You may be wondering- what even is Hashimoto’s? 🧐 What’s the difference between Hashimoto’s & Hypothyroidism? Let’s Dive in! I present to you, the NO BS Guide to Healing Hashimoto’s and Hypothyroidism.
*please note Hashimoto’s however is an autoimmune disease that can’t technically be “healed”, but can be put into “remission” by decreasing symptoms and antibodies*
Hypothyroidism is decreased activity of the thyroid gland, which can affect your metabolism and mental and physical health. This is because your thyroid affects almost all cells and organs of your body! It includes primary and secondary hypothyroidism, which are NOT autoimmune conditions- but have the same symptoms as Hashimoto’s- which IS an autoimmune disease. Hypothyroidism can be caused by the same issues as Hashimoto’s, noted below, but also includes other pituitary causes. Primary hypothyrodism involves the thyroid itself, while secondary involves disease or malfunction of other organs that they affect thyroid function or levels, such as pituitary or hypothalamus related issues. A common condition seen in 2-7% of adults in the US is subclinical hypothyroidism, in which TSH is mildly elevated or normal with normal or slightly decreased thyroid levels.
Hashimoto’s Disease is an autoimmune disease that flares due to the body attacking its own thyroid tissue. It can result in either depletion of T4 and/or T3 levels on the body or prevent conversion of T4 (inactive) to T3 (active) by turning to reverse T3. TPO antibodies tend to sky rocket in this scenario, which gives a diagnosis of active Hashimoto’s. Antibodies bind to thyroid peroxidase enzyme, thyroglobin, and TSH receptors, inhibiting thyroid hormone synthesis and availability. TSH typically sky rockets in this case, signaling that thyroid levels are below optimal levels.
How does the thyroid gland work?
The thyroid is a butter fly shaped gland located just below your larynx. T4 is released by the thyroid and converted to the active thyroid hormone, T3, in multiple tissues, including the liver, gut, and brain. T4 has the ability to convert to Reverse T3, which is metabolically inactive in times of stress or inflammation. TSH, Thyroid Stimulating Hormone, is a pituitary hormone that signals the thyroid to decrease or increase thyroid hormone production. The pituitary is controlled by your hypothalamus, which produces TRH, thyrotropin-releasing hormone, to control TSH levels.
Typically, when T4 is low, the pituitary produces more TSH to signal to the thyroid to produce more T4. When it senses high T4 levels, typically the pituitary will produce less TSH, in attempt to bring down thyroid levels back to normal. Essentially, the thyroid and pituitary work together to control thyroid levels in the body like a thermostat. If it gets “too cold” and thyroid hormones are low, TSH will go up. If it gets “too hot” and thyroid hormones are high, TSH will go down. However, there are mulitple conditions and reasons for the thermostat not “reading” properly, in which TSH may be normal and yet T4 or T3 levels are low, such as with low TBG (thyroid binding globulin, commonly caused by high testosterone) or thyroid resistance.
Symptoms of both conditions include:
-Weight gain, hair loss, chronic fatigue, low heart rate, digestive problems like chronic bloating, constipation, or diarrhea, joint and muscle pain, irregular menstrual cycles (or none!), cold intolerance, depression, anxiety, dry skin, brain fog. Some commonly see elevated cholesterol levels as well.
It is important to note that these are also symptoms seen in other conditions!
Common Causes of Hashimoto’s and Hypothyroidism include:
-Nutrient deficiencies (specifically Selenium, Iodine, B vitamins, Vitamin D, Iron, thiamin, Zinc, magnesium, Omega 3’s)
-Environmental Toxins (BPA, heavy metals, xenoestrogens, parabens)
-Gut infections (SIBO- Small Intestine Bacterial overgrowth, Candida, Fungal overgrowths, parasites
-Food Intolerances or Intestinal permeability (aka leaky gut)
-Chronic infections (EBV and lupus being the most common)
-Hormone dysfunction (Estrogen dominance, low progesterone, low or high testosterone)
-Adrenal dysfunction (high cortisol or low cortisol both can happen!)
The KEY to HEALING Hypothyroidism and Hashimoto’s is FINDING THE ROOT CAUSE. How do you find it? Medical health history assessment, symptoms, and lab work!! So let’s chat what labs to get and why.
Above are my suggested thyroid labs to assess most root causes. If you want to check thyroid function alone, testing TSH, Free T3, Free T4 would be a start to save money (team frugal here so I get it!). Sadly many conventional doctors will just check TSH these days. Rememeber that TSH is a pituitary hormone. It does not tell you how your active thyroid levels are acting in the body (your T3!) A brief description of these labs and why to check them.
✅TSH= Thyroid Stimulating Hormone, typically increased when thyroid levels are low, and decreases when they are high (But not always!)
✅T4 and T3= Thyroid hormones. T4 is inactive and T3 is active. You want to check FREE levels because this is what indicates what is unbound by proteins and active in your blood. Low levels indicate Hypothyroidism, and high levels, hyperthyroidism. Some people have poor conversion from T4 to T3 due to nutritional deficiencies, stress/cortisol, gut or stealth infections (check last post).
✅Reverse T3= Inactive form of thyroid. What happens is an infection, stress, high cortisol, poor thyroid conversion will move T4 to Reverse T3 instead of T3. Which means your active thyroid levels will be very low yet T4 may look normal!
✅TPO and TgAB Antibodies= Helpful in diagnosis of HASHIMOTO’s Hypothyroidism- which indicates current autoimmune attack.
✅Vitamin D, Iron, B12, Folate, Magnesium= Common deficiencies seen
✅Salivary Cortisol= Important to test for Adrenal causes. This could be hypopituitary, adrenal insufficiency or just Adrenal dysfunction.
✅Sex Hormones= important to test for hormonal causes (though of course the thyroid condition itself could be a cause of the hormonal imbalance or vice versa) Test these on day 3 of your cycle ladies .
*Note I am not an MD but I have full legal authority to order and review lab work for my patients. Benefits of being a Dietitian*
If your doctor will not order bloodwork for you, my suggestion is to use UltaLabs or MyMedLab (www.ultalabs.com) or (https://www.mymedlab.com/upliftfit-nutrition/dna-stool-map-diagnostic-solutions–2). Please always remember to TEST, don’t GUESS.
What supplements can help in healing??
The focus should first be on diet for optimizing your thyroid levels and removing food intolerances, however there are several key supplements I like to suggest for all of my Hashimoto’s and Hypothyroid clients! (Of course not ALL are for everyone- must individualize ☝🏼Just a good common list of a few!!!) NOT A COMPREHENSIVE LIST. There are more or less I suggest based on somebody’s ROOT cause❗️
✅ Vitamin D: you want one with K2 which works synergistically. Dose- between 2,000 IU-5,000 IU for most people (if LOW vitamin D levels below 30, may need more). Helps boost mood, improve insulin sensitivity, and increase immune function❗️COMMON DEFICIENCY
✅ Multivitamin: helps to bridge the micronutrient gap many people have. If you have the MTHFR mutation- look for METHYLATED folate and B vitamins. .
✅ Omega 3’s: helps to decrease inflammation and supplement low omega 3’s in the diet. Dose- Look for at least 350mg EPA and DHA per serving and 1000mg Omega 3. Can do fish oil or cod liver oil. .
✅ Iodine: Only in deficiency and be careful if you have an autoimmune disease or Hashimoto’s as this can make things worse. I wouldn’t add in unless you have been tested for deficiency. Iodized salt is an easy and cheap option. Many don’t need this as a multi will have some.
✅ Selenium: Aids in the conversion of T4 (inactive) to T3 (active). Dose- Take 200mg or eat just 3 Brazil nuts .
✅ Curcumin: Incredible for reducing inflammation which can trigger autoimmunity. Need black pepper for proper absorption. Dose- 1000mg
✅ Probiotics: Not for someone with a gut infection!!! So this is case by case dependent. Can help increase immunity and improve digestion. Probiotic type depends on if there is an overgrowth. In no overgrowth- I tend to suggest Renew Life Ultimate Flora 30 billion Or Align
✅ Iron: Only if deficient! Dose- talk with your doctor based on your levels. .
✅ N-acetyl-cysteine: Helps to improve immunity through boosting glutathione levels (body’s main antioxidant!) and aids in normal body detoxification. Dose- 1200mg/day
✅ Adaptogen: helps to soothe and nourish the adrenals. Will make a separate adaptogen blog! Many have different mechanisms. I personally am a fan of KSM 66 Ashwaghanda.
What about the diet? What is the best “Hypothyroid Diet”?
There is no “Hypothyroid” Diet🙅🏻♀️
Because there are multiple causes for Hypothyroidism & individual needs matter!!
As a dietitian- it’s my goal to make sure each person I work with gets the best diet for THEIR root cause. Someone with SIBO may need low FODMAPs and low carb, someone with Adrenal dysfunction may need more carbs, blood sugar balance, and nutrient depletion. Though there isn’t one best approach- there is a best approach for YOU❗️
Common things I do suggest avoiding if you have Hypothyroidism ior Hashimoto’s include:
-Foods and ingredients YOU are sensitive to (based on elimination protocol and food journals). Common= gluten, wheat, soy, dairy, eggs, nuts, nightshades, grains
-Gluten (studies show that gluten, through cellular mimicry, can cause autoimmune attack of the thyroid. Most Hashimoto’s patients should avoid gluten. Some people can tolerate sprouted grains)
-Dairy and soy for some- can be inflammatory (some do well on organic dairy)
-Too many vegetable oils (inflammatory)
What to focus on eating regardless of cause- leafy greens, cooked cruciferous vegetables (provides DIM and indol 3 carbinol- which can help in natural liver support and elimination of environmental toxins and excess estrogen), variety in fruit and vegetables, lean proteins (organic if possible as they have increased omega 3 content compared to conventional), and healthy fats! (Think avocados, eggs, seeds, nuts, with some full fat dairy and coconut in moderation).
I hope you found this article helpful. To learn more, please check out my podcast at: UpliftFit Nutrition on Apple Podcastshttps://podcasts.apple.com/us/podcast/upliftfit-nutrition/id1207668246 or click “Podcast” on the top of my web page!
Further resources for learning include Dr. Becky Campbell, Dr. Aviva Romm, Dr. Jolene Brighten, and StoptheThyroidMadness.com.
Here’s to all the Thyroid Warriors!
Xoxo Lacey Dunn, MS, RD, LD, CPT
*fellow hypothyroid warrior*