5 min|Dr. Maya Kuczma

Autoimmune Disease 101: Treating Hashimoto's Thyroiditis

Immune Health

Treatment of Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is an autoimmune condition. For this reason, treatment plans must aim to directly support and/or replace thyroid hormone production, as well as regulate the immune system.

Medication

The standard treatment for hypothyroidism, whether it is a result of an autoimmune condition or alternate etiology (such as a conversion issue or nutrient deficiency), is T4 replacement. Examples of T4-only medications include Synthroid, Eltroxen, and Tirosint. T4 is the less active form of thyroid hormone; it also has to be converted (into T3) to have a potent effect on the body. This conversion can be inhibited by elevated cortisol (as a result of stress, trauma, or sleep deprivation), selenium deficiency, and zinc deficiency. Additionally, a lot of this conversion occurs in the liver and the gut. In cases of impaired liver function, or a dysfunctional gut microbiome, conversion will not occur optimally. If we are experiencing impaired conversion, we may not notice improvements with T4-only medications, or improvements may be small and insufficient, or we may require gradual increases in dosage over time in order to achieve symptom improvement.

Due to these factors, Naturopathic Doctors tend to utilize medications that provide both T3 and T4, or only T3. Natural desiccated thyroid (NDT) is made from animal thyroid gland (typically pig); since it is natural thyroid tissue, it includes substances a healthy thyroid would make, including T3 and T4. Thyroid hormones can also be compounded into an individualized prescription, via a compounding pharmacy, in varying levels of T3 and T4. Compounded hormones are preferred If there are any concerns around consumption of pork, for religious or ethical reasons, or due to allergies or sensitivity.

However, all of these replacement medications serve only to replace thyroid hormone. They do not provide the building blocks needed for thyroid hormone production or conversion, or treat the immune system. A well-rounded treatment plan takes into account all of these factors.

Diet and Lifestyle

Our diet and lifestyle greatly impact both the thyroid and our immune system. As we have learned, the thyroid hormonal cascade requires many different nutrients, without which it cannot function optimally. Additionally, certain nutrient deficiencies, such as vitamin D deficiency, has been associated with Hashimoto’s as well as other autoimmune conditions. (1,2)

Grain consumption has been linked to increased gut permeability (also known as ‘leaky gut’), which can lead to increased inflammation, and has been linked to autoimmune conditions.(3) High sugar and refined carbohydrate intake has been shown to worsen autoimmunity, due to increased inflammation.(4,5) Lactose intolerance occurs at a high frequency in hypothyroidism patients; dairy restriction has been shown to improve TSH levels.(6) Lectins, a component found in all plants but at particularly high levels in grains, beans, and legumes, have been shown to alter immune-signaling on thyroid cells, a change that may set the stage for the development of autoimmunity.(7)

When treating Hashimoto’s thyroiditis, we guide patients towards a diet that emphasizes the nutrients required by the thyroid and immune system, such as selenium, zinc, B vitamins, and iron, while eliminating potentially problematic foods, such as grains, legumes, dairy, sugar, and refined carbohydrates. The result is a diet that predominantly relies on animal protein, fruits, and vegetables, such as a Paleo, Autoimmune Paleo, or Whole 30 plan. If needed, oral supplementation and/or intravenous therapy may be utilized when dietary changes are insufficient in raising nutrient levels.

Due to the link between elevated cortisol and conversion inhibition, as well as known links between stress and autoimmunity, it is vital to manage your stress.(8) Stress management is different for everyone - some of us gain relief from light movement or exercise, whereas others respond well to creative outlets. Depending on your history of trauma and nervous system patterning, neurofeedback, cognitive behavioral therapy, or another form of therapy may be ideal. A skilled practitioner can help you determine an effective, and manageable, stress-relief plan.

Addressing Other Root Causes

At times, a healthy diet and lifestyle, along with targeted thyroid support, is enough to gain significant symptom relief and a decline in antibody levels. For others, there may be additional factors that need to be considered, such as healing the gut lining, restoring the gut microbiome (particularly in cases of yeast or Small Intestinal Bacterial Overgrowth), and/or identifying individual food sensitivities or allergies.

Additionally, many toxins such as certain herbicides and insecticides,(9) heavy metals,(10) BPA,(11) and halogens (such as chlorine, bromine, fluorine, and perchlorate)(12) have been shown to negatively impact thyroid functioning. Many steps can be taken to facilitate removal of these toxins from our bodies, as well as decrease further exposure to these toxins.

Lastly, there are many infections that have been linked to Hashimoto’s thyroiditis, such as herpes viruses,(13) Hepatitis C,(14) Yersinia enterocolitica,(15) and Helicobacter pylori.(ref for all) These infections can be tested for, and treated, if needed, by your practitioner.

Monitoring and Thriving

Your Doctor will likely test your TSH, thyroid hormones, and antibodies frequently, especially in the early days of treatment, in order to monitor your progression. Antibody levels can be helpful in monitoring if our treatment plan is leading to decreased autoimmunity. It is important for us to monitor both your labs - and how you feel. Pregnancy, menopause, stressful life events, toxic exposure, infections, and changes in diet can all affect the complex thyroid cascade; as a result, your labs, how you feel day-to-day, and required treatment, may change as well. A skilled practitioner will help guide you through signs and symptoms to be aware of, while also monitoring objective markers like the size of your thyroid and lab results.

Do you have many symptoms associated with hypothyroidism?

Have you been diagnosed with hypothyroidism, but your antibody levels weren’t tested? Are you on medication for hypothyroidism, but aren’t seeing improvement, or wonder if there’s more you could be doing to support your body?

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