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Thyrotoxinemia & ADHD

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April 2, 2015

Many of you are aware that two of the most common clinical conditions we treat at Dr. Autoimmune is ADHD and autoimmune thyroiditis, or commonly know as Hashimoto’s. An interesting article came across my desk recently when I was wondering how mom’s health could effect the future health of her unborn fetus.

The study of the complex interactions that occur in utero is called epigenetics and reflects genetic changes that occur as a result of lifestyle, nutritional and environmental influences on mom and her unborn baby.

I was already aware that Hashimoto’s Hypothyroidism disease could increase the occurrence of Attention Deficit Hyperactivity Disorder from a paper titled “Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in children: the Generation R Study.”

Specifically, elevated thyroid peroxidase enzyme antibodies (TPO Abs) were correlated to ADHD occurrence and were not completely attributable to hypothyroidism. This implicates the immune system attack as the primary culprit, causing epigenetic changes to the fetus and disrupting normal neural development.

But what about mother’s exposed to mild iodine deficiency? The most common cause of hypothyroidism in western, developed countries is Hashimoto’s hypothyroidism. But, in non-developed and specific geographic locals in developed countries iodine deficiency is the most common cause of hypothyroidism!

Iodine deficiency has been linked to severe neurological deficits due to thyroid hypofunction in the fetus and now it appears that ADHD is connected to mild to moderate iodine deficiency according to a paper titled “Attention Deficit and Hyperactivity Disorders in the Offspring of Mothers Exposed to Mild-Moderate Iodine Deficiency: A Possible Novel Iodine Deficiency Disorder in Developed Countries”. Over 10 years this study was conducted in Italy where two groups of children were compared, one group from a relatively replete iodine area (control) and another group from a relatively iodine deficient area.

Interestingly, in the iodine deficient children, 11/16 (68.7%) developed ADHD, but 0/11 (0%!) children in the control group developed ADHD! That to me is absolutely amazing! Not only is the incidence higher with iodine deficiency but it is confirmed because the control group did not develop ADHD. Additonally, they found significant differences in IQ scores with the iodine deficient group showing an average decline of 18 points (92.1 V. 110)! Another fascinating aspect of this article was how the mother’s thyroid markers changed during pregnancy.

Hypothyroxinemia is a condition where a patient has low levels of thyroxine, a critical hormone for normal physiologic function and neural development. In this study hypothyroxinemia was defined as pregnant women with normal TSH concentrations (.4-4.0 – note that the correct range should be 1-2.5!) but low serum free T4 values as compared with the bell curve averages of 50 iodine replete women.

I think this is the most important point of the study! Why? Women may or may not receive blood work (basic blood work is the pre-natal standard) before or during pregnancy but if they do, will the doctor measure free T4? Unfortunately not in most cases. So, women may be iodine deficient, become pregnant and show a normal TSH value and told by their unsuspecting doctor that they are “healthy”.

Thyroid stimulating hormone, TSH is a specific marker for pituitary function and only measures the feed back from thyroid production and metabolism. Therefore, many problems are missed because if the actual thyroid hormone levels are not measured, you don’t know if there is a problem! But, now you know! If I was to consult with a doctor for pre-natal or post-natal care I would request a FULL thyroid panel including TSH, T4/T3, fT4/fT3, reverse T3 and TPO/Tg antibodies.

This is the only way to truly scan yourself for thyrotoxinemia, Hashimoto’s hypothyroidism or other thyroid disorders. But why not test for iodine deficiency? It would make most sense to just test for iodine status but the current test is an iodine loading test which requires the person to take a high dose of iodine and infer sufficiency from the amount secreted through urine.

According to Alan Gaby, MD, author or Nutritional Medicine and a world renown nutritional expert it may not be plausible to infer iodine status from this test. Here is an excerpt from his newsletter:

“However, the validity of the test depends on the assumption that the average person can absorb at least 90% of a 50-mg dose. It may be that people are failing to excrete 90% of the iodine in the urine not because their tissues are soaking it up, but because a lot of the iodine is coming out in the feces. There is no reason to assume that a 50-mg dose of iodine, which is at least 250 times the typical daily intake, can be almost completely absorbed by the average person. While this issue has not apparently been studied in humans, cows fed supraphysiological doses of iodine (72 to 161 mg per day) excreted approximately 50% of the administered dose in the feces.”

So, the best medicine is prevention and adequate testing! In preparing for a pregnancy, or if you’ve discovered you are pregnant it is important to be consuming iodine based foods (sea food, kelp,nori, etc..) and one may consider a multi-vitamin that has potassium iodide added. If you have Hashimoto’s and are concerned about iodine creating more TPO antibodies it may be appropriate to monitor antibody levels as you start iodine therapy.

It is clear at this point that many different factors influence the potential of a child developing autism, ADHD or any other spectrum disorder. Just because our salt is iodized DOES NOT MEAN you are getting enough dietary iodine.
Consider working with a functional medicine practitioner who can help you navigate pre/post natal care or address complex conditions that require nutritional, lifestyle and supplemental support. Whether its thyroid, ADHD or staying healthy we can help you navigate and find a higher level of wellness!

Dr. Ian Hollaman, DC
Let Your Health Soar

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