Ask Dr. Casey: Hashimoto’s Disease
Hi Dr. Casey,
I was recently diagnosed with Hashimoto’s disease. Is there anything I can do to support my thyroid or reverse the autoimmune process?
- Bridget R.
Hi Bridget,
Hashimoto’s thyroiditis is the most common autoimmune disease disorder of the thyroid, and one I see pretty frequently in my practice. It is more common in women, so you are not alone in your new diagnosis. What Hashimoto's thyroiditis means is that your body is producing antibodies against certain proteins in your thyroid, making it likely less effective to work as an organ. The thyroid helps to run our metabolism, control body temperature and I see as essentially as producing the “go” juice for many of our cells. Having too little of active thyroid hormone can result in weight changes (especially gaining weight), coarsening or loss of hair, depressed mood, constipation, fatigue, dry skin, intolerance to cold, slowed mental acuity … and symptoms can show up differently in different people.
I run thyroid antibodies more frequently than most physicians because I have found it is actually pretty common for patients to be euthyroid (normal TSH, the general screening lab) with the presence of autoantibodies of anti-thyroglobulin and anti-thyroperoxidase. If caught early and before it turns to overt hypothyroidism, I have found more success in preventing the symptoms listed above by decreasing autoantibody load earlier in the disease process.
But before we get to the what for treatment, as a naturopathic physician, I love to ask the question why to try and better understand the root cause. Why has your body started to attack the thyroid, Bridget? Of course, it is a multifactorial answer, and one that often leads to the easy scapegoat of genetics in addition to exposure to endocrine-disrupting chemicals, nutrient deficiencies, hormone imbalance. While I always take into account this biological view, I also try to zoom out for the whole-person view of mind, body and soul. I appreciate Canadian medical doctor, Gabor Mate, and his work for this very reason. He asks, “Why is there this civil war in the body?” Does it have to do in part with our own self-narrative? Thoughts of “I am not enough” or “I do not like myself” are attacks we can launch on ourselves so easily in this modern era (and yes, done by women more commonly than men, usually). Mate also posits that, “When we have been prevented from learning how to say no, our bodies may end up saying it for us.” In addition to the physiologic causes so emphasized in modern-day medicine, I do ask patients about their boundaries and self-talk is a part of the healing journey, as well. This portion is the harder, deeper work. From a whole-person perspective, taking a supplement or drug is often just a part of the solution.
Nutraceutical and sometimes pharmaceutical treatment can be helpful tools for improving symptoms and decreasing the load of autoantibodies. If the TSH level is very high, indicating a lower functioning thyroid, beginning a pharmaceutical will be very helpful in reducing symptom severity and normalizing TSH levels. However, to reduce autoantibody load, I use various nutrition and supplement interventions as well.
Nutrition is a key aspect in treating any autoimmune disease, from the naturopathic physician’s standpoint. In the medical world, anything that ends with “-itis” implies an inflammatory process in the body, and Hashimoto’s thyroiditis is no different. Removing inflammation-producing products such as processed foods and decreasing sugar while increasing a whole-food diet can be a really powerful change. There has also been quite a bit of thought on how some components of gluten can cross-react with thyroid proteins, worsening disease. While research evidence shows gluten avoidance does not improve outcomes, I have seen some clinical benefit with patients in my practice who avoid gluten in both their symptoms and autoantibody levels.
Supplements can also be supportive to patient outcomes, and I have a few favorites. There are a number of studies showing the efficacy of selenium decreasing antibodies seen in Hashimoto’s thyroiditis. Selenium is a cofactor in thyroid metabolism and is a common deficiency, so including 200 mcg daily through either supplementation or food (2 Brazil nuts is usually sufficient) can be an easy add-on. The inner filet of aloe vera also has evidence in decreasing autoantibodies, as well. Omega-3s in the form of fish oil also have some decent evidence behind them, especially since it is anti-inflammatory support. Those with Hashimoto’s thyroiditis also tend to be lower in Vitamin D, and adequate levels are essential. I think about immunomodulating herbs, as well, including astragalus, mushroom extracts, and aloe vera (mentioned above). Black cumin seed is another powerful plant compound that has growing evidence behind it for decreasing autoantibody load and decreasing symptoms.
One thing to look out for, Bridget, is progression to other autoimmune diseases. Oftentimes autoimmune disease does not occur in isolation. Hashimoto’s has an increased correlation with celiac disease, especially. With autoimmune diseases in general, I see it as our body’s way of trying to scream at us: “Hey! Change something here! I am struggling and am trying to tell you!” So while not always easy, seeing autoimmune disease as an invitation to take better care of ourselves can be helpful in both treatment and prevention.
