUR LOGO46

YOUR LOGO47

YOUR LOGO48

YOUR LOGO49

Iodine in oxidized state = Iodide. It’s converted to Iodine to bind with tyrosine via Thyroid Peroxidase

(TPO) enzyme.

YOUR LOGO50

YOUR LOGO

O OH

I

I

II

OH

O

NH2

Thyroxine (T4)

O OH

I

I

I

OH

O

NH2

3,5,3’-Triiodothyronine (T3)

Thyroid Hormones

51

YOUR LOGO52

YOUR LOGO53

YOUR LOGO54

YOUR LOGO55

YOUR LOGO

Lab Testing: Thyroid Function

Laboratory Evaluation:

• TSH – thyroid stimulating hormone

• T4 – thyroxine (free and total)

• T3 – triiodothyronine (free and total)• FREE = physiologically active (not protein bound)

• Reverse T3 (RT3)

• Anti-TPO

• Thyroglobulin antibodies

• Thyroid Releasing Hormone (TRH)

56

YOUR LOGO57

YOUR LOGO58

YOUR LOGO

• TRH stimulation test is done most commonly with suspicion of Secondary Hypothyroidism – damage to hypothalamus or pituitary gland.

• Small amount of TRH given via injection (infusion)

• TSH levels then followed with subsequent blood draws, e.g. 20 to 30 minutes.

• Normal HPA Axis – increase TSH subsequent to TRH

• Problem with HPA Axis – delayed or absent TSH increase following TRH administration.

Thyroid Releasing Hormone (TRH) Stimulation Test

59

YOUR LOGO

What About Hyperthyroidism?• Definition – production of too much thyroxine which can lead

to increased metabolism, including elevated heart rate, sweating, weight loss, irregular cardiac function, fatigue, anxiety and nervousness:

• Other symptoms – difficulty sleeping, skin thinning, fine and brittle hair, muscle weakness, bowel changes (e.g. diarrhea), tremors and sensitivity to heat.

• Grave’s ophthalmopathy:

60

YOUR LOGO

Causes of Hyperthyroidism

• Graves' disease - an autoimmune disorder in which antibodies produced by your immune system stimulate the thyroid to produce too much T-4:

• Most common cause of hyperthyroidism

• Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter) - one or more thyroid adenomas produce too much T-4.

• Thyroiditis – inflammation induced hyperthyroid. The inflammation causes excess stored thyroid hormone to leak into your bloodstream:

• Rare type of thyroiditis, subacute granulomatous thyroiditis, causes pain in the thyroid gland.

• Other types are painless and may sometimes occur after pregnancy (postpartum thyroiditis).

61

YOUR LOGO

Testing

• Standard blood testing, e.g. TSH, T3, T4:• Thyroid stimulating immunoglobulin (TSI)

• Radio iodine uptake test and thyroid scan – radioactive iodine pill is taken which circulates to thyroid. Can also have radioactive isotope injected through vein.

62

YOUR LOGO

Treatment

• Block thyroid hormone:• Example: Tapazole

• Surgical removal of gland:• Partial or complete thyroidectomy

• Destroy thyroid gland:• Radioactive iodine

63

YOUR LOGO

Robert H. Noth, M.D., Stephen W. Spaulding, M.D. DECREASED SERUM DOPAMINE-BETA-HYDROXYLASE INHYPERTHYROIDISM. J Clin Endocrinol Metab (1974)

39 (3): 614-617.

ABSTRACT

In 21 patients with hyperthyroidism, the mean serum dopamine-beta-hydroxylase (DBH) activity was 19 I.U. compared to 40 I.U. in 41 normal subjects (p < .005). During therapy for hyperthyroidism in 6 of the patients, the mean DBH increased from 22 to 41. The finding of a low DBH in hyperthyroidism and the subsequent rise in DBH during treatment provides independent evidence that sympathetic nervous activity is decreased in hyperthyroidism.

64

YOUR LOGO

Tanaka T. et.al. Plasma dopamine-beta-hydroxylase activity and thyroid suppressibility

in Graves' disease. Metabolism. 1979 Aug;28(8):828-30.

Abstract:

Plasma dopamine-beta-hydroxylase (DBH) activity, serum T4, T3, T3U, and the 24-hr thyroid uptake before triiodothyronine suppression testing were studied in 34 patients with treated Graves' disease. Although all of them were in the euthyroid state, there was a statistically significant difference in presuppressionplasma DBH activity between those patients who showed suppression of their RAI uptake with triidothyronine and those who did not. This suggests a relationship between plasma DBH activity and thyroid suppressibility.

65

YOUR LOGO66

YOUR LOGO67

YOUR LOGO68

Neurotransmitter Metabolites

YOUR LOGO

Bacterial and Clostridia Markers

69

YOUR LOGO

Effects of Intestinal Bacteria Toxins On Neurotransmitters

Organic Acids Test

Organic Acids Test

Organic Acids Test

70

YOUR LOGO

Additional Test Consideration Options for Thyroid Dysfunction Including

Autoimmune Thyroid Disease

• Organic Acids Test – Great Plains Laboratory

• Hair Analysis – Doctors Data or Great Plains Laboratory:• Option: SpectraCell Micronutrient Analysis (evaluates for

cellular nutrient deficiency).

• Comprehensive Food IgG (dbs) – Great Plains Laboratory (gluten sensitivity).

• H. pylori Stool Antigen – Doctor’s Data Laboratory

71

YOUR LOGO

Deiodinases

72

YOUR LOGO

• Deiodinase enzymes act as converting enzymes for thyroid function:

• D1 (Type 1) & D2 (Type 2) – increase cellular thyroid activity: T4 to active T3 conversion.

• D3 (Type 3) – decrease cell thyroid activity; increase reverse T3 levels (inactive).

• Respond differently to various environmental changes.

• Deiodinases influence cellular thyroid levels and notserum levels.

Deiodinases

73

YOUR LOGO74

Source: American Society of Clinical Pathology

YOUR LOGO

• General T4 to T3 conversion – controlled by D2 (Type 2).

• Peripheral cellular conversion – controlled by D1 (Type 1).

• PROBLEM = D1 negatively influenced by STRESS:• Inflammation

• Chronic infection

• Emotional/Mental Stress

• Toxins

High Cortisol Downregulates D1

Deiodinases

75

YOUR LOGO

HPA and HPT Axis

76

YOUR LOGO

Hypothyroid TreatmentOptions For Improved Clinical

Outcomes

77

YOUR LOGO

Treatment of Hypothyroidism

• Diet & Lifestyle – similar approach as for HPA Stress, aka. adrenal fatigue.

• Treat chronic infections – these may be over-stimulating the immune system.

• Detoxification – removal of chemicals and heavy metals.

• Avoid goitrogenic foods:

78

YOUR LOGO

Treatment of Hypothyroidism

• Foods which support the thyroid:

• Remove allergens/gluten – stress the body and over-stimulates the immune system.

• Provide needed nutrients

• Thyroid hormone replacement

79

YOUR LOGO

General Thyroid Nutrients

Supplements:• Selenium (50mcg to 200mcg daily)

• Iodine (150mcg to 300mcg daily)

• Vitamin A (500IU to 800IU daily)

• Zinc (20mg to 30mg daily)

• Vitamin, B-vitamins, Vitamin E…

• Tyrosine – 500mg-1000+ mg per day

80

YOUR LOGO

Thyroid Supportive Herbs

• Centella (Gotu kola), Withania (Ashwaganda), Eleutherococcus (Siberian ginseng) – direct support of thyroid gland.

• Coleus forskohli – stimulates the thyroid gland to release thyroid hormone.

• Wild Oat (Aveena sativa) – restorative, nerve tonic, improves low libido and energy, supports thyroid.

• Licorice Root – balances the glandular system

• Nettles, Schisandra, Commifora mukur – endocrine tonic

• Kelp (Bladderwrack, Fucus vesiculosis) – natural source of Iodine, activates thyroid function, can boost T4.

81

YOUR LOGO82

Northwest School for Botanical Studies

Document found in

Module #4

YOUR LOGO

Herbal Therapeutic Treatments for Hypothyroidism

(Northwest School for Botanical Studies)

83

YOUR LOGO

Herbal Therapeutic Treatments for Hypothyroidism

(Northwest School for Botanical Studies)

84

YOUR LOGO

The Following Thyroid Support Supplements Are

Available From Emerson Ecologicswww.emersonecologics.com

85

YOUR LOGO

Thyroid Support Complex (Pure Encapsulations)

Amount Per Serving (2 capsules): -Vitamin A (acetate) 2,500 i.u.-Ascorbic acid 150 mg-Vitamin C (ascorbyl palmitate) 30 mg-Vitamin D3 200 i.u.-Ascophyllum nodosum (kelp) 30 mg

(whole plant) (standardized to 0.5% iodine) 150 mcg-Zinc (citrate) 20 mg-Selenium (selenomethionine) 200 mcg-L-tyrosine (free-form) 500 mg-Withania somnifera (ashwagandha) extract (root) 400 mg

(standardized to contain 5% withanolides) 20 mg-Coleus forskohlii extract (root) 100 mg

(standardized to contain 10% forskolin) 10 mg-Commiphora mukul (guggul) extract (gum resin) 150 mg

(standardized to contain 2.5% Z and E guggulsterones) 3.8 mg -Curcuma longa (turmeric) extract (root)100 mg

(standardized to contain 97% curcuminoids) 97 mg

86

Recommendations:Take 2 capsules daily with food

YOUR LOGO

Thyroid Synergy(Designs for Health)

87

2 capsules daily with food

YOUR LOGO

Thyroid Hormone Replacement

Natural Thyroid

• Dessicated Thyroid – porcine thyroid; contains T4 and T3 (and other cofactors) - Brand Names: Armour (most common), WP Thyroid (formerly Westhroid), NatureThroid.

Ex: Armour is 20% T3 and 80% T4

Compounded Thyroid

• T4 and T3 ratio can be formulated for desired amounts based on lab tests and patient clinical response.

• Ex: Armour Thyroid at 30mg (1/2 grain) = 4.5mcg T3 and 19 mcg T4.

88

YOUR LOGO

Synthetic Thyroid:

• Synthroid (T4)

• Cytomel (T3)

• Levothyroid (T4)

• Thyrolar (T4, T3)

• Unithroid (T4)

Standard Thyroid Medications

89

YOUR LOGO

BioThyro

BioThyro helps provide nutrient and glandular (Thyroxin free) support for proper thyroid function.

Suggested Use: As a dietary supplement, take 1 capsule two times per day or as directed by your healthcare professional.

Supplement Facts:Serving Size 1 Capsule

-Iodine (as potassium iodide) 75mcg-Zinc (as zinc glycinate) 8mg

-Selenium (as selenomethionine) 15mcg-Copper (as copper glycinate) 1mg

-Manganese (as manganese aspartate) 5mg-Thyroid 150mg

-N-acetyl L-tyrosine 100mg-Hypothalamus 20mg

-Pituitary 20mg

90

YOUR LOGO

• Improved focus and attention

• Less mood swings, decreased fatigue

• Increased mental energy and memory

• Accelerated growth

• Improvement in nail growth, skin color, warmth, and dryness.

• Increased cardiovascular and muscular fitness

• Increased body temperature

• Better ability to handle stress

Common Improvements With Thyroid Therapy

91

YOUR LOGO

Case Presentation

92

YOUR LOGO

Case Presentation

• 35 y/o Female with fertility issues

• 11 documented miscarriages

• Complains of fatigue, sleep issues, inability to maintain a pregnancy, hair loss, chilly.

• IVF was unsuccessful – was able to conceive, but not maintain the pregnancy. Claims thyroid and hormones were tested at that time.

• Has been working as a swim coach for 2-3 years after having been in the corporate world for many years prior.

93

YOUR LOGO

Case Presentation

• Healthy and fit, follows a GF/whole foods diet

• Has done a lot of work over the past several years to make space in her life for a family.

• Eats very well and exercises regularly

• No current medications

• Menses are regular with slightly short cycles of 25 days and moderate to heavy flow for 5-7 days.

• Difficulty falling asleep and staying asleep; affects energy the next day.

94

YOUR LOGO

HPA Stress Profile #1

• Cortisol – Morning 14.2 (13-24)

• Cortisol – Noon 4.5 (5-8)

• Cortisol – Afternoon 3.5 (4-7)

• Cortisol – Nighttime 2.0 (1-3)

• Total Cortisol 24.2 (23-42)

• DHEA-S 3.6 (2-10)

95

YOUR LOGO

Thyroid Panel #1

• TSH = 2.7 (0.45 – 4.5)

• Free T3 = 2.3 (2.0 – 4.4)

• Free T4 = 0.83 (0.82 – 1.77)

• Thyroxine = 5.2 (4.5 - 12.0)

• All thyroid antibodies are normal• Ideal reference ranges differ from standard lab reference

ranges.

• TSH – ideal range is 1.5 -2.0

• Free hormones should be in the upper third of the range

96

YOUR LOGO

HPA Stress Profile Treatment Program

• Pregnenolone – 10 drops TID

• DHEA – 2 drops TID

• Support Adrenals – 2 capsules with breakfast/lunch

• Support Minerals – 3 tablets at bedtime

• 200 mg of ZEN (L-theanine, GABA) – 2 capsules in the evening.

• Epsom salt baths nightly – 2 cups salt per bath; detox chlorine and supports relaxation.

97

YOUR LOGO

Three Month Follow-Up

• Energy is much better throughout the day

• Mental focus has also improved

• Past two menstrual cycles have been 27 days

• Sleep has improved though can still wake through the night – not as frequent and can go back to sleep.

• Feels refreshed upon waking

• Still feels chilly but hair loss may be slightly better

98

YOUR LOGO

HPA Stress Profile #2

• Cortisol – Morning 18.2 (13-24)

• Cortisol – Noon 7.2 (5-8)

• Cortisol – Afternoon 6.0 (4-7)

• Cortisol – Nighttime 2.2 (1-3)

• Total Cortisol 32.6 (23-42)

• DHEA-S 5.8 (2-10)

99

YOUR LOGO

Modified Adrenal Support

• Pregnenolone – 6 drops TID

• DHEA – 1 drop TID

• Support Adrenals – 2 capsules with breakfast and lunch.

• Support Minerals – 3 tablets at bedtime

• ZEN/Epsom Salt baths continue as previously prescribed.

100

YOUR LOGO

Six Month Follow Up

• Generally feeling good, but still having some sleep issues.

• Would like to try getting pregnant again so wanted to discuss adrenal treatment program.

• Still complains of chilliness – always the first person to feel cold. Hands and feet are often cold. Wears socks to bed.

• Still noticing some hair loss

101

YOUR LOGO

Pregnancy Support Program

• Wean off Pregnenolone, DHEA and ZEN over one month.

• Switched from Support Adrenals to PreNatal Packet (Integrative Therapeutics – EmersonEcologics.com).

• Continue with Support Minerals at bedtime

• Trial of Armour Thyroid 30 mg tablet, one PO QD in the morning on an empty stomach.

102

YOUR LOGO

Follow-Up

• Doing well on PreNatal Supplement Packet

• Feeling much better on the thyroid medication – no longer feels chilly, hair loss is less and is sleeping through the night without waking.

• Menses have stabilized at a 27-day cycle

• Has completely weaned off adrenal support hormones and energy is stable throughout the day.

• Now that she feels more stable and is off of adrenal hormones, will try to conceive naturally.

103

YOUR LOGO

Thyroid Test #2

• TSH = 1.8 (0.45 – 4.5) #1 = 2.7

• Free T3 = 3.5 (2.0 – 4.4) #1 = 2.3

• Free T4 = 1.25 (0.82 – 1.77) #1 = 0.83

• Thyroxine = 8.2 (4.5-12.0) #1 = 5.2

104

YOUR LOGO

Follow Up

• Good News - she was 5 weeks pregnant!

• Had already seen an OB/Gyn because of her history of miscarriage.

• Testing revealed a slightly low progesterone for gestational phase so was put on natural progesterone suppositories.

• Thyroid was monitored every 4-6 weeks during pregnancy with dosage modified as needed, e.g. increase by ¼ to ½ grain.

• She gave birth to a healthy baby girl a few weeks early but was able to maintain normal activity throughout pregnancy.

• Within three years, she successfully conceived and gave birth to her second child.

105

YOUR LOGO

Topic

The Role of Estrogen: Physiology, Imbalances and Therapy Options – part 1:

• Understanding the physiological role of estrogen in menstrual cycling, pregnancy, perimenopause, and menopause.

• The Estrogens – Estradiol, Estrone, Estriol

• Understanding the role of these hormones in men

• Estrogen receptors and binding proteins

• Estrogen metabolism and supporting healthy clearance of estrogen metabolites.

Module #5

106

YOUR LOGO

Thank You

Kurt N. Woeller, D.O. & Tracy Tranchitella, N.D.

107

HormoneMasteryCourse.comHormoneMasteryCourse@gmail.com