Note: It may be helpful to visit our Guide to Thyroid Labs page to familiarize yourself with different lab patterns associated with thyroid disease as well as the standard treatments for each pattern.
Thyroid Disease:
Thyroid disease is one of the most common conditions in the world, and among those with thyroid disease, hypothyroidism is by far the most prevalent type of dysfunction. We will touch on hyperthyroidism in this article but please note that hyperthyroidism is far less common and typically requires more urgent management.
Hypothyroidism is a condition in which the thyroid is under functioning and is not able to create enough thyroid hormone to meet your body’s needs.
In contrast, Hyperthyroidism is when your thyroid gland is over working, pumping out more hormones than the body needs.
There are a number of symptoms that go along with both conditions, but in order to be diagnosed, blood testing is required.
What does the Thyroid Gland do?
The thyroid gland primarily creates two types of hormones that play an essential role in our bodies. Thyroid hormones are comprised of an amino acid called tyrosine, and attached to that amino acid are either three or four iodine molecules. The hormone with four iodine molecules is called T4 (Thyroxine) and the hormone with three iodine molecules is called T3 (Triiodothyronine). The thyroid produces these hormones in a ratio of roughly 80% T4 and 20% T3.
T4 serves as the storage form of thyroid hormone and is much less bioactive (meaning it is not as readily active for the body to use it). T3 is the active form of thyroid hormone, and its effects on the body are much more pronounced. We will touch more on this later about how T4 can be converted to T3, but for now just know that this conversion must take place for optimal function.
Having adequate amounts of thyroid hormone circulating in your body is absolutely essential to the function of everything from digestion, blood pressure, mood, energy, metabolism, weight, temperature regulation, and hair growth.
As you can imagine, when your thyroid is not working as it should, you can experience a wide variety of symptoms.
Symptoms of Hypothyroidism
Symptoms of hypothyroidism can range from mild and intermittent, to absolutely debilitating. By far the most common symptoms individuals report are weight gain and fatigue. This is because thyroid hormones play such a vital role in our energy and metabolism.
If you notice you have been more tired lately, are having trouble losing weight, or are experiencing unwanted weight gain, then we would highly recommend you speak to your doctor about evaluating the health of your thyroid.
Aside from fatigue and weight gain, other symptoms of hypothyroidism include:
- Thinning of the hair
- Dry skin
- Depression
- Issues with fertility
- Trouble tolerating cold temperatures
- Joint and/or muscle pain
- Heavy or irregular menstrual cycles
- Slower heart rate
Symptoms of Hyperthyroidism
When there is too much thyroid hormone in your circulation, the symptoms are usually less subtle. Hyperthyroidism can be life threatening, and you will almost always be managed by an Endocrinologist. Hyperthyroidism needs to be treated promptly, and the cause needs to be evaluated.
Common symptoms of hyperthyroidism include:
- Weight loss
- Anxiety
- Greasy skin
- Hair loss
- Fatigue
- High blood pressure
- Rapid heart rate
- Irregular heartbeat or “arrhythmia”
- Diarrhea
- Sweating
- Muscle weakness/tremors
- Irritability
- Insomnia
What about Hashimoto’s Disease?
Another diagnosis that more people are becoming aware of is Hashimoto’s disease. Hashimoto’s, often called Hashimoto’s Thyroiditis, is an autoimmune condition in which your body’s immune system begins to attack your own thyroid gland and disrupts the pathways responsible for normal thyroid hormone production. The symptoms are usually very similar to hypothyroidism although some people may experience transient symptoms of hyperthyroidism as hormone levels can fluctuate significantly early on in this disease.
With Hashimoto’s, the thyroid eventually gets “burned out” and folks end up with the classic lab pattern of hypothyroidism (see our thyroid lab guide).
So how would I know if I have Hashimoto’s?
In order to diagnose Hashimoto’s, your doctor will order blood tests that look for elevated numbers of specific autoantibodies in your bloodstream. As you may know, antibodies are an important part of our immune system, as they help us create immunity to different viruses and bacteria.
When autoimmune conditions arise, the immune system gets confused and begins creating antibodies against our own cells. “Auto” antibodies mean “antibodies of self”.
The most commonly drawn lab tests to confirm Hashimoto’s are:
1. Anti-Thyroid Peroxidase antibodies (anti-TPO antibodies)
2. Thyroglobulin antibodies
If either of these are elevated, then your doctor will be very suspicious that you have Hashimoto’s.
Key point: You can have Hashimoto’s Disease even with normal thyroid function. You won’t need treatment in this case but be aware that you are at higher risk of developing hypothyroidism in the future. If you have identified that you are at risk, there is a lot you can do! Keep reading to learn about how to optimize your thyroid health and decrease your Hashimoto’s antibodies.
The Standard of Care:
For Hashimoto’s, treatment is typically the same as it is for “normal” hypothyroidism. This means that thyroid medication (usually levothyroxine), is given and thyroid labs are monitored closely.
But is there more that you can do to help manage Hashimoto’s?
When it comes to Hashimoto’s Disease, there is usually no clear cause. That said, there is almost always a common denominator: inflammation.
How to tell if you have inflammation:
After Hashimoto’s disease has been confirmed, it may be wise to discuss with your doctor about ordering a lab test called a high sensitivity-CRP. This is a common inflammatory marker that is often elevated in patients with confirmed Hashimoto’s. This can be a helpful marker to track and check periodically to see if certain interventions are helping to reduce inflammation in the body.
The Big Takeaway…
It has been shown time and time again through many research studies that diet and lifestyle modifications are the number one way to gain some significant ground in improving Hashimoto’s.
As is true with any autoimmune condition, improvements can be seen when we focus on improving the foundations of health. This means:
- Eating mindfully and avoiding processed foods
- Hydrating!
- Moving our bodies and getting regular exercise (please check out our Exercise section)
- Decreasing our stress (See our page dedicated to Stress Management)
- Getting adequate sleep
While everything mentioned above is very important, there are a few dietary things to consider that are specific to Hashimoto’s Disease.
Dietary interventions for Hashimoto’s Disease:
1. Minimize your gluten intake:
It is almost always worth a trial of a gluten-free diet to reduce Hashimoto’s antibodies. There is a strong correlation between inflammation, gluten consumption, and elevated Hashimoto’s antibodies. In fact, research is showing that many individuals with Hashimoto’s Disease also have Celiac Disease, which is an autoimmune disease of the GI tract that is triggered by gluten.
A common thread?
Several studies have shown that most autoimmune illnesses can be improved simply by following a gluten free diet.
What does a gluten free diet look like?
Following a gluten free diet requires avoiding the following foods, unless these foods are specified as “gluten-free”:
- Wheat
- Barley
- Rye
- Pastas
- Breads
- Most cereals
- Many baked goods
- Tortillas
- Biscuits
- Sauces and salad dressings
- Many over the counter medications (surprising right?)
Unfortunately, there is a long list of food items that contain gluten, so it is often a challenge when people first go gluten free. The good news is that given the prevalence of individuals avoiding gluten, the food market has responded and there are many alternative food options to try!
Important note about gluten free diets:
If you go 100% gluten free for a few months you will end up starving the microbes in your gut that help break down and “eat” the gluten you consume. This can make reintroducing gluten a bit challenging and can result in unpleasant symptoms.
One way to combat this is to be extremely mindful of how you choose to consume gluten. This means adhering to the following:
- Avoid all processed gluten if possible.
- Limit the amount of gluten you eat to 1 or 2 servings a day.
- Only eat organic gluten containing foods.
- Choose sourdough bread as your main gluten containing food as the natural fermentation process helps break down the gluten and is therefore more easily digested by your gut.
Interesting Connection: Some health experts claim that the increasing rates of gluten sensitivity is due to the heavily used pesticide, Glyphosate. Check out our write up for more fun information.
2. Minimize your dairy intake:
It is not uncommon for people to have dairy sensitivities, which can trigger inflammation. This inflammation can be a contributing factor in the onset of Hashimoto’s. Many patients find they feel better cutting out dairy while others find they tolerate dairy perfectly fine. Everyone is a little different, and in many cases the only way to find out is to trial a dairy free diet.
Tip: If cutting out dairy is not something you feel like you can do, we recommend sticking to A2 dairy products. A2 products come from specific breeds of cows. Some individuals report decreased bloating, abdominal discomfort, and diarrhea when strictly consuming only A2 dairy products. Dairy products from A2 cows are thought to cause less inflammation than cows that produce the standard A1 protein.
3. Try going low carb:
A low carbohydrate diet is another option that many people try, as studies have shown improvements in Hashimoto’s when following a low carb diet.
4. AIP Diet (Autoimmune Protocol Diet)
This is a more intense intervention and requires a lot of dedication. The AIP diet is a type of elimination diet that includes avoiding foods like:
- grains
- dairy
- nightshades
- coffee
- eggs
- added sugar
- alcohol
- nuts and seeds
- food additives
If you have tried steps 1-3 without a lot of luck, then it may be worth starting the AIP Diet.
Worth noting:
The quality of food matters. We can’t emphasize this enough. Especially for patients with autoimmune illness. Eating highly processed and refined foods can trigger the immune system and confuse it to the point of triggering autoimmune diseases. We recommend eating organic and non-GMO as much as possible!
To wrap up Hashimoto’s:
If you search online, you will find a number of Hashimoto’s protocols and programs. While many of these have merit, without the strong foundation outlined above, you will likely have difficulty gaining traction in managing this disease. To learn more about how to create a strong foundation, continue reading on to our Lifestyle Modifications for Thyroid Disease section. Everything that is listed in there is going to be beneficial for you.
A Deep Dive on Inflammation and Thyroid Health
While, unfortunately, hypothyroidism is an all-too-common diagnosis, the exciting news is that there are many things we can do in our day-to-day lives to help our thyroid out. In practice, we have connected with too many people who have walked away from their doctor appointments with a new diagnosis of hypothyroidism and have felt helpless in knowing how to try and improve the health of their thyroid.
So, let’s jump into to the actionable changes we can make!
But first…
Inflammation is quite complicated to say the least. This term is thrown around fairly often by medical professionals when talking about disease processes and diagnoses. Truth be told, we are no exception to this. As research continues to understand deeper and more complicated processes within the body, it is becoming abundantly clearer that at the root of (dare we say all) chronic illness and disease processes is inflammation.
One of the great drivers of chronic inflammation is what is called “Oxidative Stress” or “OS”. Inflammation is highly correlated to an increase in oxidative stress and the accumulation of harmful free radicals. These free radicals can change our DNA and can even cause cancer! Think of free radicals as little molecules that float around and disrupt our normal cellular functioning. Excess oxidative stress results when an important two-step process is not carried out efficiently in our bodies. This process is outlined below:
Part 1:
Our bodies produce what are called “reactive oxygen species” (ROS) and “reactive nitrogen species” (RNS). These are both common subsets of “free radicals” and are a normal part of our cellular metabolism. In some cases, the burden of these free radicals can become excessive when there are too many added external stressors to the body. These are things we are exposed to every day and include pollutants, poor diet, radiation (cellphones, TV, Bluetooth), chemicals, heavy metals, many drugs, etc.
Part 2:
Our antioxidant defense system! Antioxidants are the enzymes that break down and clean up the free radicals mentioned above, and they are extremely important. When there are not enough antioxidants available to clean up the free radicals, then we see the damaging results of oxidative stress take hold.
Oxidative stress can be responsible for the onset and worsening of many disease processes including:
- Cancer
- Cardiovascular diseases
- Diabetes
- Atherosclerosis
- Metabolic Disorders
- Many more…
I thought we were talking about thyroid health…
We are! But I’m sure you are wondering, where does the thyroid fit in to all this?
The release of thyroid hormones results in the production of free radicals by running our metabolism. Just like you accumulate garbage in your house, our bodies accumulate free radicals. It is an unavoidable byproduct of life and normal metabolism. When the body is in balance, we have enough antioxidants to counteract these free radicals, and all is well.
The problem occurs when we get out of balance. If external sources of inflammation pile up and our antioxidants can’t keep up, then the thyroid responds by lowering hormone production as a protective mechanism.
This means our body purposely induces a state of hypothyroidism to slow down metabolism and in turn slow down oxidative stress to protect ourselves.The hope is that slowing down our metabolism gives our antioxidants a chance to catch up and restore balance.
This sounds like a very intelligent response by the body, right? Yes and no. While the goal is to decrease inflammation, the downside is that people begin to experience symptoms of hypothyroidism; even though the body is responding appropriately to a stressful environment.
Let that sink in…
This should change the way you think about hypothyroidism! Instead of your thyroid just deciding to give up one day, it might be doing its best to try and protect us.
Unfortunately, when this state becomes chronic, a vicious cycle takes hold. A sustained hypothyroid state can worsen oxidative stress even more and can lead to several other chronic conditions like cardiac disease, cancer, and diabetes.
How does this happen?
Unfortunately, as thyroid hormones decrease, so do our antioxidant levels. This is a complex and not well understood relationship as it stands right now, but the relationship is clear. The less circulating thyroid hormones means the less antioxidants available to our body, which results in more systemic inflammation.
So, what are we left with?
Our body has detected increasing inflammation and has tried its best to compensate for it. As a result, we end up in a state of hypothyroidism and armed with even less antioxidants than we had in the first place. Not good! And to make matters worse, the inflammatory insults we are exposed to every day are still bombarding us.
The Solution:
The best thing we can do in this situation is simple and complicated all at the same time. In the end, it is simply a math problem. We need to:
1. Increase antioxidants in the body to combat the inflammation caused by oxidative stress.
AND
2. Decrease the free radicals in the body by reducing stressors to the body, and therefore decrease inflammation.
What Can We Do to Naturally Improve Our Thyroid Health?
There are a number of lifestyle modifications that we can make to help reduce free radicals in our body and improve out thyroid health. This doesn’t necessarily mean you have to make ALL the lifestyle changes in your life (although we would all strive for this in a perfect world) but it does mean that each habit you improve means less free radicals in the body. So, every bit counts… even if it is small changes! Here are the best ways we know how to naturally improve the health of your thyroid:
