The thyroid gland is a small butterfly-shaped gland that sits just below and behind the Adam’s apple.  There are a wide range of factors that can interfere with the production of thyroid hormone and lead to health problems.  Factors such as mineral deficiencies, environmental pollutants/toxins, and hormone balance impact thyroid hormone production and overall health.  As of this writing, 30 million adults suffer from thyroid dysfunction and many go undiagnosed.  The American Thyroid Association estimates that as many as 60% of the population with thyroid disease are not aware of it. 

Statistics show that women are seven times more likely than men to develop thyroid disease, facing as much as a one in five chance of developing a problem particularly during the perimenopause and menopause years when hormones start to fluctuate.

• Weight gain or an inability to lose weight despite exercise and diet
• Cold intolerance – feeling cold all the time when others do not
• Low energy and stamina
• Memory lapses or slow thinking (brain fog)
• Dry, thinning, itchy, scaly skin
• Dry, brittle or peeling nails
• Dry, brittle hair
• Hair loss
• Irregular bowel habits
• Slow intestinal movement or constipation
• Menstrual irregularities
• Inability to conceive
• Elevated cholesterol
• Rapid or slow heart rate
• Muscle or joint aches & pains

• Sudden or significant weight loss
• Rapid or irregular heartbeat
• Sweating, even at rest
• Nervousness or irritability
• Insomnia
• Agitation

• Free T3 – Triiodothyronine
  This test measures the amount of triiodothyronine, or T3, in the blood. T3 is the active thyroid hormone that regulates the metabolic activity of all cells
• Free T4 – Thyroxine
  The predominant hormone produced by the thyroid glance and must be converted to its active form, T3, inside the cells.  The free T4 test is not affected by protein levels. Since free T4 is the active form of thyroxine, the free T4 test is may be a more accurate reflection of thyroid hormone function
• Total T3 – Triiodothyronine
  Triiodothyronine (T3) is a thyroid hormone. It plays an important role in the body’s control of metabolism
• T3 Uptake
  T3 uptake is also known as T3 Resin Uptake (T3RU) or Thyroid Uptake. It estimates how much thyroid hormone-binding proteins are available in the blood through a calculation based on levels of T3 or T4 added to a person’s blood specimen 
• Total T4 Thyroxine
  Total T4 includes both Free T4 and protein-bound T4, and is an indicator of the thyroid gland’s ability to synthesize, process and release T4 into the bloodstream.  This test measures the amount of thyroxine, or T4, in the blood. T4 is one of two major hormones produced by the thyroid gland. The total T4 test is used to help diagnose hyperthyroidism and hypothyroidism. It is a useful test but can be affected by the amount of protein available in the blood to bind to the hormone
• Reverse T3 LC/MS/MS
  Reverse T3 produced in the thyroid comes from the conversion of the storage hormone T4. Your body, especially the liver, can constantly be converting T4 to RT3 as a way to get rid of any unneeded T4. In any given day approx. 40% of T4 goes to T3 and 20% of T4 goes to Reverse T3. However, in any situation where your body needs to conserve energy and focus on something else, it will change the above percentages, changing the conversion of RT3 to 50% or more, and the T3 goes down, down. Examples are emotional, physical, or biological stress, such as being chronically or acutely sick (the flu, pneumonia, etc), after surgery, after a car accident or any acute injury, chronic stress causing high cortisol, being exposed to an extremely cold environment, diabetes, aging, or even being on drugs like beta blockers and amiodarone
• TSH – Thyroid-Stimulating-Hormone
  Produced by the pituitary gland, TSH acts on the thyroid gland to stimulate the production of thyroxine (T4). A TSH test is a lab test that measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It tells the thyroid gland to make and release thyroid hormones into the blood 
• TPO(Ab) – Thyroperoxidase Antibody
  Thyroperoxidase is an enzyme involved in thyroid hormone production.  The body produces antibodies, including TPOAb, that attack the thyroid gland in autoimmune thyroiditis and Hashimoto’s. Measurement of thyroglobulin antibodies is useful in the diagnosis and management of a variety of thyroid disorders including Hashimoto’s thyroiditis, Graves Disease and certain types of goiter
• TG(Ab) – Thyroglobulin Antibody
  A protein rich in tyrosine, the residues of which when bound to iodine become the building blocks of T3 and T4.  Measurement of thyroglobulin antibodies is useful in the diagnosis and management of a variety of thyroid disorders including Hashimoto’s thyroiditis, Graves Disease and certain types of goiter

Should your health care provider not wish to order a complete thyroid panel, or if you have a high insurance deductible or copay, self-ordered testing is a convenient and low-cost option.  
You simply purchase your lab test requisition and receive it via email.  You will then take your printed lab requisition to your nearest Quest Diagnostics lab facility for your blood draw. Your results will be provided to you directly via email from the lab.  We recommend you share the results with your healthcare provider.

The most convenient and cost-effective self-ordered lab testing we’ve found is through Ulta Labshttps://www.ultalabtests.com/thyroidcare/AccountSite  

We suggest their Thyroid Profile 9 https://www.ultalabtests.com/thyroidcare/Item/Item/Thyroid-Profile-9-9-Tests which tests all the necessary key thyroid biomarkers.  

We recommend an anti-inflammatory diet based on your individual and unique food sensitivities (per lab testing) in addition to eliminating foods which play a role in molecular mimicry such as gluten, dairy, wheat, soy protein and GMO corn. Popular diets such as Paleo, Autoimmune Paleo, Vegan, Vegetarian, Keto, etc., may be beneficial for some but not all people with Hashimoto’s hypothyroidism.  It’s important to note that these popular diets, if used long-term, may result in significant nutrient deficiencies which are essential to thyroid function, energy, and overall health.  We do not advise eliminating any food(s), with the exception of those that play a role in molecular mimicry or are known to suppress thyroid function unless there is objective data (lab test results) confirming that the food(s) causes inflammatory reactions in your body.

Foods which may suppress thyroid function (goitrogens) include the following and should never be consumed raw by people with Hashimoto’s hypothyroidism; they should always be lightly cooked, steamed or fermented  to release goitrogenic chemicals: Broccoli, Bok choy, Brussels sprouts, Cabbage, Cauliflower, Collard greens, Kale, Daikon, Babassu, Radishes, Watercress, Turnips, Soy, Strawberries, Spinach, Rutabaga, Peaches, Peanuts, Pine nuts, Kohlrabi, Millet, Broccolini

Broccoli, Bok choy, Brussels sprouts, Cabbage, Cauliflower, Collard greens, Kale, Daikon, Babassu, Radishes, Watercress, Turnips, Soy, Strawberries, Spinach, Rutabaga, Peaches, Peanuts, Pine nuts, Kohlrabi, Millet, Broccolini

Please note that in  Graves disease or hyperthyroidism, consuming goitrogens may help slow down your thyroid.  Please consult with your physician before making any changes.

Autoimmune diseases are characterized by the body’s immune responses being directed against its own tissues, causing prolonged inflammation and subsequent tissue destruction. Autoimmune disorders can cause immune-responsive cells to attack the tissues and organs within the body that result in various autoimmune diseases.

A healthy immune system recognizes, identifies, remembers, attacks, and destroys bacteria, viruses, fungi, parasites, and cancer cells or any health-damaging agents not normally present in the body.  A defective immune system, on the other hand, wreaks havoc throughout the host by directing antibodies against its own tissues.

Any disease in which cytotoxic cells are directed against self-antigens in the body’s tissues is considered autoimmune in nature.  Such diseases include, but are not limited to:

• Celiac disease
• Crohn’s disease
• Systemic Lupus Erythematosus (SLE)
• Pancreatitis
• Sjogren’s syndrome
• Hashimoto’s thyroiditis
• Multiple sclerosis
• Rheumatoid arthritis
• Allergies (also the result of disordered immune functioning)
• …and many other endocrinopathies

Stress is a major risk factor in developing any disease.  Even prolonged low-level stress stimulates the adrenal glands to produce cortisol, which, in excess, impairs immune function. Lack of proper rest and sleep, depression, and emotional disturbance contribute to immune dysfunction.  In addition, there is a connection between the limbic system, the part of the brain that gives rise to emotion, and immune function.  Therefore, to balance the immune system, one must balance the mind and emotions.  Biofeedback, guided imagery, yoga, deep breathing, musical participation, positive affirmations, meditation, and prayer all help maintain balance.

A supplemental approach to stress reduction would be obtained from an adaptogen that contains a class of unique polypeptides that act as precursors to endorphins and other neurotransmitters and also support the nervous system to enable an individual to adapt to mentally and physically stressful conditions.  Another antidote to stress is an amino acid found in green tea called theanine.  Although theanine creates a tranquilizing effect on the brain, it appears to increase concentration and focus (Juneja et al. 1999).  DHEA supplementation is one of the most effective ways of blocking the effects of excess cortisol secretion.

Intestinal permeability (leaky gut syndrome) is often disrupted by health conditions such as Hashimoto’s, rheumatoid arthritis, Crohn’s disease, pancreatic dysfunction, and food allergies or food sensitivities.  Events such as aging, stress, medications, and alcohol consumption also alter permeability, compromising the barrier that separates food and intestinal bacteria from the rest of the body.

Poor intestinal motility and peristalsis can change beneficial bacterial flora by altering the natural flow of nutrients that are available to them.  These same factors can add to the overgrowth of abnormal bacteria and the byproducts they produce, leading to the absorption of antigenic substances into the bloodstream.  Immune-related disease is associated with antigenic substances produced by intestinal flora.  To correct the problem, the bacterial balance must be restored through the use of supplemental probiotics and prebiotics that feed the underproduced bacteria.  Species of bifidobacteria and lactobacilli will help restore microfloral balance and stabilize permeability.  Fructooligosaccharides (FOS) are simple sugars that are the preferred nutrient for lactobacilli and bifidobacteria (with the exception of the bifidum species).

Certain nutritional supplements are used by intestinal cells for growth and function.  They include:

• L-glutamine, a nonessential amino acid that increases the number of cells in the small intestine along with the number and height of villi on those cells
• Butyric acid, a short-chain fatty acid that enhances function and integrity in the large intestine and is an anticancer agent
• The fatty acids DHA (from fish oil) and GLA (from borage oil), which decrease inflammation and improve intestinal functioning

The liver plays a critical role in all aspects of metabolism and health.  It is important in the synthesis and secretion of albumin (a blood clotting protein), in the storage of glucose, and in the synthesis of vitamins and minerals.  Because the liver has a major role in the purification and clearance of waste products, drugs, and toxins, disease states may be improved by supporting liver function.  The herb milk thistle and its components silymarin and silibinin have two therapeutic mechanisms.  First, they alter the structure of penetration of liver poison into the interior of the cell.  Second, they stimulate the action of nucleolar polymerase A, resulting in an increase in ribosomal protein synthesis, thus stimulating the regenerative ability of the liver and the formation of new hepatocytes (liver cells). 

Autoimmune disease may be greatly improved by supporting the immune system with nutritional supplements and by making healthy lifestyle changes in diet and stress reduction. However, the protocol(s) needed may include prescription drugs as well as the following supplements:

1. Omega-3 and omega-6 fatty acids will help reduce systemic inflammation that accompanies autoimmune disease.
2. DHEA is a steroidal hormone that may reduce the effects of inflammatory cytokines. DHEA is contraindicated in men with prostate cancer and in women with estrogen-related cancer. 
3. Free-radical damage is a byproduct of normal metabolic functioning and exposure to toxic substances.  The following supplements have proven to be effective free radical scavengers:

• Vitamin C
• Vitamin E – Gamma E Tocopherol/Tocotrienols (the most balanced form of vitamin E which provides broad-spectrum protection
• Green tea extract capsules (decaffeinated)
• Beta-carotene
• Grape seed-skin extract
• CoQ10
• Selenium (selenomethionine) may be the most effective derivative to fight inflammation and neutralize free radicals
• Shark Liver Oil may modulate the immune system in certain forms of autoimmune disease
• Acetyl-L-carnitine enhances the transport of EFAs into the cell’s mitochondria and may modulate the effects of damaging saturated fats
• Carnosine will help protect against the formation of glycated proteins
•  Moducare by Thorne Research contains plant sterols that have been shown to  improve the immune system by balancing Th1/Th2 response
• Probiotics to reinoculate the gut with healthy bacteria
• Prebiotics that contain FOS, a nutrient for intestinal flora
• Butyric acid is a short-chain fatty acid needed for healthy functioning of the large intestine. Butyrate enemas may help reduce the intestinal inflammation that accompanies certain autoimmune conditions.  Butyrate enemas must be prescribed by a physician.  Alternatively, two tablespoons of flaxseed oil (NOT flaxseeds) have been shown in research studies to increase short-chain fatty acids
• L-glutamine will aid the small intestines by increasing the number and health of intestinal cells
• Adaptogens support the body’s stress response
• L–theanine, the amino acid derived from green tea, reduces stress by creating a sense of well-being
• The liver is the most important organ in the body for detoxification.  Milk thistle improves liver function.

A healthy gastrointestinal tract (gut) performs a multitude of functions.  It digests foods; absorbs small food particles that are converted into energy; transports vitamins and minerals across the intestinal lining and into the bloodstream; contributes to the chemical detoxification system of the body, and contains immunoglobulins or antibodies that act as the first line of defense against infection.

Leaky gut syndrome represents a condition in which large spaces develope in the intestinal mucosa, allowing bacteria, toxins, and food to leak into the bloodstream.  This hyperpermeable condition leads to inflammation and atrophic damage to the mucosal lining. Once the gut lining becomes inflamed or damaged, the functioning of the GI system is disrupted, allowing large food molecules and toxic pathogens that are foreign to our natural defense system to be absorbed into the body.  The result is the production of antibodies that launch an attack on the foreign invaders, with our own healthy tissue often being damaged in the process.  Food allergies and food sensitivities often complicate leaky gut syndrome.

Food sensitivity testing should be undertaken to determine food irritants at the cellular level. In addition, the avoidance of gluten, GMO corn, soy and in many cases, dairy, should be removed from the diet.

Whether you suspect you may have Hashimoto’s hypothyroidism or have already been diagnosed, it’s usually a lifelong journey, at least in the way you’ll want to always take care of yourself to feel your best and prevent flares.

Having the right doctor on your wellness team is very important.

Many people assume the best choice for autoimmune thyroid disease is to seek the help and guidance of an endocrinologist.  Although endocrinologist’s do specialize in thyroid disease; Hashimoto’s is not a “thyroid” disease per se…it is an autoimmune disease.  Typically, endocrinologist’s do not believe autoimmunity can be healed and they tend to address only thyroid replacement.

Although thyroid replacement is essential, Hashimoto’s as a disease process is so much more than that and it takes much more to feel better and get into remission. Autoimmune thyroid disease literally affects the body-mind-spirit and emotions.  

Thus, it’s been my personal experience and clinical observation that finding a practitioner who is well versed in the disciplines of functional or integrative medicine will be your best choice.  And don’t think you need to have only one practitioner on your wellness team.  Hashimoto’s is very complex, and the clients I see who experience the greatest improvement in their health and in their quality of life utilize the following experienced practitioners for their unique expertise:

• Functional or Integrative Medicine Physician’s
• Functional Nutritionist’s
• Integrative Health Coaches
• Functional Nurse Consultants
• Physical Exercise Trainer – who is experienced working with issues such as adrenal fatigue, autoimmune flare, fatigue and hormone imbalance
• Alternative Medicine Practitioners:  Acupuncturists, Massage therapists
• Functional or Integrative Pharmacists
• Stress Reduction Experts:  Seeks support from stress & anxiety management specialists who teach tools and strategies to reduce stress

Below are a few of our favorite resources to help you locate a functional or integrative medicine doctor in your area.  Please remember to check their credentials e.g. their original practicing discipline and the length of time they’ve been practicing as a functional or integrative practitioner.  Referrals or word-of-mouth may also be helpful.

Find a Provider

http://health.lifeextension.com/InnovativeDoctors/

https://www.ifm.org/find-a-practitioner/

https://www.a4m.com/directory.html

https://www.heyhashi.org/directory/ 

http://functionalmedicinedoctors.com/

https://www.ldnresearchtrust.org/LDN_Prescribers

It’s not unheard of to schedule appointments with several doctors to “interview” them.  This is your health, your body, and your life.  No one is going to care more about your health than you do.  Take it seriously and if at any time you feel you and the doctor you’ve hired for your care aren’t a good fit, it may be time to move on.  

Hashitoxicosis is the term used for a transient phase of hyperthyroid symptoms in a person diagnosed with Hashimoto’s.  The hyperthyroid phase is typically a combination of thyrotoxicosis/hyperthyroidism as a part of ongoing autoimmune thyroiditis.  The hyperthyroid phase may last for a few weeks to a few months.  During this phase, classical symptoms of mild to moderate hyperthyroidism may co-exist with a goiter.  Testing may reveal normal or slightly increased uptake, thyroid antibodies are usually positive, and justification for Doppler thyroid ultrasound.  

Treatment for Hashitoxicosis often requires beta-blockers during the active phase of thyrotoxicosis and discontinuation (usually temporary) of thyroid hormone replacement.
Hashitoxicosis doesn’t necessarily indicate a diagnosis of Graves’ disease; however, if symptoms (subjective and objective clinical data) raise suspicion for such, Graves’ disease must be confirmed or ruled out. 

Mainstream treatment for Graves’ disease is with the use of anti-thyroid medications and routine testing to prevent the onset of hypothyroidism.  

Most patients with Hashitoxicosis recover from the hyperthyroidism phase while a small proportion may continue to have persistent symptoms.

The benefits of melatonin should encourage anyone over the age of forty to take this hormone.  It can also be used for specific purposes.  However, people with exhausted adrenal glands should not take melatonin.  Constant fatigue combined with low blood pressure and feeling faint when standing up are classic signs of extreme adrenal fatigue.  This results in low tolerance for physical and emotional stress.

Melatonin can reduce the production of cortisol and is contraindicated in this situation.  Anyone who experiences reduced energy and stamina after taking melatonin should suspect exhausted adrenals and have their adrenal function checked.   Melatonin should be avoided until the adrenals are healthy.  

Melatonin can also affect the ovulation process.  So, for women who are trying to conceive, melatonin should be avoided.  Melatonin is naturally lower during ovulation.

Side Effects from Excess Melatonin

• Drowsiness upon rising
• Wild dreams 
• An excess of the active thyroid hormone (T3) resulting in waking up nervous, sweating, and with palpitations
• Decreased estrogen and progesterone levels.  One Dutch study suggested that 30 milligrams of melatonin daily could even act as a contraceptive.

Indications for Melatonin

• Sleep
• Jet lag
• Anti-aging
• Cancer protection