Restore Your Gut - Hashimoto Thyroiditis

Hypothyroidism affects an estimated 20 million Americans. About 5 out of every 100 over the age of 12 have this condition (many undiagnosed). Hypothyroidism is characterized by the deceleration of the majority of all bodily processes. Hashimoto thyroiditis is the most common cause of primary hypothyroidism in iodine-sufficient countries such as the United States, affecting women more. Four-teen million people in the United States are affected by this disease making it the #1 thyroid disorder in the nation. Hashimoto disease is also known as Hashimoto thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis.

The ongoing impact of Hashimoto disease has led to the reevaluation of its traditional treatment plan by reassessing its root cause(s). With the massive evidence of disturbed gut health contributing to autoimmunity, there is no exception with Hashimoto thyroiditis and the impact of a dis-eased gut resulting in its presentation. This has led to the assessment and restoration of gut health to promote the healing of Hashimoto's disease. 

In this article, you’ll find how healing the gut can facilitate the healing of this autoimmune condition. Also, outlined are the presentation, etiology, and gut relationship to Hashimoto thyroiditis.

WHAT IS HASHIMOTO THYROIDITIS?

There is a common misconception that when there is a problem with the thyroid that the issue must stem from the actual gland, however with Hashimoto Thyroiditis the body has created antibodies that compromise the expression of the much-needed thyroid hormone (or TH) and indirectly attacks the thyroid gland.

The thyroid is responsible for creating the thyroid hormones, T3 and T4. Starting in the brain the hypothalamus determines if there is a need for more TH and sends a signal known as thyroid releasing hormone (TRH) to the pituitary gland. The pituitary gland helps to regulate the amount of TH by releasing thyroid-stimulating hormone (TSH). When TSH is released, the thyroid gland expresses more T3 and T4. 

The antibodies mentioned earlier are known as antithyroid peroxidase and antithyroglobulin; they directly prevent the synthesis of our thyroid hormones, by inhibiting T4 conversion to T3. The effect of the antibodies results in inflammation that leads to hypoactivity of the thyroid gland and ultimately its breakdown. It is this phenomenon that makes Hashimoto thyroiditis an autoimmune disorder, hence its additional name autoimmune thyroiditis.

HOW DOES HASHIMOTO PRESENT ITSELF?

To understand the presentation of Hashimoto thyroiditis and the severity of it if left unaddressed it is important to understand the function of TH. TH is primarily known for controlling the body’s metabolic rate. T3 has the following functions:

• Brain maturation (in-utero and infancy)
• Bone growth/ maintenance 
• Basal metabolic rate of the heart, muscles, and digestive system

The continual diminished activity of the thyroid can result in the following signs and symptoms:

• Cold intolerance (due to decreased heat production)
• Weight gain
• Decrease in appetite
• Depression
• Fatigue, weakness, lethargy
• Constipation
• Difficulty breathing on exertion
• Joint pain
• Dementia in the elderly
• Infertility
• Heavy menstrual periods

Signs:

• Thyroid goiter
• Dry, cool skin
• Coarse, brittle hair
• Nonpitting edema
• Decreased heart rate
• Decreased reflexes
• Hair loss
• Hoarseness 
• Swelling in the face and around the eyes
• Carpal tunnel syndrome

The varying presentations of Hashimoto reveal the importance of an early diagnosis to avoid the development of severe signs and symptoms.

WHAT ARE THE CAUSES OF HASHIMOTO?

By now we know that Hashimoto thyroiditis is an autoimmune disease however, what causes this autoimmunity? Studies show that the manifestation of an autoimmune disease is the result of 3 major factors: genetic predisposition(epigenetics), imbalanced microbiota of the gut, and increased intestinal permeability also known as leaky gut. It is no different with Hashimoto thyroiditis; the same factors contribute to this disease and have forced a deeper look into its root causes. Although not traditionally discussed the following variables are also included in the expression of this disease:

• Abnormal digestion/ Leaky gut
• Food allergens (i.e. gluten)
• Malnutrition that has resulted in nutrient deficiencies 
• Psychological stress
• Processed food diet
• Presence of existing autoimmune disease

THE LEAKY GUT AND HASHIMOTO

To understand how restoring gut health can facilitate the healing of Hashimoto thyroiditis, we need to have a better understanding of the intestine. An abundance of research and evidence-based articles have revealed changes in the gut flora and inflammation stemming from the gut can result in chronic diseases. As mentioned before, Leaky gut is a major factor if not the major factor in developing Hashimoto thyroiditis.

Our intestinal lining is made up of tight junctions that are responsible for allowing nutrient absorption into the bloodstream as well as preventing partially digested foods, bacteria, and toxins from entering the bloodstream. When the tight junctions widen, crack, or are compromised what’s supposed to stay in the gut does not. Particles like gluten leak from the not-so-tight junctions, triggering an immune response that leads to chronic inflammation.  The incessant leakage of inflammatory particles and bacteria results in a change in the gut flora and the body attacking itself.

HOW IS HASHIMOTO THYROIDITIS DIAGNOSED?

Hypothyroidism is only present in 20% of cases when first diagnosed, and often manifests later in the disease. Therefore, in the early stages of Hashimoto thyroiditis thyroid function studies are normal and a slow decline in thyroid function is common. The diagnostic markers specific for Hashimoto’s disease are antithyroid antibodies, antiperoxidase antibodies (present in 90% of patients), and antithyroglobulin antibodies (present in 50%). Although not required, occasionally a thyroid scan is done to identify the irregular distribution of iodine, as iodine is a part of the makeup of T3 and T4.

A functional medicine/ holistic approach can include looking at liver function, CBC, allergen study, and other tests to rule out possible underlying conditions responsible for symptoms. The liver's primary function is to remove toxins, create proteins, store energy and create bile. Concerning Hashimoto, if the liver is not working properly the proteins necessary for the synthesis of thyroid hormone may not be created or the immune system may be responding to the toxins that are not being eliminated. A CBC will allow the rule out of infection and a food sensitivity test will help identify any food allergies causing an inflammatory response, leading to autoimmunity. 

RESTORE THE GUT HEAL YOUR HASHIMOTO

The traditional treatment plan once Hashimoto has been diagnosed is to prescribe synthetic thyroid hormone (levothyroxine), indefinitely to achieve and maintain a euthyroid state. This approach is effective in improving symptoms but does not fix the autoimmune disorder, the root problem. However, since we have been able to trace the immune response in Hashimoto Thyroiditis to leaky gut and other risk factors (i.e. epigenetics, poor diet, stress, etc), we know how to aid its healing. 

Making lifestyle and dietary modifications for the effective treatment of Hashimoto disease is crucial. The following changes are how you can do so.

 As noted, before, completing a food sensitivity test helps identify possible triggers to the immune system however, this test may be inaccessible or expensive for some. Without such test the following known inflammatory foods can be removed or avoided, establishing lasting beneficial results. 

• Gluten 
• Pasteurized dairy products
• Processed foods
• Too much added sugars

Other necessary dietary changes include eating gut-healing foods. In other words, a minimally processed nutrient-dense diet. Simply put this consists of consuming more vegetables and organic meats. The following prime foods are recommended to initiate the healing process of the gut:

• Vegetables and fruits (high in antioxidants, fiber, vitamins)
• Probiotic-rich foods (i.e., kimchi, fermented veggies)
• Omega-3 fatty acid foods (i.e., avocado, wild-caught fish)
• Seaweed (natural source of iodine)
• High in fiber foods (i.e., chia seeds, beans, legumes)
• Bone broth (rich in amino acids that heal gut lining)

Making these changes will immediately begin to restore the health of the gut and calm the chaotic response of the immune system.

In the event, there is an issue with detoxing in the body for example with Hepatitis or Cirrhosis resolving these conditions will alleviate Hashimoto symptoms. However, even if there isn’t an identifiable underlying condition efforts should still be made to improve the body’s ability to detox with the following:

• Quit smoking
• Reduce alcohol consumption
• Switch your OCP’s to natural contraception 
• Limit the use of BPA containers
• Use natural cleaning products instead of those with synthetic chemicals.

The presence of chronic stress can result in continuous stimulation of the stress hormone, cortisol. This results in high blood pressure, compromised immune function, insulin resistance, and so much more. Stress levels must be managed well. Studies show that the majority of individuals with an autoimmune disorder struggled with emotional distress before becoming symptomatic. This indicates it is worthwhile to work on reducing your stress. Here are some ways to do so:

• Exercise regularly
• Prayer/ Meditation
• Keep a journal
• Visit a counselor
• Practice breathing exercises 

There are supplements that have been proven to aid the healing of thyroiditis, the gut, reduce autoimmune reactions, and establish a healthy immune system. This includes but is not limited to the following:

• Probiotics
• Vitamin D
• B vitamins
• Ashwagandha

IN CONCLUSION

It is essential that thyroid symptoms are not left unaddressed and if you have suspicions of hypothyroidism or Hashimoto’s disease a diagnosis should be sought. Since thyroid function labs appear normal in the early stages of symptoms persist do not hesitate in acquiring a second opinion if necessary to ensure a proper diagnosis. It's also important to note that although unconventionally turned to if diagnosed with Hashimoto Thyroiditis, healing is possible and the quest to restore your gut will promote just that.