Living with Hashimoto’s
So you’ve been diagnosed with Hashimoto’s, what now?
Thyroid diseases are more common than you may think and affect millions of people worldwide. However, many people have very little understanding of what the diagnosis even means. While you may be told that your thyroid function will gradually deteriorate and you’ll be on medication for life, we are fortunate there are some things naturally you can do. Natural medicine provides an arsenal of tools that can be used to support your thyroid function, reduce autoimmune antibody titres, alleviate your symptoms and ensure you feel empowered and in charge of your health. It’s all about educating yourself and taking ownership of your health.
What is Hashimoto’s?
Hashimotos’s disease is an autoimmune disorder in which the body produces a specialised type of white blood cell (lymphocyte) which attacks the thyroid gland. Your thyroid then produces less thyroid hormone often to the point where a synthetic hormone replacement thyroxine, needs to be taken. It is one of the most common causes of underactive thyroid or hypothyroidism in developed countries.1 As thyroid hormones regulate metabolism, many of the body’s functions slow down without enough thyroid hormone.
Hashimoto’s affects more females than males with the ratio being at least 10:1. Most diagnoses occur between the ages of 30 to 50 years although the prevalence of thyroid disease, in general, increases with age. Pregnancy is also a major risk factor. This is because iodine requirements are high in both the mother and the foetus and changes in reproductive hormones also cause changes in thyroid hormone levels. Some women also develop antibodies to their own thyroid during pregnancy causing a condition known as postpartum autoimmune, or subacute, thyroiditis. Hashimoto’s disease is also associated with several other autoimmune disease such as pernicious anaemia, vitiligo, diabetes mellitus, Addison’s disease, rheumatoid arthritis and coeliac disease.2
Symptoms of Hashimoto’s
In the initial stages, patients may experience the symptoms of excess thyroid hormone known as hyperthyroidism. This includes racing of the heart, anxiousness and hyperactivity, heat intolerance, sweating and weight loss. This is due to inflammation of the thyroid gland, causing the gland to release much of its stored thyroid hormone. After a period of time, and after the thyroid gland essentially wears itself out, the hyperthyroid symptoms will give way to hypothyroid symptoms such as:
- Cold hands and feet
- Dry skin
- Brittle nails
- Hair loss
- Joint pain
- Brain fog and poor memory
- Menstrual irregularities and period pain
- Puffy eyes
A swollen thyroid gland, otherwise known as a goiter, is also very common with Hashimoto’s. The thyroid will enlarge as the disease process impairs its function.
Many doctors will simply run a TSH test (thyroid stimulating hormone) and call it a day. However, this misses critical information and leaves you with a lot of questions. It’s important to perform extensive thyroid blood tests to look at your thyroid function as a whole. This includes TSH, T4 and free T4 (the inactive form of thyroid hormone), T3, (the active form of thyroid hormone), reverse T3 as well as thyroid autoantibodies. This will show exactly what hormones your thyroid is making and how much, plus it shows whether the hormones are converting properly.
Diagnosis is often challenging and may take time until later in the disease process. One study found that autoantibodies are typically present many years before diagnosis in autoimmune disease.3 Testing many be warranted in those who carry various risk factors for Hashimoto’s in order to prevent complete destruction of the thyroid gland. The most common test findings demonstrate an elevated TSH, low levels of free T4 and increased thyroid peroxidase antibodies.
Causes of Hashimoto’s
The causes of Hashimoto’s disease are poorly understood. Research reveals a number of likely environmental and nutritional causes which may trigger the onset and progress of the disease. These include:
Genetics plays a huge role in Hashimoto’s disease. In fact, based on twin studies, it has been estimated that 70-80% of susceptibility to autoimmune thyroid disease is on a genetic basis.4 There’s usually an underlying genetic predisposition and a trigger that initiate a cascade of events culminating in Hashimoto’s disease. The underlying genetic predisposition also confers susceptibility to Grave’s disease, another autoimmune thyroid condition.
Parasitic, viral and bacterial infections have been known to trigger Hashimoto’s disease. Hepatitis C for example, has been associated with thyroid autoimmunity and hypothyroidism.5 Inflammation caused by viral infection may lead to activation of T-cells which can trigger autoimmunity. Molecular mimicry may also be a causative mechanism, where there is a structural similarity between viral and self-antigens leading to the body attacking its own tissues. Other triggering viruses which have been implicated include parvovirus, rubella, herpes simplex virus, Epstein Barr virus, and human T-lymphotropic virus type 1.6 Several studies also suggest an association of infection with Toxoplasma gondii with an increase of thyroid autoantibodies although more research is warranted to confirm these findings.7
- Environmental toxins and chemicals
Environmental toxins and chemicals have been shown to increase the risk of autoimmune thyroid disease. Exposure to environmental toxicants such as polyaromatic hydrocarbons, which are organics produced from coal and found in air and water, or polyhalogenated biphenyls (PBB), have been shown to trigger thyroid autoimmunity in genetically predisposed individuals.8 PBB are commonly used compounds with a wide variety of industrial applications such as flame retardants, lubricants, adhesives and plasticizers. Other compounds which have been shown to possess strong oestrogenic properties like Bisphenol A have been associated with disrupted thyroid hormone production and conversion.9
Heavy metals can also cause a lot of damage to the thyroid, in particular aluminium, lead, cadmium and mercury. Aluminium is commonly found in deodorant, over-the-counter medications like antacids, food additives, cookware and vaccines. Aluminium oxidizes the thyroid, inhibits iodide uptake and thyroid hormone production and can trigger an autoimmune response. Cadmium can trigger thyroid enlargement and nodules of the thyroid. Cadmium is released via mining and smelting activities and is present in batteries, plastics, sewage and phosphate-based fertilizers. Lead exposure has long been recognised for its toxicity and has been linked to reduced thyroid function and elevated thyroid-stimulating hormone. Lead is still prevalent in the environment and its sources include paint, ceramics, newsprint, solder, dolomite and pewter ware. Mercury, found in seafood, dental amalgams, fungicides, mining, paints, explosives, batteries, fluorescent lamps, cosmetics, hair dyes and petroleum products, has been associated with inducement of autoimmune disease including Hashimoto’s disease. It can also reduce TSH production and inhibit iodine uptake.10
Certain drugs have been reported to trigger or exacerbate Hashimoto’s in some individuals. Interferon α (IFN-α) for example, which is used extensively to treat chronic hepatitis has been associated with thyroid autoimmunity.11 Similarly, IL-2, used for melanoma and renal carcinoma, can also increase thyroid autoantibodies and hypothyroidism.12 In patients with known autoimmune thyroid disease, lithium may increase the risk of hypothyroidism. In fact, studies have shown lithium can increase thyroid antibody titres and the prevalence of thyroid autoimmunity.13 The effects of amiodarone, which is used for cardiac arrythmias, on the thyroid have also long been recognized. The structural similarity of amiodarone to thyroid hormones as well as its high iodine content may play a role in causing thyroid dysfunction.14
- Poor Gut Health- Intestinal Permeability and Food Sensitivities
What a lot of people don’t know is that there is a strong connection between gut health and thyroid function. When it comes to Hashimoto’s and in fact any other autoimmune condition, research shows that one important factor is chronic, persistent microbiome imbalance and inflammation in the gut. 70-80% of the immune cells reside in the gut and intestinal bacteria play a role in the conversion of T4 to T3. Intestinal permeability, or leaky gut, has also been implicated in Hashimoto’s thyroiditis. If the intestinal wall is porous or leaky, the bloodstream is exposed to harmful foreign molecules and food proteins that you may be sensitive to. The immune system then reacts with an inflammatory response and this can eventually lead to a mistaken immune attack on the body’s tissues such as the thyroid gland. Inflammation in the gut can also increase cortisol levels, and high cortisol also reduces the conversion of T4 to T3.
- Vitamin D deficiency
Vitamin D is not only necessary for helping your body absorb calcium and strengthen your bones, it also plays an important role in keeping the delicate balance of your immune system in check. As autoimmune conditions occur more frequently in regions farther from the equator, researchers have suggested that one of the potential reasons for this may be due to inadequate vitamin D levels. In fact, several studies have connected low vitamin D levels to various autoimmune conditions including Hashimoto’s thyroiditis.15 Significantly low levels of vitamin D were documented in patients with autoimmune thyroid disorders that were related to the presence of anti-thyroid antibodies and abnormal thyroid function. Studies have shown a decrease in thyroid antibodies with vitamin D supplementation indicating its importance in slowing down and preventing the progression of Hashimoto’s.
- Iodine Intake
Increased iodine consumption (and occasionally iodine deficiency as iodine is a building block for thyroid hormone), is strongly implicated as a trigger for Hashimoto’s. This has to do with the way that iodine is processed in the body. Iodine from both foods and supplements is metabolised in the body through a series of stages involving the hypothalamus, pituitary and thyroid gland.16 During this process, hydrogen peroxide, a free radical, is released. The body needs sufficient selenium17 in order to neutralise the hydrogen peroxide. So if someone doesn’t have adequate levels of selenium or in the case of excess iodine, the hydrogen peroxide can cause premature damage and programmed cell death in thyroid tissues.18 These iodine overloaded cells are then able to turn on the autoimmune process in genetically susceptible individuals.
Stress is one of the most overlooked triggers of thyroid autoimmunity as the onset and progress of Hashimoto’s is generally gradual. Studies have demonstrated that psychological and physiologic stressors induce various changes on the immune system either indirectly or directly through the nervous and endocrine systems.19 When you experience any kind of stress, your hypothalamus sends a signal to your pituitary gland which, in turn, signals to your adrenal glands to produce and release stress hormones including cortisol. This switches your body to a state of “fight or flight” and your stress hormones redirect your body’s normal functions to deprioritize anything that is not necessary for overcoming the stressor in front of you. This includes functions like digestion, immune response and thyroid hormone production as well as conversion from T4 to T3. These immune modulations as well as the effect on the thyroid may contribute to the development of autoimmunity in genetically predisposed individuals.
Treating Hashimoto’s Naturally
1) Avoid gluten- studies have shown an association between sensitivity to gluten-containing products and autoimmune thyroid problems in including Hashimoto’s. Research has also found that a significant number of patients with Hashimoto’s also have coeliac disease.20
2) It’s also good to undergo a more comprehensive elimination diet of the major allergens and possible sensitivities including dairy, eggs, nightshade vegetables such as eggplants and tomatoes, soy and sugar as well as avoiding caffeine and alcohol which disturbs thyroid hormone production as it supresses the body’s ability to use thyroid hormone.21
3) Avoid food additives and chemicals and all refined foods especially processed grains and sugars as well as all products containing aspartame. In the body, aspartame is metabolised into the toxic substance formaldehyde which the liver cannot clear. Thus, it remains lodged, causing inflammation and becoming a potential to autoimmune issues such as Hashimoto’s thyroiditis.22
4) Incorporating selenium-rich foods such as Brazil nuts is beneficial as it’s been shown to be an essential element for thyroid function.
5) Iodine- before you increase iodine-rich food such as seaweed and iodised salt, it is important to check your levels as excess iodine consumption can trigger or exacerbate Hashimoto’s.
6) Antioxidant-rich foods- are necessary to fight the free radical damage caused by inflammation. Emphasis on vitamin A containing foods is particularly important as vitamin A is often deficient in people with any type of autoimmune condition. Antioxidant-rich foods include berries, apples, nuts such as pecans, beams, red cabbage, beetroot and dark leafy greens.
7) Healthy fats- are important to help decrease inflammation. It also provides another energy source for the body. These are found in foods such avocados, olive oil, nuts and seeds especially walnuts and chia seeds.
8) Probiotic foods- increase probiotic-rich foods such as kombucha, sauerkraut, non-dairy kefir and yoghurt and kimchi to provide beneficial bacteria in your gut which is essential for modulating your immune response.
9) In cases of iodine deficiency, raw vegetables from the brassica family should be avoided as they can release goitrogenic chemicals which can compete with iodine uptake in the thyroid and can interfere with thyroid hormone synthesis. This includes vegetables such as broccoli, cauliflower, Brussels sprouts, kale, cabbage and more. However, if iodine intake is sufficient, strict avoidance is not recommended as many of these foods have beneficial properties too. Steaming or boiling them reduces their goitrogenic effect.
Given the vast amount of toxins in the environment which can interfere with thyroid function, it is important to reduce your exposure to environmental toxins as much as possible. Here are some tips to get you started as well as some other essential lifestyle tips:
1) Buy organic food as much as possible to avoid toxic agricultural agents and peel non-organic fruits and vegetables
2) Stop using pesticides, herbicides and fungicides (or fertilizers that contain them) in the yard and garden
3) Convert to all natural personal hygiene products and cosmetics that are free of heavy metals and other toxic compounds
4) Use chemical free, biodegradable laundry and household cleaning products and choose chlorine-free products and unbleached paper products (i.e. tampons, menstrual pads, toilet paper, paper towel, coffee filters).
5) Limit use of plastic containers for drinking and food storage or at least opt for BPA-free varieties
6) Invest in a quality water filter
7) Replace non-stick cookware items with stainless steel or cast iron options
8) Reduce stress- stress can prevent the body from healing itself and can exacerbate an autoimmune inflammatory response. By adopting stress management techniques such as a good sleep routine, massage, meditation and yoga as well as addressing stress through herbal and nutritional supplements, you may be able to reduce the symptoms of Hashimoto’s and lessen its impact.
9) Participate in frequent physical activity as not only does it aid in weight gain, sleep disturbances and anxiety, it also reduces inflammation and improves symptoms of Hashimoto’s.
Lab tests should be performed every 3-6 months in order to monitor thyroid hormone levels. Medication or supplemental adjustments should be made accordingly. It is important to consult a health practitioner to know exactly what to supplement and how much but common prescriptions include:
- Vitamin D for immune regulation
- Trace minerals such as selenium, zinc, iodine, chromium and manganese for peripheral thyroid hormone conversion. Be cautious supplementing iodine and selenium though.
- Omega 3 fatty acids to reduce inflammation
- Digestive enzymes to aid with absorption
- B vitamins to help support energy production which is often depleted in Hashimoto’s.
- L-glutamine for intestinal permeability and to aid cellular repair
- Probiotics, best to get a broad spectrum or rotate for different strain coverage
- Adaptogenic herbs such as Withania, Rhodiola and Licorice to balance adrenal function and aid with peripheral conversion of T4 to T3
- Anti-inflammatory herbs such as turmeric to help reduce inflammation as well as support the liver
- Glutathione- for its potent antioxidant activity
1 Mincer, D.L & Jialal, I. (2020). Hashimoto Thyroiditis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/
2 Mincer, D.L & Jialal, I. (2020). Hashimoto Thyroiditis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/
3 Arbuckle, M. R., McClain, M. T., Rubertone, M. V., Scofield, R. H., Dennis, G. J., James, J. A., & Harley, J. B. (2003). Development of autoantibodies before the clinical onset of systemic lupus erythematosus. The New England journal of medicine, 349(16), 1526–1533. https://doi.org/10.1056/NEJMoa021933
4 Hansen, P. S., Brix, T. H., Iachine, I., Kyvik, K. O., & Hegedüs, L. (2006). The relative importance of genetic and environmental effects for the early stages of thyroid autoimmunity: a study of healthy Danish twins. European journal of endocrinology, 154(1), 29–38. https://doi.org/10.1530/eje.1.02060
5 Zaletel, K., & Gaberšček, S. (2011). Hashimoto's Thyroiditis: From Genes to the Disease. Current genomics, 12(8), 576–588. https://doi.org/10.2174/138920211798120763
6 Desailloud, R., & Hober, D. (2009). Viruses and thyroiditis: an update. Virology journal, 6, 5. https://doi.org/10.1186/1743-422X-6-5
7 Kaňková, Š., Procházková, L., Flegr, J., Calda, P., Springer, D., & Potluková, E. (2014). Effects of latent toxoplasmosis on autoimmune thyroid diseases in pregnancy. PloS one, 9(10), e110878. https://doi.org/10.1371/journal.pone.0110878
8 Lindsay, R. H., Hill, J. B., Gaitan, E., Cooksey, R. C., & Jolley, R. L. (1992). Antithyroid effects of coal-derived pollutants. Journal of toxicology and environmental health, 37(4), 467–481. https://doi.org/10.1080/15287399209531686
9 Moriyama, K., Tagami, T., Akamizu, T., Usui, T., Saijo, M., Kanamoto, N., Hataya, Y., Shimatsu, A., Kuzuya, H. & Nakao, K. (2002). Thyroid Hormone Action Is Disrupted by Bisphenol A as an Antagonist, The Journal of Clinical Endocrinology & Metabolism, 87(11): 5185–5190, https://doi.org/10.1210/jc.2002-020209
10 Chen, A., Kim, S. S., Chung, E., & Dietrich, K. N. (2013). Thyroid hormones in relation to lead, mercury, and cadmium exposure in the National Health and Nutrition Examination Survey, 2007-2008. Environmental health perspectives, 121(2), 181–186. https://doi.org/10.1289/ehp.1205239
11 Tomer Y. (2010). Hepatitis C and interferon induced thyroiditis. Journal of autoimmunity, 34(3), J322–J326. https://doi.org/10.1016/j.jaut.2009.11.008
12 Barbesino G. (2010). Drugs affecting thyroid function. Thyroid : official journal of the American Thyroid Association, 20(7), 763–770. https://doi.org/10.1089/thy.2010.1635
13 Baethge, C., Blumentritt, H., Berghöfer, A., Bschor, T., Glenn, T., Adli, M., Schlattmann, P., Bauer, M., & Finke, R. (2005). Long-term lithium treatment and thyroid antibodies: a controlled study. Journal of psychiatry & neuroscience : JPN, 30(6), 423–427.
14 Danzi, S., & Klein, I. (2015). Amiodarone-induced thyroid dysfunction. Journal of intensive care medicine, 30(4), 179–185. https://doi.org/10.1177/0885066613503278
15 Kivity, S., Agmon-Levin, N., Zisappl, M., Shapira, Y., Nagy, E. V., Dankó, K., Szekanecz, Z., Langevitz, P., & Shoenfeld, Y. (2011). Vitamin D and autoimmune thyroid diseases. Cellular & molecular immunology, 8(3), 243–247. https://doi.org/10.1038/cmi.2010.73
16 Ahad, F., & Ganie, S. A. (2010). Iodine, Iodine metabolism and Iodine deficiency disorders revisited. Indian journal of endocrinology and metabolism, 14(1), 13–17.
17 Contempre, B., Dumont, J. E., Ngo, B., Thilly, C. H., Diplock, A. T., & Vanderpas, J. (1991). Effect of selenium supplementation in hypothyroid subjects of an iodine and selenium deficient area: the possible danger of indiscriminate supplementation of iodine-deficient subjects with selenium. The Journal of clinical endocrinology and metabolism, 73(1), 213–215. https://doi.org/10.1210/jcem-73-1-213
18 Xu, J., Liu, X. L., Yang, X. F., Guo, H. L., Zhao, L. N., & Sun, X. F. (2011). Supplemental selenium alleviates the toxic effects of excessive iodine on thyroid. Biological trace element research, 141(1-3), 110–118. https://doi.org/10.1007/s12011-010-8728-8
19 Mizokami, T., Wu Li, A., El-Kaissi, S., & Wall, J. R. (2004). Stress and thyroid autoimmunity. Thyroid : official journal of the American Thyroid Association, 14(12), 1047–1055. https://doi.org/10.1089/thy.2004.14.1047
20 Lerner, A., Jeremias, P., & Matthias, T. (2017). Gut-thyroid axis and celiac disease. Endocrine connections, 6(4), R52–R58. https://doi.org/10.1530/EC-17-0021
21 Balhara, Y. P., & Deb, K. S. (2013). Impact of alcohol use on thyroid function. Indian journal of endocrinology and metabolism, 17(4), 580–587. https://doi.org/10.4103/2230-8210.113724
22 Sachmechi, I., Khalid, A., Awan, S. I., Malik, Z. R., & Sharifzadeh, M. (2018). Autoimmune Thyroiditis with Hypothyroidism Induced by Sugar Substitutes. Cureus, 10(9), e3268. https://doi.org/10.7759/cureus.3268
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