A STEP-BY-STEP APPROACH TO HASHIMOTO'S THYROIDITIS

Hashimoto's Disease is one the most common causes of thyroid problems, particularly hypothyroid. However it is also one of the most commonly missed and mistreated causes as well. Hashimoto's is diagnosed most commonly by lab testing that reveals elevated antibodies on a lab test. It can also be diagnosed with an ultrasound or biopsy report.  There is no definitive way to completely rule out Hashimoto's because it would entail biopsy of 100% of the thyroid. When Hashimoto's Disease is found it is a lock for an autoimmune process in which the immune system has triggered the thyroid as a foreign invader and is trying to destroy it. This point is critical because it is NOT inherently A THYROID PROBLEM. Let me repeat this foundation point: Hashimoto's Disease is not primarily a thyroid problem. It is an immune system malfunction.

Possible Symptoms of Hashimoto's Thyroiditis:
✓ Weight gain or weight loss (because thyroid hormone output can fluctuate early on)
✓ fatigue
✓ brain fog
✓ hair loss
✓ dry skin
✓ thinning of outer 3rd of eyebrows
✓ palpitations
✓ tremors

Not A Thyroid Problem

Let me explain further. Conventional training has taught me and other practitioners that we treat Hashimoto's disease no different from any basic hypothyroid condition; we replace thyroid hormone.  However in Hashimoto's the thyroid is really just the innocent bystander who got falsely accused of a crime he didn't commit. The immune system is the real culprit who is misguided and killing the thyroid. If that critical component is not at the core of your thinking, treatment and further investigation then you are treating as superficial as you can get. The sad reality is that most people don't even get a diagnosis for years because it is not even looked for when symptoms are present. 

So What Do I Do? 

If you have been diagnosed with hypothyroidism and never had your antibodies checked, the first step is get them checked and make sure you get an ultrasound.  The antibodies you need to request are TPO (thyroid peroxidase) and TGB or TAA (Thyroglobulin Antibodies). If you request these from your medical provider they should be happy to run them for you. If not, look for someone who will. You are paying them. They work for you. The ultrasound is a screen to look for something really abnormal that needs further investigation like a biopsy. Thyroid cancer is relatively common and needs to be looked for or you won't find it. 

Educate Yourself

Secondly, educate yourself! Don't blindly assume others will do what's best for you. Everyone is different and you won't even know the right questions to ask your practitioner if you haven't done some reading. You will have to wade through some things online but you will find some good info if you look.  Stop the Thyroid Madness and Facebook groups like Hashimoto's 411 are popping up often helping people get educated. One of the first areas you will want to educate yourself on is the link between the immune system and the digestive system. In other words, your diet matters significantly! With any autoimmune disease the most important place to start the healing process is through using food as medicine.  Don't tune out here. Seventy to eighty percent of your immune system lines your digestive tract. If there is an unhealthy barrier system due to lack of sleep, processed foods, gluten, stress, or over-training then every time you eat you may possibly be damaging and over-working your immune system. Read about "leaky gut" or increased "intestinal permeability" and work toward an autoimmune paleo diet (AIP). 

Find an Advocate

Self education is foundational but does not negate the need of finding a health care practitioner who can take you deeper.  The reason why is because you will need to investigate deeper as to how to heal and balance your overly reactive immune system. If you don't, there is a risk of additional autoimmune diseases presenting in your future. Supporting gut healing, hormonal balance and inflammation in the body can not only improve your symptoms but it can also prevent future disease processes that are dependent on these broken systems.   Functional Medicine's philosophy is built on finding the underlying cause rather than just treating symptoms. If you can find a Functional Medicine practitioner near you, you will gain one of the best teammates you can hire.  Functional lab testing is essential to rule out digestive pathogens (i.e. bacterial infections, parasites, candida, overgrowth of opportunistic infections), hormonal imbalances (i.e. Hypothalamic Pituitary Adrenal dysfunction, estrogen dominance), or detoxification issues affecting your mitochondrial health and neurotransmitter production. These tests are typically around $500 total out of pocket but can provide a huge direction when it comes to focus on healing the body. 

Medications Versus Supplements

If you catch Hashimoto's early, there is a chance you can avoid needing thyroid replacement medications. However, it is not the worst thing in the world if you do need thyroid support. There are two main options for prescription support: synthetic medications (synthroid/levothyroxine, cytomel/liothyronine) or natural dessicated medications (Armour, Nature-throid, Westhroid). Most people do better on the natural dessicated glandulars but this is when you need a practitioner who is thoughtful and will work with you until you find the right medication for you. Once a new medicine is started you will want to recheck your labs in 4-6 weeks to see how you are responding and keep your practitioner abreast on how you feel. Very few general practitioners are thoughtful in this area but I was blessed to learn under a very thoughtful DO and he taught me a lot in this area about listening to patients and being a constant learner. Thank you Dr. Simonak! 

So if you have discovered Hashimoto's early and are not terribly symptomatic (weight gain, fatigue, brain fog, dry skin, hair loss...) then you should go hard after the root cause and see if you can facilitate healing with supplement protocols.  This should be lab based. Blindly supplementing can at times be dangerous and make things worse. But again, do not feel bad if you need a medication. Thyroid medications are not terribly expensive and for the most part are safe to be on long term. If you are a young female looking to get pregnant it is vital that your thyroid levels are optimal and this sometimes requires frequent lab checks and tapering of medications. 

Final Thoughts

While you are working with your thoughtful PCP or Functional Medicine Provider to heal the root cause of your Hashimoto's Disease, you may also want to consider looking into Low Dose Naltrexone (LDN). There are not many medications that I am excited about but this is one. The risk to benefit ratio is amazing and can help balance the immune system while the body is healing. It may not be needed long term but may prove very helpful at reducing your antibody count and need for increasing medication dosages. 

Educate + Teamwork = Healing

Here is the winning equation again. Get serious about self-educating. Let me know if you want additional reading material and I can recommend several books and websites. Next start looking for your teammate/health detective who can help you look deeper. And get to work! Don't sit on the sidelines and wait for someone else to take care of you and don't even rely on a medication or supplement protocol. Your choices each day to eat a clean nutrient dense diet, think positively, go to bed early, and exercise will be the most potent prescriptions you can fulfill! 

For Further reading, check out this very thorough article from Verywell.com on thyroid disorders.