Alison McAllister, N.D. HRT Symposium Las Vegas, Nevada February 16 18, 2017

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1 Adrenal & Thyroid Alison McAllister, N.D. HRT Symposium Las Vegas, Nevada February 16 18, 2017

Disclosure Alison McAllister, ND, is employed by ZRT Lab. Professional Education Services Group staff have no financial interest or relationships to disclose.

2 Disclosure Alison McAllister, ND, is employed by ZRT Lab. Professional Education Services Group staff have no financial interest or relationships to disclose. Disclosure This continuing education activity is managed and accredited by Professional Education Services Group. Neither PESG nor any accrediting organization supports or endorses any product or service mentioned in this activity. Educational Grant Support This continuing education activity is supported by an educational grant from PCCA All Rights Reserved. 1

Review new information regarding the HPA axis.

3 Learning Objectives At the conclusion of this activity, the participant will be able to: Discuss thyroid physiology. Review new information regarding the HPA axis. Discuss cases for both thyroid and adrenal dysfunction. THYROID All Rights Reserved. 2

TSH Hypothyroid Symptoms FATIGUE Dry skin/hair Hair loss Weight gain Irregular, heavy or painful menses Infertility Hoarseness Depression Constipation Aches and Pains Carpal Tunnel symptoms High

5 TSH Hypothyroid Symptoms FATIGUE Dry skin/hair Hair loss Weight gain Irregular, heavy or painful menses Infertility Hoarseness Depression Constipation Aches and Pains Carpal Tunnel symptoms High blood lipids Slow thought processes Headaches Cold intolerance Edema Did I say fatigue Common signs Hypertension Bradycardia Coarse hair Swelling around the eyes Yellow skin Carpal tunnel Delayed reflex Thyroid may be any size with firm texture. Unusual megacolon, cardiomegaly, congestive heart failure All Rights Reserved. 4

6 All the different Types Overt Hypothyroidism TSH is high, T4/3 are low, Sxs are reported Subclinical Hypothyroidism TSH is mildly elevated, T4/3 are N, Sx are reported. Functional Hypothyroidism TSH, T4/3 are all N, yet the patient complains of symptoms Overt Hyperthyroidism Subclinical hyperthyroidism T4 Rx Subclinical hypothyroidism Overt Hypothyroidism Inc T4 & T3 Dec TSH FT4& FT3 WNL New TSH range FT4 WNL & +TPOab T4 dec TSH inc ~0.4 ~5.50 Adapted from Current TSH reference range TSH miu/l All Rights Reserved. 5

7 Thyroid Estrogen Androgens Cortisol Glucocorticoids Adrenal diseases Cushing's Addison's Pituitary Gonads Adrenals Thyroid Antibodies cytokines TH1 Immune Cells Thyroid peroxidase Thyroglobulin T3 T4 Thyroid follicles Autoimmune Factors Viruses Coxsackie B virus, Yersinia enterocolitica, Escherichia coli, Helicobacter pylori all found in high proportions with individuals with thyroid disease. Gliadin cross reaction Food allergens Autoimmune diseases Diabetes Celiac Vitiligo All Rights Reserved. 6

8 Thyroid Medications Synthroid (levothyroxine) Tirosint T4 T3 Cytomel Armour thyroid Nature / Westhroid Desiccated thyroid Thyrolar ALL THYROID IS BIOIDENTICAL! Treatment of Thyroiditis Maintain TSH < 2.0 Selenium 200mcg 800mcg Avoid glandular thyroid Gluten free diet eliminate food intolerances Reduce stress balance cortisol Other considerations : Daily immune support, DHEA All Rights Reserved. 7

Nutrients in Thyroid Function Iodine Tyrosine Zinc Selenium Iron B Vitamins Anti oxidants THYROID CASES Disclaimer: There are many ways to approach cases, think about

9 Nutrients in Thyroid Function Iodine Tyrosine Zinc Selenium Iron B Vitamins Anti oxidants THYROID CASES Disclaimer: There are many ways to approach cases, think about supplementation, and lab work. This is my way of doing it based on my own clinical experiences. That doesn t mean that other ways are wrong All Rights Reserved. 8

10 Frank Hypothyroidism 41 y/o woman with dry, brittle hair, constipation, nails brittle and breaking, cold body temperature, puffy face and weight gain Test Result Range T4 1 ( ) T3 2.2 ( ) TSH 6.7 ( ) TPO Hashimoto s normal T4/T3 38 y/o woman with dry, brittle hair, constipation, hoarseness, low B/P, puffy face and eyes, cold body temperature, decreased stamina, nails brittle and breaking, weight gain and goiter Test Result Range T4 1.1 ( ) T3 3.1 ( ) TSH 0.7 ( ) TPO Pituitary/Tg Ab, cortisol usage 53 year old woman with loss of stamina, mild puffy eyes, dry and brittle hair, constipation and low BP Test Result Range T4 1.7 ( ) T3 2.6 ( ) TSH < 0.2 ( ) TPO All Rights Reserved. 9

11 Hashimoto s/hypothyroidism subclinical 55 y/o woman, allergies, fatigue, aches and pains, constipation, weight gain, and rapid heartbeat. Test Result Range T4 0.9 ( ) T3 3.1 ( ) TSH 7.6 ( ) TPO Subclinical hypothyroidism on meds 42 y/o woman with decreased stamina, swelling and puffy eyes and face, brittle breaking nails, cold body temperature. Taking 50 mcg levothyroxine and 30 mg Armour Test Result Range Free T Free T TSH TPO If you have thyroid problems you have adrenal issues All Rights Reserved. 10

Addison s Disease No cortisol production Weight loss Increase skin

14 Cushing s Dz Striae Severe Adrenal Disease Cushing s Syndrome High cortisol levels Increased weight Abdominal stretch marks moon face Addison s Disease No cortisol production Weight loss Increase skin pigmentation Fever Low blood pressure All Rights Reserved. 13

15 Relative Adrenal Insufficiency OR Hypocortisolemia HPA Axis Dysfunction Symptoms of HPA Dysfunction Fatigue No energy sometimes couch bound Problems balancing blood sugar values Cold body temperature Allergies Anxiety/nervousness Stress Immune problems Types of Stressors (Allosteric load) Mental/emotional Inflammation Sleep Metabolic All Rights Reserved. 14

16 Perception of Stress is Key Novelty Unpredictable Stress Threatening Loss of Control Individual at Higher Risk for Increased Stress Response Age Female Family history of anxiety Introverted Low self esteem Prenatal or early childhood events Immune Dysfunction Follows Cortisol Dysfunction Low Cortisol Inc. Cellular Immunity Inc. TNFa, IL6, IL12 INFLAMMATION & IMMUNE DISORDERS Dec Lymphatic fxn Inc. NO All Rights Reserved. 15

BLENDING THYROID AND ADRENAL Thyroid and Adrenal T4

19 Testing Methods of Assessing Cortisol 24 hour urine Diurnal cortisol curves Cortisol awakening response ACTH challenge Choosing the Best Adrenal Test Cortisol in blood work Not very helpful; rarely helpful unless Addison s or Cushing s disease Cortisol in urine Can do the daily rhythm OR a total 24 hour collection Cortisol in saliva Allows evaluation of the daily rhythm (circadian rhythm) or just a single night sample The Cortisol Awakening Response All Rights Reserved. 18

22 Lifestyle changes to heal the adrenals Acknowledge that if they keep doing what they are doing They ll keep getting what they are currently getting Lifestyle changes to heal the adrenals SLEEP Keep blood sugar and insulin balanced Change the perception of Stress Supplementation Vitamin C B vitamins B5 and B6 Essential fatty acids Vitamin E Adaptogens Ashwagandha, Siberian ginseng Stimulants American ginseng, licorice Adrenal glandulars Hydrocortisone All Rights Reserved. 21

23 Adaptogens Withania Ashwagandha Eleutherococcus Siberian ginseng Rhodiola Stimulants Panax quintifolia American ginseng Panax ginseng ginseng; Korean ginseng Glycyrrhiza glabra licorice Phosphatidylserine Decrease Cortisols Nervines Lavender, Melissa, Scutellaria off. L Theanine All Rights Reserved. 22

Adrenal Glandulars Adaptogen OR stimulant?

Recommended Reading Adrenalogic Lena Edwards The Cortisol Connection Shawn Talbott The End of Stress As You Know It Bruce McEwen The Role of Stress and the HPA Axis in Chronic Disease

25 Recommended Reading Adrenalogic Lena Edwards The Cortisol Connection Shawn Talbott The End of Stress As You Know It Bruce McEwen The Role of Stress and the HPA Axis in Chronic Disease Management Thomas Guilliams Thank you OBTAINING CME If you would like to receive continuing education credit for this activity, please visit: All Rights Reserved. 24

TEST REPORT # SB. Patient Name: Comprehensive Male Profile I Patient Phone Number: TEST NAME RESULTS 08/12/18 RANGE

TEST REPORT # SB. Patient Name: Comprehensive Male Profile I Patient Phone Number: TEST NAME RESULTS 08/12/18 RANGE TEST REPORT Ordering Provider: David Getuwell, MD 8605 SW Creekside Place Beaverton, OR 97008 Phone: 503-466-2445 Fax: 503-466-1636 Samples Received 08/15/2018 Report Date 08/20/2018 Samples Collected