Hashimoto's Thyroiditis

Do you have thyroid symptoms but have been told your thyroid is in normal range? Digging deeper sometimes reveals the root cause which may help you create a successful plan of care.

What is Autoimmune?

When the immune system is healthy, it is capable of distinguishing between beneficial or harmful substances. With Autoimmune conditions, the immune system doesn’t recognize our own tissues and identifies them as foreign invaders.  Approximately one in five people suffer from some form of autoimmune disease with the majority of these being women. Thyroid autoimmune diseases are the most common of the autoimmune disorders and account for approximately 90% of adult hypothyroidism with the majority of these being the result of Hashimoto’s disease. The immune system is nutrient dependent so in order for it to function optimally a healthy whole food diet is imperative. With an integrated approach that incorporates diet and lifestyle changes, many have been able to reduce uncomfortable symptoms and possibly experience remission.

Symptoms of Hashimoto’s

While Hashimoto’s effects people of all ages, most commonly you will find it in women or in those who have a family history. This condition usually begins as a gradual enlargement of the thyroid gland and can be accompanied with hoarseness or breathing difficulty. In the meantime hypothyroid as well as hyperthyroid symptoms may fluctuate creating a great deal of confusion and frustration. These symptoms are listed in the below.

Hashimoto’s and the Challenges of Diagnosis

Often patients are undiagnosed or misdiagnosed because a person with Hashimoto’s can have normal TSH lab results. Our amazing bodies can compensate for a period of time by shifting energy away from metabolism and other body functions in attempt to create a normal TSH level. What you typically find in advanced untreated Hashimoto’s is an elevated TSH accompanied with low levels of T3 and T4. Many times patients will only be tested for an abnormal TSH. However, TSH does not become permanently elevated until Hashimoto’s has advanced. Eventually, other autoimmune conditions can become present with Hashimoto’s creating an autoimmune cluster. With a comprehensive thyroid blood panel including thyroid antibodies, which are thyroid peroxidase (TPOAb) and thyroglobulin (TGAb), you can determine if autoimmune is part of your condition. These thyroid antibodies may appear decades before TSH levels enter the abnormal range and will help catch Hashimoto’s in earlier stages.

Conventional Treatments:

While patients spend time trying to figure out why they feel so bad, they may be dismissed with having stress, depression or anxiety and often are prescribed medication to address those symptoms instead. Steroids may also be utilized to suppress the immune response altogether. In advanced cases when patients begin experiencing abnormal lab numbers, thyroid hormone supplementation may be recommended. Thyroid hormone therapy is very individualized and many patients experience a period of trial and error when attempting to get the dose “just right.” This is a challenge because thyroid hormones are dosed in micrograms which is just 1/1000^th of a milligram. Usually the patient is started on a very low dose and increased gradually until TSH, Free T4 and Free T3 are normalized. If hormone replacement levels are adjusted to a suppressive dose, the thyroid no longer provides any hormones naturally.  Medication does not address the root cause but can help make the patient feel better. Frequent visits to monitor the results of medication becomes a new reality for patients at this point. When lifestyle changes are recommended to complement pharmaceutical protocol patients can begin feeling even better. Studies indicate that even after autoimmune damage has commenced, the thyroid has the ability to regenerate and there is hope when lifestyle and diet recommendations are integrated into the plan of care.

  Nutritional Approaches:

  The common denominator with autoimmune conditions is often intestinal permeability also known   as leaky gut syndrome. Leaky gut occurs when the lining to the intestinal tract is compromised due to   inflammation and the tight junctions in the intestinal wall become loose. This allows substances to gain   access into the body that should not normally be allowed into circulation. As a result, inflammation   throughout the body, food sensitivities and autoimmunity can occur. There are several factors that   increase intestinal permeability:

• Food allergies
• Gluten
• Nonsteroidal Anti-inflammatories
• Overgrowth of bacteria in the small intestine
• Pathogenic bacteria
• Stress
• Strenuous exercise
• Trauma
• Unsaturated fats
• Antibiotics

Roughly 70% of your immune system is located in the digestive system so it makes sense if it does not have optimal function an immune response will be inevitable. In order to fix our immune system, we need to restore digestive function through diet and lifestyle changes. Some may see an improvement within a couple weeks of making these changes. Others will have a longer road of healing which can be expedited by incorporating supplements to heal the digestive system.

The imbalance of intestinal bacterial flora needs to be address through diet, probiotic and digestive enzyme supplementation. Healing botanicals for the epithelial lining of the intestine include Marshmallow extract root, slippery elm extract bark, gamma oryzanol, marigold extract, and aloe vera extract. Deglycyrrhizinated licorice extract and glutamine also offer supportive nutrients to repair the mucosal lining.

Many of those suffering from Hashimoto’s, or other autoimmune diseases for that matter, find relief by adopting a grain-free, soy-free, legume-free diet such as the Paleo lifestyle. This lifestyle advocates eating real foods without chemicals and artificial ingredients. Avoiding foods that contain additives, preservatives, artificial colors, genetically modified ingredients and pesticides negatively impacts your body’s ability to heal.  The following foods are part of the Paleo lifestyle:

• Lean, organic, grass-fed protein
• Saturated fats such as animal fat and coconut oil
• Fresh sea food such as herring, salmon, sardines
• 7-9 servings of vegetables each day (excluding night shades which are white potatoes, peppers, tomatoes, eggplant)
• 1-2 servings of fresh fruit each day
• Nuts and seeds especially those rich in zinc such as pumpkin seeds, pecans, and Brazil nuts

If this Paleo lifestyle is not helping, it may be best to start with the Autoimmune Paleo protocol which is more restrictive initially. This diet eliminates many foods that may be reactive then they are reintroduced slowly to assess for reactions. This process helps to identify personal triggers that my cause Hashimoto’s symptoms. Eliminating these triggers permanently will help to avoid flare –ups.

Those with Hashimoto’s should avoid soy foods whether they are reactive to it or not. Soy foods contain isoflavones which reduce thyroid hormone productions and inhibit the conversion of T4 to T3. Soy products include tofu, soy milk, soy flour, soy bread, soybean oil, soy nuts, and soy sauce. Some resources say fermented soy such as miso, tempeh and tamari is acceptable as the process of fermentation removes the negative properties. However, it may be wise to check for sensitivity or allergies to soy before proceeding with fermented soy products when autoimmune conditions are present.

Cruciferous vegetables contain isothiocyanates which have been linked to decreased thyroid hormone production. These include broccoli, cauliflower, mustard, Chinese broccoli, brussels sprouts, kale, broccolini, cabbage, turnips, kohlrabi, bok choy, rapeseed, cassava, mizuna, collard greens, rutabaga tatsoi. Cooking these foods is advisable before eating as isothiocyanates contained in these food are heat sensitive.

Gluten promotes intestinal permeability which impacts our immune system and therefore should be avoided when autoimmune conditions are present. Gluten is found in wheat products such as breads, pastries, cereals and pastas but one really needs to read labels to look for hidden gluten. Here is a list of items to avoid:

• Wheat
• Wheat starch
• Wheat bran
• Wheat germ
• Couscous
• Cracked wheat
• Durum
• Einkorn
• Emmer
• Farina
• Faro
• Fu (common in Asian foods)
• Gliadin
• Graham flour
• Kamut
• Matzo
• Semolina
• Spelt
• Barley
• Bulgur
• Oats (oats themselves don't contain gluten, but are often processed in plants that produce gluten-containing grains and may be contaminated)
• Rye
• Malt products

  Nutraceuticals:

 The use of digestive enzymes and probiotics to rebalance the digestive system can be helpful. Nutrients  required for proper thyroid function include selenium, iron, vitamin A, vitamin E, B vitamins, potassium,  iodine, and zinc (30mg). A quality multivitamin and B complex should be helpful, too. Antioxidants including  vitamin C (1,000 mg) vitamin E (800mg) and selenium (200-400 mcg) are also recommended.  Vitamin D, iif  testing shows deficient, should also be supplemented. Nutritional testing can help us determine areas of  deficiency so that a customized nutrition protocol can be created for you.

Do You Just Want To Feel Better?      

Making the appropriate dietary and lifestyle changes has helped many navigate the Hashimoto’s journey. Repairing the digestive system function through supplements and elimination of toxic offenders is vital. A whole food diet that incorporates clean protein, healthy fats, 1-2 servings of fruit each day and 7-9 servings of vegetables will help to provide the nutrients, fiber and antioxidant components needed to rebalance the system and promote healing. Sometimes, medications can be avoided with lifestyle and nutrition modifications while other times pharmaceutical treatment will still need to be integrated into the plan of care. The earlier you identify the diagnosis the better. Piedmont Health Solutions is equipped to help you navigate the Hashimoto’s journey with proper testing and nutritional support.