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Thyroid Under Siege: Hashimoto’s Thyroiditis

          Hashimoto’s thyroiditis is an autoimmune thyroid condition that affects an estimated 14 million people in the United States, but truth be told, that number may be grossly underestimated since so few people are tested by their doctors.

     So what is Hashimoto’s thyroiditis? Hashimoto’s (named after the Japanese doctor who first described this condition in 1912) is an autoimmune thyroid disease. Our immune systems are on surveillance all the time to detect viruses and bacteria that need to be fought off to keep us healthy, however, for certain reasons (some of them known and some still unknown), sometimes our immune systems can turn on us and attack our very own tissues. In the case of Hashimoto’s thyroiditis, the body has produced certain antibodies which destroy the thyroid, cell by cell. This process can go on for years, even decades, and can cause a subclinical or overt hypothyroidism. Symptoms may include fatigue, negative mood, depression, dry skin, cold intolerance, puffy eyes, easy weight gain, constipation, slow thinking and poor memory, hair loss or change in hair texture, joint and muscle pain, slow heart rate, infertility, and menstrual difficulties. Some people may present with a full and puffy appearing neck and others will not. Some patients will feel a constriction or tenderness in their neck. Hashimoto’s may be present (rarely, but it does happen) with a transient hyper phase and may be misdiagnosed as Grave’s disease, which is an autoimmune high or hyperthyroid condition.shutterstock_183492188-thyroid

     Genetics play a big role in who is more likely to develop this condition as well as the severity and progression. Women have an incidence of Hashimoto’s thyroiditis seven times more than in men. 42% of daughters and 33% of sons who have a parent with Hashimoto’s thyroiditis will have positive antibodies against their thyroids. But there are certain factors that will turn these genes on to express. Possible triggers include: gluten intolerance, other food allergies, certain viral infections (ie. EBV, parvovirus, rubella, hepatitis C, herpes simplex), inflammation, bacterial infections (ie. Yersinia entericolitica, a g.i. bacteria), mold exposure, stress, iodine excess or deficiency, vitamin D deficiency, heavy-metal toxicity, environmental toxicity, etc.   Pregnancy and postpartum are particular times when Hashimoto’s thyroiditis may first present.

     Proper and thorough testing is the first place to start. The diagnosis is often missed because the only test that is commonly performed via routine blood work is a TSH (a pituitary hormone that usually rises when the thyroid isn’t producing enough thyroid hormone). In order to diagnose Hashimoto’s thyroiditis, it is important to check for anti-thyroid antibodies and a more in-depth thyroid profile. A thorough battery of thyroid tests include: TSH, thyroid peroxidase antibodies (also known as TPO or anti-microsomal antibodies), thyroglobulin antibodies, free T3, free T4, serum or urine iodine, and in some cases reverse T3.

     In other parts of the world, iodine deficiency is the biggest cause of hypothyroidism, however, in the United States it is felt that the larger percentage of people who have hypothyroidism, the underlying cause is autoimmunity. There are people who have elevated thyroid antibodies, yet, despite having all or most of the symptoms mentioned above, they have a normal TSH and they are overlooked, since this is the only test that is routinely done by their doctors. That is because it is the quickest, cheapest and easiest way to catch the majority of people with hypothyroidism, but sadly, too many cases are missed with this narrow approach. In my own practice, I have a drawer in my desk that I put in copies of any test result (of course with the patients’ names blacked out!) that flies in the face of conventional wisdom in regard to thyroid. Low TSH’s coupled with low T3 or normal TSH’s with low or high T4’s. Sometimes the patient will have every symptom of hypothyroidism and their thyroid numbers look fine but they have positive antibodies against their thyroid. These people can benefit from treatment that will help their thyroid, relieve symptoms and keep it from further destroying their thyroids. Another thing to note, anyone who has been diagnosed with hypothyroidism and they have to have their doses changed often, it should be suspicious that they do indeed have Hashimoto’s thyroiditis. There is no drug in conventional medicine that will treat or cure Hashimoto’s thyroiditis, other than treating the hypothyroidism with appropriate medication. But this is doing nothing to stop the immune system from ravaging the thyroid further. It is only in diet and lifestyle medicine that the immune system can be tamed and the thyroid can be restored back to health. A comprehensive approach to addressing Hashimoto’s thyroiditis after complete evaluation has been done, may include dietary changes, vitamin and mineral supplements, thyroid medications (when indicated).

     A gluten-free diet (whether the person has been diagnosed with celiac or has a gluten intolerance) may prove to be helpful in reversing positive antibodies. One study with celiac patients who had Hashimoto’s thyroiditis had reduction or elimination of thyroid antibodies after strictly avoiding gluten for one full year. Correcting vitamin D deficiency and shooting for numbers in the mid to upper reference range can calm down autoimmune attack in the body. Selenium has been well studied in the treatment of Hashimoto’s. Two hundred micrograms a day has been shown to be helpful in lowering antibodies. Brazil nuts are wonderful source of selenium with each averaging approximately 93 mcg per nut! Zinc is another important nutrient for the function of a healthy thyroid. Coconut oil or pure medium chain triglycerides (MCT oil) can be very beneficial for the thyroid and can calm autoimmunity. LDN therapy or low dose naltrexone, acting as an immune modulator, has shown some promise in some patients. In my practice, each person with hypothyroidism or Hashimoto’s thyroiditis is treated individually with the program that best fits their needs.

Be informed to be the best self-advocate for your thyroid’s optimal health!

Factors that inhibit proper production of thyroid hormones

Factors that contribute to proper production of thyroid hormones

Key Symptoms of Hypothyroidism (Underactive thyroid)

In addition to the above, Symptoms of Hashimoto’s Thyroiditis Include:

 

Dr. Judy Gianni, Naturopathic Physician

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