What is Hashimoto’s (and how to find out if you have it)

Why does Thyroid Disease Matter?

Do you have thyroid disease, or specifically Hashimoto’s?

If so, you probably already know that:

  • Thyroid disease can cause many varied symptoms and is a major barrier to overall health and ability to function
  • Patients often assume there are no further options beyond taking thyroid hormone replacement medication, even if they still feel poorly
  • Testing and treating thyroid disease can be confusing and overwhelming to patients
  • Failing to address the root cause of thyroid disease can lead to continued loss of thyroid gland function and other chronic dysfunction/disease

As a Naturopathic Doctor (and someone who prides herself on sorting through and organizing information well!), I LOVE helping patients navigate what can feel like a complex maze so they can actually FEEL BETTER and address the root cause(s) to actually heal and prevent future disease.

This is especially important in thyroid disease because it is so common but difficult to treat effectively without professional help from someone specifically trained and experienced with these conditions.

This article is Part 1 of a series of three articles all about Hashimoto’s disease and will cover symptoms and key Hashimoto’s testing.

What is Hashimoto’s Disease?

No, it’s not the newest sushi restaurant, it is actually the MOST common cause of hypothyroidism! If you have thyroid disease, you have probably heard this word already, but do you know for sure whether you have it (or not)?

Hashimoto’s disease (aka Hashimoto’s thyroiditis or Hashimoto’s hypothyroid) is a condition in which your body launches an immune response and produces antibodies against the thyroid gland, which is definitely not a good thing!

Thyroid

Your thyroid is a butterfly-shaped gland at the base of your throat that produces hormones that play a major role in regulating temperature, basal metabolic rate, and nearly EVERY other tissue and system in your body.

The antibodies produced in Hashimoto’s cause damage to the thyroid gland that eventually leads to hypothyroidism. Hashimoto’s is overwhelmingly the most common cause of hypothyroidism – so, if you have thyroid disease and DON’T know if it is Hashimoto’s, it’s time to find out.

What are the Symptoms of Hashimoto’s?

You’ve probably heard the terms “hypothyroid” and “hyperthyroid”. These words sound very similar and can be easily confused! HYPO means “too little”, as in too little thyroid hormones. Think “hypothermia” = too little warmth. HYPER means “too much”, as in too much thyroid hormone. Think “hyperactive” = too much activity.

Hashimoto’s can actually cause symptoms of hypothyroid OR hyperthyroid at times because as thyroid cells are damaged this can cause an irregular release of thyroid hormones. People with Hashimoto’s also often have many other symptoms of inflammation.

Hypothyroid: Too little thyroid hormone

  • Weight gain
  • Fatigue, depression
  • Poor memory
  • Constipation
  • Intolerance/sensitivity to cold
  • Dry skin, hair, nails and/or hair loss
  • Irregular or absent menstrual periods, infertility
  • Muscle cramps, stiffness, joint pain, weakness
  • Edema, puffiness

Hyperthyroid: Too much thyroid hormone

  • Weight loss
  • Fatigue and/or insomnia
  • Anxiety, irritability, nervousness
  • Heart palpitations
  • Loose stools
  • Intolerance/sensitivity to heat
  • Sweating, flushing, moist/oily skin
  • Hair loss
  • Irregular and/or heavy menstrual periods
  • Goiter, protruding eyes

How to Diagnose Hashimoto’s

Understand Hashimoto’s Testing

As a Naturopathic Doctor it is my job to seek the root cause of dysfunction or disease so that I can offer patients most effective treatment to heal and support the body’s natural self-regulation so that they STAY healthy long-term.

If you have Hashimoto’s, thorough testing to assess thyroid function and rule in/out common causes is THE KEY to personalized treatment and monitoring success of treatment over time. In many cases patients are able to do some or all of the testing listed below via their medical doctor. In cases where some of this information is missing, I can order lab testing to fill in the blanks before developing a treatment plan.

Thyroid Stimulating Hormone (TSH):

The hypothalamus in your brain makes a hormone called thyrotropin releasing hormone (TRH) that stimulates the anterior pituitary gland (also in your brain) to make thyroid stimulating hormone (TSH). TSH then tells your thyroid gland (in your neck) to make thyroid hormones.

TSH is the most basic screening test for thyroid function – a HIGH TSH level means your brain is working HARDER to get your thyroid gland to do its job and indicates HYPOTHYROIDISM (underactive thyroid gland). Conversely, a LOW TSH level means your brain is trying to turn down the thyroid gland and indicates HYPERTHYROIDISM (overactive thyroid gland).

The current normal range of TSH from LifeLabs is 0.32-4.00 mIU/L. Within this range the ideal TSH is 0.5-2.5 (for patients NOT taking any thyroid medication). This ideal range may vary depending on the reference range provided by the lab used for testing.

Free Thyroxine (free T4):

The major thyroid hormone produced by the thyroid gland is thyroxine (T4). T4 is released by the thyroid gland and converted into triiodothyronine (T3) throughout the body.

This is the next most common test for thyroid function and specifically “free” T4 should be tested. “Free” means this test measures the metabolically active hormone; a total T4 test measures both free hormone and hormone bound to a carrier protein (thyroid binding globulin).

The current normal range of free T4 from LifeLabs is 9-19 pmol/L. Within this range the ideal free T4 is 12-16 (for patients NOT taking any thyroid medication). This ideal range may vary depending on the reference range provided by the lab used for testing.

Free Triiodothyronine (free T3):

Triiodothyronine (T3) is produced is small quantities by the thyroid gland, but mostly produced via conversion from thyroxine (T4) in body tissues and is much more active than T4 so can influence patient symptoms quite significantly. Just as with T4 hormone discussed above, “free” T3 should be tested.

The current normal range of free T3 from LifeLabs is 2.6-5.8 pmol/L. Within this range the ideal free T3 is 4-5.5 (for patients NOT taking any thyroid medication). This ideal range may vary depending on the reference range provided by the lab used for testing.

Antibodies:

Next to TSH, thyroid antibodies are the MOST IMPORTANT tests for Hashimoto’s because they confirm that there is an autoimmune condition and aid in monitoring treatment.

Many medical doctors do not think that testing thyroid antibodies is helpful because this test does not change their treatment options. In cases of hypothyroidism, the first line conventional medical treatment is thyroid hormone replacement with thyroxine (T4), whether you have Hashimoto’s or not.

However, as a Naturopathic Doctor, my treatment of hypothyroidism is quite different and depends on understanding the ROOT CAUSE which is usually Hashimoto’s (autoimmunity), so testing thyroid antibodies is so important!

There are two thyroid antibodies to test in cases of Hashimoto’s:

Thyroperoxidase or Thyroid Peroxidase Antibodies (Anti-TPO):

Most people with Hashimoto’s have elevated thyroperoxidase or thyroid peroxidase antibodies (aka anti-thyroperoxidase or anti-TPO). People with Graves’ disease (autoimmune hyperthyroidism) may also have these antibodies elevated.

The current normal range of thyroperoxidase antibodies from LifeLabs is <35 kIU/L. Patients with Hashimoto’s often have antibody levels over 100, in some severe cases I have seen this number over 1000! Very high antibody levels reflect more autoimmune activity and more damage occurring to the thyroid gland.

My initial goal in Hashimoto’s patients is to bring antibody levels down under about 100-150 which reflects a much lower level of autoimmune attack on the thyroid gland.

Thyroglobulin Antibodies (Anti-TG):

Many people with Hashimoto’s have elevated thyroglobulin antibodies (aka anti-thyroglobulin or anti-TG) but these are less common. It is important to test BOTH antibodies because only by testing both can you reliably diagnose Hashimoto’s and monitor disease severity and response to treatment.

The current normal range of thyroglobulin antibodies from LifeLabs is <40 kIU/L. Patients with Hashimoto’s often have antibody levels over 100, but I rarely see extremely high numbers for these antibodies.

My initial goal in Hashimoto’s patients is to bring antibody levels down under about 100-150 which reflects a much lower level of autoimmune attack on the thyroid gland.

Other useful tests:

Reverse T3 (rT3):

Remember the hormone T3 discussed above? It is super important in influencing symptoms. Reverse T3 is a virtually inactive form of T3 that binds to T3 receptors and blocks the action of normal T3.

When treating any type of thyroid disease it is important to know if this hormone is higher than expected in relation to free T3 (discussed above) to understand the cause of your symptoms, rule in or out underlying issues that may affect thyroid function, and tailor treatment to address your specific needs.

Insulin Resistance:

Insulin resistance occurs when cells in your body become less responsive to insulin, the hormone that allows glucose (sugar) to move from your bloodstream into cells to make energy.

In the Western world, insulin resistance is extremely common because it develops mainly due to living in an environment of abundance (lots of high calorie, high sugar food available), which is the norm in developed countries. Unfortunately most adults become more insulin resistant as we age, just from living what we think of as a “typical” lifestyle. Lack of exercise, lack of sleep, excess weight, and other unhealthy lifestyle choices like smoking also contribute.

Insulin resistance can affect thyroid health by interfering with the all-important conversion of thyroid hormones and increasing thyroid antibodies.

You can assess insulin resistance by running two tests: fasting glucose and fasting insulin. The results of these tests can be used to calculate the degree of insulin resistance using a calculation called HOMA-IR which stands for Homeostatic Model Assessment of Insulin Resistance.

Gluten Sensitivity Testing:

As I’ve discussed in my blogs on gluten sensitivity, thyroid dysfunction (autoimmune and otherwise) is correlated with gluten sensitivity and in most cases avoiding gluten can aid in regulating thyroid function.

Before cutting gluten out of the diet, it is helpful to test for gluten sensitivity because once you remove gluten from the diet, this testing can be less accurate and may yield false negatives. For more on this subject, see my blog on gluten sensitivity diagnosis and why gluten sensitivity matters.

Sources:

  1. Christianson, Alan. (2013). Healing Hashimoto’s Physicians’ Training.
  2. Hashimoto’s disease. Mayo Clinic website.
  3. HOMA-IR – Insulin Resistance Calculator.
  4. LifeLabs reference ranges.
  5. Wentz I. (2017). Hashimoto’s Protocol. New York, NY. HarperOne.
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