PHW Newsletter - Edition 15

A Word from Dr. Williams

Hashimoto’s: Autoimmune Thyroiditis

The importance of the thyroid – that little butterfly-shaped gland in the front of your neck – cannot be overstated. The thyroid controls the metabolic activity within every cell throughout the body. For people with low thyroid function (“hypothyroidism”), this may cause symptoms like weight gain, constipation, dry skin, hair thinning, menstrual changes, decreased tolerance for stress, feeling tired or cold, etc.

Thyroid Physiology

Most people are familiar with TSH (Thyroid Stimulating Hormone) as that is the only thyroid lab most clinics check. TSH actually comes from the pituitary gland in the brain and is meant to stimulate the thyroid gland to produce thyroid hormones, in the forms of T4 and a little T3. T3 is the active form that turns on cellular metabolism. T4 is the inactive form that floats through the bloodstream waiting to be converted into more T3.

Introduction to Hashimoto’s

Hashimoto’s is an autoimmune condition where the body’s immune system mistakes its own thyroid tissues for a problematic invader and mounts an attack. Patients can often have no symptoms at first, sometimes even for years. Over time, the thyroid gland takes on enough damage that it can no longer keep up with demand.

Testing Recommendations

At PHW, TSH is part of our annual member panel. But whenever we are specifically questioning thyroid function, we do a full thyroid panel which includes free T4, free T3, Reverse T3, and Thyroid Antibodies. An annual thyroid ultrasound is also important for patients with Hashimoto’s to monitor for nodules.

Seeking the Root Causes

We often find patients with autoimmune diseases have high levels of chronic stress. Poor sleep, nutritional deficiencies, gut issues linked to conditions like yeast overgrowth, SIBO, and food sensitivities all increase inflammation. Research also shows exposure to toxins such as mold or mercury, and chronic infections like Epstein Barr virus or H. Pylori are linked to Hashimoto’s.

Treatment Approaches

We work to calm the triggers by decreasing autoimmunity and inflammation. There is also a medication we often recommend called Low Dose Naltrexone (LDN), which acts as an immune-modulator. If thyroid function drops, we begin adding thyroid replacement medications.

Supplements & Nutrients

Nutrients like zinc, selenium, and vitamin D can help improve thyroid function while also supporting the immune system. Herbs like ashwagandha help blunt some of the harmful effects on the thyroid from cortisol.

Lifestyle Adjustments

Stress management, prioritizing sleep, limiting environmental toxins, and dietary changes can be hugely beneficial. Many times we will advise a gluten-free diet, and it can often be helpful to also eliminate dairy and soy. More restrictive elimination diets like Paleo, AIP, and even carnivore can be useful tools.

Thyroid Medication

There are T4-only meds (Levothyroxine, Synthroid, Tirosint), T3-only meds (Liothyronine, Cytomel), and T4/T3-combo meds (NP Thyroid, Armour Thyroid). All three can also be compounded. The appropriate supplement and lifestyle measures will help optimize the body’s ability to use the thyroid replacement.