According to the American Thyroid Association more than 12% of the US population will experience thyroid dysfunction in their lifetime. The thyroid is a gland that sits in our lower neck and releases thyroid hormones, which activate genes in virtually all cells of the body. These hormones increase functional activity, which can be simplified to say they regulate our metabolism. There are many types of thyroid dysfunction. This article will focus on hypothyroidism (under functioning thyroid gland), specifically the most common type of hypothyroidism: Hashimoto’s. The technical name for Hashimoto’s is chronic autoimmune (lymphocytic) thyroiditis. Hashimoto’s is a condition in which the immune system attacks and destroys the thyroid gland. This leads to a gradual loss of thyroid function over time. Hashimoto’s is seven times more common in women than in men. Most often patients with Hashimoto’s experience the typical symptoms of hypothyroidism which can include: weight gain, fatigue, cold intolerance, constipation, hair loss, depression, heavy periods, muscle aches, poor concentration, dry skin and more. Some patients experience Hashitoxicosis, which happens when the immune system attack on the thyroid causes an excessive amount of thyroid hormone to be released for days or weeks. This excess hormone leads to hyperthyroid symptoms such as sweating, insomnia, palpitations, etc. This is often followed by a period of hypothyroid symptoms, which can leave the patient feeling like they are on a roller coaster! What causes Hashimoto’s? As with any autoimmune disease we don’t know all of the triggers that exist but here is a “short” list.
Postpartum: Pregnancy naturally causes a shift in the mother’s immune system to allow for the fetus to develop inside her body. This immune shift can trigger Hashimoto’s postpartum as the mother’s immune system tries to return to “normal”. It can be a transient or a permanent condition.
Iodine: Mild iodine deficiency is associated with a lower prevalence of Hashimoto’s disease and hypothyroidism while excessive iodine intake is associated with a higher prevalence.
Molecular mimicry: This is a critical piece to autoimmune disease. The basic concept is that your body mounts an immune response to something (pollen, food, virus, bacteria, etc.) and then those immune cells become confused and start attacking your tissues. With Hashimoto’s this happens frequently with gluten. I see many patients whose antibodies drop significantly upon going gluten-free. It also happens with certain GI bacteria especially Yersinia. Epstein Barr Virus has been implicated with triggering Hashimoto’s. On another gluten note, patients with Hashimoto’s are at an increased risk for celiac disease!
Intestinal permeability: This goes hand in hand with molecular mimicry. Intestinal permeability is often called “leaky gut”. Our GI tract is technically outside of our body, you could eat a penny and it would pass right through your GI and out into the stool. Your body determines what is brought in through the GI tract in to your blood stream. When there is a breakdown in this process and larger particles are allowed in to the blood we call that intestinal permeability. When larger strings of amino acids (pieces of food that aren’t entirely broken down) make it through, the body attacks these as foreign invaders (as it should!). This attack can go awry and lead to attack on your own bodily tissues. Intestinal permeability is caused by stress, poor diet, overuse of NSAIDS, alcohol and more..
Genetics: There is a strong association with family history of thyroid disease and developing Hashimoto’s. Several genes have been implicated but, as is true for genetics as a whole, we don’t’ yet have a full understanding of exactly what genes are contributing.
Stress: It feels like we are always talking about stress! The health implications for excessive stress that isn’t managed with healthy outlets are far reaching. Even conventional medicine recognizes the impact stress has on developing Hashimoto’s and hypothesize it is due to the effects of cortisol on the immune system. When addressing hypothyroidism/Hashimoto’s adrenal health is important to assess.
Radiation exposure: The thyroid is very susceptible to radiation so be sure to ask for a thyroid collar for any X-rays you receive. Having excessive radiation exposure to your thyroid can increase the risk of thyroid disorders. Typically conventional endocrinologists are not concerned with diagnosing Hashimoto’s. For an endocrinologist, the treatment is the same whether the patient has Hashimoto’s or plain hypothyroidism. In both cases the patient would be given synthetic T4 to replace the under functioning gland. When treating a patient naturopathically the root cause of someone’s condition matters a great deal. With Hashimoto’s the underlying issue is an autoimmune disease that needs to be addressed. With simple hypothyroidism you want to look at co-factors for thyroid hormone production, adrenal health and other issues that could be playing a role. The treatment is very different between Hashimoto’s and simple hypothyroidism. Of note, when someone has an autoimmune disease they are more likely to develop another autoimmune disease so addressing the cause is critical! Diagnosing Hashimoto’s is rather simple and can be done with blood work and/or a thyroid ultrasound. The ultrasound looks for thyroid damage characteristic of Hashimoto’s. Thorough blood work should include: TSH FT3 FT4 Anti-TPO antibodies Anti-TG antibodies Either antibody being elevated beyond normal is a clue that it might be Hashimoto’s. There is a percentage of the population that can have elevated antibodies without an elevation in their TSH or abnormalities of the T3 and T4. Conventionally this is a watch and wait situation. I recommend treating as if the patient has Hashimoto’s and working on diet and any possible underlying causes. In my experience it is possible for a patients antibodies to return to normal levels.
Approach to treatment: Treatment is always tailored to the patient and includes dietary changes with an emphasis on a high antioxidant diet rich in vegetables. We also work to help balance the immune system by using herbs and supplements. One part of working on this immune reaction is getting to the bottom of what caused it with helping to heal any intestinal permeability and balance the healthy flora in the GI tract. Mind body medicine is important for Hashimoto’s. We must analyze stressors, stress response and any somatic manifestations of that stress. I often ask my thyroid patients, are you able to speak your truth?, with the thyroid located so close the voice box one has to wonder if somatic stress manifestation is one contributing factor to thyroid dysfunction. I do recommend that patients also use thyroid medication to help treat their Hashimoto’s. Patients who use thyroid hormone can see a reduction in their antibodies. Our goal with naturopathic treatment is to keep the medication dose stable and slow or stop the thyroid destruction. I am often asked if patients can expect to stop their medication eventually and that depends on the extent of the thyroid damage. Typically there will be some lifelong hormone replacement. There is some concern that using natural desiccated thyroid (NDT) such as Armour thyroid, Nature-Throid or WP Thyroid can cause antibody levels to rise. This is mostly a theoretical concern that I have only seen once, maybe twice in practice. Many patients feel better using an NDT over synthetic thyroid hormone. How someone responds to thyroid medication is very individual and unfortunately it is often a trial and error process to find the right match. If you are struggling with Hashimoto’s or simple hypothyroidism I recommend working with a naturopathic doctor to help identify the root cause of your autoimmune disease. *The treatment discussion in this article is simplified and meant for educational purposes only. Please consult with a naturopathic doctor before implementing changes to your treatment plan.