Have you recently been diagnosed with Hashimoto’s thyroiditis? 

Take a deep breath. Now, do it again.

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 own thyroid gland, as if it was foreign tissue. Hashimoto’s actually typically starts as HYPERthyroid function and then, at varying speeds, the gland slows down thyroid hormone production and becomes hypofunctioning.

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!

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 antibodies (If you have Hashimoto’s, you have a higher risk of having Celiac disease, the autoimmune disease in which the body attacks the lining of the small intestines whenever the protein, gluten, is eaten. Gluten is found in wheat, rye, barley, spelt, kamut and products made from these. It’s important to know if you have the Celiac disease antibodies before attempting to follow a gluten free diet as blood tests become normal when you stop eating gluten. Many of my patients start this diet on their own prior to meeting with me, and then we have to decide if reintroducing gluten is a good idea. You have to be eating substantial amounts of a gluten-containing product like breads, pastas & crackers DAILY for a minimum of 2 weeks prior to this test in order for it to be accurate. Women often feel improvements in their health from taking out this potentially inflammatory food and the thought of reintroducing it can be down-right scary. Having a Celiac disease test done while you are not eating gluten is NOT going to work; you must be eating gluten when the test is done. Ok, I hope I’ve made my point.)

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…). 

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