Have you recently been diagnosed with Hashimoto’s thyroiditis? 

Take a deep breath. Now, do it again. Hashimoto’s can be a scary diagnosis.

Let me tell you, it’s going to be OK.

Hashimoto’s is a unique autoimmune condition in that it is not often associated with long-term health complications (including COVID 19 risk) and can usually be well managed with a combination of lifestyle change, diet improvements, herbal therapies, and often medication.  I do not regard my patients with Hashimoto’s as being very sick. It DOES take a lifelong commitment to living a healthier lifestyle, so there’s that, but as long as it is well managed, it is NOT associated with major organ damage or disability as we see with other autoimmune diseases.

What is Hashimoto’s thyroiditis?

Let’s talk about this VERY common (the most common, in fact) cause of hypothyroidism. Hashimoto’s is a condition caused by inflammation of the thyroid gland. It is an autoimmune disease, which means your body forms proteins that attack your thyroid gland as if it was foreign tissue. Hashimoto’s typically starts as HYPERthyroid function and then, at varying speeds, the gland slows down thyroid hormone production and becomes hypo-functioning.

The term “autoimmune disease” is scary! You probably think of yourself as a healthy person, and now you have a DISEASE? A disease that you’ll have to manage for the rest of your life? This is life-changing. How did this happen? What did you do wrong? What does this mean about life moving forward? Am I at greater risk of COVID 19? How do I treat it? What are my options?

Take another deep breath, friend.

Why do I have Hashimoto’s? Where did this come from?

Hashimoto’s, like other autoimmune diseases, seems to run in families. It is most common in middle aged women (hi there!) but we also diagnose it in younger and older women as well as in men and kids, too. According to conventional literature, the underlying cause of the autoimmune process remains unknown. 

I often see Hashimoto’s diagnosed around times of big life events or stressors like pregnancy, perimenopause and trauma to name a few. There is some interesting info that it can be triggered by chronic infections like Lyme or EBV, by certain dental procedures, like root canals, and even by certain breast implants. 

Most physicians don’t put much work into understanding why the autoimmune process has started. I have to admit that I often overlook this, too, as it seems like the important piece is helping women feel their best while managing the condition. In my practice, I may think about the underlying cause when the treatments that should work aren’t working. Admittedly, I should do better. 

What tests should I ask for?

Most GP’s and PCP’s run a TSH screening test to diagnose hypothyroidism. Antibodies are rarely run. If the TSH is normal, you will be told that you do not have thyroid issues. 

Many naturopaths, functional medicine practitioners and endocrinologists have a more narrow range of normal and see that many women struggle with LOW thyroid symptoms when the TSH, although within the lab’s reference range of normal, is not ideal. Given normal vs Ideal, I’ll take Ideal functioning every time!

What if the tests come back normal?

It’s important to know, though, that TSH can be ideal and you could still have Hashimoto’s. It’s important to get the whole picture. Ask for the following labs and find a practitioner who will order these, if your provider will not*.

1. TSH (thyroid stimulating hormone)
2. Free T4
3. Free T3
4. Reverse T3
5. Thyroid Peroxidase (TPO) antibody
6. Thyroglobulin (TG) antibody
7. Celiac disease: If you have Hashimoto’s, your risk of developing Celiac disease increases. In Celiac disease, the body attacks the small intestine lining whenever you consume gluten, a protein found in wheat, rye, barley, spelt, kamut, and related products. Knowing whether you possess Celiac disease antibodies is crucial before starting a gluten-free diet, as blood tests return to normal once you stop consuming gluten. Many patients begin this diet independently before consulting with me, leading to discussions about whether reintroducing gluten makes sense. For accurate test results, you must consume significant amounts of gluten-containing foods like bread, pasta, and crackers daily for at least two weeks before the test. Removing this potentially inflammatory food often improves women’s health, and the thought of reintroducing it can feel daunting. Testing for Celiac disease without eating gluten proves ineffective; you must include gluten in your diet during the test. I hope I’ve made my point clear.

What thyroid lab values should I aim for? What’s ideal?

This is a recap from a previous post: 

1. TSH: you want a value between 1-2 uIU/mL. This varies per person, but you definitely want a value less than 2.5. (NOTE: this is still within the lab’s reference range for normal).
2. Free T4: a value of 1.25 ng/dL or greater (up to the top of the normal range, and not to exceed that or you risk becoming HYPERthyroid). Some lab ranges have a normal of .6 – 1.2; for these labs, I recommend a value of 1.0 or greater.
3. Free T3: a value of 3.0 pg/mL or greater (up to the top of the normal range, and not to exceed that or you risk becoming HYPERthyroid).
4. Reverse T3: a value less than 15 ng/dL (NOTE: this is still within the lab’s reference range for normal).
5. TPO antibody: within the reference range of normal. 
6. TG antibody: within the reference range of normal.
7. Celiac antibodies: all should be within the reference range of normal.

Ok, so in a conventional medical practice, If TSH is abnormal, OCCASIONALLY (but really, rarely) thyroid antibodies are then ordered. If the antibodies are positive, you have Hashimoto’s. 

Thyroid peroxidase (TPO) antibody is the most common antibody elevated in Hashimoto’s.

Why wouldn’t doctors want to know if the cause of your hypothyroidism is Hashimoto’s? Conventionally, treatment options do not change. The option you’ll be given is medication and the most common medication recommended is Levothyroxine (generic) or Synthroid (brand).

Next time, we’ll discuss both conventional and naturopathic treatment options for Hashimoto’s thyroiditis, including other medication options (and a hint: we may talk about gluten again…). 

Ready to start your journey back to health? Contact me for your free 15-minute Discovery call!

* resources for finding help: Naturopathic Physicians and Functional Medicine Providers.