Hashimoto’s Disease is the cause of 90-95% of cases of hypothyroidism, or low thyroid. Also known as Hashimoto’s Thyroiditis, it is an autoimmune disease where specific antibodies produced in the body attack the thyroid gland, damaging it and blocking it from producing the thyroid hormones all cells in our bodies need to produce energy.
People who have Hashimoto's generally have symptoms of low thyroid – fatigue, weight gain, feeling cold, joint and muscle pain, constipation, dry skin and hair, slow heart rate, and more – and they often have other autoimmune diseases as well, such as Type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease or Celiac disease too. In addition to the typical hypothyroid symptoms, patients with Hashimoto’s may have acid reflux, nutrient deficiencies, anemia, intestinal permeability, gut dysbiosis (“bad” gut bacteria), impaired digestion, and inflammation. These symptoms suggest something more is going on...
With Hashimoto's, as the thyroid gland is destroyed and stored thyroid hormone is released, some people will also experience transient symptoms of high thyroid – sweating, rapid heart beat, nervousness, weight loss, heat intolerance creating confusion and misdiagnoses. Hashimoto’s is the main cause of low thyroid, accounting for 90-95% of cases of hypothyroidism. The thyroid hormone replacement medication, Synthroid (synthetic levothyroxine or T4), is generally the only treatment offered and this medication is one of the most prescribed drugs in North America.
Hashimoto’s disease is diagnosed by doing blood tests. These tests will show an elevated TSH (thyroid stimulating hormone, produced in the pituitary gland in the brain, that pushes the thyroid to produce more thyroid hormone), and the thyroid hormones, T4 and T3, will be normal initially as the thyroid responds to the increased TSH. As the autoimmune damage to the thyroid progresses, levels of these thyroid hormones will start to decrease. The key diagnostic test, though, is for TPOab (anti-Thyroid Peroxidase antibodies), the antibodies that attack Thyroid Peroxidase enzyme, causing damage to the thyroid gland and disrupting production of thyroid hormones.
So far, the only standard treatment offered is replacement of the missing thyroid hormones after the disease has progressed. There is debate whether starting replacement before thyroid hormones actually start to decrease may be beneficial. While replacing thyroid hormone can help make you feel better, it does not address the underlying problem with the immune system or the cause of the disease. Wouldn’t it make more sense to determine what is causing production of antibodies, treat the cause and prevent the damage, rather than simply replace thyroid hormone for the rest of your life?
The causes are elusive, but some of the additional symptoms of Hashimoto’s, over and above those of simple low thyroid, give us some clues. With Hashimoto’s, nutrient deficiencies, food sensitivities, adrenal dysfunction (impaired ability to handle stress), impaired ability to clear away toxins and intestinal permeability are also commonly seen.
Gastroenterologist and autoimmune researcher, Dr. Alessio Fasano, suggests there are three root causes of autoimmunity, and that all three need to be present for autoimmunity to develop:
Genetic predisposition (genes that increase susceptibility)
Exposure to an antigen (a substance that acts as a trigger)
Intestinal permeability (or leaky gut)
You can’t change the genes you inherited, but you can remove triggers or decrease intestinal permeability by improving your gut health. The problem is, the triggers and causes of intestinal permeability are not the same for everyone, making it a challenge to find the root cause.
Triggers that start the autoimmune process could be infection, severe stress, or something that causes an allergic reaction. Reviewing your past to match events with worsening symptoms is one way to identify your trigger; testing for allergens, intestinal parasites or infection is another. Making lifestyle or diet changes, such as eliminating common allergy-causing foods like gluten or dairy, switching to a Paleo diet, or doing a parasite cleanse (consult a healthcare practitioner!) and noting whether your symptoms improve can also be helpful – just keep in mind that it can take 3 to 6 months for these changes to show results. A decrease in TPOab or reduction in the required dose of thyroid supplement would also suggest you are on the right track.
Addressing digestive issues can work to decrease intestinal permeability: ensuring healthy gut bacterial flora, avoiding foods you are allergic or sensitive to, and adding the supplement, L-glutamine (2.5g twice daily increasing gradually to as high as 10g twice daily) and sometimes adding digestive enzymes are often recommended to promote healing of the gut lining.
In my research for this article, I came across a website/blog that appears very complete and well-researched: www.thyroidpharmacist.com . It is written by Dr. Izabella Wentz, a pharmacist with Hashimoto’s disease, who treated it successfully with lifestyle and diet changes, and now writes about her experiences, both personal and with patients she has subsequently treated. She emphasizes that it is often difficult to find and remove triggers for the disease, and to correct digestive problems, as the causes can vary from person to person. She warns readers that it can take years, but encourages them to keep experimenting until they find the solutions that improve their health.
She has written a book about her experiences and strategies to find solutions: Hashimoto’s Thyroiditis: The Root Cause. Her blog also discusses many aspects of the development of Hashimoto’s and approaches to correct the underlying immune dysfunction with good explanations of the reasons for her recommendations.
For example, there is a strong association between development of Hashimoto’s and Celiac diseases, and the two will often occur together, although sometimes without overt symptoms. Absorption of the mineral, selenium, is impaired in Celiac disease and selenium is important in thyroid function. Selenium is also needed for the conversion of low-activity T4 thyroid into T3 thyroid, a form that is 4 times more active. It also protects thyroid cells from oxidative damage caused by hydrogen peroxide that is produced during the normal production of thyroid hormones. So, two of her recommendations to try initially are a gluten free diet to prevent the Celiac process and supplementation with selenium to protect the thyroid gland cells and improve thyroid activity.
Much more research remains to be done in this area and finding the interventions that work for you can take several years, but these changes are safe to try and have the potential to reverse the autoimmune process. I would encourage you to seek a proper diagnosis if you have the symptoms described above, to educate yourself further about options, to consult with a knowledgeable healthcare professional and to work for as long as it takes to improve your health.
