First, you gotta know what you’re dealing with.
Hey friends! Today, I’m here to help guide you through the overwhelm and confusion that comes along with a diagnosis of hypothyroidism and Hashimoto’s Thyroiditis. I’m going to warn you, there is a lot of info to cover, so much so that I broke this post into two parts to organize it all in a more easy-to-follow way. This post, Part I, will cover what it means to have Hashimoto’s and hypothyroidism, how thyroid hormones and thyroid autoimmunity affect the body, and what kinds of blood markers you should be keeping an eye on. Part II will dive into my top nutrient, dietary, and lifestyle interventions for supporting a healthy thyroid and working towards remission. Okay! Let’s dive into Nutrition for Hashimoto’s and Hypothyroidism: Part I.
If you’re not familiar with Hashimoto’s, it is a type of autoimmune thyroid disease that leads to the destruction of the thyroid gland, a subsequent decline in thyroid hormone production, and the progression of hypothyroidism. Thyroid hormones affect every cell in your body, so this is kind of a big deal! Hashimoto’s is actually the leading cause of hypothyroidism in the US for those over the age of six.
And guess what? I have it. And some of my friends have it. And I’m guessing you know someone that has it, too—maybe even you! Guess what else? It’s eight times more common in women than it is in men, and I’ve got to say in my time spent practicing nutrition I am constantly floored by the number of women I meet dealing with this disease. So what can we do to take care of ourselves, despite this unfortunate diagnosis? The answer, luckily, is lots of things.
First, let me touch a little more on why we need thyroid hormones and what kinds of symptoms arise when we don’t have enough of them. Thyroid hormones are made within the thyroid gland, created out of iodine and an amino acid called tyrosine. Like I said, these hormones impact your entire body by controlling metabolism, body temperature, heart rate, rate of digestion, and cellular turnover, just to name a few.
Let’s take a little walk through the thyroid hormone cascade, shall we? The hypothalamus is responsible for keeping an eye on our thyroid hormone levels, and when needed it produces thyrotropin-releasing hormone, TRH, which then acts on the pituitary gland to produce thyroid stimulating hormone, or TSH. TSH acts on the thyroid gland to produce T3 and T4, the major thyroid hormones. Lower levels of these two hormones signal the hypothalamus to release more TRH, which produces more TSH, with the goal of producing more of the much needed T3 and T4 from the thyroid. It’s a feedback loop designed to keep your thyroid hormones in a delicate balance. Hypothyroidism is the result of too little thyroid hormone, while hyperthyroidism happens when there is too much.
T3 and T4 are the two key thyroid hormones that you normally hear the most about, with T3 being the biologically active form and T4 being the storage form. Our bodies produce way more T4 than T3, but they also convert T4 into T3, though this process is not always working as well as it should. Since these hormones are carried through the body by transport proteins, it’s important to measure free T3 and free T4 in blood work to get accurate views of the levels available to hormone receptors.
Then, we have another hormone called reverse T3, which again is usually ignored by conventional medicine. You know how I said that T4 is converted to T3 in the body? Well, when the body is under a lot of stress, whether it’s from infection, inflammation, external causes, or autoimmunity, it may decide to save some energy and convert T4 into reverse T3 instead of active T3. Reverse T3 doesn’t do us any good, and it’s basically just sucking away hormones that should be going towards making us that beautiful biologically active T3. So, in addition to getting your free T3, free T4, and TSH tested, reverse T3 should also be on the list.
Now, let’s talk about antibodies. This is where autoimmunity and Hashimoto’s come in to play. To put it simply, autoimmunity occurs when the body is attacking itself. Antibodies are normally used by the immune system to fight off foreign invaders, like viruses, and bacteria. When the body gets confused and begins destroying its own cells, these antibodies are referred to as autoantibodies, and they are the main marker for diagnosing autoimmune diseases. There are many different types of autoantibodies that can occur, which are specific to the part of the body they are affecting. When it comes to Hashimoto’s, the two we look at are the thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb). When levels of these antibodies are elevated, we can see there is an active attack happening on the thyroid gland. When we monitor the thyroid through bloodwork and see them fall, we know that we’re doing the right things to slow that attack and find remission.
You guys, it’s super important to have these antibodies tested. This is a huge piece of the thyroid health puzzle, and often doctors will ignore these extremely important markers. Be your own health advocate and ask that your thyroid antibodies be tested—like I said at the beginning of this article, Hashimoto’s autoimmune disease is the leading cause of hypothyroidism.
It astounds me that many allopathic doctors don’t look at these from the very beginning. In my own experience, the endocrinologist I originally went to told me I didn’t need to worry about testing antibodies, he said that this autoimmune disease was not one that we needed to worry about and that we would just focus on TSH. I’m sorry, but screw that! 25% of patients with one autoimmune disease will develop another one. That’s one of the reasons it’s imperative to calm the autoimmune attack inside your body. If your practitioner doesn’t hear your concerns and agree to collaborate with you on your plan of care, find a new one. I did, and I’m so grateful I took my health into my own hands.
Clearly, if we don’t have T3 and T4 in the correct amounts, all of those systems I mentioned above will be negatively impacted and many different kinds of symptoms can occur. BUT—this is where things get a little tricky—since Hashimoto’s can be active long before hypothyroidism occurs, someone may not have any symptoms or altered thyroid hormones until the tissue destruction is already well underway. We should, though, be able to see the elevated antibodies at this stage, which is important to note.
Common symptoms of hypothyroidism are feeling cold all the time, having a hard time losing weight, trouble sleeping, heart palpitations, dry skin, hair loss, menstrual irregularities, and major brain fog. If you have any of these symptoms, talk to your practitioner. Obviously, there are other reasons these issues could occur, but it’s important to monitor them and get to the root cause.
This might be TMI, but I was finally diagnosed with both Hashimoto’s and hypothyroidism after over three months without getting my period. My doctor ran some hormonal tests, called me up, and said she couldn’t believe I was even able to get out of bed in the morning! My results were that bad. Sure, I was tired and a bit down, and I’ve always constantly been cold, but I was also working full-time and getting my master’s degree! I just thought it was normal to feel that way when I was under so much stress.
And now I really want to point out—stress is a huge culprit in autoimmunity. Studies have found a connection between intense physical and psychological stressors and the onset of autoimmune disease. Let me be clear, we still have a lot to learn about autoimmune diseases, which involve genetic, hormonal, environmental, and immunological factors as well as gut health and other physiological states, it’s just useful to know that stress is part of that equation too. Unfortunately, once that autoimmune switch is flipped it can’t be completely turned off. It can, however, be subdued, which is what we refer to as remission. After my initial diagnosis of Hashimoto’s and hypothyroidism, I was able to reduce my symptoms and find remission after about two years of constant tinkering and paying close attention to my body. This number varies for everyone! That was just my personal experience.
Along with blood work to test for all of these hormones and antibodies, ultrasounds are often employed for identifying thyroid problems and providing a diagnosis of Hashimoto’s and hypothyroidism, which usually causes an enlarged thyroid gland.
Okay! That’s a lot of background info. It’s important that you find a practitioner that you trust, who will hear your concerns and work with you on a treatment protocol you’re comfortable with. I’d highly recommend looking for a Functional Medicine doctor or naturopath so you can work on your health as a whole, rather than solely focusing on the thyroid. And of course, having a nutritionist on your health care team is an amazing way to learn how to eat for your unique body, for life! I’m here for you if you’re interested in nutritional therapy.
Check out my next post, Nutrition for Hashimoto’s and Hypothyroidism: Part II, for specific dietary and nutrient recommendations to support thyroid health and calm autoimmunity.