Hashimoto’s Hypothyroidism and Gastroparesis

Hashimoto's Hypothyroidism Gastroparesis

Research has shown a link between Hashimoto’s and hypothyroidism to a condition called gastroparesis.  Although I have not experienced this condition personally as of yet and hope I never do, I have had many clients who have reported symptoms of what could potentially be related gastroparesis – particularly when TSH is chronically elevated despite thyroid medication.

What is Gastroparesis?

The medical definition for gastroparesis is “the delayed emptying of food from the stomach into the small bowel,”  which is basically slow motility or delayed transit time of food that’s entered the stomach and GI tract.   The condition commonly occurs in patients receiving enteral nutrition (tube feeding). However, gastroparesis may also be a chronic complication related to conditions such as kidney failure, uncontrolled diabetes, damage to the vagus nerve, Multiple sclerosis, Parkinson’s disease, stomach surgery, chronic use of antidepressant or narcotic medications, autoimmune thyroid disease, and hypothyroidism.  

When food stays in the stomach too long, it can ferment and trigger an overgrowth of bacteria.  It can also lead to obstructions that can prevent food from passing through the small intestine.  The condition can be very scary especially when stomach pain, fullness, and bloating occurs after only a few bites of food.


A 2009 study reviewed gastroparesis as it relates to hypothyroidism and autoimmune thyroid disease.  The study included 30 women diagnosed with hypothyroidism.  In their discussion, the researchers pointed out that thyroid antibodies found in autoimmune thyroid disease commonly associated with inflammation of the lining of the stomach.  Typically, at least from what I have studied and learned, it is often suspected that H. pylori may be the cause of this type of inflammation since H. pylori is believed to be one of the primary stealth infections diagnosed in patients with Hashimoto’s.

Thyroid Meds & Gastroparesis

Absorption issues with levothyroxine is a concern when gastroparesis is an issue.  Levothyroxine is a T4-only thyroid replacement medication (it must be converted after absorption to T3 (the active form usable by the cells).

Although it is not uncommon for thyroid patients to require regular raises in the dose to improve hypothyroid symptoms and bring thyroid markers to optimal levels, if this continues to be the case, there may be more than a conversion problem going on.

What this 2016 study found is that gastroparesis could be the underlying/undiagnosed factor which would explain why thyroid medication isn’t being absorbed and properly converted.  What the researchers also found in this particular study is that as far as absorption of the medication is concerned the issue can be corrected by changing thyroid medication to a gelatin capsule. While the gelatin form may improve thyroid markers, it does not fix the underlying cause of malabsorption in the first place.  Also, one of the researchers’ conclusions was the following:

“…patients with uncontrolled hypothyroidism despite adequate treatment titration, gastroparesis should be considered as a possible mechanism for malabsorption…”

Symptoms related to Gastroparesis

Please note that these are similar to many other common symptoms experienced by people with Hashimoto’s and hypothroidism and not necessarily caused by gastroparesis:

  • Feeling full soon after eating or during a meal (could be a red flag for SIBO, inflammation due to food sensitivity, food allergy, or low stomach acid)
  • Abdominal bloating (might also be assumed to be related to SIBO, bacteria imbalance, Celiac disease, food sensitivities, or gluten exposure, etc.)
  • Blood sugar imbalance (often associated with diet, elevated thyroid hormone, adrenal imbalance, stress, hormone imbalance)
  • Heartburn-like symptoms (often thought to be related to LOW stomach acid in Hashimoto’s patients)
  • Nausea, vomiting, and constipation (may be due to a variety of factors)
  • Chronically elevated TSH despite thyroid hormone replacement

I found this Abstract which underscores what most of the studies have found in that if your TSH is consistently elevated or it spikes and remains elevated even though you’re taking thyroid hormone – and particularly if your practitioner continues to raise the dose and you have other symptoms that are suspect for gastroparesis, it’s probably time for further investigation.

If symptoms like these are lingering and the typical protocols for digestive enzymes and specialized thyroid diets aren’t helping, please don’t assume it’s a food sensitivity, food allergy, or that you’ve accidentally been exposed to gluten, or that it’s SIBO, etc. See a gastroenterologist and get tested to rule out or confirm gastroparesis.

Testing for Gastroparesis

Diagnosing gastroparesis may involve a battery of tests: ultrasound, endoscopy, electrogastrography, scintigraphy, Barium X-ray, or the “smart pill,” an electronic device that you swallow!  It reports data back to a computer to indicate the rate at which food is traveling through the digestive system.  Pretty cool, right?

Interventions & Diet

Increasing transit time in the stomach is usually accomplished through prescription medications such as Reglan, erythromycin, domperidone, or Cisapride.  Other medications routinely prescribed are for nausea and vomiting if needed.  But, please don’t think that any of these “fixes” the problem.

According to the European Journal of Gastroenterology & Hepatology, 1,200 mg per day of Ginger (as a supplement) taken in divided doses has been found to improve the transit time of food in the stomach and intestines.

If gastroparesis is diagnosed, it is best to work with a knowledgeable and caring nutritionist, gastroenterologist, and supportive health care team.  It is extremely important that you meet your caloric needs every day, keep hydrated, and consume nutrient-dense foods.  Depending on the severity of your symptoms this may be a challenge.

Consuming smaller meals throughout the day will help with feeling full and with bloating.  Many patients diagnosed with gastroparesis find it more comfortable to make the switch to a liquid-only diet but please do this only under medical supervision and in working with a nutritionist who is knowledgeable in with your complete health history and this condition.

Should gastroparesis be diagnosed you should avoid these foods as they may lead to obstructions in the GI tract due to slower transit time:

  • Apples, Berries, Brussels sprouts, Coconuts
  • Corn, Figs, Green beans, Legumes
  • Oranges, Persimmons, Potato peels
  • Sauerkraut, Tomato skins
  • High Fiber Bulking Agents:  Citrucel, psyllium products (Metamucil, etc), Acacia fiber
  • Nuts, seeds, dried fruits
  • Vegetables (green peas, broccoli)
  • Popcorn
  • Cereals
    Source:  University of Virgina-Digestive Health/images-docs-gastroparesis

The Essential Gastroparesis Cookbook is a great resource to help anyone who is struggling with bloating, stomach pain, feeling full immediately after or during a meal.  The recipes can also help with energy levels and mood.

Self-care interventions such as acupuncture may be helpful with stress, discomfort, pain, nausea and inflammation.  Biofeedback (I love the RespErate unit) is effective for stress, and acupressure can definitely help with nausea.

As a last resort, surgical intervention is sometimes necessary.  If you cannot tolerate food or liquids, surgery is vital to survival.

Nurses Orders!

Gastroparesis is a serious yet manageable condition that’s often overlooked until advanced stages.  If you’ve been experiencing bloating after a meal, feeling full almost as soon as you start to eat or immediately after, stomach pain, nausea or vomiting, and your TSH level is chronically elevated despite thyroid hormone replacement, it may be time to have a conversation with your doctor and seek to be tested for gastroparesis. Gastroparesis is not a topic usually discussed in thyroid forums; however, it is real and it is more common in patients with hypothyroidism than you may think.

Hashimoto’s Hypothyroidism Gastroparesis References

  1. European Journal of Gastroenterology & Hepatology: May 2008 – Volume 20 – Issue 5 – pp 436-440 doi: 10.1097/MEG.0b013e3282f4b224.
  2. Gastroparesis Overview: Causes & Symptoms. (n.d.). Retrieved December 1, 2016, from http://www.webmd.com/digestive-disorders/digestive-disorders-gastroparesis.
  3. Reardon, D. P., & Yoo, P. S. (2016). Levothyroxine Tablet Malabsorption Associated with Gastroparesis Corrected with Gelatin Capsule Formulation. Case Reports in Endocrinology, 2016, 1-3. doi:10.1155/2016/1316724.
  4. J La State Med Soc. 2015 Mar-Apr;167(2):47-9. Epub 2015 Apr 15.
  5. Yaylali, O., Kirac, S., Yilmaz, M., Akin, F., Yuksel, D., Demirkan, N., & Akdag, B. (2009). Does Hypothyroidism Affect Gastrointestinal Motility? Gastroenterology Research and Practice, 2009, 1-7. doi:10.1155/2009/529802.