CHAPTER TWO Creating Herbal Formulas for Endocrine Conditions Formulas for Thyroiditis 28 Formulas for Goiter 32 Formulas for Hypothyroidism 34 Formulas for Hyperthyroidism 39 Formulas for Adrenal Disorders 46 Formulas for Addison’s Disease 50 Formulas for Cushing's Syndrome 52 Specific Indications: Herbs for Endocrine Conditions 54. ‘Thyroid and adrenal dysfunction are both very com: mon issues in the general population, and practitioners treat these conditions on a regular basis. Alternative medicine often gives more attention to the subtler presentations of adrenal and thyroid disorders, recognizing symptomseven when lab workis within nor. mal limits. Thus, many patients who are told everything isnormal yt continue to feel unwell often find their way to naturopathic physicians, herbalists, and other alter. native practitioners, who employ herbal and nutritional approaches with excellent results. Herbalists often first aim to restore thyroid and adrenal function, if possible, rather than immediately recommending thyroid replace ment therapy or corticoid prescriptions. Because all the endocrine organs (pituitary, adrenal, thyroid, para- thyroid, and pineal glands) are synergistic, practitioners approach adrenal and thyroid imbalances ‘wholistically, supporting entire systems, such as the hypothalamic-pituitary-adrenal (HPA) axis, rather than focusing on single hormones, Naming a formal diagnosis is less important to alternative pra ‘on recognizing organ system strengths and weaknesses and making an effort to restore balance, feedback loops, and synergism. The adrenal glands and the thyroid gland are a synergistic pair when functioning properly: They both promote metabolism and they both burn fuel to provide energy. Ifeither the thyroid gland or the adrenal slands are weak, the other will lso be affected. As the brain attempts to stimulate the malfunctioning organ, ‘what endocrinologists refer to as “crosstalk” ensues, as feedback loops with the hypothalamus and pituitary become involved and hormonal signals are altered in numerous complex ways. Altered thyroid and adrenal function also lead to metabolic changes, and both increased and decreased metabolic function will increase oxidative and inflam- matory strese in the entire body. Hypothyroidism contributes to high cholesterol, diabetes, and polycystic ovarian syndrome (PCOS), highlighting the synergism. between endocrine and metabolic systems. Adrenal dysfunction can also involve glucocorticoid and miner- alocorticoid abnormalities and can contribute to blood sugar, blood pressure, and electrolyte imbalances. In this chapter I explore the most common thyroid disorders including thyroiditis, goiter, hypothyroidism. and hyperthyroidism, as well as the most common adrenal disorders, Addison's disease and Cushing's syn drome. This chapter will also share treatment strategies for subclinical adrenal and thyroid disorders that do not strictly fit the common disease categories. An Overview of Thyroid Hormones ‘Thyroid hormones are important to embryologic and adolescent growth and development. In adulthood, these hormones help to regulate the function and metabolism26 HERBAL ORM of virtually every organ system. Tissue-specifie modula- tion of thyroid hormone action is achieved by complex and redundant control systems that include thyroid hormone secretion, plasma transport, transmembrane transport, hormone receptor up- and downregulation, eynergitm with other hormones, and coregulation at the level of the nuclear membrane. The detailed mech anisms of these systems are beyond the scope of what is ‘covered in this chapter. ‘The thyroid gland’s primary secretion is thyroxine, which serves to regulate basic metabolic rate. Thyroxine ‘causes stored energy to be metabolized for energy and to maintain body heat. Thyroxine, also called involved in basie metabolic balance and helps regulate the pulse and the respiratory rate. The thyroid also pro duces triiodothyronine, or 3, 73 is at least three times more powerful in target cells than 7 ‘The thyroid synthesizes thyroid hormones in response to thyroid-stimulating hormone (TSH), which is pro duced in the pituitary gland and released into systemic ability co stimulate metabolism ia circulation, TSH travels inthe bloodstream to ultimately bind to TSH receptors on thyroid cells. The hormones are synthesized from tyrosine and iodine with the help of iodine-processing enzymes called iodinases. The thyroid secretes T4at substantially greater levels than 7S, relying ‘on peripheral mechanisms fo convert T4 00 T3 TSI receptors are noted to occur in many tasues besides the thyroid gland including on the thymus, adre nal glands, kidneys, brain, adipose cells, and bone cells? all of which also respond in organ-specific ways when bound by TSI. Estrogen and corticosteroids also play a role in the production of thyroid hormones Factors influencing the peripheral conversion and cellular responses (0 thyroid hormones continue be elucidated and help explain why many patients ‘experience symptoms consistent with hypothyroidism, including low body temperature, even when their thy: rod blood teste are normal Common Thyroid Disorders ‘Thyroid disorders are extremely common in the general population and are 8 times more common in women than in men. Onset of both hyper- and hypothyroid disorders may begin during the menopassal transition, as the pituitary-thyroid-gonadal axis goes through changes. The bypothalamus-pituitary-adrenal (HPA) axis is more widely known, but similar hormonal ‘cascades involve the brain's feedback loope with the ARIES, VOLUME 3 thyroid and reproductive organs, and this is referred to as the pituitary-thyroid-gonadal axis. There are many ‘well-known conditions where thyroid disorders affect, the reproductive system and lead tolow sperm counts in ‘men and menstrual irregularities in women. For exam ple, women with hypothyroidism ean be amenorrheic. ‘Transient hypo- and hyperthyroidism are also common postpartum, all indicating synergism between the thy: roid and reproductive hormones. Excessive thyroxine (hyperthyroidism) can lead to hyperthermia, tachycardia, and excessive calorie use and anabolism prone to hypoglycemia, Conversely, deficient thyroxine ‘output (hypothyroidism) can lead to obesity and byper- lipidemia as excessive nutrients are stored instead of ‘being metabolized ‘The typical signs and symptoms of thyroid insufh ciency include at induces thin, restless individuals + Racigue, lethargy, poor stamina Coldness, sensation of chil, cold hands and feet Overweight or difficuley maintaining weight Blevated lipids, possibly glucose Constipation, digestive dysfunction Dry skin, ry brittle hair and nails, poor healing wounds Slow pulse Allergies frequent upper respiratory infections Menstrual irregularities or amenorrhea ‘Low sperm counts Patients with hypothyroidism display 2 higher prevalence of diabetes, hyperlipidemia, coronary artery disease, and possibly depression. Herbal formulas for hypothyroidism may include glucose-regulating, hypo lipidemic, and antidepressant herbs, depending on the person and the presentation, Hypothyroidism involves an inadequate production ‘of thyroid hormones, due either to poor hormonal regulation or to the inability of the thyroid gland to respond to TSH. Reduced conversion of T4 to T3 may contribute to a variety of chronic diseases The deio. ddinase enzymes responsible for the conversion may be up- or downregulated in different disease states or may be affected by oxidative stress. Some drugs may alter peripheral conversion of T4 to TS, including cor. ticosteroids, propylthiouracil, radiographic contrast dyes, amiodarone, and the beta blocker propranolol ‘Target tissue may also be resistant to thyroxine, even in the presence of seemingly normal lab tests. ResistanceENDOCRINE CONDITIONS 27 to thyroid hormones may present with elevated levels ff thyroid hormone, with normal or slightly elevated levels of TSH, with goiter, and in the absence of symp- toms of thyrotoxicosis§ Although resistance to thyroi hormones was first described in the 1960s, the disorder remains underrecognized, poorly studied, and without standard treatment protocol. Inflammation in the thyroid and autoimmune reactivity ean also contribute to both hypo- and hyperthyroidism. The body may proxluce antithyroid peroxidase antibodies (anti-TPO antibodies), thyrotropin receptor antibodies (TRAbs), and thyroglobulin antibodies that can contribute to both Dietary Seaweed for Thyroid and Metabolic Function Seaweeds are some of the richest sources of organic iodine com- pounds, and these compounds are shown to be readily absorbed by the human body: In Japan, where sea- weed is a dietary staple, the daily average intake of iodine has been estimated at 1.2 milligrams per day,® which is well above the RDA, Fucus vesiculosus, commonly referred to as kelp or bladderwrack, is an edible brown alga and an excellent source of bioavailable iodine? In addition to iodine, Fucus also con- tains the flavonoid fucoxanthing which thas antioxidant activity? and fucoidans, reported co have anticancer iy29 Other brown seaweeds include Undaria pinnatfida (wakame), Sargassum fusiforme (also known as Hizikia fusi- formis, common name hijki), Laminaria japonica (ena-kombu), and Sargassum falvellum (brown, algae). Fucoxanthin isan orange-pigmented marine xanthophyll carotenoid found in brown seaweed that is credited with antiobesity effects as well as benefits to a wide variety of related pathologies, including metabolic syndrome, type 2 diabetes, and hheart disease, Fucoxanthin supports metabolism {in white adipose tissue cells, which helps to atten- uate inflammation in metabolic syndrome! and ‘optimize cytokine production. Weight loss is sup- ported via thermogenic effects, improved insulin Pas vuln, ‘Makderrack receptor response,!and increased uptake ‘of glucose by skeletal muscle! Fucox- also optimizes lipid metabolism in adipocytes, helping to lower serum and hepatic lipids when elevated.” In addi fucoxanthin increases hepatic docosahexaenoic acid (DHA) levels:® DHA isan important fatty acid useful to both prevent and treat metabolic syndrome. Sea- weed fucoxanthins are best taken with oi because lipids incre their sbeorp- tion? and fucoxanthin may in turn boot off the activity of fish c oils? also the Fucus vesiculosus lentry on page 58, Laminaria pons, apanese kelp