There is still a lot of confusion among autoimmune and hypothyroid sufferers regarding the particularities of these illnesses and the kind of treatment that needs to be followed.
Even when treatment is followed, symptoms can persist or are exchanged with different ones. A lot of questions arise: “Can I have Hashimoto’s Disease but not be hypothyroid?” “Can I be hypothyroid without having Hashimoto’s?” “Which one comes first and why?”
Below are the basic facts and connections you need to know between Hashimoto’s and hypothyroid conditions so you can make the best decision for your treatment and health.
Hypothyroidism, Hashimoto’s, or Both?
Hashimoto’s is an autoimmune disease where antibodies develop and gradually destroy the thyroid, causing an underactive thyroid.
Unfortunately, it may take a person a long time to learn that he/she has hypothyroidism, Hashimoto’s or both. This lack of diagnosis is due to inadequate use of the TSH screening test by conventional medicine. Then, once diagnosis of hypothyroidism is made, many patients are only told that their “thyroid is sluggish” and they need to take medication for that. But is this the end of the story?
In reality, many doctors simply don’t test their patients for Hashimoto’s. Thyroid peroxidase antibody (TPO) is the most common antibody present (in up to 95% of those with Hashimoto’s), and often antibodies against thyroglobulin (TGA) are found as well (around 80%).
At the same time, around 5% of people who have Hashimoto’s thyroiditis diagnosed by other means (i.e., ultrasound, biopsy, etc.) do not have measurable thyroid antibodies.
Studies have shown that overt hypothyroidism, which is defined as an elevated thyroid stimulating hormone (TSH) level and low Free Thyroxine (Free T4) levels, is more common in patients who test positive for thyroid antibodies. Subclinical hypothyroidism — mildly increased TSH — is more common in individuals who don’t test positive for antibodies.
So you can also have Hashimoto’s disease, even if you test negative for TPO antibodies. This goes against some of the standard dogma of conventional medicine, which claims that only those who have elevated TPO antibodies can be diagnosed with Hashimoto’s disease.
The Importance of Choosing the Right Treatment at the Right Time
In the early stages of Hashimoto’s, you may still be able to make enough thyroid hormone, and thus you’ll have “normal” thyroid function. But in reality, you can actually suffer from autoimmune disease for decades, with your thyroid being under continuous attack, without even knowing it!
Ideally, a person would get diagnosed with Hashimoto’s before diagnosed with hypothyroidism. But often times, a person will be diagnosed with Hashimoto’s after already being diagnosed with hypothyroidism. Thus he or she will already have both Hashimoto’s and hypothyroidism. Fortunately, by proactively treating Hashimoto’s disease early in patients who show any level of antibodies, it may be possible to stop the progression of the disease, save the thyroid from further damage, and save the patient from development of hypothyroidism.
Antibodies may appear decades before a change in TSH is detected, thus allowing people to make an intervention before the thyroid gland gets damaged to a point where it will no longer function. There is a higher likelihood of developing overt hypothyroidism, and possible additional autoimmune conditions, as higher thyroid antibodies are detected.
An integrative physician will use the correct thyroid and antibody-testing panel to detect a possible autoimmune disease and use the opportunity to identify the underlying causes for your immune system’s attack on the thyroid.
Progression of Hashimoto’s
The early warning signs of autoimmune disease are often gut related, generating a high inflammation in the body: acid reflux, bloating, irritable bowel syndrome, diarrhea, and constipation. This is also the stage where you might develop increased fatigue and leaky gut, which can cause your body to stop absorbing nutrients properly. The TSH test will likely be normal, but thyroid antibodies might be present. This is the best time to act on lifestyle changes as it’s much easier to prevent damage at this point!
If these warning signs go undetected, the immune system starts to attack the thyroid more aggressively. You might experience symptoms of anxiety, irritability, insomnia, and heart palpitations. At this point, thyroid antibodies might be detectable, and a slight change in TSH may be seen.
If you don’t intervene, the thyroid becomes severely damaged and scarred and can’t produce more hormones. You might become hypothyroid and experience additional negative symptoms of hair loss, cold intolerance, depression, brain fog, and inability to lose weight. Now a change in TSH is more likely going to be seen. And unfortunately, only now are most people being diagnosed, IF the doctor uses the proper testing.
Conventional treatment will usually include synthetic thyroid hormones, regardless if you suffer from an autoimmune disease or not. But the first thing to understand about autoimmune diseases is that they are a disease of the immune system. Not of your thyroid or any other gland or organ that is under attack. So in order to treat, prevent, and reverse autoimmune disease, you’ll need to get your immune system back under control.
It’s important to find experienced integrative physicians to properly assess your thyroid function, the presence of autoimmune disease, and offer the most efficient treatments available.
For more information on Hashimoto’s thyroiditis, watch this interview with Dr. Kent Holtorf.