Restore Your Gut - Hashimoto Thyroiditis

Hypothyroidism affects an estimated 20 million Americans. About 5 out of every 100 over the age of 12 have this condition (many undiagnosed). Hypothyroidism is characterized by the deceleration of the majority of all bodily processes. Hashimoto thyroiditis is the most common cause of primary hypothyroidism in iodine-sufficient countries such as the United States, affecting women more. Four-teen million people in the United States are affected by this disease making it the #1 thyroid disorder in the nation. Hashimoto disease is also known as Hashimoto thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis.

The ongoing impact of Hashimoto disease has led to the reevaluation of its traditional treatment plan by reassessing its root cause(s). With the massive evidence of disturbed gut health contributing to autoimmunity, there is no exception with Hashimoto thyroiditis and the impact of a dis-eased gut resulting in its presentation. This has led to the assessment and restoration of gut health to promote the healing of Hashimoto's disease. 

In this article, you’ll find how healing the gut can facilitate the healing of this autoimmune condition. Also, outlined are the presentation, etiology, and gut relationship to Hashimoto thyroiditis.

WHAT IS HASHIMOTO THYROIDITIS?

There is a common misconception that when there is a problem with the thyroid that the issue must stem from the actual gland, however with Hashimoto Thyroiditis the body has created antibodies that compromise the expression of the much-needed thyroid hormone (or TH) and indirectly attacks the thyroid gland.

The thyroid is responsible for creating the thyroid hormones, T3 and T4. Starting in the brain the hypothalamus determines if there is a need for more TH and sends a signal known as thyroid releasing hormone (TRH) to the pituitary gland. The pituitary gland helps to regulate the amount of TH by releasing thyroid-stimulating hormone (TSH). When TSH is released, the thyroid gland expresses more T3 and T4. 

The antibodies mentioned earlier are known as antithyroid peroxidase and antithyroglobulin; they directly prevent the synthesis of our thyroid hormones, by inhibiting T4 conversion to T3. The effect of the antibodies results in inflammation that leads to hypoactivity of the thyroid gland and ultimately its breakdown. It is this phenomenon that makes Hashimoto thyroiditis an autoimmune disorder, hence its additional name autoimmune thyroiditis.

HOW DOES HASHIMOTO PRESENT ITSELF?

To understand the presentation of Hashimoto thyroiditis and the severity of it if left unaddressed it is important to understand the function of TH. TH is primarily known for controlling the body’s metabolic rate. T3 has the following functions:

• Brain maturation (in-utero and infancy)
• Bone growth/ maintenance 
• Basal metabolic rate of the heart, muscles, and digestive system

The continual diminished activity of the thyroid can result in the following signs and symptoms:

• Cold intolerance (due to decreased heat production)
• Weight gain
• Decrease in appetite
• Depression
• Fatigue, weakness, lethargy
• Constipation
• Difficulty breathing on exertion
• Joint pain
• Dementia in the elderly
• Infertility
• Heavy menstrual periods

Signs:

• Thyroid goiter
• Dry, cool skin
• Coarse, brittle hair
• Nonpitting edema
• Decreased heart rate
• Decreased reflexes
• Hair loss
• Hoarseness 
• Swelling in the face and around the eyes
• Carpal tunnel syndrome

The varying presentations of Hashimoto reveal the importance of an early diagnosis to avoid the development of severe signs and symptoms.

WHAT ARE THE CAUSES OF HASHIMOTO?

By now we know that Hashimoto thyroiditis is an autoimmune disease however, what causes this autoimmunity? Studies show that the manifestation of an autoimmune disease is the result of 3 major factors: genetic predisposition(epigenetics), imbalanced microbiota of the gut, and increased intestinal permeability also known as leaky gut. It is no different with Hashimoto thyroiditis; the same factors contribute to this disease and have forced a deeper look into its root causes. Although not traditionally discussed the following variables are also included in the expression of this disease:

• Abnormal digestion/ Leaky gut
• Food allergens (i.e. gluten)
• Malnutrition that has resulted in nutrient deficiencies 
• Psychological stress
• Processed food diet
• Presence of existing autoimmune disease

THE LEAKY GUT AND HASHIMOTO

To understand how restoring gut health can facilitate the healing of Hashimoto thyroiditis, we need to have a better understanding of the intestine. An abundance of research and evidence-based articles have revealed changes in the gut flora and inflammation stemming from the gut can result in chronic diseases. As mentioned before, Leaky gut is a major factor if not the major factor in developing Hashimoto thyroiditis.

Our intestinal lining is made up of tight junctions that are responsible for allowing nutrient absorption into the bloodstream as well as preventing partially digested foods, bacteria, and toxins from entering the bloodstream. When the tight junctions widen, crack, or are compromised what’s supposed to stay in the gut does not. Particles like gluten leak from the not-so-tight junctions, triggering an immune response that leads to chronic inflammation.  The incessant leakage of inflammatory particles and bacteria results in a change in the gut flora and the body attacking itself.

HOW IS HASHIMOTO THYROIDITIS DIAGNOSED?

Hypothyroidism is only present in 20% of cases when first diagnosed, and often manifests later in the disease. Therefore, in the early stages of Hashimoto thyroiditis thyroid function studies are normal and a slow decline in thyroid function is common. The diagnostic markers specific for Hashimoto’s disease are antithyroid antibodies, antiperoxidase antibodies (present in 90% of patients), and antithyroglobulin antibodies (present in 50%). Although not required, occasionally a thyroid scan is done to identify the irregular distribution of iodine, as iodine is a part of the makeup of T3 and T4.

A functional medicine/ holistic approach can include looking at liver function, CBC, allergen study, and other tests to rule out possible underlying conditions responsible for symptoms. The liver's primary function is to remove toxins, create proteins, store energy and create bile. Concerning Hashimoto, if the liver is not working properly the proteins necessary for the synthesis of thyroid hormone may not be created or the immune system may be responding to the toxins that are not being eliminated. A CBC will allow the rule out of infection and a food sensitivity test will help identify any food allergies causing an inflammatory response, leading to autoimmunity. 

RESTORE THE GUT HEAL YOUR HASHIMOTO

The traditional treatment plan once Hashimoto has been diagnosed is to prescribe synthetic thyroid hormone (levothyroxine), indefinitely to achieve and maintain a euthyroid state. This approach is effective in improving symptoms but does not fix the autoimmune disorder, the root problem. However, since we have been able to trace the immune response in Hashimoto Thyroiditis to leaky gut and other risk factors (i.e. epigenetics, poor diet, stress, etc), we know how to aid its healing. 

Making lifestyle and dietary modifications for the effective treatment of Hashimoto disease is crucial. The following changes are how you can do so.

STEP 1. Remove Inflammatory Foods from the Diet

As noted, before, completing a food sensitivity test helps identify possible triggers to the immune system however, this test may be inaccessible or expensive for some. Without such test the following known inflammatory foods can be removed or avoided, establishing lasting beneficial results. 

• Gluten 
• Pasteurized dairy products
• Processed foods
• Too much added sugars

STEP 2. Eat Foods that Restore Gut Health

Other necessary dietary changes include eating gut-healing foods. In other words, a minimally processed nutrient-dense diet. Simply put this consists of consuming more vegetables and organic meats. The following prime foods are recommended to initiate the healing process of the gut:

• Vegetables and fruits (high in antioxidants, fiber, vitamins)
• Probiotic-rich foods (i.e., kimchi, fermented veggies)
• Omega-3 fatty acid foods (i.e., avocado, wild-caught fish)
• Seaweed (natural source of iodine)
• High in fiber foods (i.e., chia seeds, beans, legumes)
• Bone broth (rich in amino acids that heal gut lining)

Making these changes will immediately begin to restore the health of the gut and calm the chaotic response of the immune system.

STEP 3: Help the Body to Detox

In the event, there is an issue with detoxing in the body for example with Hepatitis or Cirrhosis resolving these conditions will alleviate Hashimoto symptoms. However, even if there isn’t an identifiable underlying condition efforts should still be made to improve the body’s ability to detox with the following:

• Quit smoking
• Reduce alcohol consumption
• Switch your OCP’s to natural contraception 
• Limit the use of BPA containers
• Use natural cleaning products instead of those with synthetic chemicals.

STEP 4: Reduce Stress

The presence of chronic stress can result in continuous stimulation of the stress hormone, cortisol. This results in high blood pressure, compromised immune function, insulin resistance, and so much more. Stress levels must be managed well. Studies show that the majority of individuals with an autoimmune disorder struggled with emotional distress before becoming symptomatic. This indicates it is worthwhile to work on reducing your stress. Here are some ways to do so:

• Exercise regularly
• Prayer/ Meditation
• Keep a journal
• Visit a counselor
• Practice breathing exercises 

STEP 5: Take Supplements

There are supplements that have been proven to aid the healing of thyroiditis, the gut, reduce autoimmune reactions, and establish a healthy immune system. This includes but is not limited to the following:

• Probiotics
• Vitamin D
• B vitamins
• Ashwagandha

Advancements in Understanding Hashimoto's Thyroiditis

Hashimoto’s thyroiditis (HT) is the leading cause of hypothyroidism, characterized by the immune system attacking the thyroid gland, ultimately impairing its ability to produce thyroid hormones, T3 and T4. This condition often leads to debilitating symptoms like fatigue, weight gain, and depression. While the exact causes remain multifactorial, a combination of genetic predisposition and environmental triggers plays a crucial role in the development of this autoimmune disease.

Recent research has revealed that autoimmune diseases like HT involve more than just the thyroid. It’s now understood that environmental factors, particularly gut health, are intimately connected to the immune system’s malfunction. The emerging field of the gut-thyroid axis emphasizes how disturbances in gut flora can affect thyroid function and contribute to autoimmune responses, especially in conditions like Hashimoto’s thyroiditis.

The Gut-Thyroid Axis: A Critical Connection

One of the most exciting areas of research surrounding Hashimoto’s thyroiditis is the discovery of the gut-thyroid axis. The gut microbiota, which includes trillions of bacteria in the digestive tract, has a profound influence on immune function and thyroid hormone regulation. Alterations in gut microbiota composition can directly impact thyroid hormone levels and immune system function, exacerbating autoimmune conditions like HT.

Emerging studies, such as those published in Frontiers in Nutrition, suggest that a healthy gut microbiota may offer protection against thyroid-related issues. For example, specific bacteria like Akkermansia muciniphila have been identified as potentially beneficial in regulating immune responses and improving thyroid health. Conversely, dysbiosis (imbalance of gut flora) may trigger or worsen autoimmune responses, leading to conditions like Hashimoto’s thyroiditis. This growing body of evidence is paving the way for treatments that aim to restore gut health as a strategy for managing autoimmune diseases like Hashimoto’s.

This discovery has shifted the traditional approach to managing HT. While thyroid hormone replacement therapy (levothyroxine) remains a cornerstone of treatment, healthcare professionals are now also exploring ways to address gut health as part of a more holistic management plan for Hashimoto’s thyroiditis.

Impact of Diet and Lifestyle on Gut Health

Diet and lifestyle choices are fundamental to maintaining a healthy gut microbiome, which in turn can impact thyroid function. A diet rich in fiber, antioxidants, fermented foods, and omega-3 fatty acids is known to support the growth of beneficial bacteria in the gut, thereby promoting overall health, including thyroid health.

• Fiber-Rich Foods: Vegetables, fruits, and whole grains are excellent sources of dietary fiber, which helps maintain a healthy gut microbiota. Fiber also aids in digestion and supports the absorption of key nutrients that the thyroid needs to function optimally.

• Fermented Foods: Foods like kimchi, sauerkraut, kefir, and yogurt contain probiotics that help repopulate the gut with beneficial bacteria. These probiotics are essential for maintaining a balanced gut microbiome and may help modulate the immune system in autoimmune conditions such as Hashimoto’s.

• Omega-3 Fatty Acids: Found in foods like fatty fish (salmon, mackerel), chia seeds, and flaxseeds, omega-3 fatty acids are known to reduce inflammation and support immune function. Incorporating these foods into the diet can help reduce the chronic inflammation associated with autoimmune thyroid disease.

On the other hand, a diet high in processed foods, sugars, and gluten can negatively affect the gut microbiome, leading to gut dysbiosis. The disruption of the gut microbiota can promote systemic inflammation and immune system dysfunction, potentially triggering autoimmune responses in susceptible individuals.

Integrating Gut Health into Hashimoto’s Thyroiditis Management

Given the strong connection between gut health and Hashimoto’s thyroiditis, addressing gut imbalances has become an integral part of managing the condition. Traditional treatment involves the use of synthetic thyroid hormone (levothyroxine) to normalize thyroid hormone levels. However, this approach does not address the root cause—the autoimmune process triggered by gut dysfunction.

Incorporating gut health restoration into Hashimoto’s treatment plans could enhance therapeutic outcomes. Here are some effective strategies for promoting gut health in individuals with Hashimoto’s thyroiditis:

• Eliminating Inflammatory Foods: Certain foods can trigger inflammation and exacerbate autoimmune responses. Common culprits include gluten, dairy, processed foods, and refined sugars. Removing these from the diet may help reduce gut inflammation and immune system dysfunction. Even without access to food sensitivity testing, avoiding these foods can be beneficial for managing symptoms of HT.

• Eating Gut-Healing Foods: To promote gut healing, focus on a nutrient-dense, minimally processed diet. Foods like bone broth (rich in collagen and amino acids), antioxidant-rich fruits and vegetables, and omega-3-rich foods are crucial for restoring gut lining and reducing inflammation.

• Probiotic Supplementation: Probiotics are essential for repopulating the gut with beneficial bacteria that can support immune function and reduce inflammation. Probiotic supplements or foods like fermented vegetables, kimchi, and yogurt can help restore balance to the gut microbiome.

• Detoxification: Toxins in the body can contribute to chronic inflammation and exacerbate autoimmune diseases. Supporting detoxification through lifestyle changes—such as reducing alcohol consumption, quitting smoking, and avoiding exposure to chemicals like BPA—can promote overall health and alleviate Hashimoto’s symptoms.

• Stress Management: Chronic stress can exacerbate autoimmune conditions by increasing the production of cortisol, a stress hormone that suppresses immune function and contributes to inflammation. Managing stress through regular exercise, meditation, and relaxation techniques is crucial for individuals with Hashimoto’s thyroiditis.

Conclusion

The growing understanding of the gut-thyroid connection highlights the importance of a holistic approach to managing Hashimoto’s thyroiditis. By focusing on gut health through dietary changes, probiotic supplementation, and lifestyle modifications, individuals with Hashimoto’s may experience improved thyroid function and a reduction in autoimmune symptoms. Although thyroid hormone replacement remains a vital part of treatment, addressing gut imbalances could lead to better long-term outcomes for those living with this autoimmune condition.

Continued research into the gut-thyroid axis will undoubtedly refine and expand treatment strategies, offering hope for more effective, personalized interventions for Hashimoto’s thyroiditis. As we move forward, integrating gut health into the management of autoimmune diseases like Hashimoto’s will become increasingly vital, offering a more comprehensive and potentially transformative approach to healing.

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