Hashimoto’s Thyroiditis: Symptoms, Causes, Treatments, and Natural Approaches

• Age: HT can occur at any age, including childhood and adolescence. However, it typically affects women between the ages of 30 and 50.
• Sex: The risk of developing HT is at least four times greater for women than men. Additionally, thyroiditis can occur after giving birth. About 20 percent of women who develop postpartum thyroiditis eventually develop HT.
• Children with genetic syndromes: Although HT is less common in children than adults, children with genetic conditions such as Turner syndrome, Down syndrome, Klinefelter syndrome, and 22Q11DS have an increased risk. Due to this heightened risk, regular screening and monitoring for HT in these children is recommended.
• Ethnicity: Although anyone can get HT, it is diagnosed most often in those of European descent.
• Socioeconomic level: Research indicates that people in low- to middle-income areas are at a higher risk of developing HT thyroiditis. Interestingly, the prevalence is also higher in high-income areas compared to upper-middle-income areas.
• Family history: Having a family member with HT increases the likelihood of developing it. The risk is almost 17 times higher in siblings.
• Obesity: Research indicates that obesity can increase the risk of developing HT and is linked to higher thyroid peroxidase antibodies (TPOAbs) levels. Additionally, gaining weight in childhood has been connected to a higher chance of developing thyroid autoimmunity and hypothyroidism later in life.
• Autoimmunity: Patients diagnosed with other autoimmune conditions are more likely to develop HT.

1. Clinical assessment: Doctors begin by reviewing symptoms and medical history and physically examining the thyroid gland. A goiter may be firm and enlarged, while atrophy or fibrosis renders the thyroid inaccessible.
2. Blood tests: These measure thyroid hormone levels (TSH, fT4, fT3) and thyroid-specific antibodies (TPOAbs and TGAbs). It is important to note that while TPOAbs are commonly present, only TGAbs may be present in about 5 percent of cases.
3. Ultrasound imaging: This may be performed to detect any enlargement, patchy or uneven textures, abnormally dense tissue, or small nodules in the thyroid.
4. Fine needle aspiration (FNA): This is a minimally invasive way to obtain a sample of tissue or biopsy from the thyroid using a fine needle. The sample can then be evaluated for lymphocytic infiltration to diagnose HT. In the case of a thyroid nodule or any abnormal lymph nodes, the sample would be examined for benign or cancerous properties.

It is important to note that HT thyroiditis does not always present as hypothyroidism with elevated TSH. Other presentations include:

• Hashitoxicosis: Periods of hyperthyroidism (low TSH, high fT4) may occur initially before progressing to hypothyroidism.
• Euthyroidism: This exhibits normal TSH and T4 levels but with TPOAbs and typical ultrasound features.
• Subclinical hypothyroidism: TSH is elevated, but fT4 and fT3 are normal.
• Overt hypothyroidism: TSH is elevated, but fT4 is low.

If TSH is the only biomarker measured, this variability could result in delayed diagnosis and advanced tissue damage. Thus, comprehensive testing, which includes measuring free T4 and thyroid antibodies, is necessary to assess thyroid status and monitor HT progression accurately.

Functional Medicine Approach

Practitioners in this field might recommend a more extensive set of tests to uncover underlying autoimmune triggers and imbalances. These tests include:

• Full thyroid panel measures TSH, total T4, free T4, total T3, free T3, reverse T3, and thyroid antibodies (TPOAbs and TGAbs) to evaluate thyroid metabolism and possible conversion issues.
• Hormonal assessment tests hormones like cortisol to assess overall hormonal balance and adrenal function.
• Complete blood count (CBC) with differential helps understand general health and immune status.
• Nutritional testing assesses levels of crucial nutrients such as selenium, iodine, iron, zinc, vitamin D, and fatty acids.
• Stool testing evaluates gut health and microbiome status to help understand autoimmune triggers and provide insights into inflammation.
• Food sensitivity testing identifies potential food triggers that can cause immune reactions and inflammation. Alternatively, an elimination diet may be recommended.
• Toxic exposure screening checks for harmful exposures that could influence thyroid and immune function.

• Increased cancer risk: While not all researchers agree, a recent systematic review and meta-analysis determined that individuals with HT may face a higher risk of certain cancers and should, therefore, undergo regular screenings. The types of cancer associated with HT include thyroid, breast, lung, digestive system, urogenital, and blood cancers, as well as prolactinoma, a benign tumor of the pituitary gland.
• Pregnancy risks: Even with optimal levothyroxine supplementation, some—but not all—studies have found women with TPOAbs or TGAbs to have a higher risk of in vitro fertilization failure, miscarriage, and preterm birth. Proactive management of thyroid health before and during pregnancy is crucial.
• Cognitive decline: The chronic inflammation and autoimmune processes in HT may contribute to cognitive impairment and accelerated brain aging over time.
• Metabolic disorders: Research has linked HT with an increased risk of developing certain metabolic health issues, such as insulin resistance and metabolic syndrome, a cluster of conditions. These include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels that occur together, increasing your risk of heart disease, stroke, and Type 2 diabetes.
• Adverse cardiovascular outcomes: HT has been linked to an increased risk of adverse cardiovascular outcomes, including high blood pressure, atherosclerosis, coronary heart disease, and congestive heart failure.
• Myxedema coma: Untreated hypothyroidism, a possible outcome of HT, can progress to myxedema coma, a rare but life-threatening condition. This extreme endocrine emergency requires immediate treatment in an intensive care unit. Myxedema coma typically affects individuals over 60, predominantly women, occurring almost exclusively in the winter months. It is characterized by severe metabolic slowing, which leads to profound lethargy, hypothermia, and other critical symptoms that necessitate urgent medical intervention.
• Hashimoto’s encephalopathy: Hashimoto’s encephalopathy, a rare but serious neurological condition, is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT). It is characterized by symptoms such as confusion, stroke-like episodes, and seizures. The condition is likely due to complex immune system responses that extend beyond the thyroid.

What Are the Treatments for Hashimoto’s Thyroiditis?

High levels of TSH can be associated with health issues like poor heart health and metabolic problems, and low levels can lead to lower bone density and a higher risk of fractures. Therefore, the dosage of levothyroxine must be carefully adjusted, which is done through regular monitoring of TSH levels, usually every six to eight weeks after any dosage change.

Although levothyroxine (synthetic T4) is the conventional treatment for HT, it might not be the best option for everyone. Some patients may find that alternative thyroid medications offer improved symptom relief and better overall health outcomes.

What Are the Natural Approaches to Hashimoto’s Thyroiditis?

The consistent message in reviews of the research is that the results are mixed. Researchers agree that an anti-inflammatory diet is necessary and that pro-inflammatory saturated fats, sweets, and refined carbs should be restricted. However, they are still searching for that “one” elusive diet that works for Hashimoto’s. The reality is that what causes inflammation and immune reactions varies by individual.