Hypothyroidism & Hashimoto’s Disease

Hypothyroidism & Hashimoto’s Disease 

Hypothyroidism and Hashimoto’s disease occurs when the thyroid gland produces too little thyroid hormone, when there is a decreased conversion from T4 to T3, when there is an overproduction of reverse T3, or when the body is not efficiently using thyroid hormone.

In a healthy patient, a normal thyroid secretes all of the circulating T4 and about 20% of the circulating T3.  T4 is converted in the liver and kidneys to T3, the biologically active thyroid hormone, and reverse T3, which is virtually inactive and is a T3 antagonist. Normal metabolism depends on a balanced ratio between T3 and rT3. If there is too much rT3, then symptoms of hypothyroidism may arise, despite sufficient circulating T4 and T3, due to blocking of the T3 receptors.

There are multiple reasons that hypothyroidism occurs,

Causes of Hypothyroid Disease and Hashimoto’s Thyroiditis

• Hashimoto‘s disease: an inflammatory auto-immune disease of the thyroid gland and the most common cause of hypothyroidism
• Wilson‘s syndrome: hypothyroidism caused by rT3 dominance. T3 and T4 are within normal limits.
• Post-therapeutic hypothyroidism: results from the treatment of hyperthyroidism with radioactive iodine or surgical removal of part or all of the thyroid gland
• Goitrous hypothyroidism – caused by a lack of iodine in the diet
• Congenital birth defects
• Post-partum hypothyroidism
• Radiotherapy to the neck area
• Viral thyroiditis
• Certain drugs e.g. hyperthyroid medication, lithium

Risk factors

• Family history of thyroid disease
• Age over 50
• Female gender
• Prolonged stress: cortisol inhibits TSH secretion, suppresses the enzymes needed to convert T4 to T3 and increases synthesis of rT3. Additionally, if tyrosine is preferentially needed to produce stress hormones (dopamine, adrenaline and noradrenaline), less will be available for thyroid hormone synthesis
• Nutritional deficiency e.g. zinc, iron, selenium, chromium, B6, B12, D, iodine
• Iodine excess: can cause autoimmune hypothyroidism, especially in the absence of selenium, which is protective of iodine excess.
• Toxicity: mercury, polychorinated biphenyls (PCBs), pesticides, dioxins and plasticisers (e.g. BPA) all impact on thyroid function
• Low ferritin: can cause increased rT3
• Hyperthyroid treatment – permanent damage via radition is often conducted for hyperthyroid patients along with surgery to remove the thyroid
• Type I diabetes
• Leptin resistance: due to high sugar and carbohydrate diet

Signs & symptoms of Hypothyroidism & Hashimoto’s disease

• Fatigue and lethargy
• Difficulty concentrating or thinking
• Weight gain
• Intolerance to cold
• Headaches
• Depression
• Constipation
• Dry skin
• Enlarged neck or goitre
• Dry, brittle hair or loss of hair
• Heavy or irregular periods
• Reduced libido
• Low basal body temperature: can use BBT to test for subclinical hypothyroidism: take axillary temperature (for 10 minutes) 3 consecutive mornings on waking. Should be between 36.4 and 36.7.
• Increased cholesterol

Differential diagnosis

• Euthyroid sick syndrome
• Depression
• Alzheimer‘s disease or other types of dementia
• Carpal tunnel syndrome

Testing for Hypothyroidism & Hashimoto’s

• In hypothyroidism, TSH is increased while T4 and T3 are either low or low-normal.
• Subclinical hypothyroidism is diagnosed when TSH is elevated, but T4 and T3 are in the normal range. Subclinical hypothyroidism is quite common and is thought to occur in a significant percentage of the adult population.
• If thyroid antibodies are present with a high TSH, a diagnosis of Hashimoto‘s is made.
• Screening for coeliac disease should be considered

TREATMENT STRATEGY FOR HASHIMOTOS

• Support thyroid hormone synthesis and metabolism
• Regulate immune system (Hashimoto‘s)
• Reduce thyroid antibodies (Hashimoto‘s)
• Reduce inflammation and oxidative stress (Hashimoto‘s)
• Reduce stress and support nervous system and adrenal glands
• Reduce exposure to foods and toxins that inhibit thyroid function
• Balance blood sugars and improve insulin sensitivity

Support thyroid hormone synthesis and metabolism

• Assess iodine status
  • Iodine deficiency is the biggest cause of hypothyroidism worldwide, whereas in Western countries, hypothyroidism is generally caused by autoimmune disease rather than iodine deficiency.
  • Australians, on average, are iodine-replete (especially in WA and Qld). However, it is worth testing iodine levels as they can be low in vegans and vegetarians or people who live in areas where soil is iodine-deficient.  Current times has caused a shift away from iodised salt, in certain individuals this can contribute to low Iodine levels.  We commonly uncover low iodine levels when conducting Iodine loading tests on our patients.   We always test iodine before supplementation.
  • Studies have shown that excess iodine can cause or worsen Hashimoto‘s (Luo et al, 2014). Therefore, it is important to assess iodine status prior to supplementing or recommending iodine-rich foods.
  • Iodine levels may be assessed by a simple urine test done through functional pathology testing laboratories
  • If hypothyroidism is caused by iodine deficiency, then iodine-rich foods should be included in the diet: seaweed, spirulina, seafood, eggs and iodised salt.  Supplementation will also likely be required.
  • If iodine status is high, iodine-rich foods may need to be restricted, especially in Hashimoto‘s disease. In this case, avoid intake of iodised salt, kelp and spirulina
  • Ensure adequate protein in diet: to supply tyrosine needed for synthesis of thyroid hormone
  • Increase selenium-rich foods to reduce thyroid antibodies and protect thyroid gland: Brazil nuts, seafood, lean meats
  • Increase zinc-rich foods: pumpkin seeds, seafood, lean meats

Diet plan guidelines for Hypothyroidism

Reduce exposure to foods that inhibit thyroid function

• Soy isoflavones:
  • Soy isoflavones are known to reduce activity of the thyroid peroxidase enzyme; however, studies have largely found that this has a limited impact on thyroid function itself as long as iodine status is normal. In people with normal thyroid function and adequate iodine status, soy is not found to adversely affect thyroid function (Messina & Redmond, 2006; Doerge & Sheehan, 2002)
  • However, in people with subclinical thyroid function and iodine deficiency, a high intake of soy foods may increase the risk of overt hypothyroidism (Sathyapalan et al, 2010). In this case, soy food intake should be moderated and iodine foods increased.
  • Goitrogens:
    • Substances that can suppress thyroid function by interfering with iodine uptake. Include cassava, soybeans, pine nuts, peanuts, flax seed, millet and Brassica family vegetables such as brocolli, cauliflower, cabbage, kale etc.
    • Goitrogenic foods are mostly important to avoid in hypothyroidism associated with iodine deficiency
    • Soaking, cooking and fermenting largely inactivates goitrogens, making them safe to consume
• Balance blood sugars and reduce insulin sensitivity: low GI diet with a focus on complex carbohydrates, adequate protein and healthy fats
• Assess for food allergies and sensitivities:
  • Food sensitivities can increase the antigenic load, upregulating the immune response.
  • Gluten (and possibly casein) should be removed from the diet to reduce antigenic load.  Ideally an autoimmune paleo (AIP) style diet should be followed, particularly in the first instance.
• Assess and correct gut dysbiosis / intestinal permeability
  • High-fibre diet and probiotic foods are necessary for proper gut flora balance.  A thorough stool test and SIBO breath test are recommended with anyone with hypothyroid disease.
• Reduce thyroid antibodies
  • Increase selenium containing foods: Brazil nuts, fish and shellfish, sunflower seeds, meat and poultry, mushrooms.
• Anti-inflammatory, antioxidant diet:
  • Reduce sugar, refined grains, refined oils, processed foods and animal proteins
  • Emphasise colourful fruit and vegetables, turmeric, ginger, green tea, dark chocolate, berries, etc.

Supplements that support Hypothyroidism and Hashimoto’s disease

• Tyrosine – precursor for thyroid hormone synthesis
• Iodine – in iodine deficiency only. Iodine supplementation in Hashimoto‘s disease may worsen the condition. Always assess iodine status first.
• Selenium – needed for conversion of T4 to T3, to protect thyroid from oxidative damage, and reduce thyroid antibodies in autoimmune thyroid disease
• Zinc –  needed for uptake of thyroid hormone and protect thyroid from oxidative damage
• Vitamin C – anti-inflammatory and needed for thyroid hormone production
• Omega-3 EFA‘s – reduce inflammation in Hashimoto‘s disease
• Probiotics: regulate immune response in Hashimoto‘s disease, a thorough gut investigation should be completed
• Vitamin D –  if deficient; to support immune response in Hashimoto‘s disease
• Vitamin A –  needed for TSH production
• Vitamin E –  needed for conversion of T4 to T3
• Chromium –  needed for conversion of T4 to T3
• B-complex – needed for conversion of T4 to T3 and to support nervous system
• Iron: if low ferritin

Herbal medicine treatment that supports Hypothyroid Disease

• Thyroid stimulant – bladderwrack (iodine deficiency only), coleus, withania
• Immune modulator – echinacea, astragalus, reishi/shitake, withania, Korean ginseng
• Anti-inflammatory – rehmannia, withania, turmeric, ginger
• Adaptogenic – withania, Siberian ginseng, Korean ginseng, rhodiola, codonopsis
• Nervines – St Johns wort, passionflower, scullcap, oats, lavender, hops
• Weight loss – coleus
• Tissue repair/antioxidant – gotu kola, turmeric, St Mary‘s thistle, bilberry, hawthorn
• Liver support – St Mary‘s thistle, globe artichoke, bupleurum

 Lifestyle / Physical measures

• Hypothyroidism and Hashimoto’s disease is greatly affected by diet and lifestyle
• Regular vigorous exercise important for thyroid function and stimulating metabolism
• Contrast hydrotherapy to neck and throat may stimulate thyroid function: alternating hot and cold applications brings nutrients to the site and diffuses metabolic waste from inflammation. Alternate three minutes hot with one minute cold – repeat three times to complete one set – do two/three sets per day
• Yoga may be useful to stimulate thyroid function, especially shoulder stands
• Avoid fluoride and chlorine: blocks iodine receptors in thyroid gland

FUNCTIONAL MEDICINE NATURAL TREATMENT OF HYPOTHYROIDISM & HASHIMOTO’S DISEASE

Hypothyroidism is a common condition that occurs more often with females.  There can be a number of different causative factors of Hypothyroidism.  It is important to conduct a thorough investigation into the exact cause of the disease and to identify the underlying body systems that are dysfunctional, these body overtime are what has likely caused the disease to manifest in the first place. 

Just treating the condition without assessing and addressing the underlying dysfunction will not resolve the condition, but rather give relief from the symptoms.  Assessing gut health, gut bacterial overgrowth, SIBO, nutrient levels including iodine, methylation and digestive function are all vital areas to be assessed.  A comprehensive blood panel should also be taken.

At our Perth clinic of Functional Medicine we have experience with thyroid disorders and other autoimmune conditions.  If you or a family member are suffering from a thyroid condition or have a number of the thyroid related symptoms we would love to hear from you. 

Have you had you thyroid bloods tested and been told they are “in range” however you still don’t feel right?  What treatment has enabled you to recover from your thyroid disorder?  Have you had your gut tested in relation to your thyroid condition?  Please leave a comment below.

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