Hashimoto's thyroiditis is an autoimmune disease of the thyroid gland, in which the body’s immune system starts producing antibodies against the thyroid hormones. This leads to a hormonal deficiency in the body. To confirm the diagnosis usually a blood work of ft3, ft4 and TSH hormones is ordered, as well as the antibodies. Ultrasound is also used. There are different phases in the course of the disease and is usually discovered during the hypothyroidism stage – decreased function of the thyroid. Providing missing hormones is the usual course of treatment.
At the onset of the disease a slight hyper function (hyperthyroidism) might occur as a reaction to the inflammation. Some of the following symptoms might appear:
- Weight loss;
- Increased irritability;
- Increases perspiration;
The most characteristic symptoms appear later on when there is significant thyroid tissue damage and hormone production has been reduced considerably.
Common symptoms reported by patients are the following:
- Apathy and even depressive conditions;
- Difficulty to concentrate;
- Cold sensitivity;
- Dry skin;
- Dry and brittle hair;
- Weight gain without change of lifestyle or eating habits to be present.
What causes Hashimoto’s Disease
The exact reasons causing autoimmune reactions, as well as the mechanisms through which they appear, have not been scientifically established. This is due to the many underlying factors related to the disease.
Genetic predisposition is considered a major factor as the disease can be more common in some families. But even if there is family history of the disease, it doesn’t necessary mean that it can affect members of this family. Underlying factors, such as infections, and poor lifestyle choices, are considered medically important as well.
Epstein–Barr virus, found in many Hashimoto patients, is very often cited as a culprit for the disease. But this hypothesis faces some skepticism. Scientists claim that this virus is so common (more than 70% of European population are carriers) that it can be blamed for pretty much everything.
Different publications mention more than 20 possible infections that could cause the disease. It is presumed that herpes (simplex and zoster), cytomegalovirus, coxsackievirus and some other viruses play a significant role. There are many bacteria, such as yersinia, helicobacter pylori to name a couple, that possibly cause the initial inflammation of the gland.
Another hypothesis is related to the high iodine intake, claiming to increase the risk in people with family history of the disease.
Most probably the actual cause of the disease is a combination of underlying factors – specific genes, combined with chronic infections, stress, nutritional deficiency (certain vitamins and minerals).
Possible correlation between vitamin D, selenium, zinc and magnesium deficiency and problems with the thyroid are often debated in medical literature.
Relation to other diseases
Hashimoto patients are known to suffer from autoimmune diseases more frequently than others. This is supported by extensive research and statistics. That is why it is recommended to monitor for diseases such as celiac disease, Crohn's disease, ulcerative colitis, vitiligo, lupus, rheumatic diseases. It is not uncommon for patients having these conditions to have problems with insulin resistance.
How is Hashimoto diagnosed
Bloodwork and ultrasound are used to establish the disease. TAT and MAT antibodies presence is determined in laboratory. TSH hormone is also monitored to determine the thyroid function – the higher the levels, the worse the function of the gland. Ft3 and f4 hormone levels is also tested.
Ultrasound is used in order to determine if the thyroid has inhomogeneous structure. Areas that are thicker and have knots might be found but they are not directly related to Hashimoto.
There are several stages of this autoimmune disease. At the early stage it is manifested by high antibody levels that target the thyroid gland cells, TSH, Т3, and Т4 hormone levels at the same time remain normal. It is important that all hormone levels are being tested because each of them is a specific indicator for the health of the patient and points towards a possible need for hormone replacement therapy. The next stage is characterized by thyroid deficiency and replacement therapy is necessary. The most common drug is the synthetic hormone T4 (Levothyroxine). Once it is administered it turns into the biologically active T3.
When a hormone replacement therapy is applied
TSH upper limit, that would indicate replacement therapy, depends on the age of the patient. In patients at the age range 65-70 and lack of other symptoms, levels up to 7 mcrgIU/l are considered normal.
When a replacement therapy is due is a question that concerns many patients that have established problematic thyroid function results. On one hand, there are many subclinical conditions (stages before the actual manifestation of the disease) during which it is better to wait. There are cases in which the reason for high TSH levels might go away. On the other hand, in some patients, it is important to start therapy as soon as possible in order to avoid development of the disease and to achieve remission.
Each individual case requires careful consideration of the overall well-being of the patient before proceeding to replacement therapy. In less severe cases selenium treatment could be applied at first. This antioxidant takes part in many processes related to thyroid hormonal function.
Replacement therapy is started with the minimal dosage of the drug – 25 mg and monitoring is carried out more frequently (every one or two months) until the optimal dosage is achieved. With the right treatment in place, patients can have a normal life.
Switching from synthetic to natural hormone
There are “natural” hormones offered online, that are produced by dried pig’s glands (Desiccated thyroid extract). Doctors are positive, though, that one should not by hormone drugs over the web. In the so called “natural” drugs there is no precise dosage and patients might end up either taking too much or too little of the hormone. Purification is also questionable and, although it is rare, there might be virus contamination coming from the animal.
Natural hormones come in place only in rare cases where patients can’t transform drugs into bioactive hormones (fT3). In these cases, these drugs should come only from authorized sources.
In most cases, natural hormones are used when patients cannot tolerate well enough the standard levothyroxine treatment. One should be cautious though – these are not dietary supplements and if you come across a product labeled as such this means that the producer or seller of the drug labeled it in this way to avoid certain procedures. These drugs can do more harm than good.
Are there side effects of the treatment
Sometimes people are afraid to start the lifelong Hashimoto treatment. Experts agree that there is no reason to be afraid. Drug manufacturing has improved dramatically, drugs are purified and there are almost no side effects. Adverse events such as anxiety and palpitations are quite rare and in cases of overdosage. That is why dosage should be controlled from the start by a specialist.
In patients, undergoing a levothyroxine, bone density should be monitored due to an osteoporosis risk. Toxicity should be out of the question should the drug is taken adequately.
Constant fatigue and weight increase – are they related to Hashimoto’s
Weight increase, with ongoing replacement therapy and achieved hormonal balance, is a manifestation of several changes in the body associated with the autoimmune process: chronic inflammation, hypothalamic-pituitary-adrenal axis dysfunction, estrogen predominance, environmental factors etc. When patients complain from constant fatigue, this is points towards an insufficient level of the T3 hormone.
Insulin resistance and Hashimoto
Insulin resistance is a possibility, main reason being the chronic inflammation associated with the autoimmune process. Insulin resistance could also “unlock” Hashimoto. That is why regular monitoring on insulin levels is recommended.
Pregnancy and Hashimoto’s
When pregnancy is planned, it should start when normal hormonal levels are at place. This is important especially during first weeks of pregnancy when the fetus relies on hormones produced by the mother. If there is disbalance, the future child could have slight psychological and behavioural challenges
Diet and Hashimoto’s
There has been quite vigorous debate on diet, nutrition and food supplements among the scientific community. There have been many researches that establishes a correlation between the disease and gluten intake or deficiency of certain nutrients. So far, the medical communities in EU and US haven’t accepted the data as proof in order to come up with specific guidelines.
Nevertheless, there are some dietary habits patients with the disease can try without, of course, going to extremes. Gluten-free diet is the most recommended approach. The explanation being that gluten molecule looks much like the thyroid hormones’ molecules. Thus, the presence of too much gluten aggravates the immune system that starts producing more antibodies. There has been research indicating that gluten-free diet, for some time, could help decrease some of the more unpleasant symptoms of the disease – fatigue and poor concentration. Gluten is a protein found in many grains – wheat, rye and even in oats in some small quantities. It is where elasticity of dough comes from. Gluten-free diet is officially recommended only to people suffering from celiac disease who amount to around 1% of the population.
The recommendation is to maintain a gluten-free diet for 3 to 6 months. The reason being that removing gluten from the diet whatsoever will deprive people from the benefits of consuming wholegrain foods that are rich in fibre, vitamins and minerals. Of course, each diet plan should be individually prepared but maintaining a balanced diet rich in fruits and vegetables applies to everyone.
Many patients stick to the so-called autoimmune protocol. This makes sense only when certain conditions are in place. In some patients it is established it is the herpes virus causing high antibody levels. In this case maintaining a specific diet is not necessary. In patients where there is insulin resistance, overweight or obesity, a personal diet plan is recommended.
Vitamins and minerals that relief the symptoms
Taking supplements such as antioxidants, vitamins and minerals could help patients feel better. This is important because many people achieve the right hormonal balance but still feel fatigued.
It is important to keep track of the vitamin D levels in your body – especially during the winter when there is a deficiency. If the levels are low, you can obtain it through supplements. Omega-3 products combined with vitamin E are also beneficial as the vitamin helps for detoxing of the liver which often comes as a need for Hashimoto’s patients, while omega-3 has anti-inflammatory effect proven in many researches.
From the antioxidants group glutathione brings the biggest benefit since it enhances enzyme and hormone recycling. Zinc is also recommended as an immune system booster. Taking zinc especially in during the winter, when there are more viruses and flu outbreaks, is recommended. Magnesium is another important element that aids the nervous system and helps battling depression which is associated with Hashimoto’s. It is recommended to combine it with vitamins from the B group.
Amino acids such as arginine, histidine, methionine and some others are also important. It is not necessary to take them all at once as supplements but to take them in courses. Watch out for how your body reacts when you take supplements and keep a close track on the control tests and how they might be affected.
What you shouldn’t take
There are foods and nutrients you should not take when having Hashimoto’s. Anything rich in iodine is not recommended – walnuts, seaweed, green-lipped mussel. The reason to avoid these foods and supplements is that high levels of iodine in your body might accelerate the autoimmune process.
Different immune system boosters should also be avoided unless recommended by a doctor. When there is an autoimmune disease present, they can boost the attack on the body’s own tissues. That is why anti-flu vaccines are not recommended as well.