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Five key components to managing Hashimoto's

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  • Five key components to managing Hashimotos

Autoimmune thyroid disease is the most prevalent cause of thyroid dysfunction in Australia; up to 15% of the population tests positive for thyroid antibodies.[1] Hashimoto’s, the most common form of thyroid dysfunction,[2] is an autoimmune condition where cell- and antibody-mediated immune processes attack thyroid cells.[3] This leads to inflammation and, in most cases, destruction and reduced function of the thyroid tissue. The resulting damage reduces the thyroid’s ability to produce hormones that are important for numerous metabolic processes[4] involved in energy production, heart rate control, digestion, mood stabilisation, and body temperature regulation.[5]

Thyroid dysfunction is currently one of the leading endocrine disorders worldwide, with data suggesting about half of the population with thyroid dysfunction has not been diagnosed.[6] This, in part, could be due to the fact that the signs and symptoms of Hashimoto’s, such as fatigue, brain fog, weight gain, low body temperature, hair loss, constipation and mood changes[7] overlap with various other common conditions. These include hormonal imbalances, sleep disorders, other autoimmune conditions, chronic fatigue and fibromyalgia, menopause and depression.[8] However, with a growing incidence and prevalence of Hashimoto’s,[2] alongside a greater requirement to support altered immune function to reduce comorbidities,[9] more people are turning to complementary medicine for answers.

After working with thousands of Hashimoto’s patients to successfully reverse their condition, and empowering tens of thousands more with her New York Times bestseller, The Thyroid Connection, Dr Myers has identified five key components of successfully managing Hashimoto’s, that are vital for improving
patient outcomes.

Heal the gut

While the exact aetiology of Hashimoto’s is unknown, the gut-brain axis and microbiota dysbiosis play an integral role in the expression of autoimmune conditions.[10,11]

The intestinal epithelium comprises the largest mucosal surface present in the human body and acts as the border between internal and external environments.[10] The tight junctions that orchestrate the locomotor, digestive, absorptive, neuroendocrinological and immunological functions of the intestine are slightly permeable so that the nutrients from food can enter cells and the bloodstream. However, their function is dependent on various stimuli, including dietary intake, endocrine and neural signals and immunological triggers from inflammatory mediators and mast cells.[10] These factors may enhance the permeability of the epithelial layer, causing it to become leakier than it should be, altering the epithelium’s capacity to reject compounds that shouldn’t be able to enter.

Once the intestines become more permeable, larger molecules – food particles, bacteria, viruses, and toxins – enter the bloodstream where the immune system detects them as antigens, attacking them and contributing to chronic inflammation. For example, gluten, a protein found in wheat, barley and rye, is one of the major causes of increased intestinal permeability. It produces a chemical called zonulin that causes tight gap junctions to open up.[10] This increase in permeability can also be worsened by stress, gut infections (such as Candida overgrowth and small intestinal bacterial overgrowth [SIBO]), antibiotics, and the contraceptive pill.
The antigens circulating through the bloodstream are very similar to the body’s own cells, leading to molecular mimicry. In the case of Hashimoto’s specifically, gluten’s chemical structure is very similar to that of thyroid tissue. So, apart from contributing to an increase in intestinal permeability, gluten also travels through the bloodstream and the process of molecular mimicry leads to the immune system attacking the thyroid, mistakenly identifying it as gluten. Simultaneously, when the gut is inflamed, the digestive enzymes needed to digest or absorb foods properly are not secreted. Instead, carrier proteins are damaged, leading to malabsorption and nutrient deficiencies. 

The detoxification pathways that line the gut are also compromised and chemical sensitivities can result. Furthermore the protective coating of gut antibodies can be broken down, triggering more food sensitivities and causing the body to become more vulnerable to bacterial infections. Bacteria and yeast can then translocate around the body from the gut through the bloodstream causing systemic infections.[12] It is clear to see why healing the gut is such an important component in the management of Hashimoto’s, and how this fundamental therapeutic consideration can lead to great benefit for Hashimoto’s patients.  

One of the classical approaches to repairing intestinal wall lining is the ‘4R’ approach of remove, replace, re-inoculate and repair.[13] Quite simply:

  • Remove inflammatory foods, toxins, infections, parasites
  • Restore the enzymes and acids necessary for proper digestion
  • Re-inoculate the gut with healthy bacteria (probiotics)
  • Repair the gut and intestines with the nutrients and amino acids it needs.

Optimise nutrition

Knowing which foods to eat and which to avoid can be confusing, however getting it right is crucial. Foods that are generally considered healthy such as dairy,[13] legumes, eggs, corn and soy could all be contributing to the progression of Hashimoto’s as all of these foods contribute to inflammation and increased intestinal permeability.[12] For example, casein, the protein found in dairy, has a very similar molecular structure to gluten and exerts the same inflammatory and molecular mimicry effects as gluten. Eliminating foods that contributeto known sensitivities, inflammation, and intestinal permeability is one component of optimising nutrition that needs to be considered. 

The other important aspect for consideration is rectifying nutritional deficiencies caused by intestinal permeability (such as magnesium, chromium and zinc) and ensuring the main nutrients for thyroid health are being consumed and absorbed in sufficient quantities. Supporting the body with the nutrients it needs is just as important as removing toxic foods from the diet.

The four nutrients in particular that are key for optimal thyroid function include iodine, selenium, zinc and iron:[14]

  • Iodine – this is one of two components required for healthy hormone production by the thyroid.
  • Selenium – needed to convert thyroid hormones to their active state and also reduces Hashimoto’s antibodies.
  • Zinc – necessary to trigger the hypothalamus’ thyroid hormone receptors and also plays a role in converting thyroid hormones to their active state.
  • Iron – converts dietary iodide into iodine to help support thyroid hormone production, as well as assisting the conversion of thyroid hormones to their active state.

Other important nutrients to consider could include vitamins A[14] and D[15] and inositol[16], to provide further thyroid, immune system and antioxidant support.

Eating a diet rich in clean, whole foods will go a long way to boosting levels of these critical nutrients. However, it is suggested that benefit may be seen from taking a high-quality multivitamin that includes these nutrients in order to maintain sufficient levels.

Tame the toxins

Toxins are ubiquitous in modern society. Each day we are exposed to numerous toxins that can accumulate in the body and impact health in various ways, including contributing to the progression of autoimmune conditions[10] and impacting how well the thyroid can function.[17]

The toxins that pose the biggest threat to thyroid health are mercury, perchlorate and nitrates, while metals such as aluminium hydroxide, nickel and cobalt may induce inflammation via the activation of pattern recognition receptors.[10]

Mercury, perchlorates, and nitrates are all chemically similar to iodine and are readily absorbed by the thyroid in place of iodine.[18,19] When this occurs, the thyroid doesn’t have enough iodine to produce adequate levels of its hormones, perpetuating Hashimoto’s symptoms. Additionally, nitrates have been linked to increased rates of thyroid cancer.[19]
To reduce exposure and minimise the impact of these toxins, it is important to identify how exposure to these are occurring. For example these toxins can be found in air, water, cosmetics, fish, pesticides, dental fillings and vaccinations. Next, it is important to reduce exposure to these toxins. This can be achieved by filtering water and air, choosing organic food and low-mercury fish, avoiding foods with a lot of chemical-based additives, buying non-toxic cosmetics and making informed choices about vaccines. Finally, it is essential to support the liver to ensure the proper detoxification and elimination of these toxins from the body.[12]

Antioxidant nutrients found in foods such as selenium and vitamin A,[14] alongside nutraceuticals, glutathione[20,21] and alpha-lipoic-acid,[22] help support the liver and removal of toxic substances.

Heal infections

The mechanisms by which infections may induce autoimmune responses are many. However, there are a few that are correlated with the onset and progression of Hashimoto’s specifically. First of all, molecular mimicry, as seen with the consumption of certain foods, may also occur with the presence of specific infections in the body. Viruses, parasites and bacteria (pathogens) sometimes look similar to components of the thyroid gland, causing the immune system confusion. The immune system remembers isolated protein sequences on pathogens and seeks out similar looking proteins as targets for an attack.[23] If thyroid proteins match the proteins remembered by the immune system, the thyroid may be targeted for attack as well. Another mechanism of action involves infections invading the thyroid gland or hiding in its cells. When this happens, the immune system’s attempt to try to kill the virus or bacteria, may also result in damage to the thyroid.[24]

There are a number of infections associated with autoimmune diseases, and there are five often found in people with Hashimoto’s. These include herpes viruses, Epstein-Barr virus, hepatitis C,[24] Helicobacter pylori,[25] and Yersinia enterocolitica.[26] These are common infections that are often asymptomatic, so it is difficult to determine infection via signs and symptoms. These viruses and bacteria can all be tested for and treated. Pathological investigations are suggested to determine the diagnosis of these infections, and appropriate treatment be administered in signs of their presence.

Relieve stress

Physical and psychological stressors have been implicated in the development of autoimmune diseases due to the impact of stress on immune system function and gene expression.[27] Furthermore, chronic stress may intensify inflammation and increase an individual’s risk of developing infections and other inflammatory conditions associated with autoimmune disease.[27] When the body feels threatened or experiences stress, vital functions begin to shut down. These include processes involving digestion, immune response and thyroid function. During periods of stress, thyroid hormone production slows down, and there is a reduction in conversion of thyroid hormones T4 to T3, and a shortage of free thyroid hormones.[28]

Ideally, stress passes quickly, and the body’s functions return to normal. However, today, there is an increased prevalence of chronic stress, meaning that this process cycles over and over again, causing detrimental and long-term impacts on the thyroid.[12] Chronic stress, leading to adrenal insufficiency, can also contribute directly to increased intestinal permeability and inflammation[29] and can reactivate the latent infections that trigger Hashimoto’s.[30]
While stress in life is inevitable, numerous techniques can be employed to help manage and relieve it. How people de-stress is unique to the individual. Figuring out which method is best for your patient, whether it be professional behavioural interventions, deep breathing, meditation, yoga, regular exercise or simply making time to get outside, are important considerations in the prevention of stress-related immune imbalances and in managing Hashimoto’s.[27]

In conclusion, Hashimoto’s is a complicated and multifaceted condition that is unique for every individual.
Unlike hereditary and genetic factors that influence the onset of autoimmune conditions, many lifestyle and environmental factors can be modified in order to better manage the disease’s progression. Following the guidelines listed and adapting them to your patient’s needs may help in managing Hashimoto’s, its associated symptoms, and improving your patient’s overall health and quality of life.


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Amy Myers
Dr. Amy Myers is a specialist in autoimmune diseases whose career was set in motion by her own experience dealing with autoimmune issues. Dr Myers graduated cum laude from the Honors College at the University of South Carolina and earned her medical degree at Louisiana State University Health Sciences Center. After completing her residency in emergency medicine at the University of Maryland, she underwent certification training with The Institute for Functional Medicine and founded the nationally renowned functional medicine center, Austin UltraHealth, where she currently serves as its medical director. Dr. Myers is a 2 x New York Times Bestselling author of The Autoimmune Solution and The Thyroid Connection. She is the founder and medical director of Austin UltraHealth, a functional medicine clinic that treats patients from all over the world who are overcoming chronic illness.