Getting to the ROOT CAUSE of Hashimoto’s Thyroiditis

By Dr. Laura Ruby

Tired of feeling SICK & TIRED?  Concerned that it may be your thyroid, but your labs always come back “normal”?  Thyroid disease is my specialty so let’s chat.

Hashimoto’s thyroiditis is an autoimmune condition in which the body attacks the thyroid gland, leading to a chronic destructive process. While it is the most common cause of hypothyroidism, it is often overlooked and is still not fully understood. Thyroid autoimmune diseases are one of the most common autoimmune disorders seen in the US.

Common treatment for Hashimoto’s thyroiditis is typically thyroxine replacement. In some cases, a combination of thyroxine T4 and T3 are used. While this may alleviate some of the symptoms associated with autoimmune thyroid disease, it fails to address the underlying problem. In fact, in some cases, you may actually feel worse with the thyroid hormone replacement. From my standpoint, this problem is related to fact that standard thyroid screening often misses this autoimmune disorder, and traditional health care professionals are not trained to look for the underlying triggers that drive Hashimoto’s disease.

Traditional thyroid labs do not fully reflect the severity of the underlying condition.

I often see clients with classic symptoms of hypothyroidism that have perfectly normal thyroid labs. In this case, you must dig a little deeper. The most important test for Hashimoto’s disease is TPO or thyroid peroxidase antibodies, which reflects the fact that the immune system is attacking the thyroid gland.  TPO is an enzyme responsible for thyroid hormone production. TGB or thyroglobulin antibodies are also measured since Hashimoto’s can follow a TGB attack. Thyroglobulin is produced by the thyroid and can also be used to produce thyroid hormones. Thyroid stimulating hormone antibodies are seen in Graves disease, but can also be elevated in Hashimoto’s thyroiditis.  I have also seen clients with negative thyroid antibodies have Hashimoto’s changes in their thyroid by ultrasound.

Most health care provider are not trained to ask the simple question ~ What is driving the underlying autoimmune process?

For more than 10 years I treated Hashimoto’s thyroiditis with never really asking the why. Why does this person have an autoimmune thyroiditis?  And furthermore, why doesn’t everyone feel better with thyroid hormone replacement therapy?  From a traditional medicine standpoint, the answer that I would have typically given in the past, is that particular person is genetically pre-disposed to autoimmune disease AND that you cannot reverse the autoimmune process.  Additionally, we also know that women account for more than 70% of all autoimmune conditions and many health care professionals believe that the incidence is grossly underestimated. We now know that genetics is only a small piece of the autoimmune puzzle. 

Did you know that Gluten is strongly linked to Hashimoto’s Thyroiditis?

I have come to realize that autoimmune disorders, like Hashimoto’s disease, often have an underlying trigger. Gluten is one of the top offenders in my experience.   Based on current research, it is thought that 1 in every 100 people have celiac disease with an estimated 87% being un-diagnosed.  Furthermore, it is thought that nearly 35% of Americans are gluten intolerant.  Other major drivers of Hashimoto’s I see in my practice are chronic Epstein Barr virus, gastrointestinal imbalance such as leaky gut syndrome and in some cases, chronic hidden infections.

I have also seen major life stressors trigger an autoimmune attack on the thyroid.  Again, we go back to “looking upstream” and peeling each layer of the onion.  It goes beyond how much or what type of thyroid hormone replacement to give someone.  If you do not get to the underlying triggers for autoimmunity, you put the person at risk for developing additional autoimmune and inflammatory conditions.

What about Iodine?

In his groundbreaking book Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal, Dr. Kharrazian also addressed the hot topic of iodine supplementation and equates giving iodine to someone with Hashimoto’s to “Throwing gasoline onto a fire.”  While iodine is essential to thyroid function, it is also a major co-factor for the enzyme TPO.  Giving iodine may increase TPO antibodies, in turn creating a flare up of the autoimmune process.  Of course, there are always exceptions, especially if you have a documented iodine deficiency.

A Functional Medicine approach to Hashimoto’s thyroiditis

Over the last 10 years I have fine-tuned my Hashimoto’s Protocol to include a comprehensive consultation which focuses on a timeline of physiologic and emotional life events, genetic predisposition, and other factors to clue me in to potential underlying triggers.  So often traditional medical care is time-limited, which further emphasizes the treatment of symptoms without ever hearing the individual’s entire story.  Our approach incorporates a team-based personalized treatment plan designed to help each person treat the root cause of their Hashimoto’s.   Once I started incorporating Functional Medicine into my practice, I could not believe how much I was missing.  There may be many layers to go through before the full picture is evident.  We need to start treating Hashimoto’s thyroiditis for what it is……An immune mediated disease and look for and TREAT the ROOT CAUSE such as chronic viral infections, gluten intolerance, vitamin D deficiency, leaky gut syndrome and many other potential triggers. AND with a Functional Medicine approach, I have seen clients reduce their thyroid antibodies and reverse the autoimmune process.

For more information on functional medicine, visit www.owforlife.com.

Be well, 

Dr. Laura Ruby, DNP, CRNP, IFM Board Certified in Functional Medicine