Hashimoto’s is an autoimmune disease and a thyroid disease. But the autoimmune part of the disease is often poorly understood and sometimes completely ignored.
There are many reasons for this, but the result is that there is a huge void in our healthcare model for treating, managing and, even, properly understanding this condition. In this post I will explore many aspects of autoimmune disease and why it should matter to you.
There is a a global epidemic of autoimmune disease taking place right now. Its shocking how little attention it is getting. According to the American Autoimmune Related Disease Association’s current statistics: 1 out of every 12 men and 1 out of every 9 women have autoimmune disease.
This is especially shocking when you understand how autoimmune disease is defined. An autoimmune disease is officially recognized when about 70 to 90% of the target disease is destroyed. You don’t just go from 0% to 70% destruction overnight. How many people do you think have undiagnosed autoimmune disease? Millions and millions.
Why aren’t more people talking about this? Is it because its not life threatening? No. Actually, autoimmune disease is the one of the top 10 leading causes of death in female children and women in all age groups up to 64 years of age.
And the numbers are higher than other major diseases: the NIH (National Institute of Health) thinks that up to 23.5 million Americans have autoimmune disease. 9 million have cancer, 22 million have heart disease.
In the US, thyroid autoimmune disease is the most common of all autoimmune disorders, affecting 7 – 8% of the U.S. population. By some estimates, autoimmune disease accounts for approximately 90% of all hypothyroid disorders and these are mostly due to Hashimoto’s.
One thing that is important to understand about autoimmune disease is that it is incurable. The condition can go into remission, but it never goes away. Unfortunately, some healthcare practitioners and patients believe this remission is a cure.
Let me put it to you simply: Anyone who tells you that they can cure your autoimmune disease is either a liar, a con artist or they don’t understand what is going on.
To date, there is no “off switch” to the autoimmune process. Once you have crossed over into autoimmunity you can not turn back. You can learn to manage it effectively, you can calm the attack, but you can never reverse the loss of self-tolerance.
The immune system doesn’t work that way. Once something has been labeled as a bad guy by the immune system, you can’t miraculously change that.
This is true of all autoimmune diseases. We are composed of tissue made of proteins. These proteins have specific amino acid sequences. There are only a finite number of amino acids, so there many places where sequences from one tissue to another have the same sequences.
If your immune system identifies one protein as a bad guy, its not hard for it to mistake another that looks pretty similar. And this is also a natural process, part of the job of your immune system is to get rid of old dead cells.
Let’s take a look at Hashimoto’s as an example:
According to a study from the UK, 14.3 % of Hashimoto’s patients had another autoimmune diseases, with rheumatoid arthritis being the most common. Here’s a list of other common autoimmune diseases that this population could have:
According to Dr. Datis Kharrazian, DC, autoimmune disease is a progressive disease that goes through 3 stages. While these are not recognized by the general medical community, they are very useful clinically.
As I stated above, autoimmune disease is not officially recognized until close to 70 to 90% of the target tissue is destroyed. Wouldn’t it be better to have some other way to identify these diseases before they destroy the target tissue? For my way of thinking the answer is YES!
Stage 1: Silent Autoimmunity
In this stage, the body has lost tolerance to its own tissue, but there are no symptoms yet and it doesn’t really affect the way that the system functions. This stage can, however, be identified by lab tests that show elevated antibodies.
People can stay in this stage for years. This is the best place to begin some sort of treatment because your odds of getting good results are highest.
Stage 2: Autoimmune Reactivity
In this stage, the destruction of the target tissue has begun. There are elevated antibodies and some symptoms. However, the destruction is not significant enough to actually be labeled autoimmune disease because 70 to 90% of the target tissue has not yet been destroyed.
This stage is where a lot of Hashimoto’s patients are. They may or may not have been placed on thyroid replacement hormone and that may or may not have normalized their thyroid lab results. However, the destructive autoimmune process is active and is progressing.
This is a very important stage for treating the immune dysfunction because you have a greater chance to slow or stop the destruction of that tissue and slow the progression to other autoimmune diseases.
Stage 3: Autoimmune Disease
This is the stage where Western medicine finally acknowledges that this is an autoimmune disease. And it takes this long because you need significant destruction of tissue in order to see the destruction with an MRI or ultrasound.
Other findings include elevated antibodies, serious and significant symptoms, lab results, and special studies that all confirm a loss of function.
Unfortunately, this is really late in the game. With Hashimoto’s, this is the stage where the thyroid is almost completely destroyed. Most people don’t reach this stage before they have been given thyroid replacement hormone because the symptoms have already become so serious that they will have sought out a doctor to help them before they got here.
Research on the effects of thyroid hormone therapy suggest that L-T4 (Levothyroxine) does reduce goiter size and autoantibody levels, however it does not seem to have an effect on specific immune cells that are known to be involved in autoimmune attacks.
That being said, there is evidence that taking thyroid hormone replacement in Stage 1 or Stage 2 may help slow the progression of the disease and this includes its progression to other diseases.
According the Mary Shomon, thyroid advocate, “The practice of treating patients who have Hashimoto’s thyroiditis but normal range thyroid function tests is supported by a study, reported on in the March 2001 issue of the journal Thyroid.
In this study, German researchers reported that use of levothyroxine treatment for cases of Hashimoto’s autoimmune thyroiditis where TSH had not yet elevated beyond normal range (people who were considered “euthyroid”) could reduce the incidence and degree of autoimmune disease progression.
In the study of 21 patients with euthyroid Hashimoto’s Thyroiditis (normal range TSH, but elevated antibodies), half of the patients were treated with levothyroxine for a year, the other half were not treated.
After 1 year of therapy with levothyroxine, the antibody levels and lymphocytes (evidence of inflammation) decreased significantly only in the group receiving the medication. Among the untreated group, the antibody levels rose or remained the same.
The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto’s disease reduced the various markers of autoimmune thyroiditis, and speculated that that such treatment might even be able to stop the progression of Hashimoto’s disease, or perhaps even prevent development of the hypothyroidism.”
Thyroid hormone may definitely provide some benefits, and there are also natural sources of thyroid hormone for those in stage 1 or stage 2 who may want to go the natural approach.
In my practice, we use a product that has thyroid glandular and a number of other herbs and supplements that support the thyroid gland, thyroid hormone function, thyroid hormone receptor binding and promotes healthy T3 and T4 levels.
Even though the research mentioned above has shown that there may be some benefit to thyroid replacement therapy, for many people it is not enough. The reasons for this is simple, they are doing nothing to stop the triggers that drive flare ups of the autoimmune attack and they are not working to balance the immune system.
For example, there are many things that can be done to strengthen the regulatory part of the immune system (this is the part that slows the attack). It is also important to assess and treat the parts of the immune system that are responsible for the assault on your own tissue.
In future posts in this series I will go in depth about how this works and give you some real clinical examples for how we assess, treat and balance the immune system.
Autoimmune disease is on the rise. It must be taken seriously and anyone with hypothyroid symptoms should be tested for thyroid autoimmune antibodies to rule out Hashimoto’s. Thyroid hormone may help slow the destructive inflammatory process, but by itself it is not enough.
There is a lot you can do to balance your immune system and heal your Hashimoto’s. Because I have Hashimoto’s and another autoimmune disease (Ankylosing Spondylitis) myself I have had to focus on healing and managing autoimmunity.
I’m happy to speak without you about how you can do this effectively, as well. Click here to set up a time to chat: Click here to book a session with Marc
What are your thoughts, comments, questions about this issue?
Hashimoto’s and pregnancy are linked in many ways. Hashimoto’s is the most common autoimmune disease in the United States and pregnancy is one of the factors that can lead to it. Many people do not know that thyroid hormones can also affect the hormones that are responsible for fertility and successful pregnancies. In this blog post, I will explore how the thyroid and thyroid hormones may affect a woman’s ability to have a baby.
Before we look at how thyroid hormones can affect pregnancy, let’s review some of the basics of the hormones used to make babies and how they work.
Estrogen rises and falls and helps to orchestrate a woman’s cycle. It makes the lining of the uterus thick so that an egg can be implanted and can grow happily there. The body signals the pituitary gland which helps to control the increase and decrease of this hormone. At the end of the cycle a sharp fall in estrogen and progesterone signals the uterus that there is no pregnancy.
Follicle Stimulating Hormone (FSH)
As its name implies, Follicle Stimulating hormone stimulates the follicles in the ovaries to grow. When estrogen levels drop at the end of the cycle, FSH levels go up (this is what is called a negative feedback loop) to start the process all over again. Once the follicles in the ovaries are stimulated, one becomes dominant and it starts secreting estrogen. This is when the effects of estrogen on the lining of the uterus take place and prepare it for nurturing the egg.
Luteinizing Hormone (LH)
At mid cycle (about day 14), the lining of the uterus stimulates a large and sudden release of luteinizing hormone. When this happens, there is a sudden rise in body temperature and this is a sign that ovulation is about to happen. This surge also causes the follicle to break open and release an egg into the fallopian tubes.
When the follicle breaks open, its walls collapse and this cavity is called the corpus luteum. After ovulation, the corpus luteum begins secreting large amounts of progesterone, which helps prepare the lining of the uterus for the fertilized egg.
Human Chorionic Gonadatropin (HCG)
Made popular by the recent diet fad, this hormone is released once the egg is fertilized. It keeps the corpus luteum healthy so that it can continue to pump out more estrogen and progesterone. This keeps the lining of the uterus healthy. After about 6 to 8 weeks of gestation, the newly formed placenta takes over the secretion of progesterone.
As you can see, a lot of things must happen to have a healthy egg implanted in a healthy uterus to make a healthy baby. If there are problems with any of these hormones or their release, then there will be problems with pregnancy and fertilization. As it turns out, thyroid hormone can affect all of these hormones.
When women have hypothyroidism, a common problem is an increase of another hormone called prolactin. This causes less of a release of LH, and a loss of progesterone receptor site sensitivity, and a loss in sensitivity to FSH in the follicle. All of these losses lead to problems with ovulation, and they also mess with the communication to the pituitary gland.
Using birth control pills on top of this can further harm the communication and feedback loops in this system. Using herbs to stimulate the ovaries or the reproductive system will also not work unless the hypothyroid issues are corrected.
Studies have found that even mild hypothyroidism may cause ovarian problems. Testing thyroid function is very important with women who suffer from infertility, especially if they have elevated prolactin or they can’t ovulate.
Hypothyroidism may lead to low FSH levels, which may lead to immature follicles and infertility. Suppressed LH levels will often lead to problems with ovulation in timing or abnormal luteal phase progesterone levels. These changes may cause miscarriage, depression in the second half of your cycle, or migraines in the second half of your cycle.
To summarize, hypothyroidism can cause:
* A decrease in FSH release and FSH receptor sensitivity, this leads to problems with the development of the follicle and infertility
* Suppressed LH which leads to problems with ovulation and abnormal progesterone levels, this leads to abnormal cycles and infertility
* Progesterone receptor insensitivity which also leads to abnormal cycles and infertility
* Increased Prolactin, which leads to problems with ovulation, abnormal menstrual cycles and infertility
First of all, don’t assume your OB/Gyn or endocrinologist have any idea about this. Some do, but many do not, that’s the sad truth.
Secondly, visit this website: www.hypothyroidmom.com, this is a excellent site full of great information from a woman who has been through it.
Let me summarize her suggestions because they are brilliant:
Get a full thyroid panel (TSH, free T4, free T3, and antibodies if you haven’t tested for them before). Some doctors recommend the range for TSH prior to conception of 1.0-2.0 mIU/L. This is in keeping with the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum.
Here is their actual recommendation:
“RECOMMENDATION 15 – Treated hypothyroid patients (receiving thyroid hormone replacement medication) who are planning pregnancy should have their dose adjusted by their provider in order to optimize serum TSH values to <2.5 mIU/L preconception. Lower preconception TSH values (within the non-pregnant reference range) reduce the risk of TSH elevation during the first trimester.”
Your chances of success are better if you know your body and how it is working. Women with Hashimoto’s or hypothyroidism often have lower than normal body temperature. Keep track and find out when your body temperature goes up because, as I stated above, this signals ovulation, the best time to make babies.
Don’t wait to have no period, buy lots of pregnancy tests and test early and often. The developing fetus relies almost entirely on the mother for thyroid hormone. Hypothyroid Mom, Dana Trentini, sums it up beautifully:
“In a person with healthy thyroid function, her body is able to meet the extra demands of pregnancy to provide the fetus with the necessary hormones. In a woman with thyroid dysfunction, her body may not be able to meet the increased demand for thyroid hormone during pregnancy. According to the Endocrine Society’s 2007 Clinical Guidelines for the Management of Thyroid Dysfunction during Pregnancy and Postpartum, thyroid replacement dosage usually needs to be incremented by 4-6 week gestation and may require a 30-50% increase in dosage.”
This is HUGELY IMPORTANT. Because if your TSH levels or T4 levels get too low, it can seriously threaten your baby and you could lose him or her.
According to the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum:
RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.
RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.
RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation
Like so many things that involve Hashimoto’s, you need to be proactive and armed with knowledge and information to deal with your condition because many doctors and practitioners out there don’t know how to deal with you. This is why I have created Healing Hashimoto’s: The 5 Elements of Thyroid Health, an effective system for understanding and managing your Hashimoto’s. Click on the link to the right to watch my 4 part video series and learn more.
Ylostala P, Kujala P, Kontula K, Amenorrhea with low thyroid function and thyroxine treatment. Int J Gynaecol Obstet. 1980;18(3):176-80
Bruni JF, Masxhall S, Dibbet JA, Meites J., Effects of hyper- and hypothyroidism on serum LH and FSH levels in intact and gonadectomized male and female rats. Endocrinology. 1975:97(3):558-63
Marou T, Katayama K, Barnea ER, Mochizuki M., A role for thyroid hormone in the induction of ovulation and corpus luteum function. Horm Res. 1992;37 Supple 1:12-8
Akande Eo. Plasma concentrations of gonadatropins, estrogen and progesterone in hypothyroid women. Br J Obste Gynaecol. 1975:82(7):9-20
Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum