The thyroid is the butterfly-shaped gland at the base of the neck. Hormones produced by the thyroid are essential for regulating metabolism, body temperature, energy, heart rate, menstrual cycle, mood, and hair and nail growth.
Hashimoto’s disease (chronic lymphocytic thyroiditis or autoimmune thyroiditis) is an autoimmune condition where the body produces antibodies that affect the thyroid. This immune response can impact the thyroid’s ability to produce hormones over time. Since these hormones influence every cell in the body, Hashimoto’s may have wide-reaching effects.
Hashimoto’s is the most common cause of hypothyroidism (an underactive thyroid) in iodine-sufficient areas of the world like the US, impacting 1-4% of Americans. Hashimoto’s is ten times more common in women than men, developing most commonly between ages 30 to 50. While Thyroid Stimulating Hormone (TSH) is often used as a screening test, it is not enough alone to fully assess thyroid function.
[signup]
Hashimoto’s Disease Signs & Symptoms
Over time with this autoimmune condition, the body produces antibodies that affect the thyroid (TPO antibodies). This response can cause inflammation and may reduce the gland's effectiveness at producing hormones. The resulting decrease in thyroid hormones can influence cells throughout the body, potentially causing symptoms such as:
- Fatigue
- Weight gain
- Headaches and migraines
- Thinning or dry hair, nails, and skin
- Feeling cold all the time
- Irregular periods
- Puffiness or fluid retention
- Fertility problems
- Slow digestion and constipation
- Brain fog
- Depression
- Aching muscles and joints
- Loss of muscle strength and tone
These symptoms may be vague early on, but the inflammation can result in an enlarged thyroid (goiter) and thyroid nodules over time. Untreated hypothyroidism can also lead to additional bodywide complications, including:
- Elevated cholesterol
- Heart disease and heart failure
- High blood pressure
- Pregnancy complications
- Myxedema- a rare, life-threatening condition where the body’s functions slow down significantly.
A Hashimoto’s flare, especially early in the disease process, can cause a hyperthyroid state. As the thyroid comes under attack from autoantibodies, the cells of the gland can release hormones quickly into the bloodstream, leading to symptoms of hyperthyroidism like
- Fatigue
- Heat intolerance
- Irritability
- Rapid heartbeat
- Sleep problems
- Anxiety
Hashimoto’s Disease Possible Causes
Digestive Factors
Various factors underlie autoimmunity that may contribute to Hashimoto’s, including gut health, nutrition, infections, environmental exposures, and genetics. The immune system may become dysregulated when someone with a genetic predisposition is exposed to environmental or other factors.
The digestive tract acts as a barrier to the outside world and plays a role in immune system mediation. The microbiome plays a role in regulating hormones, immunity, and detoxification. Ongoing stressors may lead to dysbiosis, where bacteria become imbalanced and affect the gut lining, contributing to inflammation. With chronic exposures to toxicants, inflammatory foods such as gluten or lectins, and chronic stress, the barrier may become less effective, and substances can enter the body and trigger immune responses and inflammation.
A compromised digestive system can lead to imbalances in nutrients like selenium, zinc, tyrosine, and essential fatty acids that support the immune system and help maintain thyroid and other hormone balance.
Infections
Viral or bacterial infections such as Helicobacter Pylori and Yersinia enterocolitica may contribute to molecular mimicry where the immune system mistakenly identifies its own tissues as foreign invaders and attacks.
Toxins
Exposures to heavy metals, mercury, arsenic, plastics, and pesticides may contribute to dysbiosis, inflammation, and autoimmunity by affecting the body’s detoxification, nervous, and endocrine systems.
Fluoride and bromine in municipal water supplies, flame retardants, and some baked goods may compete with iodine in the thyroid gland, impacting its functioning.
Autoimmune Diseases
Those with other autoimmune disorders such as celiac disease, lupus, rheumatoid arthritis, Sjogren’s syndrome, and type 1 diabetes may be more likely to develop Hashimoto’s. Many patients also have a family history of the condition.
Functional Medicine Labs to Test for Hashimoto’s Disease
Functional medicine testing can help identify Hashimoto’s and explore underlying factors. Testing may assess immune system balance to uncover potential contributors to autoimmunity and systemic inflammation.
Thyroid Function and Autoantibodies
A Complete Thyroid Panel including thyroid-stimulating hormone (TSH), T3 (free and total), T4 (free and total), and reverse T3 may be assessed using functional medicine ranges.
- TSH measures how the pituitary gland in the brain communicates with the thyroid, indicating hypothyroidism when elevated. A normal TSH does not rule out thyroid issues on its own since it is an indirect measure of function.
- Free T4 measures bioavailable unbound thyroid hormone and is a marker of low thyroid function when decreased.
- In the peripheral tissues, T4 is converted to T3. Low T3 may indicate decreased thyroid function or a problem with conversion, which can occur with chronic stress, inflammation, or high toxic burden.
- Some T4 is also converted to reverse T3, which serves as a “brake” by competing with free T3 for cell receptors. High reverse T3 may reflect a systemic issue like chronic inflammation.
In addition, testing for thyroid peroxidase (TPO) and anti-thyroglobulin (TG) antibodies may help identify Hashimoto’s. Elevated TPO antibodies are typical, and thyroglobulin antibodies may also be elevated and are associated with symptom burden.
Thyroid Supportive Nutrients
Nutrients including iodine, iron, tyrosine, zinc, selenium, magnesium, and vitamins E, B2, B3, B6, C, and D all contribute to proper thyroid balance. Other nutrients like vitamin A may improve cellular sensitivity to thyroid hormones.
Micronutrient testing analyzes how well your body is absorbing these nutrients.
Gut Health
Since dysbiosis and leaky gut may contribute to autoimmunity, assessing gut health can help provide targeted interventions to regain balance. A Comprehensive Stool Test measures amounts of healthy and unbalanced gut bacteria (dysbiosis), inflammatory markers, leaky gut, parasites, and yeast to assess the state of the gut and guide potential interventions.
Food Sensitivities
Food sensitivities and allergies may contribute to intestinal permeability, inflammation, and autoimmunity. ELISA testing identifies foods to which an individual may be sensitive.
In particular, a protein within gluten called gliadin is molecularly very similar to transglutaminase in the thyroid. When the gut lining is leaky (which can be worsened by consuming gluten and other foods one is sensitive to), gluten can enter the bloodstream and encounter cells of the immune system. In Hashimoto’s, the immune system may already be primed to affect the thyroid tissue, so additional immune stimulation and this molecular mimicry by gluten proteins may trigger the body to further affect the thyroid, contributing to worsening symptoms. Testing for gluten sensitivity or celiac disease with Genova Diagnostics Celiac and Gluten Sensitivity and evaluating the leaky gut marker zonulin can help uncover these contributing factors.
Detoxification
Specialized labs assess methylation, detoxification capacity, and glutathione production to understand genetic susceptibilities and current detoxification ability. This type of testing may help pinpoint specific areas to support that can help bring the body back into balance.
[signup]
Functional Medicine Approaches for Hashimoto’s Disease
While thyroid hormone replacement medication is often part of a comprehensive approach, it does not address the condition itself but rather the symptoms of low thyroid hormones. A functional medicine approach to Hashimoto’s aims to support and regulate the immune system. It is important to identify and avoid individual factors that may contribute to autoimmunity to support thyroid health. Utilizing lifestyle and functional medicine approaches to address potential underlying factors also supports thyroid well-being.
Individualized Anti-inflammatory Diet
Inflammation may increase autoimmunity, so a nutrient-rich, anti-inflammatory diet tailored to individual sensitivities and needs can support balance.
Individualized Food Sensitivity Elimination Diet
Eliminating trigger foods, such as gluten and grains, dairy, processed sugars, and other foods an individual may be sensitive to while balancing the intake of micronutrients like vitamin A, zinc, vitamin D, omega-3 fatty acids, and selenium can support inflammation management and help maintain thyroid function.
Note: While the thyroid uses iodine to make hormones, too much iodine intake (often from salt in processed foods or excessive seaweed consumption) may affect function.
Rebalance the Microbiome
Since the microbiome can significantly impact the immune system, maintaining diverse and balanced gut bacteria may help manage autoimmunity.
Restoring gut diversity by eating various whole foods and incorporating probiotic-rich foods like kimchi and sauerkraut and prebiotic-rich foods like artichokes, garlic, and beans may nourish healthy bacteria, which is important for supporting the mucosal barrier and managing autoimmunity.
Adequate Sleep and Stress Management
Chronic stress may contribute to inflammation and is associated with autoimmunity. Finding balance via adequate sleep, stress management, and balanced movement can support thyroid and overall health. Restorative exercises such as yoga, walking, and Qi gong may help manage inflammation more than overly intense exercise. Time in nature may also support inflammation management via exposure to sunlight to optimize vitamin D and direct contact with the earth.
Address Environmental Factors
Chemicals in plastics, pesticides, heavy metals, and other pollutants may affect thyroid function. High-quality water and air filters, organic produce, and assessment of other exposures such as metal dental amalgams may help reduce exposures.
[signup]
Summary
Since Hashimoto’s is a multisystemic condition, identifying and addressing potential underlying factors of inflammation and autoimmunity may help support thyroid health.
A Functional Medicine approach to Hashimoto’s includes screening for a comprehensive thyroid panel, and assessing supportive thyroid nutrients, markers of gut health, food sensitivities, and detoxification capacity.
%201.svg){kind=logo}
