Hashimoto’s is an autoimmune thyroid condition that results in hypothyroidism due to the destruction of the thyroid gland by the immune system. Symptoms of Hashimoto’s may include those associated with hyper and hypothyroidism, like fatigue, anxiety, depression, weight gain, weight loss, cold/heat intolerance, and pain.
Testing for Hashimoto’s should include thyroid antibody tests and a thyroid ultrasound. See below in this post for more information on testing.
Hashimoto’s is a progressive condition, and 5-stages of Hashimoto’s have been identified. During the first stage, a person just has the genetic predisposition to develop Hashimoto’s, but for all intents and purposes, they do not have thyroid disease or autoimmune disease. Their thyroid function is normal, and there is no attack on the thyroid.
In the second stage, the immune system begins to recognize the thyroid gland as a foreign invader, and immune cells become lodged in the thyroid gland. At this stage, a person will have symptoms, but their TSH, T3 and T4 will be normal. However, thyroid antibody tests may reveal that the person has thyroid antibodies. If left untreated, this condition often progresses, especially if a person has a high number of thyroid antibodies. There is also a variant of Hashimoto’s known as seronegative Hashimoto’s, where no antibodies are present, but a person will still have immune cells in the thyroid gland. These can be measured through more invasive testing like cytology, where a needle is inserted into the thyroid gland and thyroid cells are withdrawn, then evaluated under microscope.
The third progressive stage occurs when the thyroid loses its ability to compensate, and thyroid hormone production starts to become affected. This stage will show a mildly elevated TSH (between 2-10), while the T4 and T3 levels will remain “normal”. This is often described as subclinical hypothyroidism. Also, TSH may fluctuate because the thyroid is still somewhat able to compensate. More symptoms are usually present at this stage, however, some doctors refuse to prescribe medications. Many patients are told to come back when their thyroid begins to burn out. Read more about this in my post: What To Do If Your Tsh Is Normal And You Are Anything But.
The fourth stage is defined as thyroid gland failure, where the thyroid gland loses its ability to make thyroid hormones. Too much of it has been destroyed, TSH will be elevated, T4 and T3 will be low, and you will finally be “diagnosable” and “treatable”. At this point, most conventional doctors are willing to prescribe medications. However, I would argue that people as early as stage 2 can benefit from medications, which allow the thyroid gland to rest and slow down internal inflammation by reducing thyroid hormone production. Conventional medicine states that if you start thyroid hormones, you will never be able to get off them. I disagree. Reports have shown that thyroid function spontaneously returned in 20% of patients with Hashimoto’s. Thyroid function will remain normal in these patients, even after thyroid hormone replacement is withdrawn. Studies also show that once the autoimmune attack is stopped, the damaged thyroid has the ability to regenerate.
The fifth stage of Hashimoto’s, which is unknown to many, is progression to other autoimmune diseases, such as Sjögren’s, lupus, and many others. Some doctors offer to test their patients annually for additional autoimmune disorders for this reason.
Because Hashimoto’s is progressive, things can go from bad to worse if you don’t make a concerted effort to improve them. This is because our environment impacts our disease expression and disease progression. Various triggers, ever present in our environment, can accelerate the movement between the stages, while lifestyle and functional medicine interventions can slow down the movement between the stages and even help a person move backwards, reversing the condition.
In order for an autoimmune thyroid condition to develop, the following factors need to be present:
1. The right genes
2. Environmental triggers
3. Intestinal permeability
But environment is far more important than genes. Research leads me to believe that most of us actually have the genetic predisposition to develop autoimmune thyroid disease and when presented with a strong enough trigger, or multiple simultaneous triggers that overwhelm the body’s natural defenses, an autoimmune thyroid condition is inevitable.
For example, A 1997 study of children who were between age 0 and 7 at the time of the Chernobyl nuclear fallout and lived close to the Chernobyl nuclear reactor showed that 80% of them had thyroid antibodies, compared to 17% of genetically similar children who were farther away from the Chernobyl site.
Study after study is showing that rates of Hashimoto’s are going up with each passing year. The likely culprit? Environmental toxicity in our air, water, and food that weakens our internal resilience.
In my research and work with Hashimoto’s patients, I’ve found that Hashimoto’s is caused by a combination of nutrient depletions, food sensitivities, an impaired stress response, and impaired ability to handle toxins as well as chronic low-grade infections. Intestinal permeability is also present.
If you or your family members are genetically at risk for developing Hashimoto’s (or another autoimmune condition), here are some things you can do to reduce your likelihood of getting Hashimoto’s:
1. Get to the bottom of your gut problems. We know that intestinal permeability (aka leaky gut) is present in every case of autoimmunity and often precedes the development of Hashimoto’s. Symptoms of leaky gut may include bloating, diarrhea, constipation, stomach aches, acid reflux and irritable bowel syndrome. According to the Institute of Functional Medicine, many people develop IBS 5-10 years before an autoimmune diagnosis. Your poops should be well-formed, easy to pass, and should occur with a frequency of once or twice per day. If you’re pooping once a week, we have a problem! If you have a hard time passing stools or have hemorrhoids, this is also a problem. Check out the Bristol Stool Scale. You should be at a 3 or 4 on most days. If you’re not, we need to figure out why. Gut problems are often caused by infections like H. pylori, parasites like Blasto, SIBO, an imbalance of bacteria, and enzyme deficiencies or food sensitivities (especially to gluten, dairy and/or soy). Even stress can be a factor in gut permeability. Sometimes it’s a combination of all of the above. I recommend doing a 3-4-day stool collection to determine if you have an infection in the gut, and follow the suggestions below for more information.
Figure out your Food sensitivities. Food sensitivities create intestinal permeability and rob us of nutrients required by our thyroid and immune system. Furthermore, there’s evidence that the same types of antibodies to various reactive foods may also perpetuate or cross-react with thyroid antibodies! Up to 20% of people with celiac disease can completely reverse Hashimoto’s when they switch to a gluten-free diet. Additionally, in a recent survey of 2,232 of my readers, 86% of people who went gluten-free reported an improvement in digestive symptoms. I personally had a celiac-like reaction to dairy, likely for most of my life. It wasn’t until I cut out dairy from my diet that I realized that it wasn’t normal to have stomach aches every day. One of the challenges with food sensitivities is, when we eat the foods that our body is sensitive to regularly, it can be difficult to connect the foods with the symptoms we are having. As a starting point, I recommend a lifestyle that is gluten-free, dairy-free, soy-free, low in processed foods, and nutrient dense to heal and prevent disease. In some cases, further dietary protocols, like the Elimination Diet, can help to uncover additional problematic foods, and may need to be utilized to heal the gut.
2. Soak up the Sun (and supplement with Vitamin D!). Autoimmune disease seems to be more prevalent the further away we are from the equator. Vitamin D deficiency may be to blame, as this important vitamin, required for proper immune system, gut, and thyroid function, is primarily absorbed through our sunscreen-free skin on sunny days. I recommend getting lots of sunshine as a preventative measure. I also recommend Vitamin D supplements for most people. Vitamin D levels should be between 60-80 ng/ml for optimal thyroid receptor and immune system function. Vitamin D has been shown to prevent autoimmune disease in clinical trials and may help us properly fight infections like the Epstein-Barr virus. As I’ve written in my article on Epstein-Barr, 80% of people with Hashimoto’s have the Epstein-Barr virus in their thyroid glands, as do 62.5% of those with Graves disease. The virus can be a trigger or an exacerbating factor for many with autoimmune disease. While 90% of people have this virus, those who contract the virus as teens or adults (in contrast to during childhood), are more likely to be debilitated by the virus. This is because our body uses Vitamin D-dependent immune cells known as CD8+ T to suppress the Epstein-Barr virus. CD8+ T cells decrease with age, are lower in women, and are further reduced when Vitamin D intake is low. Thus, keeping Vitamin D levels at an optimal range can help us fight and suppress the virus. Keeping the virus suppressed can not just prevent Hashimoto’s, but can also be the key to getting an active case of Hashimoto’s into remission
3. Pack those probiotics. A common story I hear is that a person will be traveling and will have a bout of “traveler’s diarrhea”, or food poisoning, before their health begins to decline. From a functional medicine perspective this makes a lot of sense to me – the person’s gut barrier had become compromised by a pathogen and the pathogen remains in the gut creating a chronic low grade infection that leads to intestinal permeability, and eventually leads to the manifestation of autoimmune disease. I recommend S. Boulardii from Pure Encapsulations, as it boosts our body’s secretory IgA. This acts as a natural defense, preventing us from getting pathogens. I prefer the Pure Encapsulations brand of S. Boulardii (it seems to be more potent), but it does have to be refrigerated.
4. Supplement with selenium. Selenium deficiency has been recognized as a risk factor for autoimmune thyroid disease, including Hashimoto’s, Graves and postpartum thyroiditis. Doses of 200 mcg were used as a preventative and as a way to reduce thyroid antibodies in those who already had them. Many people may try to get their selenium from brazil nuts, rather than supplementing. While I love the idea of Food Pharmacology and getting our nutrients from food, the amount of selenium in Brazil nuts has been found to vary greatly, depending on where the nut was grown. So, I recommend taking a selenium supplement instead, like Pure Encapsulations Selenomethionine, to get a consistent dose.
5. Easy on the iodine. Numerous studies have shown that iodine, when used in excess (especially when selenium is deficient), can trigger and/or exacerbate Hashimoto’s. I recommend doing an evaluation of your daily iodine intake and keeping it to less than 500 mcg per day (The recommended daily allowance is 150 mcg for adults, 220 mcg for pregnant women and 290 mcg for breastfeeding women. Children’s doses are based on age). The amount of iodine that is present in multivitamins is usually not an issue for most people with Hashimoto’s, especially when combined with a high quality selenium supplement. However, be wary of using high dose iodine supplements, spirulina, kelp or seaweed snacks. I have a few clients who traced the onset of Hashimoto’s to high dose iodine consumption. Furthermore, some clients have reported that iodine has exacerbated their Hashimoto’s, causing an acceleration of thyroid tissue damage, increased thyroid antibodies and making them feel worse. Please note, for some people (especially those with fibrocystic breasts), iodine may be helpful in their journey to health and wellness, but if you have Hashimoto’s (or are at risk for it), I would recommend proceeding with caution. Overall, my survey of 2,232 people with Hashimoto’s found that 28% of people felt better, but 30% felt worse using high doses of iodine. Please remember that iodine does not live by itself in a vacuum. If you’re considering taking iodine beyond the dose that’s present in multivitamins and prenatals, I recommend working with a knowledgeable practitioner who will test your thyroid antibodies before and after starting to ensure that you are not having an adverse reaction.
6. Skip the soy and don’t formula feed your babies with soy-based formulas! There are only a few studies that connect soy to thyroid disease, and one of them found that babies fed soy formulas had higher rates of thyroid antibodies later in life compared to breastfed babies. Soy has also been reported to block thyroid peroxidase and can inhibit T4 to T3 conversion. My clients and readers have reported an increase in palpitations, nervousness and thyroid antibodies after consuming soy. I recommend skipping tofu, miso and soy-beans to support your thyroid. Better yet, cut out all processed foods as soy is often a hidden ingredient in these products!
7. Manage your magnesium. Magnesium is needed for iodine utilization by the thyroid gland, and conditions like Type 2 Diabetes, Crohn’s disease, and hypothyroidism, as well as stress and certain medications can all put us at a greater risk for depletions in magnesium. In my experience, joint pain, leg cramps, menstrual cramps and thyroid disorders are all reasons to suspect magnesium deficiency. Also, researchers have found that supplementing with magnesium citrate can help to lower an elevated TSH.
8. Vet your vaccines. While I certainly believe vaccines are a life-saving intervention that has helped the masses, the truth is, any foreign invader in the body can produce an immune response, and sometimes the immune response could be autoimmune in nature! A recent study, sponsored by Merck, found that the Gardasil vaccine for HPV (Human Papilloma Virus) has been associated with higher levels of Hashimoto’s in young women, though the researchers concluded that “based on a lack of temporal clustering and biological plausibility of a relationship, there was no consistent evidence for a safety signal for autoimmune thyroid conditions”. I believe the relationship is plausible, via the molecular mimicry mechanism: when the immune system creates a reaction to a vaccine, it may also attack any other “similar” looking structure. While most doctors will tell you that all vaccines are absolutely safe, in past years, other vaccines were taken off the market due to reports of autoimmune reactions, and independent case reports have tied HPV to other autoimmune conditions. As a Naturopath, I am well aware that all medications can have various adverse reactions, especially in those who are genetically susceptible, however there is a lack of independent studies (not funded by manufacturers or public health organizations) measuring adverse reactions to vaccines. I personally believe that educating our sons and daughters about sexuality, safety, and self-worth can hold the key to lowering rates of the sexually transmitted viruses.
9. Smarten up about stress. Looking over the health histories of thousands of people with Hashimoto’s, I‘ve found that an inability to manage stress is often at the core of the condition. Most people can trace back the development of Hashimoto’s and autoimmune conditions to a particularly stressful time period. Stress is inherent, and it’s how we handle our stress that matters. I recommend self-management stress-reducing habits like mindfulness, yoga, and meditation. Meditation has specifically been found to be helpful in building resilience to stress. Discover your own unique reaction to stress and learn a relaxation tool to help get grounded by checking out this free, online master class called “Stress Less, Accomplish More” with meditation teacher, Emily Fletcher. I’m not kidding when I say these 40 minutes may just change your life. If you have a history of childhood trauma like I do, your stress response could be severely impacted, leading you to overreact and get into a ‘fight or flight’ state at the easiest provocations. I recommend therapies like the self-guided tapping, self-help books, neurofeedback or therapist guided EMDR to reset your stress response.
10. Green your routine. People who live closer to petrochemical plants are more likely to suffer from thyroid disease. What we don’t realize is that often times our homes can be full of toxic chemicals as well! Studies have found people living in fluoridated communities are more likely to have thyroid disorders. The higher the levels of fluoride, the higher the number of thyroid disorders. BPA in plastics has been connected to hormonal disturbances, as has triclosan in antibacterial soaps and toothpastes! Chemicals in mattress covers can also contribute to thyroid autoimmunity. Don’t even get me started on conventional beauty products!
11. Speak your soul. I don’t think it’s a coincidence that women are 5-8 times more likely to suffer a thyroid condition. Hormones and personal care products contribute for sure, but other factors in our society, such as the forced suppression of self-expression for women can be a part of the perfect storm by creating an impaired stress response. I remember seeing a quote “Speak your voice ladies, the only person you will scare off is your future ex-husband”. If you are finding that you too have been socialized to be a wallflower, nice, polite, a victim, martyr or judge, I recommend that you consider this behavior pattern as big of a risk factor as gluten or infections for autoimmune thyroid disease. I believe the book Warrior Goddess Training should be required reading for all women who want to connect with their true selves. It’s the equivalent of 10 years of therapy, self-seminars and personal growth wrapped up in one elegant little book.
12. Sweating and sauna therapy. We know that toxins are implicated in autoimmune thyroid disease. One great way to get rid of toxins is to sweat it out. I recommend an infrared sauna like the Sunlighten, hot yoga, and Epsom Salt baths.
Try my blissful bedtime bath recipe:
-10 drops of frankincense essential oil
-10 drops of myrrh essential oil
-10 drops of lemongrass essential oil
-10 drop of tangerine essential oil
-2 cups of Epsom salts
13. Consider an annual cleanse. Annual check-ups are recommended for people at risk for thyroid disease, and they sure can be helpful to catch thyroid illness early, but wouldn’t it be better if every year, you did something that reduced your chance of diagnosis instead? Since we know that toxins are an issue, doing an annual cleanse for the healthy person, can prevent the buildup of toxins, which lead to a breakdown of self-tolerance. A parasite cleanse may help with getting rid of intestinal toxins that are causing gut inflammation.
14. Get a gander at your genes. I like Smart DNA, , interpreting your genes can help with predicting some of your risk factors. Some individuals with Hashimoto’s may have a gene variation that prevents them from properly activating folic acid. If your genes reveal that you are a “poor methylator”, you may benefit from supporting your methylation pathways.
15. Be mindful of mercury. Mercury toxicity can lead to autoimmune thyroid disease. Be wary of dental amalgams – the mercury from them can build up in thyroid tissue, so avoid them if possible. If you do have them, removing them can help reduce thyroid antibodies if you are sensitive to mercury. Your dentist can also run the MELISA test to see if you are, in fact, sensitive. Please be sure to work with a holistic dentist to get them removed, because for some people, removing mercury amalgams can be worse than keeping them.