Is Your Thyroid Problem Really Just a Thyroid Problem, or Is There Something More to Know?

Have a diagnosis of hypothyroid but not satisfied with the answers you are getting about why and what to do? Felt better at first on your medication but now feel crummy again?

Your thyroid is your air traffic controller. It regulates your body temperature, your mood, hormones and cognitive function. It is involved in brain function, breathing and heart rate, and hormones that govern fertility, weight and cholesterol levels.

It determines how much energy you have, how regular your bowel movements and periods are, and whether you are depressed, anxious, or joyful.

The word “thyroid” comes from thyreos, which means shield. The thyroid gland is shaped like a shield and lies across the Adam’s apple area in your neck. It also serves as a shield, protecting you from extremes. When you are cold, it speeds up to warm you up. If you get sick, it revs up your immune system. When you are overly stressed, it will slow in order to help you settle.

So, if your thyroid is under-functioning you get a diagnosis of hypothyroid. And you receive a prescription for hormone replacement, usually Levothyroxine, Synthroid, or a generic. Problem solved, end of story. Right?

You feel better for a while, then not so much. Your prescription gets increased. You feel better again, but less so this time, and so on, until you don’t feel so good and your health care provider doesn’t have further answers.

There is a good chance that your thyroid problem is not just a thyroid problem. It may be an autoimmune disease. Studies show that 90% of people with hypothyroidism are producing antibodies to thyroid tissue. The immune system attacks and destroys the thyroid. Over time thyroid hormone levels decrease accordingly. 

This is Hashimoto’s, the most common autoimmune disorder in the U.S. It affects between 7-8% of the population, mostly women.

It is possible that you’ve been hypothyroid for years but never been told you had an autoimmune disorder. That is because in conventional medicine the treatment isn’t altered due to the autoimmunity. Once thyroid function decreases enough, thyroid hormone replacement is given to compensate. Over time, associated conditions like depression and insulin resistance may show up. And further medications are prescribed.

Sometimes iodine is given. Unfortunately, it can speed up the inflammation and destruction of the thyroid. Too much or too little iodine is problematic in Hashimoto’s.

How do you know if your hypothyroid is Hashimoto’s? 

 Well, first you may recall that your early symptoms were quite erratic, varying from hypo- to hyper-thyroid and everything in between. You might have felt like you were going crazy. TSH might have been low, high, or normal at various times. This is due to Hashimoto’s thyroiditis. It is a typical presentation, especially when Hashimoto’s is diagnosed in the months following childbirth. 

Secondly, your blood work needs to include thyroid antibodies, both TPO Ab (thyroid peroxidase antibodies) and TGA (thyroglobulin antibodies). If one or both of these is elevated above the normal range, Hashimoto’s can be diagnosed. This means the immune system is the target for therapy, not the thyroid gland. 

However, because the immune system fluctuates, antibodies can be normal at times, even though one does have Hashimoto’s. When the autoimmune condition is dormant, the immune system is not attacking the thyroid and antibodies will not be elevated. If symptoms strongly suggest Hashimoto’s a retest should be done, perhaps first provoking the immune system to create a flare-up.

Numerous studies connect gluten, the protein found in wheat, spelt, barley, and rye to Hashimoto’s. If the person has been gluten free, we can have them consume gluten for a couple weeks and retest. This will often trigger elevated antibodies if the person truly does have Hashimoto’s, and a diagnosis can be made.

Okay, so how does one treat an autoimmune disease like Hashimoto’s? 

We want to regulate and balance the immune system. 

Remove autoimmune triggers

The first way to do this is through diet. I recommend a basic paleo diet, plus removing foods that may trigger or exacerbate an autoimmune response. This includes eggs, nightshades, and dairy. After 60 days foods can be slowly and methodically added back in, observing closely for reaction. Many people will be able to consume these foods without reaction. But, for instance, if you know that eggplant triggers a Hashimoto flare, you may want to avoid eating them long term.

Check what’s in your gut that could be triggering autoimmunity. A stool test will tell us if there are too many “bad” bugs, or not enough beneficial bacteria in your large intestine. A breath test can tell us if there is overgrowth of bacteria in the small intestine.

A dried urine test can give us levels of cortisol and related hormones so we know if stress is a factor.

Other potential autoimmune triggers include estrogens, infectious agents, and environmental toxins. 

Estrogen fluctuations can trigger Hashimoto’s. This is why Hashimoto’s expression is common surrounding pregnancy and perimenopause, when estrogen can fluctuate wildly.

Environmental toxins can trigger Hashimoto’s. You can’t do much about the air you breathe outside but you can minimize mercury in your diet and clean up the products you use in your home and on your skin. Go to EWG.org for abundant info on this. 

Nutrients important for optimum immune function 

 The chronic inflammation caused by autoimmune diseases increases oxidative stress. Glutathione is a powerful anti-oxidant. Stimulate glutathione production by eating protein, collagen, polyphenols (berries, peaches, pears, pomegranates, purple sweet potatoes, broccoli, garlic, cabbage, and spinach) and selenium (brazil nuts, ocean fish, poultry).

Decrease inflammation with turmeric, or curcumin, it’s most active ingredient. Cook w non-irradiated turmeric. And/or take turmeric or curcumin daily.

Optimize vitamin D through diet, sun exposure, and supplements. Be careful though. We are learning that too much vitamin D can be problematic as well as too little. Aim to get it through food in cod liver oil (I like Rosita brand), cold-water fatty fish, and pastured duck and chicken eggs, or from sunshine (halfway to burn) if possible. If you don’t know your Vitamin D blood level it is probably ok to supplement with 1000-2000iu per day. Best to test your levels before going above that.

Get adequate EPA and DHA, the primary omega-3 fatty acids that have been shown to significantly reduce inflammation. Consume one pound of cold-water, fatty fish per week, such as salmon, mackerel, tuna (skipjack is lower in mercury), herring, and sardines.

Several other nutrients directly or indirectly contribute to glutathione synthesis and immune health. These include niacin (B3), riboflavin (B2), pyridoxine (B6), vitamin C, magnesium, iron, copper, zinc, and manganese. The best way to optimize your intake of these nutrients is to focus on foods with the highest nutrient density: 

Organ meats
Herbs and spices
Nuts and seeds (soaked and dehydrated first to maximize nutrient absorption) 
Cacao
Fish and seafood
Fresh vegetables
Red meat, pork, and poultry (pasture raised, of course)
Eggs and dairy (pasture raised) (if you tolerate dairy, or try goat/sheep dairy)
Seaweed 

Support a healthy gut 

Eat several fermented foods each day. That includes kefir, yogurt, sauerkraut, kimchi and kombucha. These contain beneficial bacteria, which regulate and balance the immune system. Remember 70% of your immune system is in your gut. 

Bone broth or meat stock are soothing and healing to your gut lining.

You also want fermentable fibers in your diet. The soluble fibers in fruits, vegetable, starches and nuts/seeds are a food source for beneficial bacteria in your gut. Cooked and cooled starches like potatoes and sweet potatoes are particularly good for this. One caveat though. If you have certain gut issues, you may find that high fiber foods exacerbate your symptoms.

Make lifestyle changes that can aid your recovery 

Regular aerobic exercise and strength training have been shown to increase glutathione levels in both healthy and sick people. Exercise also releases chemicals called endorphins, the “feel good hormone”. Endorphins play an important role in regulating the immune system. 

Acupuncture has been shown to restore balance in the immune system.

Pleasure and physical contact also produce endorphins, which have a regulatory effect on the immune system. 

Exposure to sunlight (or UVA/UVB light in tanning beds) appears to be especially important for those with autoimmune disease. Evidence for the benefit of sunlight in autoimmune disease is strong. Spend time outside in the sunlight as much as you can. 

Sufficient sleep and a healthy circadian rhythm are critical to minimizing stress and balancing your immune system. Research indicates that 7 to 10 hours of sleep is optimal. Sun exposure in the morning and dimming lights and screen time in the evening helps support a normal circadian rhythm.

These strategies are all designed to enhance the function of regulatory T cells in your immune system. Regulatory T cells are used to balance the activity between T-helper cells and T-suppressor cells. T-suppressor cells “turn off” the immune attack. 

Ultimately, you may need some sort of additional support for your condition. 

The reason conventional T4 therapy, levothyroxine, rarely works long term is because it needs to be converted to T3 to have an effect. We know that 90 percent of patients with hypothyroidism have Hashimoto’s. And remember, it is an autoimmune inflammatory condition, and we know that inflammation inhibits the conversion of T4 to T3. 

In addition to inflammation, stress, gut dysfunction, aging, iron excess or deficiency, fasting, nutrient deficiency, low testosterone, and genetics can also inhibit conversion of T4 to T3.

For this reason, you may do better with a T4-to-T3 combo such as natural desiccated thyroid, NDT for short. Contrary to what you may have been told, NDT does meet the stringent guidelines of the U.S. Pharmacopeia. It is made according to the applicable quality standards. It has been used successfully for over 115 years, and it is still in active current use.

If you have tested several times and never had elevated thyroid antibodies, it is possible that you have non-autoimmune hypothyroid. I suggest you always have antibodies tested whenever you check thyroid levels since they do fluctuate. However, remember, negative antibodies does not necessarily mean you don’t have the autoimmune variety, Hashimoto’s.

Whether you have one or the other, the basic information given here can be applied. If you would like more information or would like to check your thyroid function or follow up on previously diagnosed hypothyroid, contact me.

I look forward to hearing from you.