Hashimoto's Disease Part 2

A Hashimoto’s case study

Hashimoto’s disease is the common name for one of the two varieties of Autoimmune Thyroid disease.   It affects 15% of all Americans and some 24% of allergic women. It does run in families, and is frequently the first autoimmune disease people develop when they have that genetic tendency.  It is the most common cause of hypothyroidism, but frequently people don’t realize they have it until their thyroid gland is already severely damaged. 

They present, generally, because of some other concern, like a recent 16 year old young lady I saw who was suffering from hoarseness and sore throat while singing, but also had, on examination, a nodular and uncomfortable thyroid gland. She also had, at first glance, seemingly normal levels of thyroid hormones and TSH. But she had several other symptoms that suggested low thyroid function. And on closer examination, her thyroid hormone numbers were borderline elevated and her TSH was suppressed. And her reverse T3 was very high. Her antibody levels were elevated but not enough to indicate that the damage was acute. (for a more detailed intro to Hashimoto’s disease, see part 1)

So what about a cure?

After a diagnosis of Hashimoto’s disease - like all autoimmune diseases, the immune cells in our bodies don’t just disappear once they are there. So no - there’s not really a “cure” for autoimmune disease. For this reason, people who have the autoimmune tendency should do all in their power to reduce their tendency to develop new autoimmune diseases in themselves and their children. More about that below. 

We will first need to do some additional labs and tests to make sure this is indeed Hashimoto's and not the more difficult Graves disease, or a suspicious (even cancerous) thyroid nodule. This is done by checking for TRAB and TSI antibody tests, thyroid sonogram and maybe even a biopsy.  We also need to check for elevated Iodine, as taking in high levels of iodine is a known trigger for Autoimmune thyroid disease.

Can we do things to increase the likelihood of remission? 

Short answer, probably yes. Remission (defined as complete disappearance of the lab evidence of the disease in your body) is possible, even likely. This occurs without any treatment at all in up to 50% of people who are diagnosed with AIT. But what if we can increase the chance of getting into remission?? Some experts believe we can "turn off" the autoimmune attack or hasten a remission.  The methods I will discuss below are also potentially helpful in prevention.

-A few trials suggest that simply shutting down thyroid function with high dose prescription hormones may relieve the problem. In theory, when the gland goes "on vacation," it no longer makes the proteins that have alarmed the immune system. After a while, the clones of cells making the self-reacting antibodies die out for lack of ongoing stimulation and presto - a cure! Once again, here, the problem is if you use Levothyroxine alone to do this, a person who already had elevated reverse T3 to begin with is going to feel even worse, because Reverse T3 will go even higher. (See my other blog post, “Levothyroxine and I Don’t Feel Better”) 

Wait - why not use Armour thyroid? Or Natural Dessicated Thyroid, as it is sometimes called (click here for more info about Armour Thyroid) . It has balanced T3 and T4, but the problems are this:  it’s made from animal thyroid glands, so it has thyroid peroxidase and thyroglobulin proteins in it. This can actually stimulate more antibody production, exactly what we don’t want to do. The second reason is, It may be the right balance for some people, but I generally find a higher ratio of T3 necessary for my patients.

-European studies suggest taking selenomethionine, 200 micrograms daily specifically, stops TPO-antibody production in 75% of cases. My colleagues and I in the USA have not found this to be as successful.  Sometimes I wonder if our lack of success is because of the toxins in the American diet, such as glyphosate, that are banned in Europe - though I have no proof of that. Nevertheless, a deficiency of Selenium may be a trigger. Trace mineral supplements that contain Selenomethionine are preferred and can be super helpful.

-While evidence is slim, modulating the diet to reduce inflammation has a place in the treatment of Hashimoto’s as well.  Generally a whole food high fiber diet that eliminates exposure to pro-inflammatory food ingredients such as sweeteners and  dairy can be a valuable adjunct to hormone modulation to help improve Hashimoto’s. This is particularly the case if someone has food sensitivities.

-While many non-physician “experts” insist on a gluten free diet, I have not seen convincing evidence that this is necessary. There are many reasons why this could be helpful, including possibly the prevention of other autoimmune diseases, though that discussion is beyond the scope of today’s post. 

-Reducing exposure to toxins in food and beauty products is also recommended. There are easy apps you can use to scan labels looking for not good stuff in beauty products - Skin Deep, and Think Dirty are two. Try to avoid plastic containers whenever possible, especially for heating food. 

Treating symptoms of Hashimoto’s disease

It will be important to keep track of the levels of antibodies in your system, to know what is helping or not helping. The Labs to follow are the same 7 tests we did previously:

FreeT3, FreeT4, TSH, Total T3, ReverseT3 - These should all be tested together, and at the same time of day each time the tests are repeated. My preference is midday for someone who is already taking thyroid replacement. FreeT3, Free T4 and TSH in my clinic all have very tight ideal ranges within the “normal” reference range as given by the lab. The Ratio of Total T3 divided by Reverse T3 is an excellent indicator of healthy thyroid FUNCTION. Levels between 10 and 14 are ideal, but some people feel better even higher than that. Lower than 10 indicate inadequate action and availability of FreeT3. 

Thyroid peroxidase antibody, and Thyroglobulin antibody - Frequent repetition of these tests is not required, but can give a rough indicator of whether your lifestyle changes are helping to control autoimmune inflammation.

For those who already have enough damage that their thyroid hormone production/function is inadequate or gone:  We carefully use prescription Liothyronine (synthetic T3) to replace and gradually reduce the reverse T3 until that Ratio of Total T3 to Reverse T3 is above 10, then add enough T4 to get the thyroid gland to turn off and stop producing thyroglobulin, which is what the antibodies are attacking in the first place. This has the added benefit of normalizing hormone levels, eliminating many of the symptoms of Hashimoto’s disease even in those who do not achieve remission.

It’s also important to check 25-Hydroxy D - “vitamin D”, and then supplement this! A recent Harvard study has shown that higher levels of Vitamin D can actually prevent autoimmune diseases!  and since 70% of kids 6-11 are DEFICIENT! it might be that just fixing this thing alone would help prevent the vast majority of Hashimoto’s disease.  (For more on this, see this post about the seemingly miraculous Hormone “vitamin” D )

Harvard also tested supplementing high levels of Omega 3 fatty acids, which also seemed to help reduce onset of autoimmune disease in older adults. 

Recommendations regarding lifestyle changes

Remember - Autoimmune disease is an inflammatory process, a dysfunction of the immune system gone awry. Stress is a huge trigger for these kinds of diseases, as is inflammation.

-Eat clean whole foods, avoid fried foods, avoid pro-inflammatory “vegetable oils” (corn, canola, soybean oils or hydrogenated oils), processed foods particularly those made with flour,or with added sweetener of any kind. If you have any GI upset, take a high quality Probiotic, and consider digestive enzymes if you have GERD. If that doesn't improve, consider having an integrative allergy specialist check your IgG food sensitivities.

-Keep a regular sleep schedule, your goal is 8 hours of solid sleep/night. Turn off screens and do something relaxing for 30 minutes to an hour before bed. A hot soak or shower is particularly helpful to warm your hands and feet before climbing into bed. A guided meditation is also very helpful, lying flat under the covers.

-Manage stress using yoga, dance or other gentle exercise, with added HIIT, not extensive cardio, which your body perceives as stress.

To hear me talk more about this, check out this video that I did on hormone replacement therapy in which I cover lifestyle changes towards the end.

Supplements

I have a few other supplements that I recommend. So I made a free Supplements guide that has not only the name and brand of these supplements, but the dosing schedules I recommend to my patients as well. I don’t sell these, but I do take them myself. You can find the link to that HERE.

-The categories include: trace minerals, magnesium and calcium, B vitamins, adrenal support, probiotics, digestive enzymes.

Because Hashimoto's has so many "faces," there are lots of items on our “treatment menu." If you have thyroid antibodies - especially Hashimoto’s, I encourage you to explore some of these options.

If you are reading this and are not a physician, please keep in mind: 

Scientific proof is not nearly as black and white as people think, and In order to make treatment decisions for individual people sometimes we have to consider evidence that is not nearly as absolute as we would like. This is not meant to be medical advice, and you should consult your own physician for any medical issues or diagnosis you may have.

Dana Gibbs, MD,  is an integrative physician in North Texas. She helps people address thyroid and other hormone imbalances. You can read more of her blog posts about hormone issues HERE. If you’re a thyroid or chronic fatigue sufferer in Texas or Iowa and you want a caring doctor to help you finally resolve your exhaustion,  joint and muscle aches, poor sleep issues, and weight gain, you can sign up for a new patient evaluation with Dr. Gibbs at www.danagibbsmd.com.