Hashimoto’s Thyroiditis Symptoms

What is Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis is an autoimmune condition that impacts the thyroid gland. This is where the body’s immune system starts to attack the thyroid gland. It is the most common thyroid disorder.

In Hashimoto’s thyroiditis, this immune attack on the thyroid gland can reduce how well the thyroid functions. Due to the role of the thyroid in regulating many processes within the body, particularly related to energy production, low levels of thyroid hormones can lead to a wide range of symptoms.

Symptoms of Hashimoto’s thyroiditis include:

· Fatigue

· Constipation

· Hair loss

· Depression

· Memory loss

· Hair loss

· Hoarse voice

· Feeling cold

Hashimoto’s Thyroiditis is estimated to have a general prevalence of 10-12%, with more commonly being seen in women. Approximately 70-80% of the susceptibility to Hashimoto’s thyroiditis is understood to be based on genetics, with specific genes found to increase the risk. [1]

The additional factors that contribute to the remaining 20-30% of the risk of Hashimoto’s thyroiditis are understood to be environmental factors. These include various factors such as life stress, dietary patterns, exposure to radiation, environmental toxins and infections.

Several viruses have been associated with Hashimoto’s.

These include:

· Hepatitis C virus

· Human parvovirus B19

· Coxsackie virus · Herpes virus [2]

There are certain risk factors for Hashimoto’s thyroiditis. The risk of Hashimoto’s thyroiditis increases with:

· Age (risk of Hashimoto’s thyroiditis increases with age)

· In those with other autoimmune conditions

· Autoimmune conditions include:

· Myasthenia gravis

· Systemic sclerosis

· Sjögren’s syndrome

· Pernicious anaemia · Celiac disease [3]

What causes Hashimoto’s thyroiditis?

In this condition, an ongoing immune response starts to damage the thyroid gland. As with all autoimmune conditions, this can be considered as a case of mistaken identity, where the immune system starts to attack something it should not.

Risk increased with certain factors, such as:

· Genetic – there is an increased risk with a family history of this condition.

· Environmental – viral infections and chemical exposure can both increase the risk of its onset.

· Gender – women are at an increased risk of developing Hashimoto’s.

Does Hashimoto’s thyroiditis cause IBS?

Due to the role of the thyroid in supporting muscle function, poor thyroid health can lead to reduced motility of the gut. The reduced motility can then contribute to symptoms, such as dyspepsia, constipation and IBS.

The symptoms of dyspepsia include:

· Pain or a burning sensation in the stomach after meals

· Bloating or belching after meals

· Feeling full very quickly

· Pain or discomfort in the stomach

The muscle contractions within the small intestine help in regulating the microbial balance. However, if these muscle contractions are altered, this may then lead to changes in the microbial balance in the small intestine.

This is a reason why an underperforming thyroid gland is considered a risk factor for SIBO due to the slow movement of the muscles in the small intestine, creating an environment that allows more bacteria to flourish. SIBO stands for small intestinal bacterial overgrowth and is defined by an increase in the bacterial load within the small intestine. SIBO has been indicated to be the underlying cause of symptoms in up to 80% of those with IBS. This condition has also been reported to be present in up to 50% of those with an underactive thyroid.

Even without digestive symptoms such as bloating, constipation and dyspepsia, imbalances in the gut bacteria can still be present. These imbalances may then further impact the functioning of the thyroid gland. [4, 5]

Gut health and Hypothyroidism

The connection between the thyroid and the gut is called the thyroid-gut axis. This describes the way in which the gut impacts the thyroid, as well as the way in which the thyroid may impact the gut.

Alterations in this communication pathway may be partly responsible for the development of thyroid symptoms. This means that thyroid issues may actually stem from the gut.

Imbalances in the gut microbiome are referred to as dysbiosis and lead to changes within the gut such as:

· Increased inflammation

· Reduce immune tolerance

· Damage to the gut lining

· Increased intestinal permeability (leaky gut)

The gut can also impact thyroid hormones directly through changes in the enzymes required to produce thyroid hormones as well as by inhibiting TSH (thyroid stimulating hormone).

It is also known that the gut microbiome supports the absorption of nutrients that are required for thyroid function. These include iodine, selenium, zinc and iron and low levels of these are associated with poor thyroid function; therefore, imbalances in the gut can impact how we absorb these nutrients [1].

Imbalances in the gut have been linked to autoimmune processes via several possible mechanisms, all of which influence the immune response and progression.

These include:

· Molecular mimicry

· Bystander activation · Epitope spreading [6]

Additionally, changes in the lining of the gut have been seen in those with Hashimoto’s thyroiditis, in particular in the duodenum (the first part of the small intestine).

These changes included a thickening in the microvilli as well as an increased space between these, which may indicate alterations in the structure of the gut wall that may contribute to the local and systemic immune response.

Does IBS cause thyroid issues?

Simply having IBS doesn’t cause thyroid issues. However, there is a clear link between these diseases. As already discussed, certain gut imbalances, such as SIBO, can increase the chance of developing both of these conditions.

This means that gut imbalances, inflammation and genetics may all be partly responsible for the onset of IBS as well as the onset of thyroid issues.

Symptoms of Hashimoto’s thyroiditis

A diagnosis of Hashimoto’s Thyroiditis is given by a doctor and is based on certain symptoms and tests.

As mentioned, the symptoms of Hashimoto’s thyroiditis can include:

· Fatigue

· Constipation

· Hair loss

· Depression

· Memory loss

· Hair loss

· Hoarse voice · Feeling cold [3]

If symptoms are present, an initial test into the thyroid glands’ function will be for TSH (thyroid stimulating hormone) and T4 (the main thyroid hormone).

A high level of TSH and a low level of T4 indicate that the thyroid is underperforming. This underperformance is termed hypothyroidism.

There are further blood tests that assist with the diagnosis of Hashimoto’s thyroiditis. In particular, the presence of antibodies indicates an autoimmune process. These are the antibodies anti-TPO and anti-Tg. Anti-TPO antibodies are seen in approximately 95% of those with the condition, and anti-Tg antibodies in between 60-80% of those with the condition.

An ultrasound may also be performed to help with the diagnosis of Hashimoto’s thyroiditis. This can indicate the condition with the presence of small cysts and the alteration of the texture of the thyroid gland.

What areas of the body does Hashimoto’s thyroiditis impact?’

The symptoms of Hashimoto’s thyroiditis are varied and can impact several areas of the body. This is due to the role of thyroid hormones and the ability of these hormones to affect all cells within the body.

These symptoms can include:

· Hair loss

· Gut – constipation, ileus and dyspepsia (indigestion)

· Fat – increased fat deposits

· Skin issue – dry and cold skin. It may also be yellowish in colour and thickened.

· Lung – slow breathing, low levels of oxygen in the body

· Heart – slow heart rate, decreased cardiac-out out

· Kidney – decreased glomerular filtration rate, decreased free water excretion

· Liver – increased cholesterol, gallstones

· Ovaries – menstrual irregularities, menorrhagia (menstrual bleeding that lasts more than 7 days)

· Muscles – reduce muscle contractility and muscle cramps

· Bain – poor memory, poor concentration and low mood

· Voice – thickening of the vocal cords and hoarse voice

While these symptoms can appear in many areas of the body, an underperforming thyroid gland can be the factor that links them all to a common underlying issue [6].

How is thyroiditis diagnosed?

Thyroid conditions are diagnosed via blood tests which measure levels of TSH and T4. These indicate how well the thyroid is functioning.

· In adults, the normal range for TSH is: 0.27–4.2 milli-international units per litre (mU/L)

Levels of TSH above this range start to indicate the thyroid is underperforming.

For T4, 2 measurements are considered: Total T4 and Free T4.

· Total T4: A normal level for adults is 5.0–12.0 micrograms per deciliter (μg/dL)

· Free T4: A normal level for adults is 0.8–1.8 nanograms per deciliter (ng/dL)

Levels below this indicate that not enough T4 is being produced.

These markers (TSH and T4) will initially indicate an underactive thyroid. However, elevated levels of thyroid antibodies need to be present for a diagnosis of Hashimoto’s.

How is thyroiditis treated?

The medical approach to address thyroid conditions is primarily focused on thyroid replacement hormones. This consists of T4 medications such as Levothyroxine.

In more specialised settings, a combination of T3 and T4 may be prescribed.

However, there are natural approaches that focus on treating thyroiditis without pharmaceuticals via focusing on:

· Diet

· Lifestyle

· Natural thyroid support

· Natural gut support

· Considering other environmental factors such as viral or chemical burden

Probiotics for Hypothyroidism

Probiotics are defined as non-pathogenic organisms that, when taken in adequate amounts, have a beneficial effect on their host. Certain probiotics have been studied in thyroid conditions.

Part of the benefit of how probiotics support thyroid health is via supporting the immune response in the gut, particularly by enhancing the immune cells that regulate the immune system. These are known as T-regulatory cells.

An 8-week study using a supplement containing a probiotic and prebiotic (known as a symbiotic) led to an improvement in several areas of thyroid health. This improvement in thyroid health was seen in results such as:

· Reducing TSH

· Reducing the dose of thyroid replacement hormone (levothyroxine) · Increasing fT3 (free-T3) [7]

Another study found that certain groups of bacteria in the gut act as a store for thyroid hormones. This means that the appropriate balance of the gut organisms can support thyroid function by supplying thyroid hormones and reducing the fluctuation in levels. This was shown to result in less need for thyroid medications.

Probiotics can also be helpful for Hashimoto’s thyroiditis by their beneficial effect on nutrient levels. This has been seen via their impact on key nutrients required for thyroid function. These include selenium, zinc and copper. [1]

Best Diet for Hashimoto’s Thyroiditis

There is often the need to personalise the diet in those with thyroid and autoimmune conditions. However, there are key nutrients required for thyroid health which can be obtained through the diet.

These vitamins and sources are:

Dairy-free diet and Hashimoto’s Thyroiditis

Certain foods can lead to increased symptoms of Hashimoto’s thyroiditis. When approaching this condition, a period avoiding certain food or group of foods may help improve symptoms but also calm the immune response.

Lactose is a sugar found in dairy products, and one study found lactose intolerance to be present in 75.9% of patients with Hashimoto’s. Avoiding lactose from dairy products is important to be aware of when taking the thyroid hormone replacement medication levothyroxine. This is partly due to calcium inhibiting the absorption of levothyroxine by between 20-25%.

It can also be linked to the high incidence of lactose intolerance in those with Hashimoto’s thyroiditis, which can impair the absorption of levothyroxine. [9]

Do I need to go gluten-free with Hashimoto’s thyroiditis?

Gluten is highly associated with autoimmune conditions. This is partly due to the cross-reactivity between the gliadin component of gluten and the thyroid. This cross-reactivity

is where the immune system sees (and attacks) gluten, but since the structure of the thyroid looks similar, the thyroid is also targeted by the immune system. Coeliac disease is 10 times more likely in those with autoimmune thyroid conditions when compared to the general population. This can be cause to test for coeliac disease in those with Hashimoto’s disease. However, it is best to test for Coeliac disease before going gluten-free as once gluten has been removed, the Coeliac test results will not be accurate. [9]

Also Read: How to Go Gluten-Free

A 2018 study found that a gluten-free diet helped to normalise the levels of thyroid hormones and lower the level of thyroid antibodies. Both are indications of a positive effect of a gluten-free diet in Hashimoto’s thyroiditis. It is important that a gluten-free diet is adopted with the support of a practitioner to reduce the risk of nutrient deficiencies.

The cross-reactivity of foods can extend beyond gluten. A 2020 study examined over 200 foods and found that many others have the potential to cross-react with thyroid hormones. For example, buckwheat was found to cross-react with the enzyme that is responsible for converting thyroid hormones into their active form. As buckwheat may be consumed in high amounts when following a gluten-free diet, this is particularly noteworthy.

Other foods with the potential to cross-react are:

· Gluten-containing cereals

· Seaweed

· Potatoes

· Nuts (almonds, cashews, hazelnut, peanut, Brazil nut)

· Seafood

· Amaranth

· Coffee

· Corn

· Egg yolks

· Quinoa

· Sorghum

· Tapioca · Tofu [8]

Conclusion

There are clear links between thyroid health and gut health, with one impacting the other.

Rather than medications being the only option to address thyroid conditions, working holistically with diet, lifestyle and natural supplements can consider and address the other causes of this condition.

Contact us for an initial assessment or your symptoms and health history to understand how we can help you.

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