Hashimoto’s is one of the most common autoimmune disease in the United States, yet is is also one of the most poorly managed. One of the most common questions I get is, what tests should I ask my doctor to order?
Because Hashimoto’s is a thyroid disorder and an autoimmune disease there are a number of additional lab tests that are important but are not, specifically, tests for the thyroid. In this post I will discuss them all and explain why it is important to order them, as well.
There are some people out there on the internet, who, out of frustration, believe that you should forget about asking a doctor to order tests for you and just order them for yourself.
In their defense, many doctors do not order the appropriate tests to do proper management of thyroid patients. There is too much emphasis put on some tests, and not enough on others that can give a great deal of information about how you are doing and how your medication is working.
However, here’s my take on that:
If you bought a luxury car, say a Tesla or a Lamborghini, you’d want to make sure it was kept in tip top shape. Would you do the diagnostics yourself? Think about how long it would take you to master the proper care of those vehicles.
It’s kind of the same thing with your body and lab testing. Hashimoto’s has so many moving parts. You are better off finding a doctor who you can have a partnership with who can give you his years of clinical expertise and help you to make sense of it all.
And if your doctor can’t or won’t do that? Well, find a doctor who will and work together to do a proper history, evaluation and diagnostic testing so that you can optimize your body and your health.
For myself, my health and my body are worth way more than a luxury car. I want to do everything I can to make sure it is kept in the best possible running order. And ordering your own lab tests can be very expensive, especially if you don’t have insurance. I give my patients lab tests at my cost. We can get them at a substantial discount and we are able to pass the savings onto them.
When interpreting Hashimoto’s lab tests you are always given 2 sets of numbers. Your test results and the laboratory range. The laboratory range is an average that is calculated based on the number of people who go to the lab in a given geographic area for a fixed amount of time.
These averages are influenced by many things: the health of that general population, the medication that is popular and prescribed during that period of time and by what general diseases those people have.
All of these factors skew the numbers. Have you been to a lab lately in your area? Spend a day there and ask yourself if those people represent the quality of life and general state of health that you want.
In many areas, in the US in particular, the general population has not gotten any healthier over the last 20 years. Look at the statistics. You probably don’t want to be among that average group. What I am getting at is, the laboratory range is not really a measure of good health. This is particularly true when it comes to the thyroid.
Millions and millions of Americans have thyroid disease and are on thyroid medication. This skews the numbers. Practitioners of functional medicine, like myself, use an additional set of numbers when we evaluate people’s health.
This is called the functional range and different specialists in various fields have identified these ranges as being where optimal health is.
So, when you are looking at laboratory results make sure you ask about functional ranges as well as laboratory ranges. Many doctors do not look at functional ranges, so be aware that asking about this may elicit a confused or dismissive response. (In this post we are focusing on lab tests alone, in a future post I will discuss how to interpret these tests.)
Hashimoto’s is an autoimmune disease and a thyroid disorder, so we must evaluate many things not just the thyroid. Here’s a list of what any good workup should include:
* Thyroid tests: TSH, free T3 (fT3), free T4 (fT4), Reverse T3, (rT3)
* Blood Sugar Analysis: Fasting glucose, HgA1C, Triglycerides, Cholesterol, LDL, and HDL
* Iron: Serum iron, TIBC, Transferrin and Ferritin
* Vitamin D3
* Vitamin B12 and B6
* Red and White Blood Cell Count: Complete CBC
* Tests to determine Adrenal Gland Health: BUN, Creatinine, Sodium and Potassium, Special test(s)
* Electrolytes: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous
* Markers that Evaluate the Health of the Intestines: Protein and Globulin, Special tests
* Hormone Testing: Saliva tests
* Immune Cell Testing: Special tests
…and maybe more, depending on what is found in a good thorough history. Let’s take a look at each of these briefly to give you a good sense of what we are looking for.
TSH – Thyroid stimulating hormone (TSH), also called thyrotropin is released by the pituitary gland after the hypothalamus releases TRH (thyrotropin releasing hormone). TSH is the most common and most sensitive marker used to assess thyroid function. But it is not the be all and end all in thyroid testing, the way that so many doctors and practitioners make it.
In addition, many laboratories have do what is called a “thyroid cascade” in order to save themselves and insurance companies money. Basically, if the TSH is deemed to be in the normal range they will not analyze for T3 or T4 or anything else. That doesn’t help you and there not much agreement on what the normal range should be.
TSH levels increase as T4 levels drop and TSH levels decrease as T4 levels rise. The reason this is the most popular test in today’s medical model is because the only treatment offered for thyroid dysfunction is thyroid hormone replacement and that’s what doctors are checking when they test your TSH.
A TSH test alone doesn’t give you information about thyroid-pituitary communication, about T3 to T4 conversion in other parts of the body or about whether or not your immune system is attacking your thyroid.
One important thing for Hashimoto’s people to understand is that some antibodies can inhibit thyroid function by turning off instead of stimulating TSH receptors on cells. In this case, you will see high TSH and high antibodies.
Free T3 – measures the free T3 hormone levels. This test is rarely ordered by traditional endocrinologists and is usually only used when a patient has hyperthyroid symptoms and the fT4 levels are normal.
Even so, this test can be really useful for finding out what amount of active thyroid hormones are available for the thyroid receptor sites. Free T3 is high in hyperthyroid conditions and low in hypothyroid conditions. May also be high in thyroid toxicosis.
Free T4 – used to measure the amount of free or active T4 in the blood. High with hyperthyroidism, low with hypothyroidism. The drug Heparin can also cause elevated free T4 as can some acute illness. Its also high in an overdose of thyroid hormone.
Reverse T3 – Reverse T3 is usually produced when there is an extreme amount of stress. For example, a serious car accident, or surgery or really bad chronic stress.
Its no surprise that this is elevated after a stress response or when the body produces high amounts of the stress hormone cortisol. Reverse T3 is low when you have severe tissue damage like a bad burn or laceration or when you have liver disease like cirrhosis.
This may also be high if your iron is low.
When these antibodies are present, it means that your immune system is attacking your own tissue. When your body produces thyroid autoantibodies it could create a hypo- or hyper- thyroid state.
They may also be elevated if there is thyroid cancer. Some antibodies can attach to TSH receptors, but they don’t cause a response in the thyroid.
These people will complain of low thyroid symptoms, but the TSH might not change at all. In other cases, the antibodies bind to receptor sites and cause the thyroid to be over active. Here you will see high T4, low TSH and high antibodies.
There are 3 autoantibodies that are tested. The first 2 are the most common:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.
TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
Thyroid-Stimulating Hormone Receptor Antibody (TRAb): This antibody is only ordered when a patient is hyperthyroid. Positive results usually mean Grave’s disease.
Measuring blood sugar is critically important for Hashimoto’s patients because if you have issues with your blood sugar (too high or too low) it can undermine everything else you are trying to do.
Fasting Glucose: A snapshot of how your blood sugar is at the time of the test.
HbA1C (Hemaglobin A1C): This test is a long term sugar marker and commonly used to assess type II diabetes and metabolic syndrome. (It’s optional, but should be ordered if you are overweight and have a history of high triglycerides and fat around your waist.)
Triglycerides: These are sugars stored in the fat in the liver.
Cholesterol, LDL, HDL: Most people have been brainwashed into thinking cholesterol is about fat. Don’t be misled. Its about sugar and sugar consumption and statin drugs do nothing to fix this.
Iron is another “deal breaker”. If you have low iron it will undermine everything you are trying to do and make it unsuccessful. Hashimoto’s folks, especially women, often have issues with their iron levels. Most iron panels contain all of the following tests:
Serum Iron – Iron is necessary for making hemoglobin which carries oxygen on red blood cells. Decreased iron levels must be correlated with RBC, HGB, and HCT to rule out anemia (more on what those mean in a moment).
TIBC – Total iron binding capacity. this will be elevated in iron deficiency because this increases the cells’ potential to bind to iron. TIBC is high before anemia develops and, therefore, can be a good way to find iron deficiency early.
Transferrin – Regulates iron absorption. Increased with iron anemia.
Ferritin – A good marker for total body iron levels and reflects how much iron the body has stored. It also called an “acute phase reactant” and can be a good marker of inflammation.
Test for Vitamin D3 (25-hydroxyvitamin D). Vitamin D is hugely important for people with Hashimoto’s because it strengthens the regulatory part of the immune system and we often have difficulty absorbing it.
Vitamin B12, B6 and Folate
These tests can be expensive and B12 and B6 can be tested by reading a CBC (Complete Blood Count) properly, a test that is available for under $20. (I’ll explain how to do this in a future post.)
A complete blood count that includes: Red Blood Cell counts: Red Blood Cells (RBC), Hemoglobin (HGb), Hematcrit (HCT), MCV, MCH, MCHC
and White Blood cell counts: White Blood Cell Count (WBC), Lymphocytes, Neutrophils, Basophils, Monocytes, Eosinophils.
There is a ton of information that you can gather from this very inexpensive test, including information about various anemias, autoimmunity, and possible infections that may be affecting your progress. (More on how to interpret this in a future post).
Electrolytes: These tests are usually part of what is called a “metabolic panel” and can be helpful in finding mineral deficiencies and electrolyte imbalances. These include: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous. The metabolic panel will also include Serum Protein, Albumin and Globulin.
On a simple blood test, you can test the adrenals by ordering a Renal panel (BUN, Uric Acid, Creatinine) and by evaluating electrolytes, Potassium and Sodium.
The gold standard for measuring adrenal health is a saliva test that tests cortisol levels throughout the day. This can tell you a lot about how adversely stress may be affecting your health and your thyroid.
These are all tests that can be very important for Hashimoto’s patients, but they are complicated and should be ordered by someone who knows what to do with the information that they provide.
Healing the intestines is job #1 for many Hashimoto’s patients because the gut is where the immune system lives and if you want to modulate and calm your immune system, you must go there it lives. In a common blood test, Serum protein, and globulin levels can give clues to intestinal issues.
There are test on the market for intestinal permeability (leaky gut), gluten sensitivity and intolerance, and cross reactive foods that may be causing immune flare ups. The best Lab for this is Cyrex labs.
There are various hormones that can be tested including, estrogen, progesterone and testosterone. This is involved and deserves a blog post of its own (which I will, humbly provide, in due time).
Depending on what you want to accomplish, the best of these to determine fertility and possible defects throughout a woman’s cycle are saliva tests gathered at intervals throughout the entire month.
Immune System Testing:
There are various ways to test the different aspects of the immune system from Cytokine testing, to TH-1 and TH-2 challenges. This is also quite complicated and involved and must be done with someone who understands what to do with this data.
As you can see, this can get pretty complicated, pretty quick. The best thing to do is inform yourself and then work with someone who is experienced in reading and evaluating these kinds of tests and who knows what to do with the data that is gathered.
That is what I offer here at Hashimotoshealing.com and why I created my program, Healing Hashimoto’s: the 5 Elements of Thyroid Health. In this 6 week intensive you will learn how to interpret your blood tests and, more importantly, learn what to do with that information in order to create an effective strategy for Healing your Hashimoto’s.
Hashimoto’s is the most common autoimmune disease in the United States. It is a thyroid disorder and an autoimmune disease. The autoimmune part of the equation makes virtually everything a challenge and this is particularly true when it comes to trying to figure out what to eat.
One of the absolute truths about Hashimoto’s is that no 2 people have the same version of the disease. There are too many variables, people are at different stages of progression, and they have other autoimmune, endocrine, digestive or systemic problems.
So, generalizing about what kind of diet is the best is kind of like asking, “Where do I build my house on this minefield?”
You build it where it won’t set off the mines. Some people estimate that 70 – 80% of the immune system is found in the gut.
Whatever the actual percentage, there is no doubt that what goes through your digestive system has a huge impact on your immune system. Huge.
This concept is just common sense, but many doctors and health care practitioners ignore it. Why? One doctor friend of mine put it to me this way.
He said, “I don’t bother trying to change people’s diets. It’s easier to get an alcoholic to stop drinking than to get people to change the way they eat.”
People are attached to food. It has cultural, emotional and psychological roots that run deep. However, if you have Hashimoto’s and you want to learn to manage it properly, you need to abandon all of that. It will not serve you.
Many people with Hashimoto’s also have intestinal permeability, also known as leaky gut. A healthy GI tract is one that one has a lush forrest of villi, all held tightly together.
This keeps the bad guys, like bacteria, chemicals, environmental toxins and undigested food out of the blood stream. Unfortunately, chronic inflammation turns this lush forrest into a desert and poor diet, blood sugar imbalances and chronic stress open up wide chasms that a molecular 18 wheeler could drive through.
Many people believe that this actually sets the stage for the onset of autoimmune disease when the immune system shorts circuits and starts confusing other stuff with our own tissue. The one food that is most often implicated in this is gluten.
Many people also believe that the best way to heal autoimmune disease is by healing the gut. ( I am one of those people. ) So this begs the question, what heals the gut?
The first step to healing the GI tract is to remove all the foods that are creating chronic immune responses. Eventually, you can add them back in one at a time (hopefully). When you do you will begin to discover your own unique set of land mines.
And instead of rummaging around in the dark there are now also diagnostic tests available to help determine which foods cause an autoimmune response in you (More on this in a moment). This can save you a lot of trial and error and can help you identify the really bad ones.
The foods that tend to be the worst are those that you, invariably, love the most. Like ice cream, cheese, bread, and pasta. And there is a biological reason for this. Both foods made from gluten and milk have proteins that are very similar in structure to morphine.
They are called casomorphin in milk and gluteomorphin or gliadorphin in wheat products. Now wonder we love them, we’re freakin’ addicted to them!
There are a few different camps out there for autoimmune disease diets. Most of them involve elimination and provocation. In other words, you take foods out and put foods back. The biggest differences seem to be which foods you put back.
Once again, the reality is that some people can put some foods back and others can’t. Remember, your Hashimoto’s is not your brother’s or sister’s Hashimoto’s. You have to find your own way. There are some foods that some people will have to eliminate from their diets forever. FOREVER.
And this is the real challenge. Because some people will suffer more from cheating than others. But, even if you feel like the damage wasn’t so bad and you can live with it, it may be destroying valuable tissue like your brain or something that you might want to use later in life.
Cheating can have serious and, sometimes, silent consequences, like the destruction of important tissue.
Here’s a quick overview of the most popular diets currently being used.
The Paleo diet or Paleolithic diet, also called the Cave man diet or Hunter-Gatherer diet, is one in which you are told to eat like our nomadic ancestors. Centered around common modern foods, this diet consists mainly of fish, grass-fed pasture raised meats, eggs, vegetables, fruit, fungi, roots, and nuts, and excludes grains, legumes, dairy products, potatoes, refined salt, refined sugar, and processed oils.
Critics argue that this diet is essentially just the Atkins diet with a few updates, but it has a loyal following. And if you really ate like our Paleolithic brethren, that is, you hunted around the African plains with a spear and a few rocks, you would eat a diet that was largely plant based with a few lucky days of meat binging thrown in.
And you would spend a lot of time running and doing old school cross fit maneuvers as you escaped hungry lions and hyenas. Definitely a formula for good health – if you didn’t get eaten.
The autoimmune version of this diet removes grains, eggs, beans, legumes, dairy, soy, refined sugar and salt, all processed oils and nut based oils, and night shades (tomatoes, eggplants, peppers and potatoes) and, sometimes, nuts.
Its really restrictive, but can be quite effective. The real issue seems to be – can you come up with a diet plan that isn’t basically all meat all the time? And you definitely can. You need to make a conscious effort to have plenty of fruit and vegetables.
Some people with Hashimoto’s do very well on this diet and it can dramatically improve the health of your gut on its own. Add some supplements that heal the intestines, as well, and you could have a winning formula. (More on that in an upcoming post)
The flip side of Paleo is the Vegan autoimmune diet. It is, essentially a gluten and, in some cases, grain free vegan diet. No meat, no dairy, no eggs, no animals, and no fish. And in some cases, no grains or beans.
Critics of this diet argue that you don’t get enough amino acids from plants alone and many Hashimoto’s folks are also iron, B12 and Vitamin D deficient and its hard to virtually impossible to effectively keep those levels up without animal products or supplementation.
It also takes a lot of things, pardon the pun, off the table. So it doesn’t leave you a lot left to eat.
But this diet also has its loyal fans and can be very effective in reducing the inflammation that drives the autoimmune process and destruction of the gut. If supplements are added here, and you eat enough, you can also have a winning formula with this approach.
Some people think that one way to figure out which version of the autoimmune diet is best for you might be to use blood typing. Those with blood types that need meat (Type O) might do better on Paleo, those who are not big meat eaters (Type A) may do better with the Vegan version.
The remaining blood types (B and AB) might need some hybrid of the two. Which ever you chose it is vitally important to eat as much variety as you can within all these restrictions and to supplement with iron, Vitamin B12 and Vitamin D as it becomes necessary.
All of these autoimmune diets remove lectins. Lectins are nature’s answer to insects long before Monsanto began its evil march towards domination of our food supply.
They are, basically, natural pesticides that live in plants to help them survive the ravages of fungi, bacteria and viruses. They are kind of like natural toxins.
Lectins are carb binding proteins that protect plants and have other functions like protein synthesis and delivery in animals. They’re pretty sticky molecules, which makes them cause problems in our intestines because they get stuck there and start eating away at the walls.
It is believed that lectins leave leaky gut in their wake, in a trail of savaged villi. Once they have wrought their carnage, they breach the walls of the intestines and leak into the bloodstream with lots of other unwanted particles. And the immune system goes nuts trying to deal with it all.
Foods with the highest amounts of lectins are: grains of all kinds (wheat being the worst), legumes (soy being the worst), nightshades (mentioned earlier), and oils made from seeds. GMO foods also have lots of lectins because they are used in genetic modification to enhance pest and fungal resistance.
Salt: Recent studies have indicated that that high salt levels may push the initiation of autoimmunity by driving the TH-17 pathways. Basically, its an on switch.
Problem. Lots of Hashimoto’s people have low blood pressure and desperately need salt. Iodine can also be bad for some Hashimoto’s people. Answer: Moderate salt without iodine (unless you are iodine deficient – there’s always a caveat).
Sugar Issues: Many Hashimoto’s people have blood sugar issues and if their blood sugar goes too high or too low it can really impede their progress. Some of these diets are so restrictive that people’s blood sugars end up dropping and spiking and they wind up defeating the very program that they are on.
Answer: Find the foods you like, eat them often. Start the day with a protein. Don’t ever skip meals.
Anemia: Many Hashimoto’s patients develop anemia for a host of reasons. This can completely undermine any dietary changes you are trying to make. Test for iron deficiency and red blood cell counts and make sure you are supplementing with iron if necessary (especially if you are choosing the vegan route). Vitamin C can also enhance iron absorption.
Cross Reactors: These are foods that have a similar protein structure to gluten and our own tissue. Like gluten, they may have to permanently avoided because they drive the autoimmune attack and disease progression.
Parasites, Candida and Other Critters: Some people with Hashimoto’s may also also require additional treatment of the ecosystem of their intestines. These can further complicate dietary restrictions and supplementation.
Adrenal Issues: The adrenals play a critical role in intestinal permeability and with insulin resistance. Cortisol causes the intestinal walls to open further and it makes insulin not work a well. So stress management and adrenal love are also really important.
Other Autoimmune Diseases: Many Hashimoto’s people have other autoimmune diseases in various stages of progression and some of these can have a huge impact on the digestive system, such as Type I diabetes, adrenal autoimmunity, liver autoimmune, Crohn’s disease and more. If these factors are present, adjustments must be made accordingly.
And this is just an overview to give you a sense of the complexity, difficulty and variability of what you are dealing with. There are many more issues that can come into play and undermine your progress. These include, the gall bladder, neurotransmitters and the brain, low stomach acid and more!
There is some terrific diagnostic testing available today that can help to decipher some of these puzzles. We can test for intestinal permeability, cross reactors, additional autoimmune issues, etc. These tests are not that expensive if your doctor won’t order them or doesn’t know that they exist.
Diet is critically important in the successful treatment of Hashimoto’s, but a diet that works for someone else may not work for you. You need a program that is tailor made for your unique set of circumstances and related issues.
That’s why I created my program, Healing Hashimoto’s: The 5 Elements of Thyroid Health. In this program you learn the tools you need to successfully identify your unique challenges and how to craft a healing strategy that will work.
Interleukin 18; An Immune Protein That Causes Inflammation in Hashimoto’s
Hashimoto’s is the most common autoimmune disease in the United States, but very few doctors, alternative practitioners or patients understand what is happening to the immune system or what to do about it.
As a result, treatment largely ignores the autoimmune part of the disease. In this post, I break down the basics of the immune system, explain how it affects people with Hashimoto’s and why it matters.
The immune system protects us from foreign invaders. Its like our body’s military. It finds the bad guys (like bacteria, fungus, parasites and viruses) and it kills them. It also cleans things up by destroying our own dead and dying cells. This is called cellular apoptosis, and if this process stops working, cancer develops.
In addition, the immune system creates inflammation as part of the process of healing after an injury. Recent research has shown that immune system has the ability to communicate with the nervous system, the endocrine system and digestive system and that it is actively modulating and influencing the body all the time.
The immune system has many different parts, but the 2 important parts are called non-specific and specific immunity.
The non-specific immune system is our immediate attack response. These are the front line soldiers that hang out in our borders (the mucous membranes of our lungs, digestive tract, skin and brain) and kill invaders.
This part of our immune system is called the T-Helper 1 (or TH-1) response. These are the macrophages (the Pac-man cells) and Killer T cells, the elite squads that are pathogen killing machines.
TH-1 is also broken down into messenger proteins like Interleukin-12 (IL 12), Interleukin 2 (IL-2), Interferon Gamma (IFN) and Tumor Necrosis Factor (TNF). These are the bad ass cells that get the job done.
IL-12 is a commander and facilitator that is responsible for helping cytotoxic lymphocytes, natural killer cells mature and it also supplies growth factor to help certain cells grow into the killers that they are.
It is also involved in turning on genes that result in attacks on specific organs and has been implicated as an important player in Hashimoto’s.
IL-2 is synthesized by CD 4 T cells, it increases antibody production, improves bone marrow responses to other immune cells and is used in the treatment of HIV.
A close relative of IL-2, IL-15, has been shown to be low in Hashimoto’s and treatment with levothyroxine increases IL-15 levels, as do some Chinese herbs.
Here is a perfect example of the contradictory nature of the immune system. Increasing IL-15, some theorize, may reduce the destruction of thyroid cells in Hashimoto’s.
Interferon Gamma is another commander that fights viruses and prevents their RNA from passing on genetic information, it activates the pacman cells (macrophages) to destroy organisms that get inside of cells and it kills tumor cells.
Tumor Necrosis Factor (alpha) also kills tumor cells, it turns on angiogenesis (the hallmark of malignant tumors), promotes fibroblasts and is involved in wound healing.
TNF (beta) is another commander who helps kill tumor cells, activates genes, and it helps instruct CD8 T cells, NK cells, and helper-killer T cells to induce them to fatally injure their targets.
A TNF receptor called CD95, which is responsible for cell death, has been found to be very high in patients with Hashimoto’s.
The specific immune system produces antibodies that label the bad guys. This part of the immune system is like the C.I.A., it gathers intelligence on the invaders and it labels them with an antibody. Once a foreign invader has been labeled by an antibody, its much easier for the killer cells to destroy it.
And like the C.I.A., it takes a while for them to gather the intelligence, so this process is usually delayed for a period of time. This part of the immune system is called T-Helper 2 (or TH-2).
These cells also do more than just labeling, they also attach themselves to certain cells like viruses to keep them from entering into our cells. This is important because once they are in our cells, they are much harder to kill and they can replicate more quickly.
TH-2 is also broken down into interleukins. The proteins IL-10 and IL-4 being 2 important ones.
IL-10 has been implicated in numerous autoimmune disease such as type I diabetes and multiple sclerosis. But it is another perfect example of the unpredictability of the immune system. It turns on some immune functions and shuts off others. It can block IL-1, IL-6 and TNF alpha, but turns on IL-2 and IL-4.
IL-4 is produced by CD 4 T cells and activates IgE, an immunoglobin important for creating immunity to parasites and involved in allergies.
To further complicate matters we have other parts of the immune system driving the immune attack and this is the family of interleukins that belong to IL-1. IL-1 is released by the pacman cells that are the front line attackers.
IL-18 belongs in this family of proteins and there is a lot of it in Hashimoto’s patients, especially those with severe symptoms that don’t respond to levothyroxine treatment. It may be responsible for severe inflammation.
Both parts of the immune system are needed for certain types of invaders. For example, viruses are often very small and can sneak past the border security. Then the TH-2 system uses it’s cellular informants to sniff them out and it tags them.
This can take several days to initiate and this is why it takes most people a few days to fight the common cold, which is caused by a virus.
In a general sense, the TH-1 system is considered inflammatory and the TH-2 system is considered anti-inflammatory. But in reality, they are both involved in the process of inflammation. And IL-12 and IL-18 are important drivers of inflammation in Hashimoto’s.
Recent research has shown that there are other parts of the immune system that play important roles in this process. T-Helper 3 (TH-3) cells are the regulatory part of the immune system. They help to orchestrate TH-1 and TH-2 cells and act as kind of cellular general to call off or calm the attack.
T-Helper 17 (TH-17) cells are instigators and they rev up the attack and can make the damage and the carnage much more intense. A delicate balance of all parts of the immune system is important and with an autoimmune disease, like Hashimoto’s, this balance is lost.
There are many possible reasons for the immune system to start labeling the thyroid as foreign tissue and create autoimmune thyroid conditions (including genetics, environment, endocrine imbalance, chemical exposure, responses to viruses and other antigens, stress responses and more).
It is probably some combination of those many factors that lead to the loss of self tolerance and the immune system attacking the body’s own tissue.
In most cases of Hashimoto’s, some combination of the factors mentioned above lead to a slow, gradual attack against the thyroid. This eventually leads to the loss of enough thyroid cells that the condition presents as primary hypothyroidism and is seen on a blood test as high TSH.
TSH becomes high because, when the thyroid is not working properly, the pituitary gland increases production of TSH to increase thyroid gland activity. For most people with Hashimoto’s, the thyroid never develops overactive symptoms. Over time, they develop symptoms of low thyroid function and get put on thyroid replacement hormone.
The issue of the autoimmune attack is never addressed. Instead, they are considered to be properly managed by having normalized TSH.
In a sense, these patients are having their TSH managed, but they are not managing the underlying problem. Over time, they lose more and more thyroid cells and they need more thyroid replacement hormone.
The result, for many people, is that they continue to have all the hypothyroid symptoms (like fatigue, hair loss, depression, constipation, cold hands and feet, etc.) because the root cause has been largely ignored.
Since the thyroid is being destroyed, there is less thyroid hormone production. The immune system needs thyroid hormones to modulate TH-1 and TH-2 activity, so when this happens, the immune system can short circuit.
This leads to a larger number of TH cells, and autoantibody producing B cells. These cells accumulate in the thyroid and kill thyroid cells.
There are many possible scenarios that can lead to this outcome. For example:
In his book, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal, Dr. Datis Kharrazian gives some examples of things that can cause this:
* The T suppressor cells that regulate the immune response could be too few in number, and like a weak general that has lost control of his troops, this can lead to unchecked attacks by the immune system. And tissue like the thyroid becomes a casualty.
* TH-1 has a number of different soldiers, known as interleukins. These all have specific jobs. For example, interleukin 2 (IL-2) is a messenger chemical that sends out orders for the killer cells to start killing.
Some people make too much IL-2 and this creates a frenzy of destruction that can lead to the death of the thyroid cells. Chronic viral infections can cause too much IL-2 to be made and have been linked to the development of autoimmune thyroid disease.
* TH-2 also has lots of different soldiers. Interleukin 4 (IL-4) deploys B cells. Like some rouge C.I.A. agents, these cells can go crazy and tag the wrong proteins, and destruction of thyroid tissue is the result. Parasites and food allergies can cause too much IL-4 to be made.
* Too much sugar can cause the body to rapidly release insulin. These spikes in insulin can stimulate the production of too many B cells, they start tagging too many things, and this can lead to destruction of the thyroid.
And this is just the tip of the iceberg. In reality, there are many variables and many potential reasons for the immune system to short circuit. This is what makes treatment and management so challenging. And this is also why you must have a multi-pronged approach.
In most cases of Hashimoto’s, researchers think TH-1 cells become overactive (but this is not true for everyone and is an oversimplification). It seems IL-18 and IL-12 also act together to throw a beating to the thyroid.
Look for development of drugs that inhibit these 2 interleukins. In the meantime, stay tuned to learn about herbs and foods that can accomplish that naturally!
Hashimoto’s people also often have a weak TH-3 regulatory system and their TH-2 may or may not be out of control. TH-17 is also often wound up, making the attack more intense. And none of this happens in a vacuum.
This is all taking place in the context of the body where the immune system is interacting with the endocrine system, the digestive system and the nervous system. Further complicating the task of unwinding this mess. Its no wonder patients and doctors alike get frustrated and overwhelmed.
The reality is that your Hashimoto’s is not the same as anyone else’s. You may have an overactive TH-1 system or you may not. You may also have a weak TH-2 system or you may not. TH-3 is probably weak and TH-17 is also probably revved up.
And you may have leaky gut, and/or blood sugar issues, and/or adrenal fatigue, and/or anemia, and/or some active parasite or latent viral infection. It goes on and on.
You need an individualized approach that will create a unique action plan for your unique set of circumstances.
This is why I have created my 3 month program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. In this program you will learn how to develop your own unique template for healing your Hashimoto’s and, most importantly, how to calm, balance and manage your immune system.
Here’s a video of a webinar I did called Introduction to the 5 Elements of Thyroid Health that you might enjoy.
In my next post, I will discuss how this is done and we’ll look at some real examples to see how all of these different pieces fit together.
Risk factors for and prevalence of thyroid disorders in a cross sectional study among healthy female relatives of patients with autoimmune thyroid disease. Clin Endocrinol (Oxf) 2003 Sep;59(3): 396-401
Autoimmune Disease and Chinese Medicine, M.M. Van Benschoten, O.M.D. 9/13/2003
Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal, Dr. Datis Kharrazian, DHSc., DC, MS, Morgan James Publishing, 2010, page 46