Understanding Hypothyroid and Hashimoto's Disease

Hypothyroidism is estimated to affect around 4.6% of the U.S. population, with women being significantly more susceptible than men. Hashimoto's thyroiditis, an autoimmune form of hypothyroidism, is the leading cause of thyroid-related issues in the United States and affects approximately 1-2% of the global population. These conditions vary in severity and can manifest differently from person to person, making awareness and early detection crucial.

Hypothyroidism occurs when the thyroid gland doesn't produce enough thyroid hormones to meet the body's needs. This can lead to a variety of symptoms such as fatigue, weight gain, cold intolerance, and more.

These disorders can profoundly impact daily life, yet they often remain undiagnosed or misunderstood. This guide will be an introduction to better understanding your thyroid condition.

Types of Hypothyroid

Hashimoto's Thyroiditis: As the most prevalent cause of hypothyroidism, effecting 14 million Americans and accounting for 90% of hypothyroid cases. Hashimoto's thyroiditis is an autoimmune disorder where the immune system mistakenly attacks the thyroid gland. This chronic inflammation gradually impairs thyroid function, leading to hypothyroidism. Diagnosis involves elevated TPO antibodies and often requires lifelong thyroid hormone replacement therapy to manage symptoms and prevent complications.

Primary Hypothyroidism: This is the most common type, primarily caused by dysfunction within the thyroid gland itself. Conditions like Hashimoto's thyroiditis, an autoimmune disorder where the immune system attacks the thyroid tissue, are leading causes. Other factors contributing to primary hypothyroidism include thyroid surgery, radioactive iodine treatment for hyperthyroidism, certain medications, congenital disorders, or iodine deficiency. Diagnosis typically involves elevated TSH levels and low T4 levels on thyroid function tests.

Secondary Hypothyroidism: Unlike primary hypothyroidism, this type results from dysfunction in the pituitary gland or hypothalamus, which are brain structures that regulate thyroid hormone production. Causes may include pituitary tumors, head trauma, radiation therapy, or certain medications affecting these brain regions. Secondary hypothyroidism leads to decreased stimulation of the thyroid gland, resulting in lower levels of thyroid hormones (T4 and T3). Diagnosis involves low or normal TSH levels alongside low T4 and T3 levels.

Subclinical Hypothyroidism: This form is characterized by mildly elevated TSH levels with normal free T4 levels, indicating early-stage thyroid dysfunction. Individuals with subclinical hypothyroidism may not manifest obvious symptoms initially but are at risk of progressing to overt hypothyroidism over time. It's often detected incidentally during routine blood tests or when investigating non-specific symptoms.

Common Symptoms of Hypothyroidism

The symptoms of hypothyroidism can be subtle and develop gradually over time, often mimicking other health issues. Common signs include unexplained weight gain, fatigue, cold intolerance, dry skin, and brittle hair. Other symptoms may include muscle weakness, depression, memory problems, and menstrual irregularities in women.

Common Symptoms of Hashimoto's Thyroiditis

Hashimoto's thyroiditis shares many symptoms with hypothyroidism but is distinguished by its autoimmune nature. Beyond the hallmark symptoms of hypothyroidism, individuals with Hashimoto's may experience swelling in the neck (goiter), difficulty swallowing, or a feeling of fullness in the throat. Additionally, fluctuations in thyroid hormone levels can lead to periods of hyperthyroidism, causing symptoms like palpitations, anxiety, and weight loss.

Lab work to diagnose thyroid disease

TSH (Thyroid Stimulating Hormone):

Function: TSH is produced by the pituitary gland and stimulates the thyroid gland to produce T4 and T3 hormones.
Significance: Elevated TSH levels indicate hypothyroidism (underactive thyroid), while low TSH levels suggest hyperthyroidism (overactive thyroid).

T4 (Thyroxine):

Function: T4 is the primary hormone produced by the thyroid gland.
Significance: Total T4 levels can indicate overall thyroid function, but free T4 (FT4) is more clinically relevant as it represents the biologically active form.

Free T4 (FT4):

Function: FT4 represents the unbound, active form of thyroxine available for cellular uptake.
Significance: Low FT4 levels suggest hypothyroidism, while high levels may indicate hyperthyroidism.

T3 (Triiodothyronine):

Function: T3 is the active thyroid hormone that regulates metabolism.
Significance: Total T3 levels indicate overall thyroid function, but free T3 (FT3) is more relevant for assessing metabolic activity and thyroid function.

Free T3 (FT3):

Function: FT3 is the biologically active form of T3 that influences cellular metabolism.
Significance: Low FT3 levels are associated with hypothyroidism, while high levels may indicate hyperthyroidism.

T3:T4 Ratio

Function: The ratio of T3 to T4 provides insights into thyroid hormone conversion and utilization.
Significance: A lower T3 ratio may suggest impaired conversion of T4 to T3, influencing thyroid function despite normal T4 levels.

Thyroid Peroxidase Antibodies (TPOAb):

Function: TPOAb detects antibodies against thyroid peroxidase, an enzyme involved in thyroid hormone production.
Significance: Elevated TPOAb levels indicate autoimmune thyroid disorders, such as Hashimoto's thyroiditis.

Thyroglobulin Antibodies (TgAb):

Function: TgAb detects antibodies against thyroglobulin, a protein in the thyroid gland.
Significance: Elevated TgAb levels are associated with autoimmune thyroid diseases, including Hashimoto's and Graves' disease.

Nutrient Markers

Selenium:

Function: Selenium is essential for thyroid hormone metabolism and immune function.
Significance: Selenium deficiency can impair thyroid function and increase the risk of autoimmune thyroid diseases.

Iron:

Function: Iron is necessary for thyroid hormone synthesis and metabolism.
Significance: Iron deficiency may contribute to thyroid dysfunction and impair thyroid hormone production.

Iodine:

Function: Iodine is a key component of thyroid hormones (T3 and T4).
Significance: Iodine deficiency can lead to hypothyroidism or goiter, while excess iodine may exacerbate thyroid disorders.

Vitamin B12:

Function: Vitamin B12 is important for neurological function and metabolism.
Significance: B12 deficiency can mimic symptoms of hypothyroidism and may coexist with autoimmune thyroid disorders.

Interpreting results from thyroid function tests and nutrient markers provides valuable insights into thyroid health and guides clinical decisions. Thyroid function tests such as TSH, T4, T3, and antibodies like TPOAb and TgAb offer a comprehensive assessment of thyroid function.

Elevated levels of TPOAb and TgAb indicate autoimmune thyroiditis, necessitating proactive management to prevent progression to thyroid dysfunction.

Regular monitoring of these markers allows providers to optimize treatment strategies, ensuring that thyroid hormone levels are maintained within optimal ranges to alleviate symptoms effectively. Adjusting medication dosages based on lab results helps achieve therapeutic goals and improves patient outcomes.

Addressing nutrient deficiencies in selenium, iron, iodine, and B12 is crucial as these nutrients play essential roles in thyroid hormone synthesis and overall thyroid function. Supplementing these nutrients when deficient supports thyroid health and enhances overall well-being.

Understanding Thyroid Medication Options

Thyroid Medication will always include a T4 molecule and sometimes a T3 molecule.

T4 (Levothyroxine):

Function: Levothyroxine is a synthetic form of thyroxine (T4), the primary hormone produced by the thyroid gland.
Mechanism: It is converted into T3 in the body, which is the active form of thyroid hormone that affects metabolism, growth, and development.
Benefits: Levothyroxine is the most commonly prescribed thyroid hormone replacement medication due to its stable and consistent effects. It helps alleviate symptoms such as fatigue, weight gain, and cold intolerance.

T3 (Triiodothyronine):

Function: Triiodothyronine (T3) is the active form of thyroid hormone directly responsible for regulating metabolism.
Mechanism: T3 is more potent and faster-acting than T4, influencing energy production and utilization in cells.
Benefits: Some individuals may benefit from T3 supplementation when T4 alone is insufficient to alleviate symptoms or when there are issues with T4 to T3 conversion.

Treatment Options: Choosing Between T4, T3, or Combination Medications

T4 (Levothyroxine) Monotherapy:

Indication: Typically prescribed as the first-line treatment for hypothyroidism.
Advantages: Stable hormone levels, well-studied efficacy, and generally well-tolerated.
Considerations: Requires conversion to T3 in the body, which may be impaired in some individuals, leading to persistent symptoms despite normal T4 levels.

T3 (Liothyronine) Monotherapy:

Indication: Considered in cases where there is poor T4 to T3 conversion or persistent symptoms despite adequate T4 levels.
Advantages: Direct supplementation with active hormone T3 can provide faster relief of symptoms.
Considerations: Shorter half-life compared to T4, requiring multiple daily dosing and potential for fluctuations in hormone levels.

Combination T4/T3 Therapy:

Indication: Used when patients do not adequately respond to T4 monotherapy or when there is evidence of impaired T4 to T3 conversion.
Advantages: Mimics the natural thyroid hormone production more closely, potentially providing better symptom control.
Considerations: Requires careful monitoring of hormone levels to achieve the right balance of T4 and T3. Some individuals may experience side effects or find it challenging to optimize dosing.

Understanding the roles of T3 and T4 in thyroid function and the options available can empower you to work collaboratively with your healthcare team in achieving optimal thyroid health. By taking an active role in your treatment plan and maintaining regular follow-ups, you can effectively manage hypothyroidism and improve your quality of life.

Additional Treatments for Thyroid Disorders.

Additional therapies and lifestyle modifications can complement conventional treatment:

Dietary adjustments: Going gluten free, dairy free, soy free. Ensuring adequate iodine intake from sources like iodized salt, ocean fish, and seaweed are important.
Exercise: Activities like yoga, particularly poses that improve circulation to the thyroid gland, can benefit thyroid function.
Traditional Chinese Medicine (TCM): While not a replacement for thyroid medication, TCM may support immune system balance and overall health.
Supplements: Multivitamins, fish oil, and vitamin D supplements are often recommended to support thyroid health and general well-being.

Some Common Thyroid Questions

What is the difference between primary and secondary hypothyroidism?

Primary hypothyroidism stems from a thyroid gland issue, like Hashimoto's disease or thyroid surgery. Secondary hypothyroidism results from problems with the pituitary gland or hypothalamus, affecting hormone production regulation.

Can you have Graves' and Hashimoto's at the same time?

Yes, it’s possible. Graves' disease causes hyperthyroidism due to excessive hormone production, while Hashimoto's leads to hypothyroidism from the immune system attacking the thyroid.

Why is gluten a common trigger for those with Hashimoto's or hypothyroidism?

Gluten, found in wheat, barley, and rye, can provoke inflammation and autoimmune responses. It may mimic thyroid tissue, intensifying immune attacks and contributing to conditions like leaky gut syndrome.

Why is weight loss difficult for those with hypothyroidism?

Hypothyroidism slows metabolism and can alter appetite and energy levels, making it challenging to burn calories efficiently. Fluid retention can also cause temporary weight gain unrelated to fat accumulation.

Is dairy a common trigger for those with Hashimoto's or hypothyroidism?

Dairy's inflammatory properties may exacerbate thyroid symptoms. Similarities between dairy and thyroid proteins can confuse the immune system, triggering autoimmune responses or aggravating inflammation.

Reasons why thyroid medications may not work effectively?

Issues include incorrect dosing, poor absorption due to interactions with medications or supplements, or underlying conditions affecting hormone utilization or absorption.

What's the connection between high cholesterol and hypothyroidism?

Hypothyroidism can elevate LDL cholesterol and triglycerides, increasing cardiovascular disease risk due to altered lipid metabolism.

What's the difference between TPO and Tg lab tests?

TPO tests for antibodies against thyroid peroxidase, crucial in hormone production, while Tg detects antibodies against thyroglobulin, a protein made by the thyroid gland.

What are goitrogens, and why are they concerning for those with hypothyroidism?

Goitrogens are substances that interfere with thyroid function, potentially causing goiter or thyroid enlargement. They can block iodine uptake, critical for thyroid hormone production.

Can my thyroid be healed if I've had Hashimoto's for a long time?

Hashimoto's can't be cured, but symptoms can be managed with medication and lifestyle changes to support thyroid function and reduce inflammation.

Why is fluoride a concern for those with thyroid conditions?

Fluoride may hinder iodine uptake by the thyroid gland, affecting hormone production and potentially exacerbating thyroid conditions.

What are reasons someone might need a thyroidectomy?

Thyroidectomy may be necessary for severe hyperthyroidism, thyroid cancer, large benign nodules causing symptoms, or treatment-resistant Graves' disease.

What made you specialize in and start treating thyroid conditions?

Being diagnosed with hypothyroidism in high school fueled my passion to help patients manage thyroid health holistically, aiming for optimal hormone levels and quality of life.