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22/06/2012




    THE THYROID
    AND FERTILITY
    Morwenna Given
    Medical Herbalist
    BA MA (Oxon) BSc m.OHA
    RH
1                            ©
2                    22/06/2012




             WHO AM I?
Iam a Medical Herbalist, trained in
 University, Hospital and clinics in the UK

 With
     a practise in downtown Toronto
 focussing on cancer & precancerous
 conditions including thyroid disorders



                                                      ©
3                22/06/2012




       WHAT IS THE THYROID?
 The thyroid is a butterfly shaped gland
 acting in concert with the Hypothalamic
 pituitary axis

 Toregulate all the metabolic and
 endocrine function of the body via a
 feedback mechanism i.e. growth & sex


                                               ©
4                  22/06/2012




    WHERE IS IT LOCATED?
 located  in the anterior (front ) side of the
 oesophagus between the carotid and
 arteries in the neck wrapped over the
 trachea.

 Due its location abnormalities can be
 easily observed to give an early indicator
 of fertility issues

                                                     ©
5                22/06/2012




       WHAT DOES IT DO?
 Itregulates all endocrine activity through
  hormones
 Principally by controlling the energy and
  growth hormones which in turn
 Control metabolism and fertility.
 The parathyroid which regulates Vitamin
  D, calcium, magnesium, phosphate, (bon
  es and kidney excretion )
                                                 ©
6                  22/06/2012




CONSEQUENCES OF DISORDER
   Although menstrual irregularities are
    common, ovulation and conception can still
    occur in hypothyroidism, if treated.
   Subclinical hypothyroidism may be
    associated with ovulatory dysfunction and
    adverse pregnancy outcome.
   Thyroid autoimmunity increases the
    miscarriage rate, and thyroxine treatment
    does not protect. In males, thyrotoxicosis has
    a significant but reversible effect on sperm
    motility.

                                                       ©
7                    22/06/2012




            HPA HORMONES
   The hypothalamus via its two lobes (anterior
    and posterior pituitary creates the following
    hormones:
   oxytocin,

   Trophic hormones of the anterior pituitary
    includes thyrotropes that produce TSH and
    gonadotropins that produce Prolactin, FSH
    and LH. Via an ERK mediated pathway in
    females only.

                                                         ©
8                   22/06/2012




           HPA HORMONES
 Also   produced are:

 ADH  ( vasopressin/ regulating kidneys )
 Somastatin ( growth & TSH inhibiting )
 Corticotrophins (ACTH - insulin)
 Dopamine
 Growth releasing hormones (GRH)


                                                     ©
9                  22/06/2012




   FEEDBACK MECHANISM

 Recentlya sperm protein (SP22) directly
 affecting TSH and androgen synthesis has
 been found in the male pituitary.

 Thelevel of all hormones is regulated
 within the body by a feed back
 mechanism
                                                  ©
10              22/06/2012




     THYROID HORMONES

 TSH,
     T4, T3, thyroglobulin, thyroid
 peroxidase and antibodies

 Conversion  of TSH to T4 @ 20% takes place
 in the thyroid – the rest in the body overall

 Calcitonin   – vitamin D – calcium
 absorption
                                                  ©
11               22/06/2012




           CONVERSION
 Deiodination  is the most important
 pathway of thyroid hormone metabolism
 not only in quantitative terms, but also
 because it accounts for most of the
 circulating T3 (~ 80%) in humans

 IODINE



                                               ©
12                       22/06/2012




    IMPACT ON FEMALE FERTILITY
    Thyroid dysfunction may cause short luteal phase, failure to
    sustain a fertilized egg, and loss of early pregnancy. Over
    50%of hypothyroid patients have menstrual irregularities
    and one third of subfertile patients have thyroid disease.
   Pituitary hormones such as TSH, prolactin, or growth
    hormone act synergistically with follicle-stimulating
    hormone (FSH) and luteinizing hormone (LH) to usher the
    follicles into the growth phase. About 46.1% of infertile
    patients with hypothyroidism exhibit hyperprolactinaemia.
   Which impairs pulsatile secretion of gonadotrophin-
    releasing hormone (GnRH) and causes ovulatory
    dysfunctions ranging from inadequate corpus luteal
    progesterone secretion when mildly elevated to
    oligomenorrhea or amenorrhea and polycystic ovaries
    when levels are high.

                                                                    ©
13               22/06/2012




IMPACT ON MALE FERTILITY
 Male  reproduction is adversely affected
 by both thyrotoxicosis and
 hypothyroidism. Erectile abnormalities
 have been reported. Thyrotoxicosis
 induces abnormalities in sperm
 motility, whereas hypothyroidism is
 associated with abnormalities in sperm
 morphology

                                                ©
14                  22/06/2012




          IMPACT ON MALES
    the participation of triiodothyronine (T3) in
    the control of Sertoli and Leydig cell
    proliferation, testicular maturation, and
    steroidogenesis is widely accepted, as well as
    the presence of thyroid hormone transporters
    and receptors in testicular cells throughout
    the development process and in adulthood.
    But even with data suggesting that T3 may
    act directly on these cells to bring about its
    effects, there is still controversy regarding the
    impact of thyroid diseases on human
    spermatogenesis and fertility
                                                         ©
                                                         ©
15                       22/06/2012




    LONG TERM CONSEQUENCES
            FOR MEN
   An increase in SHBG is a consistent feature associated with
    thyrotoxicosis, and leads to an increase in circulating levels
    of total T4 and reduction in the metabolic clearance rate
    of testosterone. However, the plasma level of free
    testosterone is usually maintained within the normal
    range, which is in keeping with the lack of clinical
    consequences of the noticeably elevated levels of total
    testosterone found in thyrotoxicosis . Peripheral conversion
    of androgen to estrogen is enhanced in
    thyrotoxicosis, probably due to changes in peripheral blood
    flow rather than a direct effect of thyroid hormones on the
    aromatase complex. An increase in the production rate of
    estrogens is also observed in some men with thyrotoxicosis,



                                                                     ©
16                22/06/2012




          INFERTILITY STARTS IN
              CHILDHOOD
   Thyroid failure in the pre-pubertal period is
    associated with testicular enlargement as well
    as alterations in sexual hormones.
    Hypothyroidism initiated in infancy may occur
    in association with macroorchidism without
    virilization. The longer the hypothyroidism
    persists, the greater is the degree of damage
    to the testes. When adequately treated with
    thyroid hormone, however, boys with
    congenital hypothyroidism progress through
    puberty normally and at the appropriate
    time.

                                                      ©
17               22/06/2012




ONTARIO & THYROID ISSUES
 Itis widely recognised that sub clinical
  hypothyroidism is endemic in Ontario for
  which there is conventional remedy
 But
 Leaving this condition to worsen actively
  promotes diseases such as
  cancer, diabetes and infertility as the only
  available drug has a poor efficacy level.

                                                  ©
18                 22/06/2012




   STANDARD PARAMETERS
 Thyroidfunction is measured in blood-
  work as being @ between 0.35-5.5

 Itis ignored by conventional medicine as
  there are no drugs to treat
 But even a small deviation from the mean
  can have a huge effect on fertility
  hormones.

                                                  ©
19                              22/06/2012




    LONG TERM CONSEQUENCES
   Controlled ovarian hyperstimulation leads to important increases in
    estradiol, which in turn may have an adverse effect on thyroid hormones
    and TSH. When autoimmune thyroid disease is present, the impact of
    controlled ovarian hyperstimulation may become more
    severe, depending on pre-existing thyroid abnormalities.

   Autoimmune thyroid disease is present in 5-20% of unselected pregnant
    women. Isolated hypothyroxinemia has been described in
    approximately 2% of pregnancies, without serum TSH elevation and in
    the absence of thyroid autoantibodies.

   Overt hypothyroidism has been associated with increased rates of
    spontaneous abortion, premature delivery and/or low birth weight, fetal
    distress in labor, and perhaps gestation-induced hypertension and
    placental abruption. The links between such obstetrical complications
    and subclinical hypothyroidism are less evident.

   Thyrotoxicosis during pregnancy is due to Graves' disease and
    gestational transient thyrotoxicosis. All antithyroid drugs cross the
    placenta and may potentially affect fetal thyroid function.

                                                                                    ©
20               22/06/2012




            IVF/Cancer
A brief discussion on the thyroid hormones
 show why IVF can have such devastating
 consequences on the female body

 Last
     year I had 5 ladies who had had IVF
 and consequently within a short time
 period developed cancer.


                                                ©
21                 22/06/2012




          hypothyroidism
 Thisis traditional described as having a T3
  IN EXCESS of T4

 However    any loss of libido, weight
  gain, fatigue, menstrual irregularities are
  early warning signs

 Hashimoto’s

                                                    ©
22               22/06/2012




           hyperthyroidism
 Hyperthyroidismis traditionally measured
 as a TSH below 0.35

 Earlywarning signs are blood
 clots, rashes, heat intolerance, high
 appetite and weight loss

 Graves   disease
                                                 ©
23                22/06/2012




    Subclinical conditions
 Any    of the typical symptoms associated
  with disease are present
 Golden opportunity treat successfully
  with plants
 Avoids a lifetime use of thyroxine which
  only puts T4 into the body.
 Pre cursor to many diseases including
  fertility issues

                                                  ©
24                 22/06/2012




PLANTS & MICRO MINERALS
 Zinc   selenium chromium

 Bladderwrack,     coleus, withania, myrrh, reis
  hi, licorice, ginger, nettle

 Lemon     balm, chickweed, nettle, all heal

 Vitex,   paeony, red clover,
                                                     ©
25   22/06/2012




                  Fertility
 Impacted    also by:
 Stress
 Lifestyle
 Takes  two to tango
 Alcohol
 Toxins – pcb’s
 Excess weight


                                      ©
26                    22/06/2012




                       CAUTIONS
   PLEASE NOTE IT IS ADVISED, THAT ANY PLANTS MENTIONED
    IN THIS TALK, ARE ONLY USED UNDER PROFESSIONAL
    GUIDANCE.
   BOTANICAL MEDICINE AS SUPPLIED BY A PROFESSIONAL IS
    NOT AVAILABLE OVER THE RETAIL COUNTER.

   It is not advisable to self treat

   A professional: will recognise all the issues within the body

   Select herbs that will impact positively on these issues
    without causing problems in order to co exist with orthodox
    drugs,


                                                                      ©
27                  22/06/2012




           SUPPLEMENTS
 There  are some specific supplements
  beneficial in infertility such as zinc
 Retail supplements are not allowed by
  law to have a medical effect at the
  suggested dose and thus the doses
  maybe inappropriate
 Always consult your professional
  practitioner first before purchasing

                                                   ©
28                22/06/2012




 References & Evidence base
 www.   Pubmed, Science direct

Ihave a full list of references for those who
 are interested – if you would like either to
 email me or put your name down tonight I
 will send them to you.



                                                  ©
29           22/06/2012




            Thank you




MORWENNA GIVEN WWW.MEDICUSHERBIS.COM
               © 2012

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The thyroid and fertility

  • 1. 22/06/2012 THE THYROID AND FERTILITY Morwenna Given Medical Herbalist BA MA (Oxon) BSc m.OHA RH 1 ©
  • 2. 2 22/06/2012 WHO AM I? Iam a Medical Herbalist, trained in University, Hospital and clinics in the UK  With a practise in downtown Toronto focussing on cancer & precancerous conditions including thyroid disorders ©
  • 3. 3 22/06/2012 WHAT IS THE THYROID?  The thyroid is a butterfly shaped gland acting in concert with the Hypothalamic pituitary axis  Toregulate all the metabolic and endocrine function of the body via a feedback mechanism i.e. growth & sex ©
  • 4. 4 22/06/2012 WHERE IS IT LOCATED?  located in the anterior (front ) side of the oesophagus between the carotid and arteries in the neck wrapped over the trachea.  Due its location abnormalities can be easily observed to give an early indicator of fertility issues ©
  • 5. 5 22/06/2012 WHAT DOES IT DO?  Itregulates all endocrine activity through hormones  Principally by controlling the energy and growth hormones which in turn  Control metabolism and fertility.  The parathyroid which regulates Vitamin D, calcium, magnesium, phosphate, (bon es and kidney excretion ) ©
  • 6. 6 22/06/2012 CONSEQUENCES OF DISORDER  Although menstrual irregularities are common, ovulation and conception can still occur in hypothyroidism, if treated.  Subclinical hypothyroidism may be associated with ovulatory dysfunction and adverse pregnancy outcome.  Thyroid autoimmunity increases the miscarriage rate, and thyroxine treatment does not protect. In males, thyrotoxicosis has a significant but reversible effect on sperm motility. ©
  • 7. 7 22/06/2012 HPA HORMONES  The hypothalamus via its two lobes (anterior and posterior pituitary creates the following hormones:  oxytocin,  Trophic hormones of the anterior pituitary includes thyrotropes that produce TSH and gonadotropins that produce Prolactin, FSH and LH. Via an ERK mediated pathway in females only. ©
  • 8. 8 22/06/2012 HPA HORMONES  Also produced are:  ADH ( vasopressin/ regulating kidneys )  Somastatin ( growth & TSH inhibiting )  Corticotrophins (ACTH - insulin)  Dopamine  Growth releasing hormones (GRH) ©
  • 9. 9 22/06/2012 FEEDBACK MECHANISM  Recentlya sperm protein (SP22) directly affecting TSH and androgen synthesis has been found in the male pituitary.  Thelevel of all hormones is regulated within the body by a feed back mechanism ©
  • 10. 10 22/06/2012 THYROID HORMONES  TSH, T4, T3, thyroglobulin, thyroid peroxidase and antibodies  Conversion of TSH to T4 @ 20% takes place in the thyroid – the rest in the body overall  Calcitonin – vitamin D – calcium absorption ©
  • 11. 11 22/06/2012 CONVERSION  Deiodination is the most important pathway of thyroid hormone metabolism not only in quantitative terms, but also because it accounts for most of the circulating T3 (~ 80%) in humans  IODINE ©
  • 12. 12 22/06/2012 IMPACT ON FEMALE FERTILITY  Thyroid dysfunction may cause short luteal phase, failure to sustain a fertilized egg, and loss of early pregnancy. Over 50%of hypothyroid patients have menstrual irregularities and one third of subfertile patients have thyroid disease.  Pituitary hormones such as TSH, prolactin, or growth hormone act synergistically with follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to usher the follicles into the growth phase. About 46.1% of infertile patients with hypothyroidism exhibit hyperprolactinaemia.  Which impairs pulsatile secretion of gonadotrophin- releasing hormone (GnRH) and causes ovulatory dysfunctions ranging from inadequate corpus luteal progesterone secretion when mildly elevated to oligomenorrhea or amenorrhea and polycystic ovaries when levels are high. ©
  • 13. 13 22/06/2012 IMPACT ON MALE FERTILITY  Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology ©
  • 14. 14 22/06/2012 IMPACT ON MALES  the participation of triiodothyronine (T3) in the control of Sertoli and Leydig cell proliferation, testicular maturation, and steroidogenesis is widely accepted, as well as the presence of thyroid hormone transporters and receptors in testicular cells throughout the development process and in adulthood. But even with data suggesting that T3 may act directly on these cells to bring about its effects, there is still controversy regarding the impact of thyroid diseases on human spermatogenesis and fertility © ©
  • 15. 15 22/06/2012 LONG TERM CONSEQUENCES FOR MEN  An increase in SHBG is a consistent feature associated with thyrotoxicosis, and leads to an increase in circulating levels of total T4 and reduction in the metabolic clearance rate of testosterone. However, the plasma level of free testosterone is usually maintained within the normal range, which is in keeping with the lack of clinical consequences of the noticeably elevated levels of total testosterone found in thyrotoxicosis . Peripheral conversion of androgen to estrogen is enhanced in thyrotoxicosis, probably due to changes in peripheral blood flow rather than a direct effect of thyroid hormones on the aromatase complex. An increase in the production rate of estrogens is also observed in some men with thyrotoxicosis, ©
  • 16. 16 22/06/2012 INFERTILITY STARTS IN CHILDHOOD  Thyroid failure in the pre-pubertal period is associated with testicular enlargement as well as alterations in sexual hormones. Hypothyroidism initiated in infancy may occur in association with macroorchidism without virilization. The longer the hypothyroidism persists, the greater is the degree of damage to the testes. When adequately treated with thyroid hormone, however, boys with congenital hypothyroidism progress through puberty normally and at the appropriate time. ©
  • 17. 17 22/06/2012 ONTARIO & THYROID ISSUES  Itis widely recognised that sub clinical hypothyroidism is endemic in Ontario for which there is conventional remedy  But  Leaving this condition to worsen actively promotes diseases such as cancer, diabetes and infertility as the only available drug has a poor efficacy level. ©
  • 18. 18 22/06/2012 STANDARD PARAMETERS  Thyroidfunction is measured in blood- work as being @ between 0.35-5.5  Itis ignored by conventional medicine as there are no drugs to treat  But even a small deviation from the mean can have a huge effect on fertility hormones. ©
  • 19. 19 22/06/2012 LONG TERM CONSEQUENCES  Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on pre-existing thyroid abnormalities.  Autoimmune thyroid disease is present in 5-20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies.  Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident.  Thyrotoxicosis during pregnancy is due to Graves' disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function. ©
  • 20. 20 22/06/2012 IVF/Cancer A brief discussion on the thyroid hormones show why IVF can have such devastating consequences on the female body  Last year I had 5 ladies who had had IVF and consequently within a short time period developed cancer. ©
  • 21. 21 22/06/2012 hypothyroidism  Thisis traditional described as having a T3 IN EXCESS of T4  However any loss of libido, weight gain, fatigue, menstrual irregularities are early warning signs  Hashimoto’s ©
  • 22. 22 22/06/2012 hyperthyroidism  Hyperthyroidismis traditionally measured as a TSH below 0.35  Earlywarning signs are blood clots, rashes, heat intolerance, high appetite and weight loss  Graves disease ©
  • 23. 23 22/06/2012 Subclinical conditions  Any of the typical symptoms associated with disease are present  Golden opportunity treat successfully with plants  Avoids a lifetime use of thyroxine which only puts T4 into the body.  Pre cursor to many diseases including fertility issues ©
  • 24. 24 22/06/2012 PLANTS & MICRO MINERALS  Zinc selenium chromium  Bladderwrack, coleus, withania, myrrh, reis hi, licorice, ginger, nettle  Lemon balm, chickweed, nettle, all heal  Vitex, paeony, red clover, ©
  • 25. 25 22/06/2012 Fertility  Impacted also by:  Stress  Lifestyle  Takes two to tango  Alcohol  Toxins – pcb’s  Excess weight ©
  • 26. 26 22/06/2012 CAUTIONS  PLEASE NOTE IT IS ADVISED, THAT ANY PLANTS MENTIONED IN THIS TALK, ARE ONLY USED UNDER PROFESSIONAL GUIDANCE.  BOTANICAL MEDICINE AS SUPPLIED BY A PROFESSIONAL IS NOT AVAILABLE OVER THE RETAIL COUNTER.  It is not advisable to self treat  A professional: will recognise all the issues within the body  Select herbs that will impact positively on these issues without causing problems in order to co exist with orthodox drugs, ©
  • 27. 27 22/06/2012 SUPPLEMENTS  There are some specific supplements beneficial in infertility such as zinc  Retail supplements are not allowed by law to have a medical effect at the suggested dose and thus the doses maybe inappropriate  Always consult your professional practitioner first before purchasing ©
  • 28. 28 22/06/2012 References & Evidence base  www. Pubmed, Science direct Ihave a full list of references for those who are interested – if you would like either to email me or put your name down tonight I will send them to you. ©
  • 29. 29 22/06/2012 Thank you MORWENNA GIVEN WWW.MEDICUSHERBIS.COM © 2012