You can't get out of bed in the morning. You're exhausted all the time, always cold, your hair is falling, even your eyebrows! It's impossible to lose weight. The people around you blame you for being lazy, but you just want to sleep! If this sounds like you, there is a big chance you're suffering from Hashimoto's thyroiditis.
This autoimmune disease is a common cause of hypothyroidism (an underactive thyroid gland). It is usually diagnosed after 10 or 15 years of developing the problem because routine lab tests do not show the damage and usually remain in the normal range as the body fights to maintain homeostasis (balance). The TSH, T3, and T4 are poor indicators of tissue thyroid levels. Most doctors ask for these lab tests and refuse to perform further lab tests until the TSH shows abnormal levels. Usually, the thyroid by then is suffering from irreversible damage and it’s too late.
Symptoms of this disease are the same symptoms of hypothyroidism: mental slowing, depression, dementia, weight gain, constipation, dry skin, hair loss, cold intolerance, hoarse voice, irregular menstruation, infertility, muscle stiffness and pain. The difference between Hashimoto’s thyroiditis and Hypothyroidism is the production of antibodies against the thyroid gland in the former disease which indicates the attack of the thyroid gland by the immune system. Sometimes Hashimoto’s presents with a mixture of these symptoms and their opposite (hyperthyroidism). In that case, Hashimoto’s is suspected even if lab values still don’t show evidence of antibodies.
Lab tests
TSH - Thyroid Stimulating Hormone: This hormone is released from the pituitary gland and is more sensitive than thyroid hormone levels. A high level of TSH indicates that your thyroid hormones are too low and your pituitary gland is trying to stimulate your thyroid to produce more hormones. Most labs will consider the upper range of 4-5 mU/L to be normal. However, recent data shows that for optimal thyroid function, patients feel best at the upper limit of 1.5-2 mU/L. It might take some time and considerable damage of the thyroid gland before this hormone is elevated.
Thyroid hormones: Hashimoto's usually presents as an underactive thyroid gland and the levels of thyroid hormones are low. However, sometimes there is a fluctuation between high and low levels of thyroid hormones which means your symptoms will be alternating hyperthyroidism and hypothyroidism.
Low T3 syndrome: low T3 and high reverse T3 is almost always missed when using standard thyroid testing because the T3 is in the lower end of the normal range and reverse T3 is in the higher end of the normal range. The T3/rT3 ratio is a better indicator of hypothyroidism and diminished cellular functioning. If the ratio is less than 10, this means that your cells are deactivation T4 to reverse T3.
Thyroid antibodies: Thyroid peroxidase antibody (TPOAb) and Thyroglobulin antibody (TgAb) are the two thyroid antibodies that, when elevated, indicate the presence of the autoimmune factor (Hashimoto’s). Antibodies should be monitored every 6 months.
Finally, Your symptoms are definitely a reliable indicator of hypothyroidism. If you are suffering from symptoms, don’t accept being told: “you’re fine”! Find a well-informed doctor, preferably a Functional Medicine doctor, who will run the suitable tests for a correct diagnosis.
Causes
Most physicians will treat any patient who suffers from Hashimoto's by using thyroid replacement therapy without considering the different causes among patients.
1. Hypothyroidism caused by pituitary dysfunction
If you have an infection, chronic stress, are pregnant, have blood sugar imbalance or have insulin resistance, your body produces more cortisol - the stress hormone. This leads to dysfunction in the pituitary gland which releases TSH (Thyroid-stimulating hormone). The problem, in that case, is not the thyroid gland itself but the pituitary is not sending the right messages. You will suffer from hypothyroid symptoms and the TSH will be below the functional range (1.8-3.0) but it is usually within the "normal range" (0.5-5.0). The T4 (thyroxine) will also be below the functional range.
2. Under-conversion of T4 to T3
T4 (thyroxine) is the inactive form of thyroid hormone. T4 must be converted to T3 (tri-iodothyronine) before your body can use it. If your problem is in the conversion of T4 to T3, the active form, or you have thyroid resistance, or too much thyroid binding globulin, the usual drugs (Synthroid or Levothyroxine and Levoxyl) are not enough to restore the function of the thyroid gland. The root cause of your problem must be addressed before treatment is decided.
Inflammation and elevated cortisol levels (stressed anyone?) can lead to under-conversion of T4 to T3. In that case, the symptoms will be present but your TSH and T4 will be normal. T3, if tested, will be low but most doctors don't order for T3 if TSH is normal!!
3. Elevated TBG (Thyroid binding globulin)
Thyroid binding globulin (TBG) is a protein that transports the thyroid hormone through the blood (the same way that hemoglobin transports red blood cells through the blood). When thyroid hormone is bound to TBG, it's inactive and unavailable to be used by the tissues. In that case, again the TSH and T4 will be normal but the T3 will be low if tested. The TBG will be high.
High estrogen levels, due to birth-control pills or estrogen replacement therapy will cause elevated TBG. Getting rid of excess estrogen is an important part of treatment in case of elevated TBG. Again overlooked by physicians.
4. Decreased TBG
In that case, the levels of free thyroid hormone will be high in the blood and this causes resistance. When resistance to thyroid hormones occurs, hypothyroid symptoms develop. TSH and T4 will be normal. T3 will be high and TBG will be low.
High testosterone levels, associated with the polycystic ovarian syndrome (PCOS) and insulin resistance causes decreased TBG. It is important in that case to restore the sugar balance and reverse insulin resistance to overcome this problem.
5. Thyroid resistance
Here genetic factors play a big role. High homocysteine levels and high cortisol levels (chronic stress) might cause resistance to the thyroid hormones. Both the pituitary and the thyroid gland release the hormones normally but your cells are resistant to the hormones. They can't use them. Lab tests are normal because it's not possible to measure the function of the receptors up till now. Your symptoms are the only indicators. When your doctor sees normal lab tests, you are usually sent home and blamed for overreacting!
Treatment
It's important to replace the thyroid hormone. Levothyroxine (Synthroid) is usually used for this purpose. This is the synthetic form of Thyroxine or T4. However, as mentioned above, T4 is an inactive form of thyroid hormone and if your problem is in the conversion of T4 to T3, Levothyroxine will not help you much.
Liothyronine or T3, the active form of thyroid hormone, can be used alone or in combination with T4. Some patients experience a higher-than-needed T3 which leads to symptoms of a fast heart rate, trouble sleeping, and anxiety especially after taking the medication. Usually, this combination is used for 3-6 months to decide if it's working for you.
Natural thyroid extracts are also available. Armour Thyroid is an extract from pigs' thyroid glands. This works better with some patients. However, the ratio of T3 and T4 in animals is not the same as in humans. Also, the batches may vary when using natural hormones which may lead to unpredictable levels in the blood.
What you can do to help your body
Nutrition
First, remove the triggers!
Some foods can trigger your autoimmune response. Several studies have confirmed the connection between gluten consumption and autoimmune conditions, especially thyroid disease. The protein part of gluten, gliadin, resembles the molecular structure of the thyroid gland. This confuses your body whenever you consume gluten and causes the immune system to attack the thyroid gland. The effect of gluten consumption can remain even after 6 months of consumption! It’s important to note that you cannot be 99% gluten-free. Being 100% gluten-free is the only way to remove this trigger that is destroying your thyroid gland.
Most lab tests for gluten sensitivity are inaccurate. These tests look for antibodies in the blood. The intestines must be considerably permeable in order for the antibodies to pass in the blood. As a result, a false negative occurs in many cases.
Try to eliminate all gluten for at least 30 days and check if your symptoms improve. Re-introduce it and track your symptoms. This elimination diet is a better way to test your individual intolerance.
Conventional dairy can be problematic as well for most people. Pasteurization destroys the enzymes responsible for breaking down sugars like lactose and this makes it hard to digest. The protein A1 casein is one of the triggers of a leaky gut syndrome, which I'll mention in the next section.
Improve your gut function
Hippocrates said: "All disease begins in the gut". Now we definitely know that he was right! At least all chronic disease does.
Evidence of leaky gut, and increased permeability of the gut lining, is seen in most autoimmune conditions. Work with a Certified Health Coach or a Functional Medicine Practitioner to heal your gut.
Some of the recommendations I advise my clients are: to consume fermented foods and/or probiotics daily, use bone broth on a regular basis, increase fiber intake, and avoid all forms of sugar. I like doing this gradually using the method of “crowding out” the bad foods with better ones. However, everybody is unique. One person's food is another person's poison. It's important to consider your bio-individuality and not follow every piece of advice you read on the internet.
Some supplements like marshmallow root, slippery elm, and DGL licorice, zinc carnosine, L-glutamine can help heal your gut. Research these supplements and talk to your healthcare provider to decide the best ones for you.
Use foods that naturally contain the nutrients your body needs
Brazil nuts are abundant in selenium which is needed in the conversion of T4 to the active form of thyroid hormone, T3. It also increases the levels of glutathione, an antioxidant that boosts the immune system, detoxifies the body from excess iodine, and lower thyroid antibodies. Selenium has been found to be deficient in most hypothyroid patients. Only two nuts per day are enough to provide the selenium you need.
Cooked cruciferous vegetables (broccoli, cauliflower, kale, cabbage, and brussels sprouts). Many sources warn people against cruciferous vegetables if they suffer from Hashimoto’s because they are considered goitrogens (lower thyroid function). However, their goitrogenic effect is only seen when they are consumed raw and in large quantities. Otherwise, they are the most nutritious family in vegetables and you should be consuming them regularly in moderation.
Sea vegetables contain a healthy amount of iodine. Remember that too much or too little iodine are both dangerous to the thyroid gland. Examples are wakame, kombu, nori, dulse, and kelp.
Eggs, ocean fish, and strawberries are also good dietary sources of iodine.
Supplements
Iron
Iron deficiency leads to lower production of thyroid hormone. If you are deficient, supplement with iron or take iron in its heme form (the more bioavailable form) through animal foods like beef, liver, and lamb.
Magnesium
Magnesium glycinate supplement is the most bioavailable form. Food sources of magnesium include leafy greens, whole grains, nuts, and seeds.
Selenium
200 mcg of selenium daily (DO NOT exceed this dose)
Vitamin D
The best way to obtain vitamin D is to expose bare skin to sunlight at least 10 minutes daily. Vitamin D is important for immune function and protects the body from autoimmune disease. In food, vitamin D is found in fatty fish like salmon, mackerel, tuna, and cod liver oil. If you choose the supplement, choose vitamin D3 over D2 to ensure bioavailability. Make sure that you test before and after supplementation. Vitamin D is one of the fat-soluble vitamins which means that it's toxic when the blood level exceeds its normal range.
Zinc
Zinc is required to maintain adequate amounts of thyroid hormones in the body. It is found in animal liver, pumpkin seeds, flaxseeds, shrimp, beef, spinach, and kidney beans. Zinc supplement should be taken with meals to avoid nausea.
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