Hashimoto’s is an autoimmune thyroid disorder where the immune system attacks the thyroid peroxidase (TPO) enzyme that’s needed to make T4 thyroid hormone. This can lead to reduced thyroid hormone output with hypothyroid symptoms. You may also experience inflammation, swelling and possibly nodules in the neck or thyroid area due to inflammation from the autoimmune attack. Testing for TPO antibodies can diagnose Hashimoto’s – a level over 35 indicates autoimmunity. In the earlier stages of Hashimoto’s it’s common to swing from hyperthyroid symptoms to hypothyroid symptoms until you eventually just feel tired and sluggish all the time and become hypothyroid (you may still even show in range on a TSH test).
Hashimoto’s is much more than a thyroid issue. Your adrenals, blood sugar / sex hormones and gut health are involved. Autoimmunity actually occurs due to poor gut health (leaky gut), having a genetic predisposition and a triggering factor like stress, viruses, nutrient deficiencies, toxin overload and others. By bringing the body back into balance you can lower the autoimmune attack, reduce symptoms and some people may be able to reduce or avoid medication. Each person’s experience will be unique and medication may be helpful while also making lifestyle changes.
I recommend asking your doctor for a full thyroid panel, not just the TSH test. At the very least request TSH, Free T4, Free T3 and TPO antibodies every time you test to keep consistent data for tracking your levels and dosages (if on medication). The TSH hormone comes from the Pituitary and tells the thyroid to create T4 hormone. It doesn’t tell you how much thyroid hormone you have available in your body. Free T4 hormone is unbound in the blood making it available for the body to use or convert to T3, the active thyroid hormone. Free T3 is the active thyroid hormone in the body that’s unbound and available for uptake by your cells. TPO antibodies greater than 35 (on most lab ranges) are indicative of Hashimoto’s autoimmune disease and is helpful for diagnosing Hashimoto’s, along with seeing reduced autoimmunity during lifestyle & diet changes.
You will reduce your toxin load and improve nutrient deficiencies with a diet that is based on organic, non-gmo fruits, vegetables, leafy greens, whole grains, quality protein and healthy fats. The majority of your meals should be prepared fresh at home and not from a package. Strive to eat fiber, healthy fat and protein at each meal to maintain proper blood sugar balance and limit refined sugar. I do advise to eliminate gluten and possibly dairy depending on your symptoms as these are highly inflammatory. Some people may need to try an elimination diet to heal their gut or reduce bacteria overgrowth.
Healing diets that I recommend are Gluten and Dairy Free, Paleo, AIP, Low FODMAP (short term), or SCD/GAPS. These diets should be seen as tools to help you achieve a goal of creating better gut health. As you begin to feel better the goal is always to get as much variety of healthy food in your diet as possible. Hashimoto’s patients should be cautious of high iodine containing foods like spirulina, chlorella, kelp and seafood as it can increase the autoimmune attack on the thyroid. Experiment with what you can tolerate, some people are more sensitive than others.
Autoimmunity begins with a leaky gut where food particles, bacteria, viruses and toxins cross through breaks in the tight junctions of the mucosal layer of your intestines and into the bloodstream. The immune system then mounts an attack against these invaders and may end up attacking your own tissues that have similar protein makeup. Gluten and casein protein (in dairy) are very similar to thyroid hormone proteins and can increase the autoimmune attack on the thyroid. Having an imbalance of gut bacteria, whether SIBO, Candida overgrowth or just not enough healthy bacteria also impacts the immune system and your body’s ability to absorb nutrients, leading to symptoms.
Hashimoto’s that’s not well managed with medication and/or lifestyle slows digestion leading to low stomach acid levels, bacteria overgrowth, constipation, poor nutrient absorption and a cascade of other health issues that begin in the gut. By improving your nutrition, bowel movements and overall bacteria imbalances you will resolve many Hashimoto’s symptoms and begin to restore balance to the body.
Weight loss has many factors and isn’t just about exercising more or eating less calories. With Hashimoto’s you’ll also need to bring your hormones back into balance. You can do that with eating a nutrient dense, whole foods diet with plenty of healthy fats and minimal sugar to balance hormones and blood sugar levels. You may also need to avoid caffeine to bring cortisol and adrenal function back into balance. Proper nutrition is the cornerstone of losing weight, but getting enough sleep, exercising and managing stress levels are just as important.
All of that can seem overwhelming if you’re hypothyroid so make sure you are getting the right medication if you’re just not able to function well. As you feel better you can begin to incorporate lifestyle changes that can help you reduce the need for medication overtime. Consistent action towards eating fresh, unprocessed food and finding exercise that you enjoy will help you achieve your weight loss goals.
You can definitely reduce and even eliminate symptoms of Hashimoto’s and reduce your TPO antibodies level through nutrition, lifestyle and medication (if needed). I don’t really like the term Remission that I see many people use to describe their TPO antibodies level reduced to a normal range from lifestyle interventions. This implies that you are “cured” or that you won’t have any issues anymore and that is just very misleading and sets the wrong expectation in my opinion.
While you can reduce antibodies and the autoimmune attack on the thyroid, I like to think of it as “Well Managed” Hashimoto’s. By doing the lifestyle interventions, nutrition and bringing your body back into balance you are able to effectively manage the Hashimoto’s disease so that you may not even have issues anymore. However, you still have the genetic predisposition for it and the antibodies (even if not active) that your immune system has designated towards the thyroid. You can’t eliminate those factors so remission seems a little misleading to say. If you were to go back to a lifestyle that increases inflammation and/or have certain viruses or other triggering immune issues you can see antibodies go back up (even if not as much as before).
I’d much rather have clients focus on creating a balanced lifestyle that helps you feel great, reduces symptoms and allows you to build sustainable lifestyle choices. You might very well get within a normal TPO range, or you might still be out of range but feel amazing! Use that lab test as a helpful guide to make sure nutrition and lifestyle choices are getting you in the right direction. Always look at how you feel and if the changes are sustainable for you long term.
For those that are actively hypothyroid you’ll benefit from exercise that will give you a boost of energy. Try jumping on a trampoline or doing a short high intensity workout session around 15-30 minutes. If that feels like too much then walking and some light resistance training are also beneficial.
If you’re experiencing hyperthyroid symptoms it’s important to focus on stress reducing activities like yoga, stretching and walking. It may be difficult to do any other exercise that increases heart rate.
If your Hashimoto’s is well managed then do the exercise that you enjoy! I recommend a combination of strength training to build muscle, some form of cardio that you enjoy that gets you to sweat and yoga, pilates or stretching for stress reduction and lower intensity activity. You can find my recommended yoga videos and exercise equipment in the Mindful Thyroid Shop.
There are synthetic (lab created) and natural dessicated (from porcine) thyroid hormone medications. Most synthetic hormones only contain T4 and not T3. However, you can take a synthetic T4 and a separate synthetic T3 if needed. Natural dessicated thyroid (NDT) hormones contain T4 and T3 in combination so many people feel better on them than with T4 alone. However, NDT hormones can be too similar to our own thyroid hormone and can still cause an autoimmune attack by the body making some people feel worse on them. You’ll need to experiment to find a medication that you tolerate well.
It’s not an easy transition from synthetic to NDT or vice versa as the dosages are not the same. If you’re going from synthetic to NDT you’ll most likely start at a lower dose and need to work your way up as it will potentially feel more effective with the addition of T3. This may cause some unpleasant symptoms during transition until you find your optimal dosage. No matter which one you choose, always opt for the brand name instead of a generic counterpart to get a more effective and consistent dosage. I also recommend using a Weekly Pill Case to put your pills in so you can visually see whether you took them or not.
Hashimoto’s patients commonly have nutrient deficiencies due to several factors: poor diet or not eating nutrient rich food, inability to absorb nutrients (lack of enzymes), low stomach acid, and bacteria imbalances. The most common deficiencies or sub-optimal levels are Vitamin D, Zinc, Iron (and Ferritin), Magnesium, Omega 3, and B Vitamins. Vitamin D is important for immune function, while Zinc and B vitamins (and Selenium) are necessary for converting thyroid T4 hormone to T3. Magnesium and Omega 3 are vital for reducing overall inflammation. You can get a micro-nutrient blood test done to see if you have these or other deficiencies to be sure you’re supplementing properly.
I always recommend getting your nutrients from your food as a primary source. That means buying organic and non-gmo produce, pasture-raised eggs and grass-fed meats to get higher quality nutrients, vitamins and minerals. Include plenty of vegetables and leafy greens which contain magnesium, folate, B vitamins, potassium and calcium. You can additionally add a multi-vitamin, vitamin D3, magnesium supplement, omega 3 fish oil and B vitamins if desired. You can find my recommended vitamins and other supplements in the Mindful Thyroid Shop.
Most doctors will only test for TSH, which is the hormone from the Pituitary that tells the thyroid to create T4 thyroid hormone. It doesn’t tell you how much thyroid hormone is circulating in your body and if you’re even able to get it into your cells for use. Always ask for a full thyroid panel to get more detailed data. You can be hypothyroid even if the TSH test shows in range if you’re not absorbing or getting thyroid hormone in the cells.
Blood sugar imbalances, high cortisol, birth control pills, infections, immune stress, nutrient deficiencies and Candida overgrowth are some factors that contribute to thyroid hormone not getting converted properly to T3 and/or used by the cells. Thus, leaving you feeling hypothyroid.
Additionally, there are many other diseases, nutrient deficiencies and gut imbalances that are very similar to thyroid imbalances and may be affecting you, rather than thyroid levels. Testing for the full thyroid panel can help you rule that out if it’s all normal so that you can look at other underlying issues that might be occurring.