Hashimoto’s disease is the most common autoimmune disease in the world and causes 90 percent of hypothyroidism cases.1
Because conventional medicine often doesn’t treat Hashimoto’s disease, functional medicine practitioners are in a perfect position to help patients who aren’t responding to thyroid medication. Learn how to help patients with this common and misunderstood illness.
Thyroid peroxidase and antithyroglobulin antibodies help diagnose Hashimoto’s disease. A very small percentage of patients with Hashimoto’s disease won’t actually make antibodies so a thyroid ultrasound is useful in these cases to make the diagnosis. Hashimoto’s disease leads to hypothyroidism so looks for common symptoms of hypothyroidism such as fatigue, weight gain, depression, constipation, cold hands and feet, and more. Once the diagnosis has been made, begin investigating the reasons why the patient may have the disease.
1. Leaky Gut syndrome
The first area to investigate is gut permeability, also known as leaky gut syndrome. This results in significant stress to the immune system that can trigger autoimmunity.2 Perform a thorough diet history to identify potential food sensitivities that could cause inflammation in the GI tract. Blood testing can also be ordered to identify food sensitivities such as gluten, dairy, eggs, soy, peanuts, and many more.
2. GI tract infections
Infections in the GI tract and dysbiosis can also put stress on the intestinal barrier and cause imbalances to the immune system. A stool analysis to identify parasites, yeast, and bacterial overgrowth is important to rule out these stressors. Addressing these infections and balancing the gut bacteria can begin to heal the digestive tract and shift the immune system into better balance.
3. Stress physiology
Another significant factor in GI health and immune system balance is stress physiology. Physical and emotional stress can disrupt thyroid health, gut health, and the immune system. Cortisol produced by the adrenal cortex inhibits thyroid function, breaks down the intestinal barrier, and if elevated for long periods of time can increase inflammation.
Norepinephrine and epinephrine produced by the adrenal medulla have similar impacts on these connections.3-4 A detailed look at urinary adrenal hormones and autonomic system balance is vital for healing the GI tract and balancing the immune system in Hashimoto’s disease.
The most overlooked factor in Hashimoto’s disease is its relationship to infections. Infections such as the Epstein-Barr Virus, Helicobacter pylori, and Yersinia enterocolitica have all been shown to be triggers for Hashimoto’s disease.5-6
Additional but more rare connections include Lyme disease, hepatitis C, measles, HIV, enteroviruses, the flu, and other herpes viruses. This may require investigation based on the patient history. If any of these infections are present and active, the autoimmunity can continue.
5. Excessive estrogen
Excessive levels of estrogen can also contribute to Hashimoto’s disease because estrogen inhibits the body’s ability to control the Epstein-Barr Virus.7
Hypothyroidism can lead to elevated estrogen levels, which creates a vicious cycle of chronic infection, inflammation, elevated antibody levels, and signs and symptoms of estrogen dominance. Estrogen is metabolized in the liver and then excreted in the feces, so gut function must be optimal to have healthy estrogen levels.
6. Toxic metals
Toxic metals such as mercury, cadmium, and arsenic can be involved in Hashimoto’s disease. Environmental toxins such as those in the air, water, and in household products can disrupt thyroid function and further stress the immune system. Iodine has also been shown to be a potent trigger of Hashimoto’s disease and should be avoided while the patient is going through their treatment plan.8
Finally, certain micronutrients can be extremely important for healthy thyroid function and immune system balance. Selenium has been shown to lower thyroid antibody levels and improve sense of well-being in patients with Hashimoto’s disease.9
Vitamin D can also help balance the immune system and control the Epstein-Barr Virus if it is reactivated.10 Zinc is vital for all aspects of thyroid function as well as immune system health and stress physiology.11 Additional supplements are used to target any infections that are found, repair the gut barrier, aid in stress physiology, and reduce inflammation.
A successful patient outcome requires a thorough functional medicine analysis and treatment plan that is tailored to the individual needs of the patient. The factors outlined above are the most important and vital components to helping patients with Hashimoto’s disease.
Now more than ever it’s important to learn the proper way to identify what is causing each patient’s illness and treatment strategies that yield fast and effective results.
Nikolas R. Hedberg, DC, DABCI, DACBN, owns the Immune Restoration Center in Asheville, NC where he focuses on thyroid disorders and autoimmune diseases. He is the author of the new book The Complete Thyroid Health & Diet Guide and can be contacted through hedberginstitute.com, which offers online functional medicine education.
- Rocchi R, Rose NR, Caturegli P. (2008). Hashimoto Thyroiditis. Diagnostic Criteria in Autoimmune Diseases. 217-220. doi:10.1007/978-1-60327-285-8_41.
- Brom B. Integrative medicine and leaky gut syndrome. South African Family Practice. 2010;07;52(4): 314-316. doi:10.1080/20786204.2010.10873997.
- Maayan ML. Catecholamines and the Thyroid. Thyroid. 1990, 01;1(1), 39-42. doi:10.1089/thy.1990.1.39.
- Melander A, Westgren U, Ingemansson S, Tibblin S. Influence Of The Sympathetic Nervous System On Thyroid Hormone Secretion In Man. Abstracts. 1977;518. doi:10.1016/b978-0-08-021308-8.51258-8.
- Chatzipanagiotou S, Legakis J, Boufidou F, Petroyianni V, Nicolaou C. Prevalence of Yersinia plasmid-encoded outer protein (Yop) class-specific antibodies in patients with Hashimoto’s thyroiditis. Clinical Microbiology and Infection. 2001, 03;7(3), 138-143. doi:10.1046/j.1469-0691.2001.00221.x.
- Korani M. Helicobacter Pylori Infection: Association with Hashimoto’s Thyroiditis. Gastroenterology & Hepatology: Open Access. 2016, 04;4(5). doi:10.15406/ghoa.2016.04.00111.
- Pender MP. Epstein-Barr Virus and Autoimmunity. Infection and Autoimmunity. 2004;163-170. doi:10.1016/b978-044451271-0.50013-2.
- Saranac L, Zivanovic S, Bjelakovic B, Stamenkovic H, Novak M, Kamenov B. Why Is the Thyroid So Prone to Autoimmune Disease. Hormone Research in Paediatrics. 2011;75(3):157-165. doi:10.1159/000324442.
- Wendling, P. Selenium Slows Down Autoimmune Thyroiditis. Family Practice News. 2006, 12;36(24), 17. doi:10.1016/s0300-7073(06)74311-0.
- Kim, D. Low vitamin D status is associated with hypothyroid Hashimoto’s thyroiditis. Hj Hormones. 2016, 07;doi:10.14310/horm.2002.1681.
- Vries, M. K., & Bibi, H. A Relationship between Hypoglycemia, Hypothyroidism and Zinc Deficiency. Pediat Therapeut. 2015;05(03). doi:10.4172/2161-0665.1000253.