Each week, I get thousands of thoughtful questions from my readers. I’m so grateful for each and every one of them, but sometimes I feel like there is just not enough time in the day to respond to all of you personally, though I certainly do try. So, I thought I would share some of the most common questions I receive in the hope that someone else’s question might help others who are curious about the same thing.
Though our triggers may all be different, from a clinical perspective, there are universal things we can do to make ourselves feel better!
My mission is to spread awareness about lifestyle changes that can reduce or remove the autoimmune attack against the thyroid. I want to empower you to find answers to your root cause and reclaim your life once again. Your questions are an important part of my mission, so I’m pleased to be sharing them with all of you today!
In this article, I’ll address some of your most common questions:
- What is the difference between hypothyroidism, Graves’ disease and Hashimoto’s?
- How is Hashimoto’s diagnosed?
- Can hormonal changes lead to autoimmune disease?
- What diet is best for Hashimoto’s?
- How can I lose weight with a thyroid condition?
- And more…
What is the difference between Graves’ disease and Hashimoto’s?
Graves’ and Hashimoto’s are both autoimmune conditions that affect the thyroid. They are thought to be closely related. Sometimes one turns into the other. The difference is the site of the antibody attack. About 95 percent of people with Hashimoto’s have elevated Thyroid Peroxidase (TPO) antibodies, while 80 percent will have elevated Thyroglobulin (TG) antibodies. (Read more about thyroid antibodies here.) Hashimoto’s results in hypothyroidism and is usually treated with thyroid hormone replacement medications.
The same antibodies may be present in a smaller percentage of people who have Graves’, but the main antibody is to the TSH Receptor (TSHR-Ab). Usually, people with Graves’ have hyperthyroidism, and they are treated conventionally with thyroid-suppressing drugs (methimazole) or radioactive iodine to destroy the thyroid. At that point, the thyroid will no longer produce hormones on its own, and these people end up on thyroid hormone replacement medications as well.
Classical symptoms of Graves’ disease include weight loss, heart palpitations, anxiety, eye bulging, tremors, irritability, hormonal disturbances, fatigue, heat intolerance, diarrhea, and increased appetite. Patients will often also experience hair loss, muscle pain, irritability, and mood changes.
Hashimoto’s thyroiditis, on the other hand, is usually characterized by a slowed metabolism, weight gain, forgetfulness, feeling cold or cold intolerance, depression, fatigue, dry skin, constipation, loss of ambition, hair loss, muscle cramps, stiffness, joint pain, a loss of the outer third eyebrow, hormonal irregularities, infertility, and weakness.
Lifestyle interventions that address autoimmunity may be helpful in both conditions.
What is the difference between hypothyroidism and Hashimoto’s?
Hypothyroidism is associated with a lack of thyroid hormone that can occur as a result of a variety of different factors such as iodine deficiency, surgical removal of the thyroid, or damage to the thyroid.
Hashimoto’s is an autoimmune condition that results in the immune system damaging the thyroid, which leads to a lack of thyroid hormone production. Most cases of hypothyroidism in the United States and other countries that add iodine to their salt supply are caused by Hashimoto’s.
I am a proponent of not just using medications for hypothyroidism caused by Hashimoto’s, but also of rebalancing the immune system to prevent further attacks on the thyroid.
I’ve suffered from an underactive thyroid for many years—how do I know if it’s Hashimoto’s?
Ninety to 95 percent of cases of hypothyroidism in countries that add iodine to their salt supply, like the US, Canada, Europe, and Australia, are caused by Hashimoto’s. If you’ve been diagnosed with an underactive thyroid, which can be diagnosed when one has high TSH and/or low T4 and T3 levels, you may actually have an underlying autoimmune component causing your hypothyroidism. One way to diagnose Hashimoto’s is to test for Thyroid Peroxide (TPO) and TG (Thyroglobulin) antibodies. These antibodies are elevated for many years before a change in TSH is seen. Antibodies are elevated in most people with Hashimoto’s. You can have your physician order the antibody test, or you can order the test yourself through Ulta Labs.
I was tested for Hashimoto’s, and the antibody test came back negative, but my symptoms are consistent with Hashimoto’s. Does a negative antibody test mean that I don’t have Hashimoto’s, or do I need an ultrasound?
While about 95 percent of people with Hashimoto’s have elevated Thyroid Peroxidase antibodies and 80 percent will have elevated Thyroglobulin antibodies, about 5 to 10 percent of people with Hashimoto’s may not have any antibodies.
Research has shown that there is a variant of Hashimoto’s where the person doesn’t test positive for antibodies. This is known as seronegative Hashimoto’s, and is thought to be a less aggressive variant of the condition.
Additionally, some clinicians believe that some people with Hashimoto’s test negative for thyroid antibodies because their overall immune health is so weak, they do not produce enough antibodies. Now, I insist on a thyroid ultrasound to confirm a Hashimoto’s diagnosis. A thyroid ultrasound can be used to detect changes in the thyroid that are consistent with Hashimoto’s (such as a rubbery, shrunken, or enlarged thyroid; or a thyroid with abnormal growths). However, in some early stages of Hashimoto’s, changes may not yet be apparent on the ultrasound. In that case, I would work with an experienced practitioner to obtain a diagnosis based on symptoms.
If you do test positive for thyroid antibodies, it is possible to reduce or eliminate them through lifestyle interventions like eliminating infections and food sensitivities, addressing nutrient depletions, normalizing digestion, improving gut function, adrenal fatigue, and getting rid of toxins. By doing so, people have been able to reduce or completely eliminate their TPO antibodies.
You can test your TPO levels as often as monthly to look for antibody reduction as you go about finding your root causes and trying interventions. However, it will take a full three months to see the real impact following an intervention.
You can read more about thyroid antibodies in this article.
Help! I have just been diagnosed with Hashimoto’s. What do I do to get better?
There are several steps to take that will help you begin to get better once you’ve been diagnosed:
1. Test for thyroid antibodies. Hashimoto’s may be detected years before there is a change in TSH, by testing for thyroid antibodies. Early detection can increase the likelihood of improving symptoms and minimizing damage to the thyroid gland. The most common Hashimoto’s antibodies are thyroid peroxidase (TPO antibodies) and thyroglobulin (TG antibodies).
2. Consider the 5 R’s of thyroid medication use when consulting your doctor.
- Right Person – Are you the right candidate for thyroid medication?
- Right Medication – Which drug will be appropriate for you?
- Right Dose – What dose will put you in an optimal TSH range?
- Right Time – What time of day should you take your medication at?
- Right Way – Are you taking anything that could interact with your medication?
3. Allow time for your thyroid numbers to stabilize. After first starting a thyroid hormone medication, retest your thyroid function tests within 4-8 weeks, become familiar with the most important thyroid tests, and request a copy of your lab tests.
4. See an endocrinologist. It is important to get a thyroid ultrasound, which can give you a baseline of the condition of your thyroid and help determine if you have any nodules or tumors in your thyroid gland.
5. Know that the condition can be reversed. Lifestyle interventions and functional medicine, along with the proper medication, can lead to a reduction in symptoms and even a reversal of the condition for some people. Discovering one’s personal root causes and implementing effective interventions are key to recovering from Hashimoto’s.
6. Work with a functional medicine practitioner. Practitioners of functional medicine can help you implement lifestyle interventions and find hidden triggers that may be contributing to the development of your condition. I’ve put together a Recommended Thyroid Practitioners Guide to help you find these types of professionals!
7. Educate and empower yourself. Listen to your body. Advocate for yourself. The people with the best outcomes are educated and engaged patients. I developed the Thyroid Pharmacist website and wrote my books, Hashimoto’s: The Root Cause and Hashimoto’s Protocol, as a way for you to get a deeper understanding of what’s going on in Hashimoto’s, become empowered, and get to the root cause of your condition.
I have Graves’ disease. Will your recommended protocols help me if I’ve had radioactive iodine treatment to destroy my thyroid, or if I’ve had a thyroidectomy?
Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. This can be caused by nutrient deficiencies, food sensitivities, toxins, a gut imbalance, poor stress response and/or a chronic infection.
Even when the thyroid is taken out surgically or treated with radioactive iodine, the autoimmunity still persists in most cases. People may develop additional autoimmune disorders including lupus, rheumatoid arthritis, and others. If you are not feeling well, have leaky gut, allergies, or infections, your immune system is not working properly. The gut determines your immune system. Therefore, I recommend working on balancing the immune system to prevent this from happening.
My book Hashimoto’s: The Root Cause focuses on restoring immune balance, as well as restoring optimal thyroid hormone levels though the use of individualized medications. (This is especially important if you have had your thyroid removed).
Can pregnancy be responsible for an immune imbalance?
Pregnancy can often be a trigger due to iron deficiency and an immune shift that occurs due to an increase in hormones. Oftentimes, lifestyle interventions, such as the ones found on my website and in my books, can help bring the immune system back into balance.
What are your thoughts on breast implants and autoimmunity?
Both the chemical toxicity in silicone implants and the biotoxicity often present in saline implants can trigger an autoimmune reaction in the body that can result in illness, including Hashimoto’s thyroiditis. Those that have a genetic susceptibility to autoimmune diseases will be at particular risk for developing symptoms after being exposed to the toxins present in breast implants.
If you have any type of breast implants in your body, have been diagnosed with Hashimoto’s, and are still digging for your root cause, there is a very real chance that your implants are to blame for your condition. I have written an article on breast implants as a trigger for Hashimoto’s, and the Breast Implant Illness website offers a list of symptoms associated with the condition, as well as resources to help heal.
What is the difference between the AIP and Paleo diet?
You may have heard of these diets, as they are often recommended as dietary interventions to reduce inflammation associated with autoimmune disease. The traditional Paleo diet eliminates grains and processed foods, and focuses on nutrient-dense foods like meats, vegetables, nuts, seeds, and eggs. In some cases, dairy may also be avoided. In my survey of people with Hashimoto’s, 81 percent reported that a Paleo diet made them feel much better, and some have even been able to eliminate thyroid antibodies by following this diet.
Unfortunately, not everyone gets better on the Paleo diet. In some cases, we need to dig deeper. Some people may have additional sensitivities that contribute to immune system dysfunction. That’s where the Autoimmune Paleo (AIP) diet comes into play. This diet goes beyond Paleo and removes additional foods such as nuts, seeds, and eggs. AIP is the starting point for many people—if you don’t remove the inflammatory foods, you can’t know if your other interventions are working or not.
I have found that diet is very much an individual intervention. What works for one person, may not work for another, as each individual may be different in their triggers and needs.
If you’re considering the Root Cause Autoimmune Paleo diet, I’ve developed a FREE, downloadable 2-Week Recipe Plan with many Root Cause Autoimmune Paleo diet recipes, meal plans, and customizable shopping lists to help you start.
Can I recover from Hashimoto’s on a vegan or vegetarian diet?
Recovering from adrenal fatigue and hypothyroidism when following a vegetarian diet is very challenging, as vegetarian diets are often carbohydrate heavy. Vegetarian sources of protein such as legumes (beans), dairy, grains, soy and some seeds may be incompatible with trying to heal a leaky gut, which is almost always present with Hashimoto’s. Pea protein is an alternative that may be easier to digest and is less likely to cause food sensitivities.
Eggs, some seeds, and nuts would be the preferred sources of protein for vegetarians. However, some people with Hashimoto’s may be intolerant to those as well, especially in the early stages of starting a healing diet. Being a vegan is even more challenging, as nuts and seeds would be the go-to source of protein, which are usually too difficult to digest for many at the beginning of their thyroid healing journeys.
While vegan and vegetarian diets have been reported to be extremely helpful with autoimmune and chronic conditions, I haven’t been able to find reports of people recovering from Hashimoto’s by following a vegan diet. Even devout vegans who are nutritionally conscious still struggle with low body temperatures, hypothyroidism and Hashimoto’s.
Additionally, many former vegans have reported improved symptoms of Hashimoto’s following a transition to a Paleo diet. Based on this, I believe that animal proteins must play an important role in building back the health of people with Hashimoto’s.
That said, while meats and fats are important for healing, eating them exclusively will produce an acidic environment in the body, hindering healing. Therefore, the diet should be balanced with plenty of nutrient-rich vegetables.
Additionally, vegan and raw vegan diets can be extremely helpful for cleansing and detoxifying, especially for those with persistent protein digestion issues. A vegan diet could be followed for a few days to a few weeks and may help the body detoxify. B12 and iron or ferritin supplements often need to be utilized at this time to prevent deficiency. Please see my article on vegan diets and Hashimoto’s for more info.
I read somewhere that sensitivity to caffeine, green tea, grapes, and red wine indicates Th2 dominance. Sensitivity to mushroom and licorice indicates Th1 dominance. Is there some sort of chart to determine this?
If you’ve read my book Hashimoto’s: The Root Cause, you may be familiar with the Th1/Th2 Dominance Chart in it, which explains that certain foods and herbs may stimulate different branches of the immune system (Th1 or Th2). The theory is that if one branch is more dominant, the immune system may become imbalanced, so if you are either Th1 or Th2 dominant, you should avoid certain immune-stimulating foods that further the imbalance. Many people believe that those with Hashimoto’s have Th1 dominance.
While an increased number of Th1 cells has been associated with Hashimoto’s, and an increased number of Th2 cells has been associated with Graves’ disease and asthma, this is not the case for all people affected. Some people with Hashimoto’s may have an overabundance of Th2 cells or may not have a clear predominating pathway. Thus, I haven’t found Th1/Th2 dominance to be clinically relevant to Hashimoto’s.
In my experience, most causes of an immune system imbalance are linked to an infection. Avoiding Th1 or Th2 modulating foods will not be the most effective approach. Figuring out your triggers and reducing them is more important, as is increasing the number of T regulatory cells in your body. You can help your immune system by getting adequate amounts of vitamin C, taking a high quality probiotic, and making sure you’re getting sunshine and plenty of rest. Again, I’m not a big believer in trying to balance your immune system by tweaking your intake of Th1 or Th2 stimulating substances. However, if you have found that any of these substances make you feel unwell, I do not recommend that you continue consuming them.
What can I do if I’m gaining weight, or can’t lose weight?
Here are a few things to think about if you are having trouble losing excess weight:
- What were your recent TSH, Free T3, and Free T4 levels? Sometimes, when those numbers are on the outskirts of normal, your metabolic rate may still be impaired, making it more difficult for you to burn calories. Most people report feeling well with a TSH between 0.5-2 μIU/mL.
- What type of medication are you on? Some people report more weight loss with a T4/T3 combination versus T4 alone, as they may not convert T4 properly.
- What type of diet are you eating? The Standard American Diet (S.A.D.), full of sugar and simple carbohydrates, is perfectly designed to cause us to gain weight year after year. Even yogurts that are marketed as “healthy” may contain the equivalent of 16 teaspoons of sugar. Divorcing the S.A.D. is often a step that many of us must take to not just lose weight, but also to feel better. Some diets that have been helpful for those with Hashimoto’s include the Body Ecology diet, Paleo diet, Virgin diet, Autoimmune Paleo diet, GAPS diet, SCD diet, Weston A. Price diet, or the Mediterranean diet. You may need to modify these diets to your individuality. Check out my article on weight loss for more tips.
Can you explain what systemic enzymes do and how they help food sensitivities?
I often recommend systemic enzymes to those with Hashimoto’s. (You can read more about that in my article on using enzymes for Hashimoto’s.) They work in our blood to reduce Circulating Immune Complexes, or CICs (antibody complexes that are coupled with immune cells, which build up in our bodies when we have autoimmunity). When you take systemic enzymes on an empty stomach, there is a breakdown of those CICs. When you take them with food, they help with the digestive process. For the purpose of reducing the CICs and antibodies, I do recommend taking them on an empty stomach, one hour before you eat, or two hours after you eat.
I’ve tried EVERYTHING but can’t get better!
I often talk about how people with Hashimoto’s have a combination of food sensitivities, nutrient deficiencies, adrenal issues, gut issues, as well as an impaired ability to get rid of toxins. Any one of those things can prevent a person from getting better.
Hashimoto’s is very much an individual condition. While there are root cause commonalities, each person will have their own root cause, or in some cases, they’ll have several.
You will have to start with implementing the simplest modifications and removing triggers, followed by repairing the other broken systems, to restore equilibrium and allow the body to rebuild itself. You will dig down to why the immune system is imbalanced in the first place, and this will tell you how you begin to finally feel better, reduce your thyroid antibodies and even put your condition into remission.
You will have to create your own health timeline. Look back at your overall history as far back as you can remember. Look for infections, periods of severe stress, the use of medications (especially antibiotics, antacids, and oral contraceptives), accidents, and exposure to toxins. These are events that may have contributed to Hashimoto’s. Once you do, you will know what types of changes you need to implement to make yourself feel better.
This approach is detailed in full in my book, Hashimoto’s: The Root Cause, while my book Hashimoto’s Protocol contains a more step by step plan that streamlines the most effective interventions. It includes checklists to help you to identify your possible triggers.
Do you recommend testing for Reverse T3?
There is a test that checks Reverse T3 levels. This test is sometimes used to identify cases of poor T4 to T3 conversion, or thyroid symptoms that are due to adrenal stress, instead of thyroid malfunction or autoimmunity. The reverse T3 (rT3) test measures how much of the free, active T3 is able to bind to thyroid receptors. RT3 is produced in stressful situations and binds to thyroid receptors but turns them off instead of activating them.
When assessing your rT3 results, it is important to watch for trends of your levels going up. This usually indicates your body is reacting to a stressful situation. Your body produces rT3 to give it a break and to prevent you from becoming hyperthyroid. This is an evolutionary adaptation to slow your metabolism in times of famine. High rT3 due to stress has a snowball effect on hypothyroid symptoms. The adaptation by the body producing rT3 is not useful in our high-demand society when we must work and take care of our children, spouse, parents, etc. In cases where a lot of reverse T3 is produced, adding a thyroid medication that contains T3 ensures that the right hormone is getting to the right receptors.
When I work with clients, I don’t routinely order the rT3 test, as I normally make recommendations that make the testing irrelevant. In essence, the test results don’t change what I recommend. I always recommend focusing on adrenal health and recommend a T3 containing medication.
If I get into remission, but later I get stressed out or have kids, can the immune process start up again?
Hashimoto’s usually involves a whole system breakdown. Multiple parts need to be affected to have Hashimoto’s, or autoimmunity, manifest. If you are able to repair the damage done to your organs, one minor thing might not be an issue. I do know quite a few women personally who were able to get Hashimoto’s into remission and were able to stay in remission throughout multiple pregnancies. I would be concerned if you start experiencing a few different stressors happening at once, such as if you are pregnant, stressed, have prolonged sleep deprivation, family illness, catch a gut bug, start eating reactive foods, etc. That’s when you might start seeing the whole system begin unraveling again.
Is there another question you have been waiting to ask me?
I LOVE hearing from my readers! What are your top Hashimoto’s-related questions? Post them here and I’ll do my best to include them in future Q&A’s! I also invite you to become a part of our Facebook community where you can share your personal experiences and ask me questions about Hashimoto’s and thyroid health. I do my best to respond to all of your questions.
In the meantime, please consider picking up a copy of Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back and Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.
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Note: Originally published in November 2015, this article has been revised and updated for accuracy and thoroughness.