(All the below is in Chapter 9 of the STTM book, but with more details, which can be important. )
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? Hashimoto’s Thyroiditis is an autoimmune thyroid disease in which your thyroid is being attacked by your own 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.
WHAT ARE SYMPTOMS OF HASHIMOTOS? For many, the symptoms are silent–the early stages of the autoimmune attack. But eventually, you start to notice the same symptoms of hypothyroid, including poor stamina, easy fatigue, feeling cold, gaining weight, dry hair and skin, constipation, etc. As it progresses, you may feel very hypo one day, and very hyper another, which is caused by the destruction of your thyroid. 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 called a goiter. You might 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: anti-TPO and TgAb. 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 far below the normal or less-than range (i.e. “indicative” of, rather than “confirmation of’”), don’t worry. Do whatever you can to improve your immune system, 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.
If your result is getting close to the line between ‘normal’ and “having Hashi’s, it can be time to be concerned. Getting off gluten can be important, as is getting on selenium.
‘Want to order your own labwork to discern if you have Hashi’s?? STTM has partnered with two key labs, 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 the attack 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.
NOTE: when uninformed doctors fail to do the antibodies test on you, or don’t understand the swings of the attack, you can be wrongly diagnosed as having bi-polar, which is simply the hyper swing of the attack!! 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, they can stop the attack. We have seen those on thyroxine T4-only (aka Synthroid, Levoxyl, etc) have some success in stopping the attack, but patients who switched to desiccated thyroid noticed even better results, especially if they dosed by symptoms rather than labs. Some doctors have unwisely recommended non-treatment until labwork “stabilizes”, but that could take months and years, and you continue to suffer.
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.
WHY DID MY HASHI’S GET WORSE ON DESICCATED THYROID (and even Synthroid and other T4 meds)? Easy answer: you have stayed on lower doses too long and you haven’t risen high enough, quick enough. Lower doses of desiccated thyroid and other thyroid meds, as well as staying with each raise too long, will FEED the attack, not stop 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 is to RAISE THE DESICCATED THYROID faster and according to the elimination of symptoms and NOT labs. Most seem to end up in the 3-5 grains area to stop that attack, with a few lower and a few higher. (Also note that some patients with Hashi’s have developed adrenal fatigue, and you may need to treat that before you can raise your thyroid meds high enough to stop the attack)
Note: as of 2009, if you are on Armour, it may be the reason you’re not doing well with your Hashi’s. Armour was reformulated, and patients reported a return of symptoms no matter how high they raise it. The solution soon discovered was the thoroughly CHEW UP the tablets to release the desiccated thyroid from the excess cellulose. This may also need to be done with Naturethroid, as it was reformulated, as well.
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.
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.
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.
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, and with desiccated thyroid. 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! Time to insist that you be put on desiccated thyroid, insist to raise high enough to control the symptoms, and be your own best advocate!
There is much more detail on this in the revised STTM book.
***There is some evidence that taking Selenium can help reduce 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 Hyperthyroid folks 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.
