Essential Nutrients For Healthy Thyroid Function
The thyroid is a butterfly-shaped endocrine gland at the front of the neck below Adam's apple. Secrets hormones that primarily influence our metabolism rate. The metabolic rate of every cell in the body is controlled by thyroid hormones. Thyroid's hormone production is controlled by the Hypothalamus and pituitary gland in the brain.
The hypothalamus monitors circulating thyroid hormone levels and responds to low levels by releasing thyrotropin-releasing hormone (TRH). This TRH then stimulates the pituitary to release thyroid stimulating hormone (TSH) which makes the thyroid to produce its hormones of T3 and T4. When thyroid hormone levels increase, production of TSH decreases, which in turn slows the release of new hormone from the thyroid gland.
What Can Affect The Levels Of Thyroid Hormones?
Elevated levels of cortisol, during stress or due to certain health conditions such as Cushing’s syndrome, lowers TRH, TSH and thyroid hormones.
Cold temperatures can also increase TRH levels. This is thought to be an intrinsic mechanism that helps keep us warm in cold weather.
The thyroid requires iodine and amino acid L-tyrosine to synthesize T3 and T4. T3 is the biologically active form of thyroid hormone. The majority of T3 is produced in the by conversion of T4 to T3 via an enzyme which depends on selenium to work. Factors including nutrient deficiencies, certain medications, and chemical toxicity may interfere with the conversion of T4 to T3.
There are two types of T3; a biologically active form of T3 and the Reverse T3 which is not biologically active. Reverse T3 bonds with regular T3 receptors on the cells, and prevents the function of the biologically active form of T3. Reverse T3 is produced via another type of enzyme.
Almost all the circulating thyroid hormones are carried by carrier proteins which keep them metabolically inactive. Only a very small amount of the remaining “free” thyroid hormone which is mainly T3 is biologically active and bonds to cell receptors. Therefore, small changes in the amount of carrier proteins will affect the percentage of unbound hormones. Oral contraceptives, pregnancy, and conventional female hormone replacement therapy may increase thyroid carrier protein levels and, thereby, lower the amount of free thyroid hormone available.
What are the Thyroid Conditions?
Hyperthyroidism is a condition when the thyroid produces too much thyroid hormone, increasing metabolism rate. On the other hand, in Hypothyroidism, the thyroid does not produce enough thyroid hormone, slowing metabolism. Both conditions are dangerous. Thyroid tests can help identifying the thyroid condition and guidance during treatment.
Thyrotoxicosis is the condition of the extreme Hyperthyroidism, also, referred to as “thyroid storm.” This is a medical emergency, causing elevated heart rates, high blood pressure, extreme fatigue, and fever.
Graves’ disease is another health condition that can cause hyperthyroidism with symptoms such as rapid heartbeat, sweating, nervousness, tremors, muscle weakness, sleep difficulties, increased appetite and sudden weight loss. This condition is controlled by anti-hypertensives, certain anti-thyroid medicines, and or surgically removing the thyroid gland.
L- Carnitine supplementation is recommended for Hyperthyroidism. Increased thyroid activity increases loss of L-carnitine through the urine. based on the studies, L-carnitine at the doses of 2,000-4,000 mg daily helps prevent or reverse muscle weakness and other symptoms in individuals suffering from hyperthyroidism.
Botanicals such as passion flower (Passiflora incarnata ) and valerian root (Valeriana officinalis) provide calming effect on the nervous system and may help control the symptoms of an overactive thyroid.
In hypothyroidism the thyroid gland does not make enough thyroid hormones, causing significantly low metabolism. Hypothyroidism manifests through symptoms such as are fatigue, weakness, sensitivity to cold, constipation, weight gain, dry skin, hair loss, dry hair, muscle cramps , and depression. Most of these symptoms take time to develop, the slower the metabolism gets, the more obvious the signs and symptoms will be and become severe with swollen thyroid gland (goiter), and dementia.
Subclinical hypothyroidism, is a condition which is often under-diagnosed with slightly elevated or elevated TSH, with both T3 and T4 are normal. These individuals are at the greater risk of developing hypothyroidism. While the acceptable range of TSH is between 0.45 and 4.5 µIU/mL, In fact, a TSH reading of more than 2.0 may be indicative of sub-optimal thyroid function. Data suggests TSH greater than 2.0 is associated with increased risk of hypothyroidism, and / or thyroid auto-immune condition. TSH between 2-4 is often associated with high blood cholesterol which is corrected once treated with T4, and finally levels higher than 4 are linked to higher risks of cardiovascular disease.
Hypothyroidism affects mood, causes depression. It is related to cognitive decline, and cardiovascular conditions of high cholesterol, high blood pressure, high homocysteine levels, and high inflammatory markers.
Hypothyroidism affects other hormonal systems. In women it is associated with irregular cycles, and infertility. Fatigue, low energy, weakness, weight gain, dry hair and skin are common symptoms of hypothyroidism.
T3 is the active hormone at thyroid hormone receptor sites, but T4 is the main hormone produced by the thyroid. Conversion of T4 to T3 is therefore an important process for ensuring proper thyroid function.
Several factors influence the conversion of T4 to T3: A low carbohydrate diet can impair conversion of T4 to T3. Low levels of growth hormone impair the conversion of T4 to T3, and increase levels of the inactive reverse T3 hormone. Presence of toxic elements like cadmium and mercury poison the 5’-deiodinase enzyme and prevent conversion of T4 to T3. Excess cortisol stimulates the conversion of T4 to the inactive reverse T3 hormone. Selenium is required as a co-factor in the conversion of T4 to T3, and low levels of selenium are associated with increased hypothyroid symptoms. All of these factors can be measured only through highly specialized tests which are also available via Health Palace.
Pregnant women are especially at risk for hypothyroidism. It is very important to monitor the thyroid function during pregnancy, as uncontrolled thyroid dysfunction during pregnancy can lead to preterm birth, mental retardation, and hemorrhage in the postpartum period.
High cortisol levels arising from physical or psychological stress or synthetic glucocorticoids may normalize TSH levels, thereby masking hypothyroidism. (TSH appears normal when it would be elevated in the absence of high cortisol).
Animal studies suggest that cadmium may lower TSH levels and mask hypothyroidism (TSH appears normal when it would be elevated in the absence of cadmium).
Hashimoto Disease is an autoimmune conditions that is one of the most common cause of low thyroid function in the United States. In this condition, the body’s immune system mistakenly attacks the thyroid tissue impairing the ability to make hormones and it is treated with thyroid hormone replacement agents.
Interestingly, hashimoto’s disease usually causes hypothyroidism, may also trigger hyperthyroid symptoms. Some researchers suggest that "Hashimoto's and Graves' disease are different manifestations of a basically similar autoimmune process, and the clinical appearance reflects the spectrum of the immune response in a particular patient.” So the two conditions can overlap causing both thyroid gland stimulation and destruction simultaneously or in sequence.
Hypothyroidism is commonly treated by thyroid hormone to relieve symptoms and to provide sufficient thyroid hormone to decrease elevated TSH levels to the normal range. This begins with synthetic T4 preparations, but sometimes hypothyroid symptoms persist despite T4 treatment. A study reported that T4 therapy was not effective for improving cognitive function and psychological well-being in patients with symptoms of hypothyroidism, although it improved in free T3 levels.
Recent studies found in some patients T4 treatment alone did not increase T3 to the same level as found in healthy people meaning they could not convert the T4 to the T3. And in Others although Free T3 increased the symptoms remained, meaning that their T3 was not biologically active rather they have converted the T4 to the reverse T3 which is not biologically active. This is suggesting that standard free T3 testing does not provide adequate information for proper treatments, and there is no single approach to treat hypothyroidism. Specialized tests help to provide a complete picture of the conditions (Contact Health Palace office for inquiring these tests). Combination of synthetic T3 and T4 or Natural thyroid glandular may be considered.
Absorption of the thyroid hormone treatments is negatively impacted by food and in particular coffee, antacids, iron supplements, calcium supplements, soy, and grapefruit juice. Therefore it is advised to take thyroid hormone treatment away from any food or medication.
Also, nutrient deficiencies impact the conversion of T4 to T3. Nutrients such as selenium are necessary for the body to converting T4 to biologically active T3.
Nutrients to Support Thyroid Function:
The body uses iodine to make thyroid hormone. Iodine level is measured by urinary iodine excretion. Iodized salt has proven to be effective at preventing iodine deficiency. Iodine deficiency still has remained one of the main causes of mental retardation in Iodine deficient population, and those with untreated thyroid disease. During pregnancy T4 production doubles, causing increases in daily iodine requirements. Iodine deficient pregnant women cannot produce adequate thyroid hormones needed for proper neurological development of the growing baby, and that will increase their risks of giving birth to infants with cognitive impairment and learning delay. Even moderate iodine deficiency in a pregnant woman can lower her infant’s IQ from 8 to 16 points.
Those on a salt-restricted diet, vegetarians, vegans, and those living in low soil iodine regions may become iodine deficient. Excessive iodine due to the excessive exposure, toxicity, or imbalanced died also negatively impacts the thyroid function. The amount of supplemental iodine needed for an individual varies depending on their need. The upper intake level (UL) of iodine for adults is suggested at 1.1 mg daily. However, iodine ingestion above this amount is well tolerated.
Selenium is the next most important mineral affecting thyroid function. The thyroid contains more selenium by weight than any other organ. Selenium is necessary for the function of the enzymes to remove iodine molecules from T4 and converting it into T3. In fact, without selenium, there wouldn't be any active T3. Majority of the individuals with a thyroid problem have lower levels of selenium than healthy people. Selenium deficiency is common in celiac disease, and this may be the reason for the increased frequency of thyroid problems with celiac disease. During severe or prolonged infection, blood levels of selenium, T4, T3 and TSH decrease and the conversion of T4 to T3 slows.
Selenium supplementation helps improve conversion of T4 to T3. Selenium also helps protecting the thyroid gland itself against the oxidative damage due to the fact that cells of the thyroid generate hydrogen peroxide and use it to make thyroid hormone.
Without proper amount of selenium, high iodine levels can cause destruction of the thyroid gland cells. Low selenium is associated with developing Hashimoto's disease, which might be due to lower glutathione peroxidase activity. Therefore selenium supplementation is recommended as part of treatment for Hashimoto’s disease. Three months of supplementation with 200 mcg of selenium daily in participants with Hashimoto's condition and high levels of thyroid peroxidase antibodies, helped lowering the thyroid peroxidase antibody by 66.4% compared to their pre-treatment values, and antibody levels returned to normal in some candidates.
Zinc can help those with low T3 and may contribute to conversion of T4 to T3. In a group of individuals with low levels of free T3, normal T4, but elevated reverse T3 (non active form of T3) which also showed mild Zinc deficiency, oral zinc supplements for 12 months, normalized the serum free T3 (active Form), total T3 levels, TSH levels, and helped decrease the reversed T3.
Very high doses of zinc may negatively impact the thyroid function by impairing the copper absorption. In mouse, copper deficient pregnancies lead to the birth of infant rats with 48% less T3 production than those born from healthy mothers. So it is recommended to complement the zinc with copper to prevent copper deficiencies.
Usually, thyroid conditions are accompanied by Iron deficiency. Iron deficiency causes a reduction in the activity of thyroid peroxidase Enzyme, which impacts the Thyroid hormone production. Supplementing with Iron improves the Iodine's efficacy as well as the thyroid hormone levels in those with deficiency.
Vitamins such as Vitamin A, D, E, and B12 are also important for the health of Thyroid. Vitamin E provides antioxidant benefits and helps improve the thyroid's cellular health and function. The risks of developing thyroid autoimmune conditions increases with vitamin D deficiency. Moreover, it is suggested that vitamin D deficiency is more common among individuals with thyroid cancer or thyroid nodules, compared to the general population. Vitamin A deficiency has been associated with thyroid dysfunction. Vitamin A may cause thyroid gland structural change and disruption of the hypothalamic pituitary axis with thyroid hormone metabolism. Individuals who took 25 000 IU daily of vitamin A as retinyl palmitate for four weeks, had an increased serum T3 and decreased serum TSH levels suggesting vitamin A may help reduce the risk of subclinical hypothyroidism.
Often hypothyroidism is associated with vitamin B12 deficiency. Although the impacts of the vitamin B12 on the thyroid function has not been established, supplementing with B12 in conjunction with Iron helps improve blood formation and may prevent neurologic damage in hypothyroid individuals, therefore it is recommended that all hypothyroid cases to be tested.
Rhodiola rosea is an adaptogenic herb and it may be beneficial for some individuals with hypothyroidism by supporting the adrenal glands, energy levels, and mood.
Ashwagandha (Withania somnifera) is also another great adaptogen to alleviate physical and mental stress. The Ashwagandha Extract is obtained from the leaves, berries, and roots of the plant. One of the most important constituents of ashwagandha are oligosaccharides and withanolide glycosides. Those participants who took 500 mg ashwagandha standardized extract per day for eight weeks, had lower TSH, and increase T4 level indicating improved thyroid function, compared with baseline. In animals ashwagandha root extract raised blood levels of both biologically active forms of thyroid hormone, T3 and T4 after 20 days.
Guggul is the gum resin of the mukul myrrh tree (Commiphora mukul or Commiphora wightii) which been used in traditional medicine to treat tumors, obesity, lipid disorders, and other conditions. Guggulsterones are suggested to be the most important bioactive compounds in guggul extract.
Guggul in vitro helps to improve Iodine uptake, T3 uptake, protein bound iodine, and free T4 levels in thyroid tissue. In animals guggulsterone increased thyroid gland activity by enhancing iodine uptake and enhanced thyroid enzyme function and helped reverse induced hypothyroidism in mice.
Korean ginseng (Panax ginseng, family Araliaceae) is a native perennial plant of Asia and North America that has been studied and used to improve variety of health conditions. Korean ginseng contains a range of bioactive components such as at least 112 saponins from which the ginsenosides has been researched extensively and it is suggested to be one of the most important bioactive compounds in Korean ginseng. Treatment with ginseng extract in a group of individuals with heart conditions combined with abnormally low levels of T3 and T4, helped to increase T3 and T4 levels as well as reduced inactive reverse T3. In addition, it has helped improving symptoms of cold hands and feet, which can be indicative of suboptimal thyroid function. Participant with cold hands and feet condition after taking 500 mg of Korean ginseng extract daily for eight weeks showed higher skin temperature in their hands and feet.
Thyroid Glandulars are usually available through prescription and derived from desiccated porcine thyroid gland. Natural thyroid extracts have been used for long time. Natural thyroid extract preparations contain naturally occurring hormones plus other glandular compounds that may enhance the efficacy of the hormones.
Variety of medicinal herbs have been effective for conditions of hyperthyroidism. These may include bugleweed (Lycopus virginicus), Lemonbalm (Melissa officinalis), rosemary (Rosmarinus officinalis) and sage (Salvia officinalis).
The extract of Lemon Balm (Melissa officinalis) due to its volatile organic compounds and active constituents such as terpenoids, flavonoids, quercetin, rutin, quercitrin, gallic acid, and high antioxidant capacity, has shown a diversity of benefits on multiple organs. M. officinalis extract has been beneficial on the function of the pituitary-thyroid axis. M. officinalis extract helps to raise thyroid hormone levels, reducing thyroid stimulating hormone (TSH), and lowering serum Triglycerides and Cholesterol. Initially M. officinalis extract increases the secretion of TRH (from Hypothalamus) and TSH (from Pituitary gland) and consequently it increases the amount of T3 and T4, this increase in T3 and T4 can finally reduce TSH level through exerting a negative feedback effect.
Based on studies some neuromodulators and neurotransmitters control the neurons which secret TRH hormone in the hypothalamus. Some of these neurotransmitters, such as catecholamines have an increasing role and some, such as interleukin-1 (IL1) and gamma aminobutyric acid (GABA) have a decreasing role. GABA stops or reduces TRH secretion. Studies also indicate that there is a direct link between fat and leptin, but fats and thyroid hormone levels have an inverse and significant relation. Since M. officinalis extract can reduce blood lipid levels, it is most likely that at least part of this effect is exerted by increasing thyroid hormone.
Thyroid Dietary Factors:
Previously it was suspected that sulforaphanes (a redox-active natural product present in cruciferous vegetables like broccoli) may affect the thyroid function; however, recent findings has not found any change in serum levels of thyroid-stimulating hormone, free thyroxine and thyroglobulin, and neither the thyroid autoimmunity status of participants while on the 12 weeks period sulforaphanes treatment.
Some foods contain goitrogenic substances that reduce the utilization of iodine. These foods are such as canola oil, cassava, millet, and soy. Although the actual content of goitrogens in these foods is relatively low, cooking and fermentation helps to significantly reduce their impact on thyroid function. For those with hypothyroidism, these foods that have not undergone fermentation and/ or cooking should be consumed in moderation and discontinued if symptoms should appear.
Articles and products featured by Health Palace are collected from a variety of sources and are provided as a service by Health Palace. These newsletters, while of potential interest to readers, do not necessarily represent the opinions nor constitute the advice of Health Palace. Presented materials are only for information purposes and do not intent to treat, cure, or prevent any disease.
- 1.Tunbridge WM, Evered DC, Hall R et al. The spectrum of thyroid disease in the community. The Whickham survey. Clin Endocrinol1977;7:41–93
- 2.Alevizaki M, Mantzou E, Cimponeriu AT et al. TSH may not be a good marker for adequate thyroid hormone replacement therapy. Wien Klin Wochenschr. 2005 Sep;117(18):636-40.
- 3.Pavia Junior MA et al. Evidence suggesting that cadmium induces a non-thyroidal illness syndrome in the rat. J Endocrinol. 1997;154(1):113-7.
- 4.Basier WVL et al. Thyroid Insufficiency. Is TSH Measurement the Only Diagnostic Tool? J Nutr Environ Med. 2000;10:105-13.
- 5.Canaris GL et al. The Colorado thyroid disease prevalence study. Arch Int Medicine. 2000;Feb 28;160(4):526-34.
- 6.Takashima N et al. Characterization of subclinical thyroid dysfunction from cardiovascular and metabolic viewpoints. Circ J. 2007 Feb;71(2):191-5.
- 7.Romaldini JH, Sgarbi JA, Farah CS. Subclinical thyroid disease: subclinical hypothyroidism and hyperthyroidism. Arq Bras Endocrinol Metabol. 2004 Feb;48(1):147-58.
- 8.Wilson GR, Curry RW Jr. Subclinical thyroid disease. Am Fam Physician. 2005 Oct 15;72(8):1517-24.
- 9.Morris MS et al. Hyperhomocysteinemia and hypercholesterolemia associated with hypothyroidism in the third US National Health and Nutrition Examination Survey. Atherosclerosis. 2001;155:195-20.
- 10.Bicíková M, Hampl R, Hill M, et al. Steroids, sex hormone-binding globulin, homocysteine, selected hormones and markers of lipid and carbohydrate metabolism in patients with severe hypothyroidism and their changes following thyroid hormone supplementation. Clin Chem Lab Med. 2003 Mar;41(3):284-92.
- 11.Stamatelopoulos KS, Kyrkou K, Chrysochoou E, et al. Arterial stiffness but not intima-media thickness is increased in euthyroid patients with Hashimoto's thyroiditis: The effect of menopausal status. Thyroid. 2009 Aug;19(8):857-62.
- 12.Duntas LH. Thyroid disease and lipids. Thyroid. 2002 Apr;12(4):287-93.
- 13.Samuels MH, Schuff KG, Carlson NE, et al. Health status, mood, and cognition in experimentally induced subclinical hypothyroidism. J Clin Endocrinol Metab. 2007 Jul;92(7):2545-51.
- 14.Hogervorst E, Huppert F, Matthews FE, Brayne C. Thyroid function and cognitive decline in the MRC Cognitive Function and Ageing Study. Psychoneuroendocrinology. 2008 Aug;33(7):1013-22.
- 15.Tuzcu A et al. Subclinical hypothyroidism may be associated with elevated high-sensitive c-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J. 2005;Feb;52(1):89-94.
- 16.Tohei A. et al J Reprod Dev. Studies on the functional relationship between thyroid, adrenal and gonadal hormones. 2004 Feb;50(1):9-20.
- 17.Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002 Oct;53(4):865-71.
- 18.Mastorakos G, Pavlatou M. Exercise as a stress model and the interplay between the hypothalamus-pituitary-adrenal and the hypothalamus-pituitary-thyroid axes. Horm Metab Res. 2005 Sep;37(9):577-84.
- 19.Smallridge RC, Ladenson PW. Hypothyroidism in pregnancy: consequences to neonatal health. J Clin Endocrinol Metab. 2001 Jun;86(6):2349-53.
- 20.Clarke N, Kabadi UM. Optimizing treatment of hypothyroidism.Treat Endocrinol. 2004;3(4):217-21.
- 21.Asvold BO et al. Association between blood pressure and serum TSH concentration within the reference range: a population-based study. J Clin Endocrinol Metab. 2007 Jan 2; [Epub ahead of print].
- 22.Chueire VB et al. Sublicinical hypothyroidism increase the risk for depression in the elderly. Arch Gerentol Geriatr. 2007 Jan-Feb;44(1):21-8.
- 23.Poppe K, Velkeniers B, Glinoer D. Thyroid disease and female reproduction. Clin Endocrinol (Oxf). 2007 Mar;66(3):309-21.
- 24.Sehnert KW, Croft AC. Basal metabolic temperature vs. laboratory assessment in "posttraumatic hypothyroidism". J Manipulative Physiol Ther. 1996 Jan;19(1):6-12.
- 25.Sawin CT, Geller A, Kaplan MM, Bacharach P, Wilson PW, Hershman JM et al. Low serum thyrotropin (thyroid stimulating hormone) in older persons without hyperthyroidism. Arch Intern Med 1991;151:165-8.
- 26.Parle JV, Maisonneuve P, Sheppard MC, Boyle P and Franklyn JA. Prediction of all-cause andcardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year study.Lancet 2001Sept 15;358:861-5.
- 27.Wasniewska M, Corrias A, Arrigo T, et al. Frequency of Hashimoto's thyroiditis antecedents in the history of children and adolescents with graves' disease. Horm Res Paediatr. 2010;73(6):473-6.
- 28.McLachlan SM, Nagayama Y, Pichurin PN, et al. The link between Graves' disease and Hashimoto's thyroiditis: a role for regulatory T cells. Endocrinology. 2007 Dec;148(12):5724-33.
- 29.Selenkow HA, Wyman P, Allweiss P. Autoimmune thyroid disease: an integrated concept of Graves' and Hashimoto's diseases. Compr Ther. 1984 Apr;10(4):48-56.
- 30.Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86.
- 31.Leonard Wartofsky. Management of Subclinical Hyperthyroidism. J. Clin. Endocrinol. Metab. 2011 96: 59-61.
- 32.Boonya-Ussadorn T, Punkaew B, Sriassawaamorn N. A comparative study of bone mineral density between premenopausal women with hyperthyroidism and healthy premenopausal women. J Med Assoc Thai. 2010 Nov;93 Suppl 6:S1-5.
- 33.Vadiveloo T, Donnan PT, Cochrane L, Leese GP. The Thyroid Epidemiology, Audit, and Research Study (TEARS): the natural history of endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011 Jan;96(1):E1-8.
- 34.Sinclair C, Gilchrist JM, Hennessey JV, Kandula M. Muscle carnitine in hypo- and hyperthyroidism. Muscle Nerve. 2005 Sep;32(3):357-9.
- 35.Benvenga S, Ruggeri RM, Russo A, Lapa D, Campenni A, Trimarchi F. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2001 Aug;86(8):3579-94.
- 36.Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002 Oct;53(4):865-71.
- 37.Eric Yarnell, Kathy Abascal.Botanical Medicine for Thyroid Regulation. https://doi.org/10.1089/act.2006.12.107-12 Jun 2006.
- 38.Shan, Yaso. "Lemon balm (Melissa officinalis)." Mental Health Practice, Sept. 2005, p. 11. Academic OneFile, Accessed 5 Mar. 2019.
- 39.Weeks BS. Formulations of dietary supplements and herbal extracts for relaxation and anxiolytic action: Relarian.Med Sci Monit. 2009 Nov;15(11):RA256-62.
- 40.Zarei A, Changizi Ashtiyani S, Sokhandani M, Rezaei A, Zaheiri S, Taheri S. Comparison between the effects of the alcholic extract of Mellissia officinalis and atorvastatin on serum levels of thyroid hormones in hypercholesterolemic male rats [In Persian]. Zahedan J Res Med Sci. 2013; 15(8): 6-12.
- 41.Jun HJ, Lee JH, Jia Y, Hoang MH, Byun H, Kim KH, et al. Melissa officinalis essential oil reduces plasma triglycerides in human apolipoprotein E2 transgenic mice by inhibiting sterol regulatory element-binding protein-1c-dependent fatty acid synthesis. J Nutr. 2012; 142(3): 432-40.
- 42.Zarei A, Changizi Ashtiyani S, Sokhandani M, Rezaei A, Zaheiri S, Taheri S. Comparison between the effects of the alcholic extract of Mellissia officinalis and atorvastatin on serum levels of thyroid hormones in hypercholesterolemic male rats [In Persian]. Zahedan J Res Med Sci. 2013; 15(8): 6-12
- 43.Gharib-Naseri MK, Handali S, Hoseini H. Antispasmodic activity of Physalis alkekengi L. leaf hydroalcoholic extract on rat ileum. Iran J Med Arom Plants. 2007; 23: 340-9.
- 44.Changizi Ashtiyani S, Zarei A, Taheri S, Rezaei A, Golshan M, Ghafarzadegan R. A comparative study of hypolipidemic activities of the extracts of Melissa officinalis and Berberis vulgaris in rats. J Med Plants. 2013; 3(47): 38-47.
- 45.Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009 Sep;4(3):198-219. Epub 2009 Sep 1.
- 46.Ross C. Vitamin A. In: Encyclopedia of Dietary Supplements. London and New York: Informa Healthcare; 2010. ILHWA. GinST15 – A Breakthrough in Ginseng Science. http://www.ginst15.net/. Copyright 2015. Accessed 7/28/2016.
- 47.Jin H, Seo JH, Uhm YK, Jung CY, Lee SK, Yim SV. Pharmacokinetic comparison of ginsenoside metabolite IH-901 from fermented and non-fermented ginseng in healthy Korean volunteers. Journal of ethnopharmacology. Jan 31 2012;139(2):664-667.
- 48.Dai X, Zhou Y, Yu X. [Effect of ginseng injection in treating congestive heart failure and its influence on thyroid hormones]. Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine / Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban. Apr 1999;19(4):209-211.
- 49.Park KS, Park KI, Kim JW, et al. Efficacy and safety of Korean red ginseng for cold hypersensitivity in the hands and feet: a randomized, double-blind, placebo-controlled trial. Journal of ethnopharmacology. Dec 2 2014;158 Pt A:25-32.
- 50.Shin BK, Kwon SW, Park JH. Chemical diversity of ginseng saponins from Panax ginseng. Journal of Ginseng Research. 2015;39(4):287-298.
- 51.Zubeldia JM, Nabi HA, Del Río MJ, Genovese J. Exploring new applications for Rhodiola rosea: can we improve the quality of life of patients with short-term hypothyroidism induced by hormone withdrawal?J Med Food. 2010 Dec;13(6):1287-92. Epub 2010 Oct 14.
- 52.Panda S, Kar A. Gugulu (Commiphora mukul) induces triiodothyronine production: possible involvement of lipid peroxidation. Life Sci 1999;65:PL137-41.
- 53.Natural Medicine Comprehensive Database; online access Jan 2, 2007 Guggul.
- 54.Pharmacist’s Letter Natural Medicine Comprehensive Database; online access Jan 3, 2007 Ashwaganda.
- 55.Panda S, Kar A. Changes in thyroid hormone concentrations after administration of ashwagandha root extract to adult male mice. The Journal of pharmacy and pharmacology. Sep 1998;50(9):1065-1068.
- 56.Raju S. Withania womnifera (Ashwagandha): Analytical Method Development. http://www.aoac.org/aoac_prod_imis/AOAC_Docs/SPDS.... Accessed 7/28/2016.
- 57.Gannon JM, Forrest PE, Roy Chengappa KN. Subtle changes in thyroid indices during a placebo-controlled study of an extract of Withania somnifera in persons with bipolar disorder. Journal of Ayurveda and integrative medicine. Oct-Dec 2014;5(4):241-245.
- 58.Pharmacist’s Letter Natural Medicine Comprehensive Database; online access Jan 30, 2007 Fucus.
- 59.Panda S, Kar A. Guggulu (Commiphora mukul) potentially ameliorates hypothyroidism in female mice. Phytotherapy research: PTR. Jan 2005;19(1):78-80.
- 60.Panda S, Kar A. Gugulu (Commiphora mukul) induces triiodothyronine production: possible involvement of lipid peroxidation. Life sciences. 1999;65(12):PL137-141.
- 61.Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: A randomized controlled trial. JAMA. 2003;290(6):765-772.
- 62.Shen T, Li GH, Wang XN, Lou HX. The genus Commiphora: A review of its traditional uses, phytochemistry and pharmacology. Journal of ethnopharmacology. 2012;142(2):319-330.
- 63.Farhangi MA, Keshavarz SA, Eshraghian M, Ostadrahimi A, Saboor-Yaraghi AA. The effect of vitamin A supplementation on thyroid function in premenopausal women. Journal of the American College of Nutrition. 2012;31(4):268-274.
- 64.Aktuna D, Buchinger W, Langsteger W, Meister E, Sternad H, Lorenz O, Eber O. [Beta-carotene, vitamin A and carrier proteins in thyroid diseases]. Acta medica Austriaca. 1993;20(1-2):17-20.
- 65.Higdon J. Linus Pauling Institute: Micronutrient Information Center. Vitamin A. http://lpi.oregonstate.edu/mic/vitamins/vitamin-A.... Last updated 1/2015. Accessed 7/28/2016.
- 66.Jabbar A, Yawar A, Waseem S, et al. Vitamin B12 deficiency common in primary hypothyroidism. J Pak Med Assoc. 2008 May;58(5):258-61.
- 67.Laney N, Meza J, Lyden E, Erickson J, Treude K, Goldner W. The Prevalence of Vitamin D Deficiency Is Similar between Thyroid Nodule and Thyroid Cancer Patients. Int J Endocrinol. 2010;2010:805716.
- 68.Goswami R, Marwaha RK, Gupta N, et al. Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. Br J Nutr. 2009 Aug;102(3):382-6.
- 69.Oner J, Kükner A, Oner H, Ozan E, Yekeler H. Effect of vitamin E on follicular cell proliferation and expression of apoptosis-associated factors in rats with 6-N-propyl-2-thiouracil-induced goitrogenesis. Folia Histochem Cytobiol. 2003;41(4):213-7.
- 70.Sarandöl E, Taş S, Dirican M, Serdar Z. Oxidative stress and serum paraoxonase activity in experimental hypothyroidism: effect of vitamin E supplementation. Cell Biochem Funct. 2005 Jan-Feb;23(1):1-8.
- 71.Bastian TW, Prohaska JR, Georgieff MK, Anderson GW. Perinatal iron and copper deficiencies alter neonatal rat circulating and brain thyroid hormone concentrations. Endocrinology. 2010 Aug;151(8):4055-65.
- 72.Duntas LH, Papanastasiou L, Mantzou E, Koutras DA. Incidence of sideropenia and effects of iron repletion treatment in women with subclinical hypothyroidism. Exp Clin Endocrinol Diabetes. 1999;107(6):356-60.
- 73.Afrin LB. Fatal copper deficiency from excessive use of zinc-based denture adhesive. Am J Med Sci. 2010 Aug;340(2):164-8.
- 74.Nations SP, Boyer PJ, Love LA, Burritt MF, Butz JA, Wolfe GI, et al. Denture cream: an unusual source of excess zinc, leading to hypocupremia and neurologic disease. Neurology. 2008 Aug 26;71(9):639-43.
- 75.Maret W, Sandstead HH. Zinc requirements and the risks and benefits of zinc supplementation. J Trace Elem Med Biol. 2006;20(1):3-18.
- 76.Zimmermann MB, Köhrle J. The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health. Thyroid. 2002 Oct;12(10):867-78.
- 77.Kralik A, Eder K, Kirchgessner M. Influence of zinc and selenium deficiency on parameters relating to thyroid hormone metabolism. Horm Metab Res. 1996 May;28(5):223-6.
- 78.Gärtner R. Selenium and thyroid hormone axis in critical ill states: an overview of conflicting view points. J Trace Elem Med Biol. 2009;23(2):71-4.
- 79.Karanikas G, Schuetz M, Kontur S, et al. No immunological benefit of selenium in consecutive patients with autoimmune thyroiditis. Thyroid. 2008 Jan;18(1):7-12.
- 80.Stazi AV, Trinti B. Selenium status and over-expression of interleukin-15 in celiac disease and autoimmune thyroid diseases. Ann Ist Super Sanita. 2010;46(4):389-399.
- 81.Mazokopakis EE, Chatzipavlidou V. Hashimoto's thyroiditis and the role of selenium. Current concepts. Hell J Nucl Med. 2007 Jan-Apr;10(1):6-8.
- 82.Rayman MP. The importance of selenium to human health. Lancet. 2000 Jul 15;356(9225):233-241.
- 83.Gärtner R, Gasnier BC, Dietrich JW, Krebs B, Angstwurm MW. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002 Apr;87(4):1687-91.
- 84.Laurberg P, Bülow Pedersen I, Knudsen N, Ovesen L, Andersen S. Environmental iodine intake affects the type of nonmalignant thyroid disease. Thyroid. 2001 May;11(5):457-69.
- 85.Krajcovicová-Kudlácková M, Bucková K, Klimes I, Seboková E. Iodine deficiency in vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183-5.
- 86.de Escobar GM, Obregón MJ, del Rey FE. Iodine deficiency and brain development in the first half of pregnancy. Public Health Nutr. 2007 Dec;10(12A):1554-70.
- 87.Sidibé el H. [Reflections on mental retardation and congenital hypothyroidism: effects of trace mineral deficiencies]. Sante. 2007 Jan-Mar;17(1):41-50.
- 88.Lilja JJ, Laitinen K, Neuvonen PJ. Effects of grapefruit juice on the absorption of Thyroid treatments. Br J Clin Pharmacol. 2005 Sep;60(3):337-41.
- 89.Benvenga S, Bartolone L, Pappalardo MA, et al. Altered intestinal absorption of Thyroid treatments by coffee.Thyroid. 2008 Mar;18(3):293-301.
- 90.Sperber AD, Liel Y. Evidence for interference with the intestinal absorption of Thyroid treatments by aluminum hydroxide. Arch Intern Med. 1992 Jan;152(1):183-4.
- 91.Aamir IS, Tauheed S, Majid F, Atif A. Frequency of autoimmune thyroid disease in chronic urticaria. J Coll Physicians Surg Pak. 2010 Mar;20(3):158-61.
- 92.Meloni A, Mandas C, Jores RD, Congia M. Prevalence of autoimmune thyroiditis in children with celiac disease and effect of gluten withdrawal. J Pediatr. 2009 Jul;155(1):51-5, 55.e1.
- 93.Dayan CM, Saravanan P, Bayly G. Whose normal thyroid function is better—yours or mine? Lancet. 2002 Aug 3;360(9330):353.
- 94.Chartoumpekis DV, Ziros PG, Chen JG, Groopman JD, Kensler TW, Sykiotis GP Broccoli sprout beverage is safe for thyroid hormonal and autoimmune status: Results of a 12-week randomized trial.
- 95.Doerge DR, Sheehan DM. Goitrogenic and estrogenic activity of soy isoflavones. Environ Health Perspect. 2002 Jun;110 Suppl 3:349-53.
- 96.Millet--a possibly goitrogenic cereal. Nutr Rev. 1983 Apr;41(4):113-6.
- 97.Greer MA Goitrogenic Substances in Food. Am J Clin Nutr. 1957Jul-Aug;5(4): 440-444.
- 98.Osman BA, Ng ML, Bakar AA, Khalid BA. The effect of cassava leave intake on thyroid hormone and urinary iodine.East Afr Med J. 1993 May;70(5):314-5.