Hashimotos – The Autoimmune Thyroid Attack
(Chapter 9 of the STTM book also contains good information. Order the revised STTM book below–it’s worth it.)
Did you get a diagnosis of Hashimoto’s Disease, or someone has just suggested you might have it?? It’s a very common form of thyroid disease, and can also be called Hashi’s or Thyroiditis. See here for a more thorough explanation of thyroiditis.
WHAT IS HASHIMOTOS? According to most information, Hashimoto’s Thyroiditis is an autoimmune thyroid disease based on a dysfunctional immune system in which your thyroid is being attacked by your immune system via antibodies, attempting to destroy your gland as if it’s some vile enemy. It may start out silently, but the attack will eventually cause an inflammation and gradual destruction of your thyroid gland and can go on for years with miserable side effects to match. It can also cause nodules or lumps. It may be the most common thyroid disease, especially with women. Gut problems can go along with Hashimotos disease, and should be addressed.
Another theory promoted by Dr. Alexander Haskell is the other way around: that the thyroid first becomes inflamed due to being hypo and the excess production of the TSH, which then leads to Hashimotos. What causes the inflammation? One reason might be low iodine, as well as poor levels of certain minerals such as selenium, zinc, and iron.
WHAT ARE SYMPTOMS OF HASHIMOTOS? For many, the symptoms are silent–the early stages. But eventually, you start to notice the same symptoms of hypothyroid, including
- poor stamina
- easy fatigue
- feeling cold
- gaining weight
- dry hair and skin
- lowering of voice
As it progresses, you may feel very hypo one day, and very hyper another, which is caused by the destruction of your thyroid. More symptoms include:
- anxiety or panic
- problems with either heat or cold…etc
Additionally, since the cells of your thyroid become inefficient in converting iodine into thyroid hormones, your thyroid compensates by swelling or enlarging, and you can have a feeling of tightness around your throat or a sore throat as a result. The swelling can be a goiter. Or you might have nodules. You can also see variations in your lab work–high one time, low the next, high the next, etc. Symptoms are different from individual to individual–some can have the swelling; others may not, for example.
HOW DO I CONFIRM HASHI’S LABWISE? In most cases, Hashi’s is confirmed by two antibodies labs, and you need both, not just one:
The first antibody, anti-TPO, attacks an enzyme normally found in your thyroid gland, called the Thyroid Peroxidase, which is important in the production of thyroid hormones. The second antibody, TgAb, attacks the key protein in the thyroid gland, the thyroglobulin, which is essential in the production of the T4 and T3 thyroid hormones. Note: it is unfortunately common for a doctor to only do ONE test, and you need BOTH tests, since you can be normal in one and high in another! Also, if your doctor just chooses the TPO, there are other autoimmune diseases that can cause a raise of the TPO. We have also noted that saliva does not always accurately detect Hashi’s as well as blood tests do.
There are a very small minority of individuals who will have no reading of antibodies, yet a strong suspicion they have Hashimotos, especially when they have noted swings between feeling hyper, then feeling hypo, or a lowering of their voice, or a thickening in their throat area. If you want confirmation, ask your doctor about an FNA test (fine needle aspiration). They will look for “Hurthle Cells”, large granulated cells, which are associated with Hashimoto’s.
WHAT IF MY TEST RESULTS SHOWS “SOME” ANTIBODIES, BUT IN THE “LESS THAN” or “NORMAL” range? Some will proclaim that antibodies even within the lab’s “normal” results means you have Hashi’s. But there may be a big difference between having a result indicative of Hashi’s vs. having a result that confirms Hashi’s (the latter which would be those antibodies far above the range.)
And you’re going to have some pretty adamant opinions one way or the other.
Bottom line, if your result is in the lower area of the normal or less-than range (i.e. “indicative” of, rather than “confirmation of’”), patients say don’t worry. It’s actually NORMAL to have some antibodies. One function of the immune system is to use antibodies in the removal of dead cells.
If your “normal” antibodies are creeping up in that range towards the top end, do whatever you can to improve your immune system, just in case, which can include being on thyroid meds if your symptoms and labs point to a thyroid problem. Many of those normal or less-than results do not move up to having full-blown Hashi’s.
Want to order your own labwork to discern if you have Hashi’s?? STTM has partnered with key lab facilities, creating the right ones just for you to discuss with your doctor.No prescription needed! Go here for #1, #2 or #3: recommended labwork
WHY IS IT IMPORTANT TO KNOW IF I HAVE FULL BLOWN HASHI’S?? As Hashimotos increases, you will tend to swing between hypo and hyper, making dosing by labs, and especially the TSH, impossible. Your labs will be high one time, and low the next…back and forth. The hyper is caused by the release of thyroid hormones into your blood due to the destruction. The hypo is caused by the lessening function of your thyroid due to the attack. If you do have Hashi’s, you may have to insist to your lab-obsessed doctor to let you raise by the elimination of symptoms, not labs, due to this reality.
Also, knowing if you have Hashimotos tells you that you may need to be on the watch for other immune problems, now or later.
MY DOC SAID I HAVE Bi-POLAR? Several patients have reported being diagnosed with bipolar, only to later discover it was actually the swings between hyper- and hypo- from the attack that was causing their mood swings. Or as on Australian gal called it, the “Yeeha” of her swing.
IS IT A GOOD IDEA JUST TO “WATCH” IT, AS MY DOCTOR WANTS TO DO? In the opinion of a large body of patients who followed this advice, “watching” your Hashi’s is akin to watching a dog chew off your leg. Allowing the attack to continue on your thyroid can not only last for years, but cause all sorts of problems along the way of its destruction, including adrenal fatigue and the autoimmune Celiac disease. And once you add adrenal fatigue to the mix, you’ve got more problems to tackle. Instead, why not just stop the attack and all the consequences, as explained below. Makes a whole lot more sense, says a patient who suffered through what she calls the “insane watching”.
HOW DO I TREAT IT? You treat Hashi’s the same way you do just plan hypothyroid–with thyroid medications. Why? Because if raised high enough, some patients see the attack cease, probably due to improvement of the immune system. Some doctors have unwisely recommended non-treatment until labwork “stabilizes”, but that could take months and years, and you continue to suffer.
For more stubborn cases, selenium supplementation has helped, especially if you have high anti-TPO. Some patients noted that iodine supplementation lowered their antibodies. Low Dose Naltrexone has helped the more stubborn cases. See below.
The attack can happen over a few weeks or extend into years. It has been stated that antibodies can be present for years even after you counter the attack with desiccated thyroid hormone. But patients on desiccated thyroid have noted that antibodies greatly fall if they dose high enough, since giving yourself back what your own thyroid gives you greatly improves your immune system!
WHY DID MY HASHI’S GET WORSE ON DESICCATED THYROID (and even Synthroid and other T4 meds)? Easy answer: patients have noticed that if they stayed on lower doses too long and/or didn’t raise high enough, quick enough, it fed the attack, not stopped it. You then have further swelling in your throat, or hair loss, or high anxiety, or a raise in your antibodies…and heightened hypo symptoms with a higher TSH. And doctors who aren’t knowledgeable about desiccated thyroid might put you back on synthetics, or take you off your meds completely. The solution discovered by patients is to raise the desiccated thyroid faster and according to the elimination of symptoms and NOT labs. Many seem to end up in the 2-5 grains area to stop that attack. This is where individuality comes in.
A caveat: some have noted that it will be impossible to raise well if you have developed a cortisol issue or low iron. Those need to be tested correctly and results understood. Also, many Hashi’s patients need to be off gluten, use selenium to help lower antibodies, or use Low Dose Naltrexone for more stubborn cases (prescription by your doc). Some patients report that their iodine use greatly lowered antibodies, but they needed to use supporting nutrients because of the detox.
MY DOC SAYS I SHOULDN’T BE ON THYROID MEDS WHEN I’M HYPER FROM HASHI’S. IS HE CORRECT? The hyper when you have Hashi’s is caused by the die-off of thyroid hormones from the attack and their dump in to your blood. You also will swing between hypo and hyper as explained above. But to say you shouldn’t be on thyroid meds is wrong according to the vast experience of Hashimotos patients. You want to stop the attack and the swings, and the only way to do that is to be on thyroid meds, and raise high enough to stop the attack, which in turn will stop the hyper swings. You’ll have to fight your doctor’s tendency to hold you too long on each raise, or to dose you by the TSH or other labs.
On the other side of the coin, there are always exceptions, and someone may find the need to back off thyroid meds until they get past the thyroid hyper of Hashi’s.
WHAT ABOUT LOW DOSE NALTREXONE and HASHI’S? Naltrexone is a an opioid antagonist, and when taken in low doses, has been found to elevate your endorphins, which in turn promotes better immune function. Thus, many Hashi’s patients report a lowering of their antibodies while using this medication. It may be challenging to get a prescription from your doctor if he or she hasn’t learned about the effectiveness of LDN, so you can refer him to this LDN science site.
The way it’s used by patients is to dissolve one 50 mg tablet with 50 ml of distilled water in an amber glass bottle. It has to be shaken before use. Using a baby medicine dropper, or even more accurate, a syringe, many patients start at 1.5 ml and mix it with water or juice. It’s taken a bedtime, since the best action occurs during sleep. Patients report vivid dreaming the first several nights, but it goes away. They slowly make their way up to 3 mg. The maximum is 4.5, but many like the results from 3 mg. Once antibodies fall, you may suddenly find yourself on too much medication for your needs. Check into LDN groups on Yahoo and Facebook.
IS THERE A CONNECTION BETWEEN PREGNANCY and HASHI’S? Pregnancy can be a strong precursor to developing Hashi’s, since the increased activity of your immune system can either worsen an autoimmune disease you already have, such as thyroiditis, or cause it to appear.
CAN I TAKE IODINE WHEN I HAVE HASHI’S?? Possibly. Doing an iodine loading test can confirm if you have low iodine. And since iodine is the main component of thyroid hormones, plus has anti-cancer benefit, the use of iodine can be a wise decision. Some Hashi’s patients do wonderful on iodine. For others, it’s tricky, since iodine use has aggravated the attack on antibodies attack on the thyroid for many. But the problem may be not being on enough iodine, just as not being on enough Armour feeds the attack. It’s recommended that you be on 50 mgs at the least. It’s also key to be on selenium and other supporting nutrients with iodine.
One patient from Germany informed me that there is government-directed iodination of practically every food which can be processed, including milk. And with this has come an explosion of Hashimotos the last 20 years! The ball is out of the court to know what’s going on there.
WHAT PROBLEMS MIGHT GO HAND-IN-HAND WITH HAVING HASHI’S?? Research shows there can be a strong connection between having Hashimoto’s disease and Celiac disease. Celiac disease is a autoimmune digestive disorder that results in an overreaction to gluten, a protein found in most grains like wheat, rye, oats and barley, which can be found in breads, cereals, pasta and many processed foods. The overreaction, in turn, causes autoimmune damage to the intestines, which results in poor absorption of nutrients. (Oats, which can be gluten-free, are often contaminated within soil where gluten grains were once grown, or in the processing facility).
Gluten can also trigger the very autoimmune reactions that cause you to have Hashi’s, since supposedly, the cells of your thyroid are similar to the cells of gluten, i.e. an attack on one is going to make your ripe for the attack on the other. As a result, some Hashimoto’s patients experiment with eliminating gluten from their diets, and with good results. Or, there are tests developed to help you figure out if you have Celiac disease, and the stool test is highly recommended.
WHAT ABOUT HASHITOXICOSIS? This is a more difficult form of a thyroid autoimmune condition where you can have one or both of the antibodies above, plus an elevated TSI (Thyroid Stimulating Immunoglobulins)–the latter which is a member of the Thyroid Stimulating Hormone Receptor Antibody (TRAb) family, and which at least 80% of Graves patients can have. You can both both hyper and hypo symptoms. Low Dose Naltrexone has been helpful for many individuals who have these antibodies.
BOTTOM LINE? Patients have learned that Hashimoto’s is not a condition you let take its course (as some doctors will recommend), but that you treat with desiccated thyroid, or at the very least T3 added to your T4. See the Things We Have Learned page. And during that treatment, you raise according to the elimination of symptoms, not labs. And if a doctor tells you that your Hashi’s is “mild”, yet you have a sore throat, swollen neck, or the sensation of “wow” one time, and “whoa” another, you are much farther along in the attack than you know!
There is more on this in the revised STTM book.
Here’s a study that taking Selenium reduces the TPO antibodies, but it’s not recommended as a “replacement” for desiccated thyroid, but as an additional help.
Interesting side note: Both Hashi’s and Graves disease (hyperthyroidism) can have elevated anti-TPO. “The frequency of elevated anti-TPO levels in patients with active autoimmune thyroiditis was 90% (clinical diagnosis Hashimoto thyroiditis) compared to 64% in patients with overt hyperthyroidism (clinical diagnosis Graves’ disease).” Pub Med article here.