Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. This week we’re going to talk about the most common thyroid abnormality that I treat most everyday in my office: HASHIMOTO’S THYROIDITIS. It’s an important topic to discuss, because there are very few providers who do a good job treating it.
Your thyroid is so important. It’s not just the hormone that regulates your metabolism, it’s also your body’s thermostat! The thyroid keeps your body at the right temperature so that all of the enzymatic, chemical, and hormonal reactions that take place, can actually TAKE PLACE.
The thyroid is a small gland located in your neck. It helps produce energy from your food and nutrients. It is especially important for women because they have a lot more thyroid disease than men do.
The thyroid is complex. Not everybody’s the same. Most of the time when we think of thyroid problems we think of hypothyroidism. There is hyperthyroidism and hypothyroidism. The vast majority is hypothyroidism, or an underactive thyroid. In this Doctor’s Note, I want to talk about one in particular, a form of hypothyroidism, called Hashimoto’s.
Hashimoto’s Thyroiditis is an autoimmune disease. Ninety percent of underactive thyroid is caused by Hashimoto’s Thyroiditis. This is the main autoimmune disease that we think about when we think about autoimmune diseases. As a matter of fact, it was the first autoimmune disease ever discovered.
When we say “autoimmune”, what that means is your own body is attacking itself and in this case, it’s attacking the thyroid gland. About 10% of the US population has Hashimoto’s. For every one man that has it, seven women have it. So, it’s mostly a woman’s disease.
The peak affects for women are around puberty, pregancy, and menopause. There is a genetic predisposition to this, but there’s always a trigger. Like I’ve said before, we all walk around like a loaded gun and it’s the environment that pulls the trigger.
Here are some common triggers:
- Infections (this is a big one)
- Iodine (too much or too little)
- Hormonal imbalances
Typical Symptoms of Hypothyroidism:
- Being tired
- Gaining weight
- Thinning hair
- Brittle nails
- Cold and heat intolerance (it’s common to have cold hands and feet)
- Mood disorders
Note: A lot of times when you see depression, bipolar disorder, or even schizophrenia, it can be cured by correcting the thyroid. I’ve read in some reports that one third of all cases of schizophrenia can be cured by T3 (Cytomel).
Sometimes, you will first see the symptoms of hyperthyroidism when it’s really hypothyroidism (i.e., anxiety, weight loss, and tachycardia). When the damage is done, it then turns into hypothyroidism.
If you suspect you have Hashimoto’s, you need to have the right tests to diagnose it, because there’s a huge range of “normal” and so many different symptoms.
Here are the minimal tests that you need:
- TPO Antibodies
- Free T3
- Free T4
- Sometimes a Thyroid ultrasound
Most of the time, doctors will just do a TSH and T4, and that’s not going to cut it. It may take years of having this autoimmune disease before your TSH goes up high enough for your physician to diagnose it. But if you find the triggers early, you can actually cure it! If you’ve been told by a provider that you have a normal thyroid, but you have a lot of these symptoms, you probably have a suboptimal thyroid, and most likely it’s Hashimoto’s.
Note: Sometimes, it isn’t Hashimoto’s. Sometimes, it’s just a subclinical, non-autoimmune, poor functioning thyroid. Most of the time, the treatment is different for the latter, so make sure you check antibodies to see exactly what you have.
A lot of times when a doctor finally diagnoses you, and your TSH is through the roof, they usually start treating it with medications and tell you that you will be on that medication for the rest of your life (i.e. Synthroid/Levothyroxine). BUT… if you check antibodies and catch it early, twenty percent of the time your thyroid can recover, and you won’t have to take those medications for the rest of your life. It took me years to understand this!
How To Treat Hashimoto’s
Find your triggers! You have to eliminate the triggers and treat them. You have to heal the gut. Remember, most autoimmune diseases start in the gut. Your gut (in addition to digesting your food and absorbing your nutrients) is responsible for keeping the bad stuff out of the bloodstream. These are harmful substances which is what triggers inflammation when you have intestinal permeability (i.e., leaky gut).
Remember, ninety percent of your immune system is located in your gut. Treat the cause of it first! Even stress can be a cause. Treat the infection. It could be bacterial, like Lyme’s Disease or H. pylori.
Many of the people I see with Hashimoto’s have reflux. With this, it’s usually not that you have too much bacteria, it’s that you don’t have enough. It could be caused by a virus, like Epstein Barr. It could be parasitic (parasites are pretty common). So, you need to identify what’s triggering this.
- If bacteria is the cause then you can take antibiotics.
- If it’s a virus that is causing it, you can take other things. You can take herbs like monolaurin (which is one of my favorites), licorice root, quercetin, NAC, and CoQ10.
- If it’s a parasite you may respond to aloe, barberry, garlic, grapefruit seed extract, pomegranate, turmeric, and also wormwood (which is artemisia).
I know you have to heal the gut. For severe cases of the gut, you may have to go on an elemental diet for a few weeks, which is a liquid diet with expensive amino acids that you have to take. It tastes terrible, but if you can get through it, it can heal a severely bad gut.
You might also need to try:
- FODMap Diet (eliminate bad sugars from your diet)
- Candida Diet
- GI-Map to determine where you’re at with your gut microbiome
Treatment with Medications
Most doctors just use Synthroid, or the generic form called Levothyroxine. There are a lot of drawbacks to using this. One drawback is you may not convert the T4 to T3 (the active form of your thyroid hormone). It’s heavily promoted, and it can work. In my experience, I like the combination T3/T4 preparations, like Armour and NP. They’ve been around for many years and about 90% of my patients tell me they feel better on Armour than the Levothyroxine.
Note: If you do take Levothyroxine, take the brand name Synthroid.
I like the compounded T3/T4 medicine because there’s no fillers, no pig thyroid in it, and there’s no TPO antibodies that can actually aggravate Hashimoto’s. It’s just a lot cleaner, and you can dose it better. They can make it in whatever dose you want, so there are a lot more dosing strategies. Sometimes, I just use plain T3 (Cytomel). It’s good for some people, but has a short half life (meaning you may have to dose it twice a day).
When you start a medication, or if you change your doses, in about 6-8 weeks you need to check your levels. Every once in a while, I like to check the TPO as well, to see if I’m tamping down those antibodies and know if I’m getting somewhere.
There are some medications that can trigger Hashimoto’s:
- Antacids (especially PPIs)
- Prolonged use of medications like famotidine
- Oral contraceptives
You also have to address depletions. There are a lot of vitamins and minerals that get depleted. If you have Hashimoto’s, you probably need Zinc, NAC, and Selenium. If you have Hashimoto’s, you definitely need to go gluten free.
People with Hashimoto’s are 5X more likely to get celiac. Celiac can be cured by a gluten free diet. You probably also want to eliminate soy and dairy. Low stomach acid is common, so you’ll want to try Betaine. This, with digestive enzymes, will help your gut work better.
You need to look at iron levels. Without the storage form of iron (ferritin), your thyroid won’t work well. A lot of times, if I get your thyroid tuned up, but your iron levels are low, you’re going to continue to have hair loss, which especially bothers women.
Note: Iron won’t work without Vitamin C.
You have to look at genetics like the MTHFR genotype (the methylation gene). When you can’t convert homocysteine to methionine, you have a buildup of the inflammatory amino acid (homocysteine). This is a risk factor for many things, including cardiovascular disease and Hashimoto’s.
What about Iodine?
A lot of people take iodine indiscriminately without checking if their levels are high or low. It can be bad if it’s too high, and it can be bad if it’s too low. So you have to check it! This is controversial in the Hashimoto’s community. In doing a lot of research on this, iodine may not be good for people with Hashimoto’s, but it could be beneficial for some of those people that just have a suboptimal thyroid, without the antibodies.
What about Iodized Salt?
Izabella Wentz writes in her book, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, “Hashimoto’s was not recognized in the United States before the nation-wide salt iodization program began in 1924.” In other words, iodine can cause Hashimoto’s.
Note: I prefer sea salt anyways.
You hear that you shouldn’t eat cruciferous vegetables (like broccoli and cauliflower) if you have a thyroid problem. In some cases, you shouldn’t. But for most people with Hashimoto’s, you can do it safely. If you have just a suboptimal thyroid, you should probably avoid raw cruciferous vegetables. Note: if you cook them, they’re fine.
You really need to check your thyroid levels in the morning before you take your medication. This can make a big difference, because it can vary a little bit. Check your levels at the same time, every time you go in for labs.
If you can, try to avoid taking your thyroid medication the morning you go to the doctor. Take it the day before. Some people even take it at night, but you need to take it on an empty stomach. Note: water and black coffee are fine and won’t affect the absorption of your medication.
We treat symptoms in people, not labs. Note: You do need the lab work to know what’s going on and to know the ratios etc. Sometimes you need to do an even deeper dive and check a reverse T3. Sometimes you might need to check your adrenal labs and insulin levels as well.
If you have symptoms and you’re told that your thyroid is normal, find a provider who will do the proper testing and understands how to treat this. It’s complex. Insulin is involved. Adrenals are involved. The gut is involved. And nobody is the same.
We have a couple of Performance Medicine providers who have Hashimoto’s and I’ve learned a ton about it from them. It’s really interesting. BTW: I love LDN for the treatment of Hashimoto’s, as well (or for most any autoimmune disease we see).
One of the best books I’ve ever read on Hashimoto’s is the one I mentioned above: “Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause” by Izabella Wentz, PharmD, FASCP. If you read this book and understand it, I guarantee you will know more about Hashimoto’s than ninety-nine percent of physicians, including Endocrinologists.
I hope this helps!