Glossary > H > Hashimoto’s Disease

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Hashimoto’s Disease

What is Hashimoto’s Disease?

Hashimoto’s disease is an autoimmune condition where the immune system attacks the thyroid gland, causing damage and disrupting the production of thyroid hormones. It can lead to chronic inflammation of the thyroid and is the most common cause of hypothyroidism in the U.S. 

Hashimoto’s Symptoms

Hashimoto’s disease progresses slowly, and it is not unusual for symptoms to be missed at first or even for a person to be asymptomatic. Goiter is one of the common initial symptoms, and it is caused by the thyroid getting larger due to swelling. Chronic damage to the thyroid and the subsequent inflammation causes thyroid hormone levels to drop, usually resulting in the typical symptoms of hypothyroidism. These may include unexplained weight gain, brittle nails and hair thinning, depression, cold intolerance, persistent fatigue, a swollen face and pale skin, and memory issues.

What causes Hashimoto’s Disease?

Doctors and researchers are still not certain what causes the immune system to start not recognizing the thyroid as “self” which leads to the recurring damage. Genetics is believed to play a role, along with other factors including sex, age, and the presence of other autoimmune disorders. Some point to the idea that an outside trigger like a viral infection, such as Epstein-Barr Virus or Hepatitis C, may be associated with an increased possibility of developing the disease. 

How is Hashimoto’s diagnosed?

When a patient begins exhibiting some of the above mentioned symptoms associated with hypothyroidism, Hashimoto’s is typically diagnosed with a physical exam and laboratory tests that check for elevated TSH levels and the presence of thyroperoxidase (TPO) antibodies. If goiter is present but antibodies aren’t found in the blood, a thyroid ultrasound may be used to further inspect. Hashimoto’s may also be diagnosed earlier on if the patient has a family history of thyroid an/or autoimmune disease.

How do you treat Hashimoto’s Disease?

Treatment will depend on a patient’s blood tests. If there are elevated TPO antibodies but no hypothyroidism (normal TSH and Free T4 levels), no treatment is needed. Patients with slightly elevated TSH may not need treatment as well and are usually monitored with repeat testing. Clear hypothyroidism is treated with oral synthetic levothyroxine, a thyroid hormone replacement. It may take a while to find the proper dose for each patient, so once treatment has started TSH testing is usually done every 6-8 weeks to observe how the thyroid is responding. Most people with Hashimotos that have hypothyroidism will need levothyroxine treatment their entire life, with yearly TSH testing to check-in on the dosage. There are also less conventional ways to go about treatment that focus on nutrition and wellness, such as reducing stress or restriction and elimination diets. 

What causes Hashimoto’s to flare up?

A number of factors have been suggested as potential causes of a Hashimoto’s flare up. Certain minerals have been postulated to have a link to flares, such as zinc, selenium, and iodine deficiencies. Certain medications such as estrogens or calcium and iron supplements, may affect how well levothyroxine works by obstructing the proper dosage from being utilized. A common correlated trigger of flare ups is the presence of high levels of emotional and physical stress. Stress can increase cortisol production, which may slow the body’s metabolism and cause thyroid hormone levels to lower. Diet that may cause inflammation has also been linked to Hashimoto’s flare ups. 

Is Hashimoto’s related to Leaky Gut?

There is a strong correlation between thyroid and gut health. Studies have shown that low thyroid hormones can disrupt the intestinal barrier leading to leaky gut, and poor gut health in turn can suppress thyroid function. Thyroid and intestinal diseases commonly coexist, Hashimoto’s often co-occurs with Celiac Disease and Non-celiac wheat sensitivity.

What is the Hashimoto Diet?

While there is no specific diet currently proven to treat Hashimotos, clinical evidence supports a few ways to approach nutrition that may help with the symptoms and flares of the disease. One recommendation is an iodine-free diet. The thyroid uses iodine to synthesize thyroid hormones, and studies have shown that iodine may be harmful to those with Hashimoto’s as they may be overly sensitive to the effects of iodine. 

The most commonly explored diet is the autoimmune protocol (AIP),

a modification of the Paleo diet that attempts to reduce inflammation. The diet starts with a strict elimination of many foods, including foods that are usually considered part of a healthy diet such as nuts, nightshade vegetables, legumes and eggs. Refined sugars, emulsifiers, coffee, and alcohol are also avoided. These foods have been suggested to disrupt the gut flora and intestinal barrier, which can particularly be a problem in those with autoimmune conditions as it can lead to dysregulated antigen presentation. Besides the foods to eliminate, AIP promotes consuming nutrient-dense whole foods such as vegetables, fruits, and mono and polyunsaturated fatty acids, as well as a slow reintroduction phase of foods that were eliminated at first as it would be nutritionally harmful to have entire food groups removed permanently.

Do probiotics help with Hashimoto’s?

While specific probiotics have not been proven to directly alleviate Hashimoto’s symptoms, gut health has routinely been shown to be an important factor in the disease, in which probiotics could have a helpful effect.