Sunday, May 22, 2016

Hashimoto's Disease and Hypothyroidism

Hypothyroidism is a relatively common disorder. It affects more women then men. Symptoms of hypothyroidism include fatigue, gradual weight gain, constipation, muscle aches, joint pain, feeling cold, menstrual irregularities, weakness, hair loss, dry, cold skin and slow reaction time. Many patients will have a goiter (enlarged thyroid). 

The incidence of hypothyroidism increases with increasing age. In other words, the older we get, the more likely a thyroid deficiency will show up. The most common cause of primary hypothyroidism (hypothyroidism originating in the thyroid gland itself), isHashimoto’s Thyroiditis. Hashimoto's is an autoimmune condition. The body's own antibodies attack the thyroid gland and destroy it, leading to hypothyroidism. Hashimoto’s Thyroiditis may be a manifestation of multiple autoimmune syndromes and may occur in families. Hypothyroidism can also be due to a pituitary problem (central hypothyroidism). 
Hashimoto's Disease 
Hashimoto's disease, sometimes known as Hashimoto's thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis, is an autoimmune disease. In Hashimoto's, antibodies react against proteins in the thyroid gland, causing gradual destruction of the gland itself, and making the gland unable to produce the thyroid hormones the body needs.
Diagnosis
Hashimoto's disease is typically diagnosed by clinical examination that demonstrates one or more of the following findings:
  • Enlargement of the thyroid, known as a goiter
  • High levels of antibodies against thyroglobulin (TG) and thyroid peroxidase (TPO), detected via blood test
  • Fine needle aspiration of the thyroid (also known as a needle biopsy), which shows lymphocytes and macrophages
  • A radioactive uptake scan, which would show diffuse uptake in an enlarged thyroid gland
  • Ultrasound, which would show an enlarged thyroid gland
Symptoms
Symptoms of Hashimoto's can vary. Some people have no symptoms whatsoever, and will have no demonstrable symptoms of the underlying condition. For many Hashimoto's patients, the thyroid becomes enlarged, a condition known as a goiter. The goiter can range from slight enlargement, which may have no other symptoms, to a substantial increase in size.
Some people with Hashimoto's, especially those with a larger goiter, may feel discomfort in the neck area. Scarves or neckties may feel uncomfortable. The neck may feel swollen or uncomfortably enlarged, even sore. Sometimes the neck and/or throat is sore or tender. Less commonly, swallowing or even breathing can become difficult if a goiter is blocking the windpipe or esophagus.
Hashimoto's typically involves a slow but steady destruction of the gland that eventually results in the thyroid's inability to produce sufficient thyroid hormone -- the condition known as hypothyroidism. Along the way, however, there can be periods where the thyroid sputters back to life, even causing temporary hyperthyroidism, then a return to hypothyroidism. This cycling back and forth between hypothyroidism and hyperthyroidism is characteristic of Hashimoto's disease. So, for example, periods of anxiety/insomnia/diarrhea/weight loss may be followed by periods of depression/fatigue/constipation/weight gain.
In some cases, the onset of Hashimoto's and elevation of antibodies will be accompanied by a variety of symptoms, including anxiety, difficulty sleeping, fatigue, weight changes, depression, hair loss, muscle/joint aches and pains, and fertility problems, among others.
Treatment
If a goiter causes difficulty swallowing or breathing, or is a cosmetic problem, then thyroid hormone replacement drugs (i.e., levothyroxine or natural desiccated thyroid) will usually be given to help shrink the thyroid. If drug treatment does not work, or the goiter is too invasive, then surgery to remove all or part of the thyroid may be recommended.
Except in the case of a goiter, most endocrinologists and conventional physicians will nottreat Hashimoto's disease, as diagnosed by elevated antibody levels, unless other thyroid function tests such as TSH are outside the normal range.

In the area of nutrition, promising findings from a number of research studies have pointed to the value of the mineral selenium in helping to combat autoimmune thyroid disease.
Some studies have shown that selenium supplementation at the typically safe dose of 200 mcg per day can return elevated thyroid antibody levels to normal, or reduce them significantly, therefore warding off development of full autoimmune thyroid disease, and resulting hypothyroidism. 
Ultimately, however, the autoimmune attack on the thyroid makes the gland slowly less able to function, and eventually, the thyroid becomes underactive. When hypothyroidism itself can be measured by blood tests, many practitioners will finally diagnose the hypothyroidism, and treat the patient with thyroid hormone replacement drugs.
Autoimmune Thyroiditis Atttacks
In some cases, the thyroid becomes particularly inflamed, known as a thyroiditis attack. Dr. Steven Langer, author of the book Solved: The Riddle of Illness, refers to thyroiditis as like an "arthritis of the thyroid." He explains that just as arthritis attacks the joints with pain and inflammation, thyroiditis can mean pain and inflammation in the thyroid for some sufferers. And in particular, during a thyroiditis attack, common symptoms are anxiety, panic attacks, heart palpitations, swelling in the thyroid area, problems swallowing, and frequently, problems sleeping.
"Thyroiditis attacks classically happen in the middle of the night," says Dr. Langer, which can be particularly troublesome in terms of the ability to sleep.
Dr. Langer suggests taking some calcium/magnesium, which are nutrients that have a sedative effect, along with a pain reliever to relieve inflammation -- buffered aspirin or ibuprofen -- before you go to bed, this might help. He's found that this helps about two-thirds of his patients suffering from nighttime thyroiditis symptoms.
Reducing swelling is a key aspect of dealing with thyroiditis attacks, according to Dr. Langer. "Just as with arthritis, an anti-inflammatory pain reliever doesn't cure the problem, but it temporarily ameliorates the symptoms."
Note: Many people with Hashimoto's disease end up hypothyroid, the situation where the thyroid is either underactive or, eventually, totally unable to function. Hashimoto's disease is a disease, and is the leading cause of hypothyroidism, which is a condition. The other causes of hypothyroidism include, among others:
  • Graves' disease and hyperthyroidism treatments including radioactive iodine treatment (RAI) and surgery
  • thyroid cancer treatment, including surgery to remove all or part of the thyroid
  • surgical removal of all or part of the thyroid as a treatment for goiter or nodules
  • use of antithyroid drugs (such as Tapazole or PTU) to reduce thyroid activity
  • use of certain drugs, such as lithium
How to Decrease Symptoms
Hashimoto's Disease is the most common cause of hypothyroidism in the United States. Unfortunately, it is also the most mismanaged type of hypothyroidism. Most people who are diagnosed with Hashimoto's Disease receive only thyroid hormone replacement, yet continue to suffer with all of the same symptoms. Here are six things every Hashimoto's patient should do to help decrease their symptoms.

Eat a plant-based diet. Stop eating processed foods, fast foods, foods that contain gluten, flour, hydrogenated oils, and other processed chemicals. Avoid soda, diet soda, cow's milk, soy milk, bottled fruit juice, and tap water. Also avoid all vegetables oils, canola oil, and most animal meats. Follow a structured meal plan (such as the Death to Diabetes Meal Plan) and keep a journal of what you eat and drink.
Stop taking all iodine containing supplements: Iodine is an important nutrient for thyroid function, and iodine deficiencies are common across the country, but in cases of Hashimoto's disease iodine can actually trigger the immune system attack. Bottom line is that iodine is a very important supplement for many people, but it is contraindicated with this disease because it flares the immune system, and makes the problem worse.

Have your vitamin D level tested: A common problem among those with autoimmune diseases is vitamin D deficiency. Vitamin D is critical for immune system support. A simple blood test by your doctor can determine whether or not your body's stored vitamin D levels are high enough. It is recommended that your levels should be 33 ng/ml or higher. If you test low your doctor will recommend a high quality supplement with a retest in the future to make sure you are absorbing it properly.

Get tested for gluten sensitivity: The literature shows that a high number of people who are diagnosed with Hashimoto's Disease also have gluten sensitivity. Gluten is found in wheat, barley, rye, and other grains. Gluten sensitivity simply means that every time you eat gluten your immune system tries to attack and kill it, creating major inflammation. This immune trigger will cause your immune system to further attack and destroy your thyroid gland. The best and most sensitive test for gluten sensitivity is a stool SIgA test. Your doctor can order this test for you. If you have tested negatively with a saliva or blood test make sure you get the stool test, as continuing to eat gluten when you have a sensitivity is detrimental to your condition.

Manage blood sugar closely: You are probably thinking, "I'm not diabetic, why would this apply to me?" There are a lot functional diabetics and functional hypoglycemics walking around that have no clue they have a problem. This is a complex issue your doctor will need to work with you on, but proper blood sugar regulation is essential to keep from continuously triggering the immune system.

Do NOT take "immune supporting" supplements: This is the biggest mistake I see patients and many doctors make in an attempt to support the immune system. With an autoimmune disease the immune system has essentially become confused. One side of the immune system becomes dominant and the other side suppressed. It is this imbalance that creates the confusion and causes it to attack your own thyroid gland. It is likely the immune support supplement contains an herb or botanical that may be helpful but likely contains things that are worsening your immune dominance. It is essential to have some very special immune panels ran to determine your immune dominance and the specific pattern of immune dysfunction to really find out the true nature of the immune problem. Then a specific application of herbs, botanicals, and plant extracts that have been shown to have specific effects on various cells in the immune system can be used to modulate and re-balance it. Until you have a doctor that knows how to run these immune panels and apply that knowledge, don't play with fire, just avoid broad support immune supplements all together.If you are diagnosed with Hashimoto's Disease then do these 6 things to give yourself a better chance to feel good again. Since the immune system is the source of the problem, finding a doctor trained in looking at the specifics of the immune response, familiar with autoimmune triggers, and trained in the application of natural medicine in relation to the immune system, is your best choice to fully turn down the dimmer on your disease.

Warning Signs

According to the Endocrine Society, eighty to ninety percent of hypothyroidism in the United States, is caused from an autoimmune mechanism called Hashimoto's Autoimmune Thyroid. This means the cause of the hypofunction is the immune system attacking your own gland. Your hormone levels will slowly decrease over time because it continually loses cells from the immune attack.
Here are 5 Warning Signs that you may have hypothyroidism from an immune mechanism, and that the treatment your are currently receiving is not adequate for your particular condition:
1)The dose of your thyroid replacement hormone continually goes up over time.
If you are continually having your thyroid medication increased, this means that your are losing more and more thyroid function. Your immune system is most likely the culprit. Hormone replacement does not address the continual immune attack against the gland. If your doctor is not addressing the immune attack, you are going to continue to suffer.
2) You still suffer with hypothyroid symptoms, yet your doctor tells you that your thyroid is now "normal".
If your latest labs show that your hormone levels are in the "normal range", yet you continue to suffer with the same symptoms, you are most likely not getting the proper management of your condition.
This is a huge sign that you have Hashimoto's disease. The proteins, called cytokines, that are used by the immune system to communicate amongst each other, block the hormone receptor sites. This means you can have normal hormone levels showing on a lab report, and still not have a normal thyroid metabolic responses. Working on the immune system is the only way to fix this problem.
3) Your doctor never checked for antibodies against the gland.
If you suffer with hypothyroidism, then you have a high probability of having Autoimmune Thyroid. If your doctor didn't bother to check antibody levels, or refuses to check antibody levels, you are most likely not receiving the proper treatment. The two most important antibodies to check are Thyroid Perioxidase Antibodies (TPO Ab) and Thyroglobulin Antibodies (TBG Ab).
4) Your doctor continually checks your antibody levels.
This may seem counter-intuitive since I just mentioned that you should have your antibody levels checked. I include this because, replacement hormones do not affect the immune system. It makes no sense to continually check antibodies if the doctor is not doing any treatment to affect the immune system. If your doctor is trying to decrease your antibody levels with replacement therapy, you are not getting the proper treatment. Watch for this. It is a sign that your doctor really doesn't understand the mechanisms causing your problem.
5) You begin to get individual prescriptions for various thyroid symptoms.
If you are getting treated with antidepressants for hypothyroid based depression, it means that the replacement hormone treatment is most likely not working. With Hashimoto's you can have normal thyroid hormone levels and still suffer with symptoms, including depression. Treatment needs to be focused on immune modulation, if you want to fix the actual cause of the problem.
If you suffer with hypothyroidism, and you live in the United States, then the most likely reason you have this condition is from an autoimmune reaction called Hashimoto's Disease. Treating this condition with replacement hormone, while ignoring the immune component, is like treating a slow bleed with blood transfusions and failing to stop the site of the bleed. Without immune modulation then the viscious cycle of thyroid gland destruction, by the immune system, will continue. You can use the warning signs outlined as a guide to help you determine if you are receiving the proper management of your hypothyroid condition.
Most Commonly-Asked Questions
Most people who are diagnosed with Hashimoto's Disease receive only thyroid hormone replacement, yet continue to suffer with all of the same symptoms. Here are some of the most common questions about Hashimoto's Disease to help shed some light on what could be going wrong in your case.1. Should I take iodine supplements if I have Hashimoto's Disease?
Iodine is important for normal thyroid hormone production but in Hashimoto's, supplementing with iodine is like dropping gas on a burning fire. Supplemental iodine will trigger and flare the immune system attack and only make the thyroid problem worse.
2. Should I be taking Vitamin D when I have Hashimoto's Disease?
Vitamin D deficiency is common in Hashimoto's and many other forms of autoimmune diseases. Vitamin D is critical for the support of the immune system, specifically regulatory T cells. A simple blood test can help determine whether or not you are deficient in Vitamin D. It is important to have this tested and the proper supplementation dosage be administered.
3. Should I get tested for gluten sensitivity?
The scientific literature shows a high correlation between Hashimoto's disease and gluten sensitivity. Gluten is a protein found in wheat and other grains. With gluten sensitivity the immune system abnormally recognizes the gluten protein as a foreign invader and will try to attack and kill it. This creates systemic inflammation and increases the autoimmune attack on the thyroid.
Note: The blood tests for celiac and gluten sensitivity are notoriously inaccurate. It is recommended to have a stool SIgA test to make a proper determination of whether or not gluten is a problem.
4. Should I take "immune supporting" supplements?
My answer to this question is an emphatic NO. This is a huge mistake made by patients and doctors alike. Unless you have determined from specific immune testing what your immune system configuration is, these types of supplements should be avoided. You don't want to push the immune system in the wrong way and increase the immune attack on your thyroid gland in a blind attempt to help the immune system. Without being armed with the proper lab testing, immune stimulating supplements are discouraged.
The important thing to remember with Hashimoto's Disease is the immune system is the source of the problem, and finding a doctor trained in looking at the specifics of the immune response, familiar with autoimmune triggers, and trained in the application of natural medicine in relation to the immune system, is your best choice to fully turn down the dimmer on your disease.

Note: If you have an autoimmune disease, PCOS, or if you have issues with your thyroid, get the How to Treat Autoimmune Diseases, PCOS & Thyroid Issues Naturally ebook.  This ebook explains how to treat the more common autoimmune diseases as well as how to optimize the health of your thyroid.
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