Thyroid Thursday Episode 11: Hashimoto’s thyroiditis
Hi, this is Dr Eric Balcavage and we are back for another edition of Thyroid Thursday. We are going to continue the discussion of the patterns of hypothyroidism. We have talked about primary hypothyroidism, hypothyroidism secondary to pituitary hypofunction, thyroid under-conversion, thyroid over-conversion, we have talked about elevations in the thyroid binding globulin as a cause of hypothyroid symptoms, and we’ve talked about thyroid resistance as a cause of hypothyroid symptoms.
Today, we are going to talk about Hashimoto’s thyroiditis, which is the number one cause of hypothyroid symptoms in the United States. Technically it isn’t really a condition of the thyroid gland itself, it’s an autoimmune disorder. That means that your immune system is attacking your thyroid gland.
So, let’s get into it. What is Hashimoto’s thyroiditis Hashimoto’s thyroiditis? As I said, it’s an immune system dysregulation where your immune system is starting to attack parts of your own thyroid tissue. The two main targets are thyroid peroxidase and thyroglobulin. Thyroid peroxidase is the enzyme that helps make thyroid hormones, thyroglobulin is the base product of all thyroid hormones.
When your immune system has decided that one or both of those need to be destroyed, that then starts to cause elevations in the thyroid antibodies, you get increased destruction of the thyroid tissue as those two things are being destroyed and that sets the stage for hypothyroid symptoms because you get either too much or too little thyroid hormone dumping out into the system at any one time, which could create symptoms of both hypothyroidism and hyperthyroidism.
Hashimoto’s thyroiditis is the number one cause of hypothyroid symptoms in the United States. By far it is the most common condition that brings patients into my practice with chronic thyroid symptoms. The people I that come to my office either have been diagnosed as hypothyroid, (but not Hashimoto’s) or they’ve been told that they are just nuts, crazy or lazy and there is no thyroid problem, and yet they have these wildly fluctuating hypo and hyperthyroid symptoms.
Can Hashimoto’s be well managed by just thyroid hormone support like Synthroid?
We are finding that there can be some benefit to thyroid hormone medication. Supporting someone with thyroid hormone T4 and/or T3 may improve symptoms, but it doesn’t really address the underlying issue. The underlying issue is the fact that you have an immune system that’s decided that your own tissues need to be destroyed. That’s the real problem here. The reason that I think that so many people fail in traditional models of treatment for hypothyroidism is that the vast majority of them are being given thyroid hormone and nobody is addressing their immune system which is really the underlying issue. Giving them thyroid hormone may reduce the amount of hormone being produced by the thyroid gland, which therefore down regulates TPO enzyme activity, which may therefore decrease some of the autoimmune activity, but anything that upregulates the immune system, whether its stress, toxins, foods like gluten and dairy, if they are upregulating the immune system, they can up regulate the immune attack and create disruption on the thyroid.
So, the real issue for people who have hypothyroidism caused by Hashimoto’s is to address the immune system. The vast majority, 70-80% of the immune system lies just underneath the GI tract. It’s really important that you identify whether your condition is caused by Hashimoto’s thyroiditis, one of these other patterns, or one or more of those patterns along with Hashimoto’s. You really need to identify if the problem is that you have an autoimmune attack, because what the research shows is that if you don’t calm the immune system down, not only will you have one autoimmune disorder, but the likelihood is that you are going to develop multiple autoimmune disorders over time.
How do you know, if you have Hashimoto’s, if Hashimoto’s thyroiditis or this autoimmune disorder is the cause of your hypothyroid symptoms?
- If you have symptoms of both hypo and hyperthyroidism, you probably have Hashimoto’s thyroiditis. If you feel hypo/hyperthyroid and you go to the doctor and they say, “oh, your TSH and your T4 levels are normal”, you probably have Hashimoto’s.
- When you go to your doctor or your endocrinologist and they’ve already diagnosed you as hypothyroid and they’ve put you on thyroid medications and every time you go back to get your values checked your TSH is really high or your TSH is low and you’ve got to tweak the medications up and down almost every time you go back, you probably have Hashimoto’s.
- If you’ve gone through a series of different medications to try and help your thyroid physiology, you probably have Hashimoto’s.
- If you get that honeymoon experience when you initially get your thyroid hormone, but then your symptoms come right back, you probably have Hashimoto’s.
- If you have other autoimmune disorders, you probably have Hashimoto’s.
These are just some of the common signs or clues that you may have Hashimoto’s, but by far the clear majority of the patients that I see have Hashimoto’s. You should have your thyroid antibodies checked on every blood test that you get done. TPO and TGA antibodies should be run on every blood panel you get done until you find out whether you have Hashimoto’s. Once you determine that you have Hashimoto’s you don’t really need to run them anymore, you already know you have an autoimmune disorder, but if you have hypothyroid symptoms and you are struggling, continue to get your thyroid antibodies run.
What do you do if you have Hashimoto’s and you are currently under treatment, but you don’t feel well?
You need to find a functional medicine practitioner like myself who is knowledgeable in not just TSH and T4, but the whole thyroid physiology. The doctor needs to be very knowledgeable on the immune system and how to calm the immune system down. They need to be well versed in gut and GI function because, as I said, 70-80% of the immune system lies just underneath the GI tract and we often see people with GI disruption and barrier disruption have autoimmune disorders like Hashimoto’s. If you haven’t been diagnosed with Hashimoto’s yet, but you haven’t had those thyroid antibodies run, make sure you do it. Ask your current doctor to run thyroid antibodies on your next blood panel or find a functional practitioner like myself who will run them for you.
Hopefully this helped out. I will have another thyroid educational video ready for you next Thursday. If you have any questions, put them below the video, or you can always call my office for help, 610-558-8920. Take care.
