HASHIMOTO'S THYROIDITIS

Hashimoto's Thyroiditis is a chronic inflammatory autoimmune thyroid disease in which the immune system attacks the thyroid gland and if left untreated destroys it completely and requires the afflicted patient to be on thyroid replacement hormones for the rest of their life. It is currently the most common autoimmune disease in the United States according to the Autoimmune Diseases Association (aarda.org), and is also the most common autoimmune disease we see in our clinics. Hashimoto's affects women 10 times more than men. 

Symptoms

Symptoms of Hashimoto's may include:

  • weight gain that cant be lost
  • cold sensitivity 
  • pale or puffy face
  • joint and muscle pain
  • constipation
  • anxiety, depression, and panic disorder
  • tingling in the hands and feet
  • fatigue
  • hair loss
  • dry hair and skin
  • heavy menstrual flow or irregular periods
  • a slowed heart rate
  • fertility issues (infertility, recurrent miscarriages)
  • brain fog/ difficulty concentrating
  • a non-painful goiter (neck swelling) may be present
  • *possibly no symptoms early on

RISK FACTORS

Hashimoto's Thyroiditis is thought to have a genetic and environmental risk factors. That means if any family members have thyroid disorders or any autoimmune disorder, your risk increases. Having another autoimmune disorder also predisposes you to another one and these autoimmune diseases are most commonly associated with Hashimoto's: celiac disease, type 1 diabetes, vitiligo, and alopecia. Environmental triggers such as heavy metals, chemicals, and diet all can play roles in the activation of the disease.

PATHOPHYSIOLOGY

In a normal healthy thyroid gland, the pituitary sends a signal for the thyroid gland to produce its T4 and T3 hormones by way of a hormone called Thyroid Stimulating Hormone (TSH). In autoimmune Hashimoto's thyroiditis, the immune system turns on itself and begins to attack the TPO enzyme that helps produce the T4 and T3 hormones, or attacks the thyroglobulin protein within the gland. It is thought that disease process actually begins in the gut, whereby low stomach acid, antibiotics use, a poor diet, a food allergy or sensitivity to gluten or other GMO containing foods, heavy metals exposure, Bisphenol-a (BPA), etc., can cause leaky gut syndrome which triggers the cascade of events that through molecular mimicry causes the immune system to confuse its own tissue as non-self and attack them or whereby toxins attach themselves to proteins and then get attacked in that manner. Once the thyroid gland is under attack, the gland slowly gets destroyed and over time symptoms appear and worsen.  

DIAGNOSIS

Diagnosis is usually made by detecting elevated levels of antibodies to the thyroid in the serum. (Anti-thyroid peroxidase antibodies  TPO Ab, and/or anti- thyroglobulin antibodies TgAb). It is also possibly to be seronegative, which means not having any antibodies but still have thyroiditis. Clinically I find that sometimes repeated testing needs to be performed to catch the elevated antibodies as the antibodies will generally spike when the offending environmental trigger is introduced, such as consuming gluten containing foods or a diet high in iodine for a few days prior to blood draw. Ultrasound imaging may also be performed.    

CONVENTIONAL MEDICINE TREATMENT

Unfortunately conventional medicine solely manages thyroid hormone levels. Nothing is done to actually treat the autoimmune aspect of Hashimoto's thyroiditis and patients are counseled that once their thyroid gland is completely destroyed, they will need to be on lifelong thyroid replacement hormones. In the meantime,  patients thyroid hormone levels are gradually raised in order to keep their TSH within normal levels. Many conventional physicians do not even check for thyroid antibodies as it does not change their treatment strategy which to manage hormone levels only. Most only test serum TSH during routine testing and will only do further investigation if TSH is out of lab normal reference ranges. 

THERE IS HELP: HOW OUR CLINIC TREATS HASHIMOTO'S THYROIDITIS

The good news is that the autoimmune process usually takes many years to develop. Autoimmune antibodies usually are present in the blood 5 years before any symptoms manifest in the patient. This means that through routine spot checks of this inexpensive blood test, Hashimoto's can be caught long before it manifests as disease in the patient in the "silent autoimmune stage" and with some investigation, the correct triggers can be identified and the disease process halted before it destroys the thyroid.

I find that clinically, there are many steps within the pathophysiology of the thyroid that can present with dysfunction some of which present with a normal TSH and T4 even. That is why its important to do a full thyroid blood panel. For more information see the thyroid disorder page.

In our clinic, we treat the thyroid as well as the autoimmune aspect of Hashimoto's and the person not just the blood test value of TSH. Hashimoto's can be brought into remission with a proper adherence to diet, certain targeted supplements, and lifestyle modifications, and if caught early enough, no thyroid hormone replacement may be necessary.