{go to the videos if you learn better by listening}

    38811961 – stressed mother with the baby sitting on a sofa

    Mary had been to her doctor because she had been losing a lot of hair. She thought it was the stress of having a 7-month-old and a job that was demanding. She had heard that soon after the baby, women generally have a hair loss from low thyroid particularly a condition called Hashimoto’s. So she asked her doctor who said it was probably due to her hormones and she will be fine. She insisted on being checked for Hashimoto’s and this was “positive” but her thyroid tests were “normal”. So her doctor told her there is nothing she can do but keep checking her thyroid to catch it early enough if it starts failing. The chances are it will get better in a few months.

    Mary was shocked that she was told to “keep checking her test until they are abnormal or the thyroid fails”. On questioning this approach she was also educated that Hashimoto’s can be a progressive disease or self-limiting and there is nothing that can be done.

    I hear this all the time and note that people are angry with their doctors.

    What we fail to understand is that each physician has a different training and experience.

    If an answer does not satisfy you then this is where it becomes important to seek a different approach. Traditional medicine has always been about relieving a suffering A.K.A Symptoms instantaneously with a drug if it has been known to help with the symptoms.

    In Hashimoto’s there is a period of time everything looks normal and then the thyroid gland begins to fail. Though there are numerous factors that affect the onset of thyroid failure.

    I will try and help you understand in simple terms what you need to know.

    Understanding what Hashimoto’s Thyroiditis is:

    It is the most common Autoimmune condition, and most common cause of thyroid failure and is the most common cause of endocrine dysfunction.

    It is due to a chronic inflammation (redness, swelling, pain) of the thyroid gland. However, it is mostly a painless condition.

    What does autoimmunity mean?

    Auto means self, immunity protection, so when the body is trying to protect itself against itself it leads to self-destruction like the friendly fire causing personal devastation.

     One has to have a genetic susceptibility so it also it runs in families.

    Usually, there is a stressor that upsets the adrenal system. The hormones cortisol tends to increase the activity of the soldiers ( antibodies) who fight infections and at the same time decrease the soldiers ( suppressor cells) who control this fight. So the fight against infection gets to be long-standing and destructive to the thyroid. The checks and balances are therefore off.

     

    Tell me a little more about this autoimmune condition:

    Hashimoto’s is named after Dr. Hakaru Hashimoto who discovered this as a new problem within the thyroid.

    It used to be that 1 in 1000 women used to get it and now we have 46 in 1000 so almost 5% of women will suffer from this.

    Who does it affect?

    Mostly women in the 40’s to 50’ and among people who have it 8 out of the 10 would be women.

    We have 6 different types:

     

    The classic is the one described: Most common. 0.5% to 30% can be associated with a cancer of the thyroid.

    What happens to the thyroid?

    The thyroid gets attacked by the immune system causing lots of scarring and destruction. The thyroid becomes firm to touch, has a lot of inflammation and can have some large or very small scared cells.

    The second type of autoimmune Hashimoto’s identified are most scarred ones are called the fibrous and it has a lot more scarring and seen in the older population. The scarring can be so severe it may look like tumors of the thyroid commonly called nodules. This can get subjected to biopsy revealing not a clear picture and can lead to the removal of the thyroid.This puts the patient at a lifetime of drug replacement and symptoms. It may be a more advanced stage and can lead to advanced symptoms of low thyroid state called myxedema. ( thick skin and layers of the skin filled with mucus material

    The IgG-4 has different immune cells attacking the thyroid and has less scarring and less hard than the usual. It also has some local inflammation of the veins in the leg. It is the type seen in younger men more than women.

    The other 3 variants,(juvenile, postpartum, hashitoxicosis) are reversible and intermittent.

    Juvenile is seen in under 18 years and can present with a goiter (swelling of the gland)

    The Hashitoxicosis: can mimic Grave’s disease and can last up to 3 years and then evolves into hypothyroidism.

    The last one postpartum thyroiditis is seen in 8% of women and occurs 2 months to 5  months after childbirth. Can present itself and anxiety and then go onto postpartum depression-like symptoms. Multiple pregnancies can lead to permanent hypothyroidism.

     

    How do I know if I may have Hashimoto’s?

    Symptoms can be local or systemic that is all over and vague.

    Local symptoms:

    This is due to the increase in inflammation and scars being formed as the thyroid scarring reaches out and affects the voice box nerves(laryngeal), compresses the windpipe (trachea) and sometimes pushes against the esophagus( swallowing)

     

     

     

    Other symptoms are varied as the thyroid affects every cell in the body:

    Let us go from head to toe:

    Brain health gets affected listing some symptoms: Difficulty with memory, sometimes in advanced cases imbalance of the body and difficulty in naming what a specific object is used for instance can call a pen a pen but will not know what to do with it.

     

     

     

    Skin issues: Mostly due to destruction of the sweat glands and decreased sebum production (natural oil of the skin)

     

     

     

     

    Heart: The heart muscle becomes flabby and there is a decrease in the pumping ability and so heart failure and low rhythm can be common.There is also evidence fluid can build around the heart.

    So Shortness of breath decreased endurance and increased in heart failure and restriction of both the muscle and the fluid outside the heart muscles(pericardial effusion) look big but are weak due to this.

     

    Skeletal muscles also become weak even though they look big: this because they get filled with this slimy fluid from low thyroid but they are weak.

    In the lungs too: can affect breathing due to mechanical obstruction in the windpipe area where it lies or due to the capacity of the lung getting affected.

     

    Blood and it’s production: Anemia is very common and can be from the decreased formation or lack of the raw materials all common in the thyroid of autoimmune type.

     

     

     

    Miscellaneous issues: It affects the kidney function and sex hormones and leads to the following:

     

     

    So as you can see the symptoms can be varied, high, low or mostly low.

     

    How do I get diagnosed with Hashimoto’s?

    Hashimoto’s has to be ruled out in anyone having low thyroid symptoms as it is the most common. The 2 main blood tests done are (besides the TSH and thyroid hormones) are antibodies against one, an enzyme and one a protein in the thyroid.

    Blood tests:

    Antibodies against 2 parts of the thyroid:

    The enzyme thyroid peroxidase which helps to get the iodine oxidized so it can get attached to the tyrosine and form the hormone. If it is not present, the thyroid hormone production goes down to zero. So in Hashimoto’s, it’s action is blocked, decreasing the number of hormones released.

    The thyroglobulin is the protein in the gland that carries the amino acid tyrosine. If these antibodies are present it may indicate it is the early phase of the disease so aggressive intervention may even decrease or reverse the destruction of the thyroid.

    Ultrasound:

    The ultrasound of the thyroid shows dark areas as the thyroid gets destroyed. In the fibrous, it can show a lot of strands and nodules needing or indicating biopsy.

    Is biopsy indicated?

    Hashimoto’s’ is a clinical and medical diagnosis. When the scarring is so much that it seems hard to palpate with possible nodules, only then a biopsy can get done to ensure there is no cancer. The issue with this is the results are always equivocal. Despite the fact that even in the case of real nodules the incidence of thyroid cancer is less than 5 % most patients needlessly lose their thyroid to surgery due to overtreatment.

    So being very certain that this is cancer has to be emphasized. Unfortunately, people are paralyzed by the word cancer and tend to want the gland removed and the medical system is happy to do this so they don’t have to deal with monitoring it [ given how litigious the society is cannot blame the system].

    (Footnote: Thyroid cancers rarely cause death and they are very slow growing and in some cases have been shown to be reversed with proper nutrition).

    The only advice and recommendation I would have are:

    Protect your thyroid as much as possible. Once it is removed it is an irreversible state and no amount of medications can give you the same level of functioning as the thyroid itself.

    Work on reversing the autoimmunity.

    Treatment:

    If the biopsy indicates IgG4 then steroids can be used short-term and reverse the inflammation. The gut always has to be addressed.

    Selenium supplementations have been shown to help reduce the autoimmune state

    Newer treatments may be available but working on the cause of the immune dysfunction is important.

    The most important factor in the management of the Autoimmunity of the thyroid is the management of stressors and immune system.

    STRESS Though that has not been proven beyond doubt. However, it was a feature in many studies that stress needs to be handled.

    • Managing stressors would be the first step.

    • Remove the stressors if and when feasible(example: changing jobs)

    • Decrease the Disruption of stress with meditation, mild exercise, vitamins.

    Good nourishment: Most important is to take care of the gut bacteria.

    1. Take good quality probiotics

    2. Eat lots of fiber-rich foods: whole grains, vegetables and some fruits( if there are insulin resistance decrease fruits to 1 or 2  a day)

    3. Plenty of water.

    4. Staying gluten-free is very important. Sometimes fewer grains also decrease the inflammation. The association of celiac disease with autoimmune thyroid is very clear and so every patient with Hashimoto’s has to be screened for gluten sensitivity.

    5. Omega 3 and Omega 6 balance has to be checked ( blood test ) to help with replacement.

    6. Vitamin D

    7. Selenium-rich foods like brazil nuts.

    Monitoring the activity of other hormones:

    • Insulin: Insulin and Hemoglobin A1c

    • Cortisol: Salivary or urinary cortisol

    • Estrogen: check levels with urine and determine the herbal supplements that will be needed.

    Supplements that may benefit based on what part of the immune system has been triggered:

    If mostly Hashimoto’s

    • Vitamin D: a very important modulator of any autoimmune conditions. The level that is comfortable will be 55 to 80.

    • Selenium: has in some studies shown to decrease autoimmunity.

    • Vitamin A: this is the only vitamin that can lead to toxicity if overdone so seeking a health care provider’s input on the dose is important.

    • Glutathione: I do prefer intravenous glutathione this is detoxification agent in the liver and supporting the liver for better activation of the thyroid hormones is important.

    • Pancreatic enzymes: usually check the activity or at least give in the high antibody states to improve absorption.

    • Probiotics: is important to make sure the gut bacteria are supported till the diet is changed.

    Management overall even today remains the addition of thyroid hormones.

    Taking synthetic or natural thyroid has varied effects as the autoimmunity can be rampant or mild. Constantly changing the dosage to manage symptoms has been the challenge, as the problem is not with the thyroid but the immune system.

    I would get a complete assessment of the thyroid with:

    • TSH (thyroid stimulating hormone)

    • T4

    • T3

    • Reverse T3 in addition to the antibodies as stated above.

    If T4 and T3 are low then I would include both T4 and T3 synthetic or natural.

    I prefer synthetic over compounded because the amount of the medication is the same in every tablet.

    Natural tablets sometimes get compounded with iodine. Several studies show that Hashimoto’s is more prevalent in Iodine replete areas and not in depleted areas.

    Avoid Iodine unless testing show you may be deficient in this. Urinary excretion of >220 mcg/24 hr can be responsible for autoimmunity.

    If there is increased reverse T3 I focus on gut restoration. Avoiding gluten and focusing on vitamin supplementation by testing.

    Addressing the whole picture as thyroid is not isolated it is simply the target in Hashimoto’s

    So the best option is to reduce the autoimmunity by addressing all 5 pillars of health:

    • Nutrition support: Plant-strong and less animal protein. Selenium and fiber-rich foods and gluten and iodine free foods [Non-iodized salt]

    • Detoxification of the gut and the liver to help with proper activation of the thyroid hormone. May need glutathione or N-Acetyl cysteine and cruciferous vegetables.

    • Assessing the other hormones.( insulin, cortisol, leptin, and adiponectin)

    • Managing stress ( Meditation, exercise, Epsom salt baths, journaling, structure, sleep)

    • Optimizing an exercise program that does not activate the immunity but calms it down.

    On a fun and surprising note

    On an interesting note the one substance that reduces the incidence of Hashimoto’s is Tobacco, however, it increases the risk of Graves.

    So tobacco tea carefully made may help if there is severe autoimmunity.

    In conclusion

    So Mary had to simply understand she did not necessarily be stuck with watching her thyroid be destroyed but she would be able to take a systematic approach to help support the thyroid and reduce the autoimmune process.It was true that her thyroiditis was temporary, however, she also needs to understand if she did not take the steps to be healthy overall, the chances this will return at her next pregnancy is high. She may also after a couple of pregnancies have a persistent thyroiditis. 

    A little note…

    To date, Hashimoto’s continues to rise and its rise is not tempered by any specific intervention. It is an immune function disorder and therefore careful assessment of the immune system has to be made. Simply replacing the thyroid hormone usually is inadequate. The treatment has to be carefully orchestrated to achieve less autoimmunity, better functioning of the thyroid, adrenal, and pancreas.

    So in summary

    • Identify the stressor

    • Assess the immune system

    • Assess the nutritional status

    • Change the diet

    • Gut bacteria

    • Cleanse the liver.

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