Thyroid gland function controls your metabolic rate. If you have hypothyroidism, or low thyroid function, your metabolism slows down and you may feel fatigued, constipated, depressed, or cold.
In countries like Canada with iodine sufficiency, the most common cause of hypothyroid is autoimmune thyroiditis (Hashimoto’s disease)
WHAT HAPPENS TO THE THYROID IN HASHIMOTO’S
+ HOW TO TEST FOR IT
Hashimoto's thyroiditis (HT) is diagnosed by testing your blood for thyroid antibodies (ANTI-TPO, ANTI-TG) OR by ultrasound imaging.
Antibodies are the end result of thyroid tissue damage caused by invading immune cells and the inflammatory chemicals they release. A breakdown in the immune system’s ability to distinguish your own thyroid cells from foreign invaders eventually leads to antibody production. (1)
Antibodies can appear up to 7-10 years before elevations in TSH, and changes to thyroid tissue can be seen on ultrasound before antibodies are detectable in the blood.
The symptoms of Hashimoto’s are not due to hypothyroidism alone. Higher antibody levels are associated with increased symptoms. (2)
Bottom line: The inflammatory/autoimmune process needs to be addressed in order for you to feel better!
LABS TO DIRECT TREATMENT
Thyroid Panel: TSH, fT4, fT3, rT3, ANTI-TPO, & ANTI-TG
Vitamin B12 should be assessed, as is it is commonly deficient in HT and can worsen fatigue. The cause may be due to autoimmune gastritis or low stomach acid production as a consequence of low thyroid function, decreasing the ability to absorb B12.
Iron is required for the conversion of T4 to T3, and deficiency is common in HT (3). Many symptoms of iron deficiency are identical to those of hypothyroid: cold, fatigue, hair loss, memory loss, brain fog.
25(OH) vitamin D: low vitamin D levels are associated with higher thyroid antibodies. Vitamin D balances the immune system and inhibits inflammation. Intervention studies have shown that testing and treating to achieve blood levels of 100-150 mol/L reduces antibody and TSH levels. (4)
Auto-immune panel if other symptoms/family history suggest Celiac Disease, Rheumatoid Arthritis, Lupus, or Sjogren’s.
Inflammatory markers: hsCRP, ESR
Rule out insulin resistance with Fasting Glucose + Fasting Insulin
Bottom line: it’s essential to have comprehensive testing, rather than just 1 or 2 hormones, and an integrative medial practitioner who is evidence-based to help you interpret your lab results.
MEDICATION
Dessicated thyroid can sometimes be used successfully, but because it can sometimes aggravate autoimmune thyroiditis, Levothyroxine/Synthroid (LT4) is the best medication for treating Hashimoto’s. Research shows that reducing elevated TSH with LT4 to optimal levels significantly reduces thyroid antibody levels, inflammatory markers like hsCRP, as well as thyroid size. (5)
CAN HASHIMOTO’S BE MANAGED WITHOUT CONVENTIONAL MEDICATION?
This is more likely if caught early in Hashimoto's disease progression (ie. mild-moderate antibody levels and TSH within normal limits)
CAN PEOPLE WITH HASHIMOTO’S STOP THEIR MEDICATION?
This is more likely successful if a gradual weaning protocol is followed with your prescriber, there's been a short duration of medication use (<4.6 years), a smaller dose of medication (<50 mcg), and TSH < 1.8 mlU/mL.
Retesting must be done every few months to make sure TSH is maintained within the normal range. (6)
DIETARY FACTORS
Restrictive dieting is devastating to the thyroid and metabolic rate (MR). (7) When you restrict food, you are telling your body that it needs to go into hibernation in order to survive a season with less access to resources.
Researchers have linked an increase in TSH with increasing body weight through leptin, the hormone that regulates appetite and energy balance. In overweight patients, leptin and the message that you’re full are disturbed so nutrition goals should be focused on satiety. Hypothyroid patients do better with higher protein and fiber in their diet, likely because they’re supporting satiety. (8).
There is no good evidence (no human studies) to support the common myth that cruciferous veggies (kale, cauliflower, broccoli, Brussels sprouts) or soy are ‘goitrogenic’ in our iodine-sufficient culture. Because these are such fiber & nutrient dense, health promoting, and hormone balancing foods, consider choosing organic and lightly cooking to reduce any imagined risk. (9)
In a recent study using IgG food sensitivity testing to create individualized diets for weight loss, participants who eliminated the foods they had elevated IgG reactions to had a significantly greater reduction in TSH, increases in T3 and T4, and reduction in thyroid antibodies. This may be why a gluten free diet improves some patients with HT; in this study, wheat was one of the most common IgG reactions. (10)
LIFESTYLE
In a recent study, 60 minutes of aerobic activities (bike and treadmill), 3 times a week, for 16 weeks improved general health, emotional, mental and physical quality of life scores. There was a significant improvement in how participants felt even though their bloodwork did not change significantly within the 4 month study period. (11)
NUTRIENTS
Iron if deficient.
Vitamin D (with vitamin K) to optimal blood levels.
Selenium is required for the conversion of T4-T3, protects thyroid cells from damage, improves thyroid size on ultrasound, and reduces thyroid antibodies and other inflammatory markers in the blood. (12)
Antibody treatment: inositol, black cumin, curcumin (13)
THYROID & WEIGHT: WHAT THE RESEARCH DOES & DOESN’T SAY
Studies show that restoring TSH to optimal levels does not result in substantial weight loss without additional changes to nutrition and exercise. Patients with HT often have persistent symptoms of fatigue even after normalization of TSH. This impacts their energy intake and energy expenditure. Patients lose weight not because of their medication but because of how they feel; if their hypothyroid symptoms of fatigue improve, and they start moving their bodies more, they lose weight because of that.
Some research suggests that increased insulin resistance may be more the concern with persistent weight gain after treatment in patients with HT vs hypothyroidism itself. (14)
Bottom line: We must focus on improving fatigue as a way to support weight management because when people are fatigued, they have a difficult time losing weight.
This is why naturopathic medicine is so impactful on weight loss in hypothyroid/HT; we can screen for related conditions that can cause fatigue, like insulin resistance, work on nutrition for satiety and energy, and progressive exercise. We have a role to play in your weight loss, which is not related to your bloodwork; you have the power and control, not your lab results!
The information in this article is not intended to diagnose, treat, cure, or prevent any disease. It is not intended to replace any recommendations or relationship with your physician. Please review linked references for scientific support.
References:
1. Ajjan, R and Weetman, A. The Pathogenesis of Hashimoto's Thyroiditis: Further Developments in our Understanding. Horm Metab Res. 2015 Sep;47(10):702-10. doi: 10.1055/s-0035-1548832. Epub 2015 Apr 16.
2. Thatipamala et al. Quality of Life After Thyroidectomy for Hashimoto Disease in Patients With Persistent Symptoms. Ear Nose Throat J. 2020 Oct 22;145561320967332. doi: 10.1177/0145561320967332.
3. Hu, S and Rayman, M. Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. Thyroid. 2017 May;27(5):597-610. doi: 10.1089/thy.2016.0635. Epub 2017 Apr 6.
4. Vieira et al. Vitamin D and Autoimmune Thyroid Disease-Cause, Consequence, or a Vicious Cycle? Nutrients. 2020 Sep 11;12(9):2791. doi: 10.3390/nu12092791.
5. Guisti, M and Sidoti, M. Long-term Observation of Thyroid Volume Changes in Hashimoto's Thyroiditis in a Series of Women on or off Levo-Thyroxine Treatment in an Area of Moderate Iodine Sufficiency. Acta Endocrinol (Buchar). Apr-Jun 2021;17(1):131-136. doi: 10.4183/aeb.2021.131.
6. Jung, C et al. Risk Factors that Predict Levothyroxine Medication after Thyroid Lobectomy. Acta Endocrinol. Oct-Dec 2020;16(4):454-461. doi: 10.4183/aeb.2020.454.
7. Marzullo, P. The relationship between resting energy expenditure and thyroid hormones in response to short-term weight loss in severe obesity. PLoS One. 2018; 13(10): e0205293.
8. Yu, H et al. Decreased Leptin Is Associated with Alterations in Thyroid-Stimulating Hormone Levels after Roux-en-Y Gastric Bypass Surgery in Obese Euthyroid Patients with Type 2 Diabetes. Obes Facts. 2019;12(3):272-280. doi: 10.1159/000499385.
9. Leko et al. Environmental Factors Affecting Thyroid-Stimulating Hormone and Thyroid Hormone Levels. Int. J. Mol. Sci. 2021, 22(12), 6521; https://doi.org/10.3390/ijms22126521
10. Ostrowska, L et al. The Influence of Reducing Diets on Changes in Thyroid Parameters in Women Suffering from Obesity and Hashimoto's Disease. Nutrients. 2021 Mar 5;13(3):862.
doi: 10.3390/nu13030862.
11. Werneck, F et al. Exercise training improves quality of life in women with subclinical hypothyroidism: a randomized clinical trial. Arch Endocrinol Metab. 2018 Oct;62(5):530-536. doi: 10.20945/2359-3997000000073.
12. Ruggeri, R et al. Selenium exerts protective effects against oxidative stress and cell damage in human thyrocytes and fibroblasts. Endocrine. 2020 Apr;68(1):151-162. doi: 10.1007/s12020-019-02171-w. Epub 2019 Dec 30.
13. Nordio, M and Basciani, S. Treatment with Myo-Inositol and Selenium Ensures Euthyroidism in Patients with Autoimmune Thyroiditis. Int J Endocrinol. 2017: 2549491. doi: 10.1155/2017/2549491
14. Kalra, S et al. Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies. Int J Endocrinol. 2021; 2021: 9641846. doi: 10.1155/2021/9641846