Hashimotos — The autoimmune attack on your thyroid!

(All the below is in Chap­ter 9 of the STTM book with more details. )

Did you get a diag­no­sis of Hashimoto’s Disease, or someone has just sug­ges­ted you might have it?? It’s a very com­mon form of thy­roid disease, and can also be called Hashi’s or Thyroiditis.

WHAT IS HASHIMOTOS? Hashimoto’s Thy­roi­di­tis is an autoim­mune thy­roid disease in which your thy­roid is being attac­ked by your own immune sys­tem via anti­bo­dies, attemp­ting to des­troy your gland as if it’s some vile enemy. It may start out silently, but the attack will even­tually cause an inflam­ma­tion and gra­dual des­truc­tion of your thy­roid gland and can go on for years with mise­ra­ble side effects to match. It can also cause nodu­les or lumps. It may be the most com­mon thy­roid disease, espe­cially with women.

WHAT ARE SYMPTOMS OF HASHIMOTOS? For many, the symp­toms are silent – the early sta­ges of the autoim­mune attack. But even­tually, you start to notice the same symp­toms of hypothy­roid, inc­lu­ding poor sta­mina, easy fati­gue, fee­ling cold, gai­ning weight, dry hair and skin, cons­ti­pa­tion, etc. As it pro­gres­ses, you may feel very hypo one day, and very hyper another, which is cau­sed by the des­truc­tion of your thy­roid. Addi­tio­nally, since the cells of your thy­roid become inef­fi­cient in con­ver­ting iodine into thy­roid hor­mo­nes, your thy­roid com­pen­sa­tes by swe­lling or enlar­ging, and you can have a fee­ling of tight­ness around your throat or a sore throat as a result. The swe­lling can be called a goi­ter. You might also see varia­tions in your lab work – high one time, low the next, high the next, etc. Symp­toms are dif­fe­rent from indi­vi­dual to indi­vi­dual – some can have the swe­lling; others may not, for example.

HOW DO I CONFIRM HASHI’S LABWISE? Hashi’s is con­fir­med by two anti­bo­dies labs: anti-TPO and TgAb. The first anti­body, anti-TPO, attacks an enzyme nor­mally found in your thy­roid gland, called the Thy­roid Pero­xi­dase, which is impor­tant in the pro­duc­tion of thy­roid hor­mo­nes. The second anti­body, TgAb, attacks the key pro­tein in the thy­roid gland, the thy­ro­glo­bu­lin, which is essen­tial in the pro­duc­tion of the T4 and T3 thy­roid hor­mo­nes. Note: it is unfor­tu­na­tely com­mon for a doc­tor to only do ONE test, and you need BOTH tests, since you can be nor­mal in one and high in another! We have also noted that saliva does not always accu­ra­tely detect Hashi’s as well as blood tests do.

Want to order your own lab­work to dis­cern if you have Hashi’s?? STTM has crea­ted the right ones just for you to dis­cuss with your doc­tor. Go here: https://sttm.mymedlab.com/

WHY IS IT IMPORTANT TO KNOW IF I HAVE HASHI’S?? As the attack inc­rea­ses, you will tend to swing bet­ween hypo and hyper, making dosing by labs, and espe­cially the TSH, impos­si­ble. Your labs will be high one time, and low the next…back and forth. The hyper is cau­sed by the release of thy­roid hor­mo­nes into your blood due to the des­truc­tion. The hypo is cau­sed by the les­se­ning func­tion of your thy­roid due to the attack. If you do have Hashi’s, you may have to insist to your lab-obsessed doc­tor to let you raise by the eli­mi­na­tion of symp­toms, not labs, due to this reality.

NOTE: when unin­for­med doc­tors fail to do the anti­bo­dies test on you, or don’t unders­tand the swings of the attack, you can be wrongly diag­no­sed as having bi-polar, which is simply the hyper swing of the attack!! Or as on Aus­tra­lian gal called it, the “Yeeha” of her swing.

IS IT A GOOD IDEA JUST TO “WATCH” IT, AS MY DOCTOR WANTS TO DO? In the opi­nion of a large body of patients who follo­wed this advice, “watching” your Hashi’s is akin to watching a dog chew off your leg. Allo­wing the attack to con­ti­nue on your thy­roid can not only last for years, but cause all sorts of pro­blems along the way of its des­truc­tion, inc­lu­ding adre­nal fati­gue. And once you add adre­nal fati­gue to the mix, you’ve got more pro­blems to tac­kle. Ins­tead, why not just stop the attack and all the con­se­quen­ces, as explai­ned below. Makes a whole lot more sense, says a patient who suf­fe­red through what she calls the “insane watching”.

HOW DO I TREAT IT? You treat Hashi’s the same way you do just plan hypothy­roid – with thy­roid medi­ca­tions. Why? Because if rai­sed high enough, they can stop the attack. We have seen those on thy­ro­xine T4-only (aka Synth­roid, Levoxyl, etc) have some suc­cess in stop­ping the attack, but patients who switched to Armour or other presc­rip­tion desic­ca­ted thy­roid noti­ced even bet­ter results, espe­cially if they dosed by symp­toms rather than labs. Some doc­tors have unwi­sely recom­men­ded non-treatment until lab­work “sta­bi­li­zes”, but that could take months and years, and you con­ti­nue to suffer.

The attack can hap­pen over a few weeks or extend into years. It has been sta­ted that anti­bo­dies can be pre­sent for years even after you coun­ter the attack with thy­roid hor­mo­nes like Armour. But patients on Armour have noted that anti­bo­dies greatly fall if they dose high enough.

WHY DID MY HASHI’S GET WORSE ON ARMOUR (and even Synth­roid and other T4 meds)? Easy ans­wer: you have sta­yed on lower doses too long and you haven’t risen high enough, quick enough. Lower doses of Armour and other thy­roid meds, as well as sta­ying with each raise too long, will FEED the attack, not stop it. You then have further swe­lling in your throat, or hair loss, or high anxiety, or a raise in your antibodies…and heigh­te­ned hypo symp­toms with a higher TSH. And doc­tors who aren’t know­led­gea­ble about Armour might put you back on synthe­tics, or take you off your meds com­ple­tely. The solu­tion is to RAISE THE ARMOUR fas­ter and accor­ding to the eli­mi­na­tion of symp­toms and NOT labs. Most seem to end up in the 3 – 5 grains area to stop that attack, with a few lower and a few higher. (Also note that some patients with Hashi’s have deve­lo­ped adre­nal fati­gue, and you may need to treat that before you can raise your thy­roid meds high enough to stop the attack)

MY DOC SAYS I SHOULDN’T BE ON THYROID MEDS WHEN I’M HYPER FROM HASHI’S. IS HE CORRECT? The hyper when you have Hashi’s is cau­sed by the die-off of thy­roid hor­mo­nes from the attack and their dump in to your blood. You also will swing bet­ween hypo and hyper as explai­ned above. But to say you shouldn’t be on thy­roid meds is wrong accor­ding to the vast expe­rience of Hashi­mo­tos patients. You want to stop the attack and the swings, and the only way to do that is to be on thy­roid meds, and raise high enough to stop the attack, which in turn will stop the hyper swings. You’ll have to fight your doctor’s ten­dency to hold you too long on each raise, or to dose you by the TSH or other labs.

IS THERE A CONNECTION BETWEEN PREGNANCY and HASHI’S? Preg­nancy can be a strong pre­cur­sor to deve­lo­ping Hashi’s, since the inc­rea­sed acti­vity of your immune sys­tem can either wor­sen an autoim­mune disease you already have, such as thy­roi­di­tis, or cause it to appear.

CAN I TAKE IODINE WHEN I HAVE HASHI’S?? Pos­sibly. Doing an iodine loa­ding test can con­firm if you have low iodine. And since iodine is the main com­po­nent of thy­roid hor­mo­nes, plus has anti-cancer bene­fit, the use of iodine can be a wise deci­sion. Some Hashi’s patients do won­der­ful on iodine. For others, it’s tricky, since iodine use has aggra­va­ted the attack on anti­bo­dies attack on the thy­roid for many. But the pro­blem may be not being on enough iodine, just as not being on enough Armour feeds the attack. It’s recom­men­ded that you be on 50 mgs at the least.

One patient from Ger­many infor­med me that there is government-directed iodi­na­tion of prac­ti­cally every food which can be pro­ces­sed, inc­lu­ding milk. And with this has come an explo­sion of Hashi­mo­tos the last 20 years! The ball is out of the court to know what’s going on there.

WHAT ELSE MIGHT I NEED TO AVOID WITH HASHI’S?? Research shows there can be a strong con­nec­tion bet­ween having Hashimoto’s disease and glu­ten into­le­rance, or Celiac disease. Celiac disease is a diges­tive disor­der that results in an ove­rreac­tion to glu­ten, a pro­tein found in most grains like wheat, rye, oats and bar­ley, which can be found in breads, cereals, pasta and many pro­ces­sed foods. The ove­rreac­tion, in turn, cau­ses autoim­mune damage to the intes­ti­nes, which results in poor absorp­tion of nutrients.

Glu­ten can also trig­ger the very autoim­mune reac­tions that cause you to have Hashi’s. As a result, some Hashimoto’s patients expe­ri­ment with eli­mi­na­ting glu­ten from their diets, and with good results.

BOTTOM LINE?: Patients have lear­ned that Hashimoto’s is not a con­di­tion you let take its course (as some doc­tors will recom­mend), but that you treat, and with desic­ca­ted thy­roid like Armour. See the Things We Have Lear­ned page. And during that treat­ment, you raise accor­ding to the eli­mi­na­tion of symp­toms, not labs. And if a doc­tor tells you that your Hashi’s is “mild”, yet you have a sore throat, swo­llen neck, or the sen­sa­tion of “wow” one time, and “whoa” another, you are much farther along in the attack than you know! Time to insist that you be put on Armour, insist to raise high enough to con­trol the symp­toms, and be your own best advocate!

***There is some evi­dence that taking Sele­nium can help reduce the TPO anti­bo­dies, but it’s not recom­men­ded as a “repla­ce­ment” for Armour, but as an addi­tio­nal help.

Inte­res­ting side note: Both Hashi’s and Hyperthy­roid folks can have ele­va­ted anti-TPO. “The fre­quency of ele­va­ted anti-TPO levels in patients with active autoim­mune thy­roi­di­tis was 90% (cli­ni­cal diag­no­sis Hashi­moto thy­roi­di­tis) com­pa­red to 64% in patients with overt hyperthy­roi­dism (cli­ni­cal diag­no­sis Gra­ves’ disease).” Pub Med article here.