Hashimoto’s Hypothyroidism: Holistic Approaches to Reduce Symptoms and Reduce Antibodies (Even When You are Told your TSH & FreeT4 are “Normal”)

Hashimoto’s is an interesting condition to live with in the confines of the conventional sickcare system that essentially pushes the rhetoric that:

• If you have thyroid antibodies but your TSH is still normal, wait until you are sicker and then once the TSH is high enough, we medicate you
• If you have thyroid antibodies and already on a T4 only medication like synthyroid, let’s keep titrating the dose until the TSH is between a 1 or 2, but the antibodies “are what they are.”

Now, I am over generalizing here and I am not going to get into all the nuances of the whole AACE algorithm here, but the general tone is thyroid antibodies just help give the label “hashimoto’s
versus “regular” hypothyroidism, and most Endocrinologists don’t provider additional recommendations unless the levels are extremely high.

Have you been diagnosed with Hashimoto’s Hypothyroidism and told your only option is to take a T4 thyroid hormone replacement medicine for the rest of your life or wait until your TSH gets high enough and still end up taking the same said medicine for the rest of your life?

This is “downstream only care” in the opinion of many Functional Medicine aligned practitioners but unfortunately the way our healthcare is designed based on what conventional care algorithms say to do.

BUT there is so much more that can be looked into (that is evidenced based) if you have thyroid antibodies!

There is more to explore besides a measely TSH and T4 periodic check to titrate your synthyroid or levothyroxine dose. Don’t get me wrong: this is still a good thing and needs to be done but it’s a START. When your care team knows more, they can zoom out and do even more.

Let’s dissect a root causes and integrative approaches to Hashimoto’s.

Back story: Hashimoto’s is the autoimmune version of hypothyroidisim in which the immune system attacks thyroid cells. Overtime, the TSH will increase from the thyroid destruction. The TSH (thyroid stimulating hormone) is essentially the biomarker to measure how well the pituitary is telling the thyroid to work. As the TSH raises too high, the pituitary has to yell at the thyroid as it senses the thyroid is not putting enough of the actual thyroid hormones out into circulation. The thyroid dysfunction typically yields various signs & symptoms listed below and eventually (and hopefully) the person will visit their Doctor.

• Unintentional weight gain
• Constipation
• Heavy menstrual periods in females
• Infertility or miscarriage(s)
• Scalp hair thinning; thinning eyebrows
• Tired despite sleeping
• Poor concentration or “brain fog”
• Dry skin
• High cholesterol is also typical

If a TSH lab comes back high enough the patient will get labeled with hypothyroidism. Many experts argue this is not enough and a patient should be getting a full thyroid panel (self order a full thyroid panel here and get done at any Quest labs) to get the full picture but this sadly is not mainstream.

A full panel helps distinguish if it is autoimmune hypothyroidism (Hashimoto’s) as antibodies will also be checked. A full thyroid panel also helps gauge other thyroid markers as an adequate T4 doesn’t always translate into optimal T3 hormone.

Western medicine says its unclear why people develop Hashimoto’s and why thyroid antibodies (TPO and TgAB) are elevated….

And I agree it’s not black and white – there isn’t ONE real obvious cause with any autoimmune condition. It is thought rather that a multitude of things could be influencing autoimmune illnesses. Totality is everything but hard to study.

But when you go digging in the many “root cause” reasons for thyroid antibodies, you’ll often find something that can be improved, outside of genetics of course.

Most people with autoimmunity generally have 3 commonalities:

• Genetic predisposition
• One or more triggers
• Intestinal permeability (slang term: leaky gut)

Genetics is a fixed variable, but triggers and gut health we have some degree of control over that influence thyroid health or lack thereof.

While conventional medicine doesn’t discuss this, it is possible to reverse autoimmunity (when you dive deep into triggers, gut health, diet and lifestyle). I have seen antibodies decrease in my practice, Hashimoto’s reversed on occasion, and patients getting the okay from their Doctor to stop their thyroid medicine (because they are getting “hyper” on the med and no longer need it/bad idea to keep taking it).

Do NOT stop anything until you talk with your healthcare team and know that some will truly need medication for life. There is a time and place for prescriptions; in the same breath I am saying in this blog it is worth it to swim upstream more unstead of “downstream only care.” Look at the forest; not just the trees.

There is no gurantee (like anything in medicine or life for that matter), but it definitely doesn’t hurt to find and address triggers and optimize the gut microbiome. This is best to do a deeper dive upfront versus the “wait until you are sicker and then come back” approach.

Rhetorical question: why not take out what the body doesn’t need and make sure it’s getting plenty of what it does?

What modifiable factors CAN influence the pathogenesis of Hashimoto’s Hypothyroidism or exacerbate the condition if already established:

• Toxin exposures (heavy metals, pesticides)
• Living in a home with clinically significant levels of toxic indoor mold as shown via an ERMI at home dust test (get kit #1) and if score if >5, you need professional inspection and likely remediation
• Underlying gut infections like H. pylori
• Gut dysbiosis (overgrown opportunistic intestinal bacteria)
• Stress
• Nutrient deficiencies (selenium, vitamin D, zinc for examples)
• Radiation exposure

Any or all of these can directly or indirectly contribute to thyroid damage. Questions to ask yourself if you have Hashimoto’s?

• Is H. Pylori present? You don’t have to have raging ulcers and ungodly heartburn for this to be a colonized problem contributing to thyroid antibodies. Your EGD showed negative result? Consider doing a GIMAP as there is a degree of false negatives with some conventional testing
• Are you on hormonal birth control? There are studies linking HBC usage to hypothyroidism. Is there another contraceptive option or management option you could pursue with your healthcare team?
• Has mold exposure been looked into? Mycotoxin/CIRS testing been done yet? Start with an at home dust ERMI test of your home and if elevated call a mold inspector.
• GIMAP testing been done yet? (It really needs to be!) Find gut dysbiosis and other pathogens and remove, then replace, reinoculate, repair and rebalance the gut to decrease intestinal permeability
• Heavy metal testing been done? Have you looked into the contaminants in your water at the ewg.org/tapwater database? Purchased a quality water filter to stop daily exposures that can negatively impact thyroid health
• Screened for nutrient deficiencies and had these corrected via targeted supplementation? And then a plan to prevent relapse? Test and don’t guess when it comes figuring out if deficiencies are there. Self order labs here and get drawn at any Quest.
• Have you tried a strict gluten free diet to help decrease zonulin and shown in some studies to reduce thyroid antibodies – this is low risk high reward possibly
• Tried red light therapy held over your thyroid gland
  • Based on available research, including studies published on PubMed and other scientific platforms, some patients with hypothyroidism, particularly those with chronic autoimmune thyroiditis (Hashimoto’s disease), have shown positive results with red light therapy (RLT). One PubMed study demonstrated that approximately 48% of participants with hypothyroidism were able to stop taking thyroid medication after undergoing 10 sessions of RLT. Other sources suggest that between 30% and 50% of patients using RLT may be able to discontinue or reduce their levothyroxine dosage. This is because RLT may help reduce inflammation in the thyroid gland, improve hormone production, and potentially modulate the immune system, according to source
• Referred to a therapist to learn better coping and life skills for stress or trauma?

There is plenty of functional testing that can give more insight. Things don’t have to perfectly meet an ICD-10 code or diagnostic criteria for it be problematic or upregulate or downregulate certain processes in the body.

These are all stones that can be overturned, but a non- exhaustive list. Usually before disease is dis-ease. Find the dysfunction, imbalances, and deficiencies and address; this can often lead to autoimmunity reversal or more optimal bodily function. There are MANY studies done on thyroid antibody presence and some of the WHYS behind this.

Autoimmunity doesn’t just happen; you are allowed to ask questions about why your body is dysfunctioning; it’s not always genetics alone. Dig via testing and then control the other controllables.

In summary, keep taking your prescriptions as prescribed; but in the same breath if that answer alone is not good enough for you: explore Functional testing, address underlying triggers and fix, and do a deep dive on your gut microbiome. Also consider looking into red light therapy to reduce thyroid antibodies. All of this can only help manage your Hashimoto’s OR even reverse it in some cases.

Schedule a consult package if you have Hashimoto’s and you want an integrative approach that looks at more than just medications but also environment, lifestyle, nutrients, the gut microbiome and dealing with toxins bioaccumulated in the body.

References:

• Aghili R, Jafarzadeh F, Bhorbani R, et al. The association of Helicobacter pylori infection with Hashimoto’s thyroiditis. Acta Med Iran. 2013;51(5):293-6.
• Shi W, Liu W, Zhou X, Ye F, Zhang G. Associations of Helicobacter pylori infection and cytotoxin-associated gene A status with autoimmune thyroid diseases: A meta-analysis. Thyroid. 2013;23(10):1294-300. doi:10.1089/thy.2012.0630.
• Rojas M, Restrepo-Jiménez P, Monsalve DM, et al. Molecular mimicry and autoimmunity. J Autoimmun. 2018;95:100-123. doi:10.1016/j.jaut.2018.10.012
• Disanto G, Chaplin G, Morahan JM, et al. Month of birth, vitamin D and risk of immune-mediated disease: a case control study. BMC Med. 2012;10:69. Published 2012 Jul 6. doi:10.1186/1741-7015-10-69.
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• de Luis D, Varela C, de La Calle H, et al. Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis. Journal of Clinical Gastroenterology. 1998;26(4):259-63. doi:10.1097/00004836-199806000-00008.
• Franceschi F, Satta M, Mentella M et al. Helicobacter pylori infection in patients with Hashimoto’s thyroiditis. Helicobacter. 2004;9(4):369. doi:10.1111/j.1083-4389.2004.00241.x.
• Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012;42(1):71-78. doi:10.1007/s12016-011-8291-x
• Knezevic J, Starchl C, Tmava Berisha A, Amrein K. Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?. Nutrients. 2020;12(6):1769. Published 2020 Jun 12. doi:10.3390/nu12061769
• Bertalot G, Montresor G, Tampieri M, et al. Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection. Clin Endocrinol (Oxf). 2004;61(5):650-652. doi:10.1111/j.1365-2265.2004.02137.x
• Caron P, Grunenwald S, Persani L, Borson-Chazot F, Leroy R, Duntas L. Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults [published online ahead of print, 2021 Oct 20]. Rev Endocr Metab Disord. 2021;1-21. doi:10.1007/s11154-021-09691-9
• Castellana M, Castellana C, Giovanella L, Trimboli P. Prevalence of gastrointestinal disorders having an impact on tablet levothyroxine absorption: should this formulation still be considered as the first-line therapy?. Endocrine. 2020;67(2):281-290. doi:10.1007/s12020-019-02185-4

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