When I have a client, or hear from a reader, who has been faithfully focused on interventions such as dietary changes and removing food sensitivities, but is still experiencing symptoms, I know we need to dig deeper into other root causes for their condition.
There often isn’t a single trigger in Hashimoto’s. More often than not, there are many contributing factors.
We know that the triggers implicated in causing the development of Hashimoto’s are wide-ranging and include: stress, infections, toxins, nutrient deficiencies, medications, dental procedures, and food sensitivities, among others.
Finding your root causes is best viewed as a journey with many stops along the way. And while it’s sometimes challenging, know that as you work through identifying and addressing your particular – and unique – set of triggers, you should start to feel better along the way.
It’s important that you don’t compare your journey with another person’s. Yes, you may be able to learn from another’s discoveries, but your own root causes will likely be different. Your root causes could be a nutrient deficiency, food sensitivity and the dental work you had done in your teens. For someone else, the oral contraceptives they take and toxins in their environment, or an underlying bacterial infection, could be why their dietary intervention is not resolving all of their symptoms.
In my practice, along with food sensitivities, I have also often found infections to be a root cause for Hashimoto’s. Up to 80 percent of my clients who don’t go into remission with dietary changes alone test positive for one – or more – infections!
You may think you don’t have any. Or you may not have even considered this as a potential root cause, but surprisingly – or maybe not surprisingly, once you understand why infections can linger on and promote autoimmunity – individual infections are found in high numbers in Hashimoto’s.
So how do you determine whether it is one or more infections that are undermining your health? And what kinds of infections are most common in people with Hashimoto’s?
What Were You Doing Right Before You Started Getting Sick?
While it may sound simplistic, this is a great question that I ask in client intakes, and thoughtfully answering it has helped many of my clients discover their previously hidden triggers.
If you tell me your spouse died, or that you think you were bitten by a tick, both of those very different historical events in your life may indicate a reason why you still feel sick today, even after you may have removed other triggers. One is tied to a significant stress event (perhaps still ongoing). In a survey I did in 2015 of 2,232 readers and clients with Hashimoto’s, 69 percent said that they had experienced a lot of stress prior to experiencing thyroid symptoms.
The other, a tick bite, can mean you have a lingering bacterial infection caused by Borrelia burgdorferi, also known as Lyme disease. Or, if you indicated you started having hives and IBS symptoms at some point in your life, that could mean you were infected with a parasite called Blastocystis hominis, heavily associated with Hashimoto’s.
Hopefully you can see why, as part of a new client intake, I ask people to fill out this type of “health timeline”. I encourage you to create your own health timeline, too, to help you determine which types of risk factors you may have for developing Hashimoto’s. Try creating your own health timeline after reading this article. I’ve created a worksheet with a sample of my own timeline and some guidelines, to help get you started.
When I have clients complete their health timeline, I have them include an overall health history as far back as one can remember and include a lot of things that they likely aren’t even thinking about as potentially being related to how they feel today. A few examples: periods of severe stress, the use of medications (preventative medications, antibiotics, antacids and prescription acid blockers, oral contraceptives), accidents, surgeries, infections (we’ll talk a lot more about this, there are many!), dental procedures and environmental toxin exposures.
Once you have done your health timeline, you may see some areas where you’ll want to dig into a bit more. You may identify some potential root causes that you’ll want to confirm via testing, which we’ll talk more about.
Again, most of the people I see and hear from will have several contributing triggers, and most will identify – and test positively – for various infections.
How Do Infections Trigger Hashimoto’s in the First Place?
We know that autoimmune diseases such as Hashimoto’s require 3 things in order to manifest and be sustained:
- Genetic predisposition
- Triggers (like food sensitivities, infections)
- Intestinal permeability (leaky gut)
This “3-legged stool” must be present or you will not develop an autoimmune disease such as Hashimoto’s. So the good news is, if you remove the triggers or the intestinal permeability, you will be able to get better.
When I was first putting on my own detective cap to identify why I had so many miserable symptoms, I started by removing certain foods that were known triggers. For me, dairy was huge (even more so than removing gluten). Prior to removing dairy, I had severe issues with acid reflux, joint pain, diarrhea and bloating. Removing it made a remarkable difference, and my symptoms were dramatically reduced.
But I still had remaining symptoms, so I needed to continue my journey to find my other unique root causes. I ultimately had to work through gut infections (Small Intestinal Bacterial Overgrowth and H. pylori) and even parasites (which at first I was kind of grossed out by, but are more common than most would think).
Had someone provided me the insight and framework to put together a health timeline back then – reflecting on known triggers – I might have figured things out much more quickly. At the time I started my investigation, I had initially focused on symptoms. I didn’t pull in the relevance of my medical history for a long time. I hope creating your own health timeline will help your root cause journey be easier.
So How Do Infections Act as Triggers?
Infections can hide anywhere in your body. They can be in your gums, sinuses, gut and even your thyroid gland. They can contribute to the development of autoimmunity in 3 different ways depending on where a given infection lives (and remember, many people have more than one infection, so you may have several different things going on):
1. If the infection lives outside the thyroid gland – The infection may trigger thyroid autoimmunity through a mechanism known as molecular mimicry. This is when the infection has similar proteins to the thyroid gland, so as the immune system starts to attack the infection, it also attacks the thyroid gland. Numerous infectious pathogens have protein sequences similar to the thyroid gland. Remember, for this to trigger an autoimmune disease like Hashimoto’s, a person must be genetically susceptible and also be experiencing intestinal permeability issues.
2. If the infection lives inside the thyroid gland – The infection may trigger thyroid autoimmunity through a mechanism known as the bystander effect. This is when the immune system tries to attack the thyroid gland because that’s where the infection lives. It’s like destroying the home of an enemy in the hopes of destroying the enemy who lives there. Many of the viruses I will talk to you about today fall into this triggering mechanism. Antibodies for these viruses have been found in the thyroid, and blood testing can confirm their existence as well.
3. If the infection lives in the gut, gums or sinuses – In this case, the infection is going to trigger intestinal permeability (leaky gut). Recall that it is one vital leg of the 3-legged stool needed for the development of an autoimmune disease such as Hashimoto’s. Mouth (and dental related) infections, gut infections and even food poisoning fall into this category.
Do keep in mind that it is likely that you will find more than one infection during your search for your own unique root causes. Because the eradication of infections often takes time, I always start immune support right away with my clients. You can read much more about the steps you can take in my book, Hashimoto’s Protocol.
What Types of Infections Are Linked to Hashimoto’s?
Chronic infections are the triggers that get the least amount of attention from many people as they search for their root causes, yet identifying and treating them can often result in a complete remission of Hashimoto’s. So, it is important for you to identify which ones might be issues for you. Some infections can also be progressive, leading to more and more symptoms if not dealt with.
There are several types of infections that we see with Hashimoto’s. There are mouth infections, gut bacterial overgrowth, bacterial infections, parasites and viral infections. Here’s a list of a few specific infections I often see, so that you get a sense of what types of illnesses you might consider as you work on your own health timeline.
I’m only touching lightly on many of these types of infections in this article, as I will be focusing more specifically on viruses, but I have provided some helpful links should you desire additional information.
Common Infections Seen in People with Hashimoto’s
Dental or Mouth Infections
You may have heard the expression in functional medicine that the gut is the center of autoimmune diseases. Gut-related triggers cause autoimmunity by causing intestinal permeability issues, which are always present with Hashimoto’s. But, what you might not realize is that the mouth is part of the gut, along with the stomach and intestines.
What’s happening in your mouth is incredibly important in triggering problems. Some examples of triggers include: fluoridation procedures, amalgam fillings, x-rays, root canals, abscesses, gum disease (periodontitis), and more. As you think of your health timeline, think about your dental timeline. Have you had surgeries or other procedures that happened before your decline in health? You can learn more about how dental procedures and infections can trigger Hashimoto’s, here.
Gut infections can also occur from food poisoning, or can involve bacterial overgrowth (not truly infections, but there is a bacterial component, such as yeast or SIBO), actual bacterial infections (Yersinia, H. pylori, Lyme disease), or even parasites (Blastocystis hominis).
I’ll talk briefly about each of these.
SIBO: The research says that more than 50 percent of patients with hypothyroidism have Small Intestinal Bacterial Overgrowth or SIBO, which can cause leaky gut. This overgrowth can often be caused by low stomach acid and the use of acid-suppressing medications, which is very common with Hashimoto’s, and was, in fact, one of my root causes! I think I used every acid-blocker known to man (over the counter and prescription). Read more about the symptoms associated with SIBO, how you can do a breath test for it, and how to treat it, here.
Candida and other forms of yeast overgrowth: Yeasts grow in the intestine and suppress immune function; they acidify the digestive environment and also impair the absorption of immunity-supporting nutrients. One type of yeast, Candida, can cause leaky gut, and may result in food sensitivities, autoimmune disease progression and other problems. When you are filling out your health timeline, think about your history of antibiotics, birth control pills, steroids, pregnancies, and recurrent vaginal yeast infections. You can read more about the link between Candida and Hashimoto’s, as well as the stool testing that can help diagnose it, here.
Bacterial infections: Common bacterial infections found in people with Hashimoto’s are Yersinia, H.pylori, Borrelia burgdorferi (Lyme disease related) and Streptococcus pyogenes (strep throat).
Antibodies for Yersinia are found in people with Hashimoto’s fourteen times more often than in people without Hashimoto’s.
In my 2015 survey of 2332 readers with Hashimoto’s, 20 percent of people tested positive for H.pylori. Many of my readers and clients with Hashimoto’s have reported that their symptoms were greatly improved when they have been treated for H.pylori infection. (Most had also experienced a reduction in thyroid antibodies after doing so).
In one study, 86 percent of autoimmune thyroid patients tested positive for H.pylori versus 40 percent of non-autoimmune thyroid patients.
You can read more about H.pylori infections here, including information on testing, as well as antibiotic and natural treatment options.
When I have clients fill out their health timeline, about 4 percent say they had a possible exposure to the bacteria that causes Lyme disease through a tick bite. That bacteria, Borrelia burgdorferi, has been found to completely destroy the gut. Its symptoms can leave you tired and in pain, as well as cause memory problems and headaches. Read more about Lyme disease and Hashimoto’s, and the blood test that can diagnosis it, here.
Parasites: Blastocystis hominis is a very common parasite found in people with Hashimoto’s. In my 2015 survey, 35 percent of people tested positive for it! Multiple studies have linked it with IBS and hives, which are two conditions very commonly associated with Hashimoto’s. Blasto was one of the infections that I personally dealt with prior to feeling completely well. (Read more about how IBS and hives can point to this parasitic infection.)
I will focus on viral infections for the remainder of this article. There are many viruses that have been implicated in Hashimoto’s, but the most common viruses that I have found in my clinical practice are:
- Epstein-Barr virus (EBV)
- Herpes Simplex 1 & 2 (HSV)
- Hepatitis C infection (the treatment is also a trigger)
- Cytomegalovirus (CMV)
Others to consider as possible triggers include: Parvovirus B-19, Rubella, Mumps, Coxsackie B, Enterovirus, HTLV-1, HIV, and even influenza (the flu).
Direct evidence of the presence of viruses in Hashimoto’s thyroiditis has been found with Epstein-Barr virus (EBV), Herpes Simplex (HSV), HTLV-1, enterovirus, mumps, rubella, parvovirus, Coxsackie B, Human Herpes and Hepatitis C. Furthermore, emerging evidence implies that CMV can precede the onset of autoimmune disease.
It is worth mentioning that many of these viruses are part of the herpes virus family, including: Epstein-Barr (considered herpes 4), Herpes Simplex (1 and 2), Varicella zoster (the cause of chicken pox and known as herpes 3), Cytomegalovirus (herpes 5), and Human herpesvirus 7 (herpes 7). There are 9 herpes viruses that are known to infect humans, and the entire family is believed to be linked to the development of autoimmune disease.
All of these viruses remain dormant in the body and can become reactivated many years later, often by stress or another health event. Do you see why stress can also be a contributing factor in triggering infections?
Recognizing Common “Trigger” Viruses – Are They a Part of Your Health Timeline?
Are you feeling a little overwhelmed right now?
I understand that there are many different types of infections that I’ve been discussing, and that perhaps you had never even thought of these as triggers for your symptoms. Perhaps you’ve never even heard of many of these.
I know it can feel insurmountable. And also maybe even a bit gross! Who wants to find out they have parasites or other types of critters in their body?
But you just need to take one step at a time. Remember, it is a journey with many stops along the way.
A good place to start is working on your health timeline. And while working on that, if you haven’t already done so, start on a dietary intervention (a gluten free diet is a good place to start), as that provides the quickest way to feel better near-term. In my 2015 survey, for example, 88 percent of people with Hashimoto’s who went on a gluten free diet said they felt better! You can read about some of the other diets that have helped people, here.
You may find that a dietary intervention resolves your symptoms completely. Doesn’t that sound like it’s worth a try?
If such interventions do not remove all your symptoms, then you’ll need to start looking for additional triggers. Think about the list of infections mentioned above. It is likely that you have more than one, especially if you’ve already started a dietary intervention that hasn’t significantly helped.
Let’s go through the four common viruses that are known triggers. The one many people have heard of is Epstein-Barr. I will overview each virus and its symptoms, how it is transmitted, its relationship to thyroid disease, and what type of testing can be used to diagnosis it. In my book, Hashimoto’s: Root Cause, I go through an entire section relating to infections as well.
When I was in college, I had recurrent strep throat infections and also contracted mononucleosis. “Mono” (sometimes referred to as the “kissing” disease, as it is transmitted through saliva) is a viral infection caused by the Epstein-Barr virus (EBV). That triggered my chronic fatigue and a variety of other symptoms for me.
In reviewing the health timelines of people with Hashimoto’s, I’ve found that many of them (like me) will report having mononucleosis (that is, becoming infected with EBV), then having irritable bowel syndrome a few years later, followed by other health symptoms and a Hashimoto’s diagnosis a few years after that.
When I conducted my 2015 survey of people with Hashimoto’s, 11 percent of them reported that they started having symptoms and feeling unwell after an Epstein-Barr infection.
Research has also found direct evidence of the Epstein-Barr virus in thyroid cells of people with Hashimoto’s.
In a 2015 Polish study, the Epstein-Barr virus was found in the thyroid cells of 62 percent of people with Graves’ and 80 percent of people with Hashimoto’s, while controls did not have EBV present in their thyroid cells.
Along with being reported in patients with autoimmune thyroid disorders, the EBV infection has also been shown to cause other autoimmune diseases, such as systemic lupus erythematosus (SLE), multiple sclerosis (MS), rheumatoid arthritis (RA), Sjögren’s syndrome, and autoimmune hepatitis.
What is the Epstein-Barr virus and How is it Transmitted?
As stated above, the Epstein-Barr virus is part of the herpes family and is very common. In fact, 95 percent of American adults will have picked it up by age 40. It is transmitted by saliva and can cause mononucleosis (symptoms listed below) or be present without any symptoms.
The Epstein-Barr virus will live dormant in the body for years. It is normally kept under tight control by EBV-specific immune responses in the body, especially by CD8+T cells.
CD8+T cells are a type of fighter cells. You lose them as you age, so the older you get, the fewer of these cells you will have. That’s why those who contract EBV in childhood, when they would have more fighter cells, may not have any symptoms. But by the time people are exposed to EBV in college, their fighter cells have declined threefold, so they are more susceptible to it, and thus, they may experience greater symptoms.
People may be more vulnerable to the effects of EBV due to a low level of CD8+T immune cells. In this case, the virus can essentially hijack the thyroid or another organ and hide there.
Low levels of CD8+T cells are seen in a variety of circumstances. A low baseline level of CD8+T cells can be a genetic predisposition. As stated above, age can be a factor as well. The cells are also lower in women and in those with low levels of Vitamin D.
Vitamin D is so important to your immunity and is a common nutrient deficiency in Hashimoto’s. What common nutrient deficiencies are you at risk for? Read this article on nutrient deficiencies and Hashimoto’s and add them to your health timeline.
There is a hypothesis that in genetically susceptible patients, EBV-infected B-cells seed the thyroid gland, produce autoantibodies, and send co-stimulatory signals to autoreactive T-cells. The EBV-infected cells remain in a dormant mode, awaiting some trigger to reactivate.
Research has shown that EBV reactivation can be caused by immunosuppression, such as stress or adrenal imbalances, or certain cytokines or steroid hormones like cortisol/hydrocortisone.
In my practice, I have found that stress, hormone imbalances, toxins and food intolerances to be the most likely triggers for the reactivation of most viruses.
Mechanism of Infection Triggering Autoimmunity
When T cells in the body encounter virus-infected cells, they will release immune proteins called cytokines. The cytokines kill the EBV cells but, they also kill other healthy cells in the thyroid (where the virus is hiding). This is called the bystander effect.
Symptoms of the Epstein-Barr Virus
When the infection is symptomatic, the most common symptoms include significant fatigue, sore throat, and swollen lymph nodes. Weight loss can also occur. In some cases, the condition resolves in a few weeks, and the person goes back to normal. In other cases, the fatigue lingers, and the virus may contribute to the development of chronic fatigue syndrome (that’s why happened to me), cancers, and multiple autoimmune conditions—including Hashimoto’s.
Testing for Epstein-Barr Virus
Testing for viral reactivation may be done through your doctor. There are 3 blood tests that you might want to consider. I usually recommend to my clients that they get all 3 tests; and all 3 are included in my Ulta Labs Root Cause Infections Panel.
The first test is the EBV-VCA (viral capsid antigen) test. There are two antibody variants of this test; IgG and IgM. The IgG test will simply show whether you’ve had past exposure, but remember that about 95 percent of us have been exposed to the Epstein-Barr virus in our lifetime. A positive on the IgM viral capsid antigen test indicates that you have a reactivated infection.
There is also the EBV-EBNA (nuclear antigen) test. A positive on this IgG test usually means you’ve had a previous infection.
The third test I recommend for EBV is the EBV-EA-D (early antigen) test. A positive on this IgG test may mean you have an active or reactivated infection.
You can learn more about Epstein-Barr Virus and testing here.
Herpes Simplex Virus (HSV 1 and HSV 2)
Both HSV 1 and HSV 2 are widespread throughout the U.S., with evidence of the viruses found in documented blood serum levels at 57.7 percent (HSV 1) and 17.0 percent (HSV 2) between 1999 and 2004. In 2015, the World Health Organization (WHO) estimated that 67 percent of the world’s population was likely infected with HSV-1. In the United States, there is an estimated 500,000 primary infections each year.
Many studies have suggested that Herpes Simplex virus (HSV) infections are involved in a variety of autoimmune diseases. In a 2013 study, serological and clinical examinations supported its possible role in the onset of Hashimoto’s.
I’ve had numerous clients who reported the start of Hashimoto’s symptoms after contracting oral or genital herpes, and an improvement of Hashimoto’s symptoms with antiviral treatments targeted at the viruses.
What is the Herpes Simplex Virus and How is it Transmitted?
The Herpes Simplex type 1 and 2 viruses have been more heavily studied compared to the other members of the herpes family of viruses, as they are very prevalent and cause oral and genital herpes. Genital herpes is considered a sexually transmitted disease (STD).
The viruses are transmitted from person-to-person via infected oral secretions or sexual contact.
Mechanism of Infection Triggering Autoimmunity
As with the other viruses in the herpes family, the Herpes Simplex viruses remain in your body in a dormant state, and may not always be active.
Factors such as physical and emotional stress have been cited as triggers of HSV reactivation, along with concurrent decreased levels of thyroid hormones.
One study with rats found that thyroid hormones may regulate the gene expression of HSV, which may actually modulate the reactivation of the HSV virus.
So what does all of that mean? It means that if you have this virus infection, even if it is not currently active, you are at risk for it to become reactivated in situations where your thyroid hormone level decreases and/or during periods of stress.
Other herpes viruses that are similar to HSV, such as Varicella zoster (VZV – the chickenpox virus), have also been shown to reactivate decades later, and it has been suggested that thyroid hormone imbalance may also cause this reactivation and result in shingles. The authors of this study concluded that physicians should counsel their patients about the risk of thyroid hormone dysfunction causing virus reactivation in cases of HSV 1, HSV 2 and VZV.
Symptoms of Herpes Simplex Virus
Herpes Simplex virus can be dangerous in newborns or in those with weakened immune systems.
In some people, HSV 1 (oral herpes) can be asymptomatic, or it can produce a variety of symptoms, including: oral lesions (cold sores), non-genital skin lesions, genital skin lesions (oral herpes can cause genital herpes), and less commonly, serious systemic illnesses such as encephalitis (acute inflammation of the brain). The first outbreak after exposure often happens within 2 days to 2 weeks of being infected. Subsequent outbreaks are often less severe, and over time, the number of outbreaks may decrease.
HSV 2 (genital herpes) affects the genitals, buttocks or anal area, and is considered a sexually transmitted disease. It can also infect the mouth.
Lesions may occur near the area where the virus originally enters the body. They typically turn into blisters, become painful and itchy, and then heal. They may then be reactivated frequently or infrequently. Some people never have sores, even with genital herpes, or they may have mild symptoms that are mistaken for other skin conditions.
Other general symptoms may occur, such as: decreased appetite, fever, muscle aches, swollen lymph nodes in the groin area, vaginal discharge (in women), and urinary pain.
Testing for Herpes Simplex Virus
There are several tests that can be done. A Serum Herpes Simplex Antibody blood test can check for herpes simplex antibodies. Positive results would indicate that a person has been infected in the past, but the test doesn’t indicate whether it is a recent infection or not.
The tests I recommend are:
- Herpes Simplex virus 1/2 Antibody (IgM)
- IFA with Reflex to Titier, Serum
- Herpes Simplex virus 1/2 (IgG) Type Specific Antibodies
They are available in my Ulta Labs Root Cause Infections Panel.
Tests can also be done on skin sores or blisters. A culture of fluid from a blister or open sore can be taken and examined. Polymerase chain reaction tests (HSV PCR) can be done on fluid from a blister and are considered very accurate.)
Hepatitis C (Note: the treatment for Hep C is also a trigger for autoimmune thyroid disease!)
Hepatitis C is a virus that attacks the liver and affects nearly three million Americans. The Center for Disease Control states that people born from 1945-1965 are 5 times more likely to have Hepatitis C.
It is a serious disease, as 75 percent of affected patients with an acute infection develop chronic disease with a high risk of cirrhosis of the liver and hepatocellular carcinoma.
Additionally, many of those infected (about 70-80 percent), don’t experience any symptoms, so they may be unaware that they are infected.
As this virus is not as common in the general population as the others mentioned in this article, I personally haven’t worked with any clients who have had this virus as a trigger. Nonetheless, the research here is pretty solid…
Studies have found higher rates of autoimmune thyroid disease in chronic untreated Hepatitis C patients, indicating that the virus can somehow cause an autoimmune reaction in the thyroid.
Rates of autoimmune thyroid disease have also been found in treated Hepatitis C patients, and this is due to one of the treatment medications used for Hepatitis C, interferon. Research has found that interferon is a trigger for autoimmune thyroid disease.
What is Hepatitis C and How is it Transmitted?
Hepatitis C is a contagious liver disease which is spread primarily through contact with the blood of an infected person. Transmission usually occurs through a blood transfusion or by sharing drug needles with someone who is infected. Less frequently, transmission can be via sexual intercourse. The infection can range in severity from a very mild illness – lasting a few weeks – to a lifelong disease that attacks the liver.
The disease can be acute or chronic. While the acute version is a short-term illness, for many people, it can lead to a chronic infection. (This means the virus will remain in the person’s body.) This condition can lead to serious liver conditions.
Mechanisms of Infections Triggering Autoimmunity
The exact mechanism by which Hepatitis C triggers autoimmune thyroid conditions is still not completely understood. We do know that the Hepatitis C virus can travel from the liver throughout the bloodstream and infect the thyroid gland.
There are two theories as to how the thyroid autoimmunity occurs. One is that the Hepatitis C virus directly infects the thyroid. The other is that thyroid symptoms may be secondary to a generalized autoimmune phenomenon induced by the Hepatitis C infection.
In the first case, once the Hepatitis C virus infects the thyroid, the immune system may be triggered to attack the virus. The immune system may attack the thyroid cells as well. This would be another example of the bystander effect.
Medication Effects (Interferon-based Treatments)
Interferon (IFN) is a treatment for Hepatitis C, however, in addition to its antiviral activity, IFN has been shown to produce side effects affecting many different organs, including the thyroid.
In fact, interferon-induced thyroiditis (IIT) is a major clinical problem for patients who receive IFN therapy. You can read more about interferon causing thyroid conditions, here.
Symptoms of Hepatitis C
Many people have no symptoms. Those that do may have mild to severe symptoms soon after being infected, including: fatigue, fever, jaundice (yellowing of the skin or eyes), joint pain, nausea, vomiting, loss of appetite, dark urine, and abdominal pain.
Testing for the Hepatitis C Virus
You can get a blood test to screen for antibodies to the Hepatitis C virus. This test will indicate whether you’ve been exposed to the virus, but it will not indicate whether it is reactivated. If the antibody test is positive, you should have your doctor order additional tests.
My Ulta Labs Liver Panel contains several tests for Hepatitis C. The Hepatitis C panel tests for 7 biomarkers related to Hepatitis:
- Hepatitis A Ab, Total
- Hepatitis B Surface
- Hepatitis B Core Ab Total
- Hepatitis B Surface
- Hepatitis C Antibody
- Signal to Cut-Off
Why liver testing? With Hepatitis C, you are also likely to see elevated liver enzymes (AST and ALT), as well as other inflammatory markers.
You likely have never heard of the Cytomegalovirus (CMV), but it is very common. The Center for Disease Control estimates that over 50 percent of adults will have been infected by age 40.
Research has suggested that CMV can precede the onset of autoimmune disease, particularly in individuals predisposed for autoimmunity.
What is the Cytomegalovirus and How is it Transmitted?
CMV is a member of the herpes virus family and is referred to as herpesvirus 5. It affects people of all ages; and in the United States, almost one in three children are already infected by the age of five.
The virus is transmitted via body fluids such as saliva, blood, urine, tears, cervical mucus, semen and breast milk. It can spread from an infected individual through sexual contact, through transplanted organs and blood transfusions, through breast milk, and from direct contact with bodily fluids.
If a pregnant woman is infected, the fetus may acquire the infection during pregnancy, or the baby may acquire the infection during delivery. The results can be quite serious, leading to miscarriage, stillbirth or even death.
Mechanism of Infection Triggering Autoimmunity
As with other herpes viruses, the mechanism of infection triggering autoimmunity is thought to be the bystander effect.
After a primary infection, which is generally asymptomatic in immunocompetent people, CMV establishes latency and remains dormant in the body. Studies have shown that the thyroid gland is one of the reservoirs of latent human CMV infection.
The prevalence of antibodies detected in blood serum increases with age. In most studies, seroprevalence reached 60 percent or more in individuals older than 50 years.
CMV infection often exhibits an altered pattern of protein expression that allows it to avoid detection and elimination by the immune system.
The virus likely reactivates in people with weakened immune systems.
Symptoms of CMV
Most people with CMV infection experience no symptoms and aren’t even aware that they have been infected. In some cases, an infection in healthy people can cause mild symptoms such as fever, fatigue, swollen glands and a sore throat.
In those with a compromised immune system, CMV infections can be more serious, attacking different organs and systems in the body. The virus can cause blindness (CMV retinitis) along with other conditions such as lung infection, encephalitis (inflammation of the brain) and liver disease.
Testing for the Cytomegalovirus
Blood tests that detect antibodies to CMV can confirm a new infection but cannot confirm reactivation of the virus.
A biopsy of affected tissue may be necessary to confirm CMV infection. People with severely weakened immune systems, such as those with AIDS, may have viral complications if they are infected with CMV.
Moving Forward and Feeling Better
Determining your root causes is definitely like peeling back an onion. There are layers, and the deeper you get, sometimes the trickier it will be to pinpoint exactly what is happening.
It may take time to completely eradicate what is triggering your symptoms. I always say that discovering your root causes is a journey with many stops along the way. And the good news is that most of those stops – when you identify and address a trigger – can help make you feel better.
I recommend doing the “easiest” things first, and I have found that dietary interventions dramatically – and relatively quickly – improve how most people with Hashimoto’s feel. My survey of readers proves this. So start with assessing your diet and try to eliminate one of the common offenders, such as gluten and/or dairy. This alone could dramatically improve your symptoms.
And if you’ve tried dietary changes, yet haven’t noticed significant improvements, then it’s time to peel back the next layer.
Working on your health timeline is a great first step here. It will help you determine where to look next. Identifying “what was happening prior to your feeling unwell” may point you to particular testing you may want to do for any number of infections, for example. Or, perhaps stress management is the next layer you will determine you should focus on.
There are also many other steps you can take along the way that can accelerate your recovery. For example, 65 percent of people who work through my liver protocol feel better in just a few weeks.
There could be many layers, but you can do it. You just need to start. I’m rooting for you!
P.S. Want some inspiration as you start your health journey? You can download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter by signing up for my newsletter. You will also receive occasional updates about new research, resources, giveaways and helpful information.
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- de Luis DA, Varela C, de La Calle H, et al. Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis. J Clin Gastroenterol. 1998 Jun; 26(4): 259–263.
- Desailloud R, Hober D. Viruses and thyroiditis: an update. Virology Journal. 2009;6:5. doi:10.1186/1743-422X-6-5.
- Vojdani A. A Potential Link between Environmental Triggers and Autoimmunity. Autoimmune Diseases. 2014;2014:437231. doi:10.1155/2014/437231.
- Söderberg-Nauclér C. Autoimmunity induced by human cytomegalovirus in patients with systemic lupus erythematosus. Arthritis Research & Therapy. 2012;14(1):101. doi:10.1186/ar3525.
- Janegova A, Janega P, Rychly B, Kuracinova K, Babal P. Rola infekcji wirusem Epstein-Barr’a w rozwoju autoimmunologicznych chorób tarczycy. Endokrynologia Polska. 2015;66(2):132-136. doi:10.5603/ep.2015.0020.
- Dittfeld A, Gwizdek K, Michalski M, Wojnicz R. A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders. Central-European Journal of Immunology. 2016;41(3):297-301. doi:10.5114/ceji.2016.63130.
- Pringle CR. Infectious Mononucleosis. Merck Manual. https://www.merckmanuals.com/home/infections/viral-infections/infectious-mononucleosis. Accessed February 27, 2018.
- Pender M. CD8+ T-Cell Deficiency, Epstein-Barr Virus Infection, Vitamin D Deficiency, and Steps to Autoimmunity: A Unifying Hypothesis. Autoimmune Diseases. 2012;2012:1-16. doi:10.1155/2012/189096.
- Ajavon A, Killian D, Odom R, et al. Influence of Thyroid Hormone Disruption on the Incidence of Shingles. Epidemiology and infection. 2015;143(16):3557-3571. doi:10.1017/S0950268815000655.
- World Health Organization. Globally, an estimated two-thirds of the population under 50 are infected with herpes simplex virus type 1. WHO. http://www.who.int/mediacentre/news/releases/2015/herpes/en/. Published October 28, 2015. Accessed February 27, 2018.
- Klein RS. Epidemiology of herpes simplex virus type 1 infection. UpToDate. https://www.uptodate.com/contents/epidemiology-of-herpes-simplex-virus-type-1-infection. Updated August 21, 2017. Accessed February 27, 2018.
- Di Crescenzo V, D’Antonio A, Tonacchera M, Carlomagno C, Minfez V. Human herpes virus associated with Hashimoto’s thyroiditis. Med. 2013 Sep;21(3):224-8.
- Varedi M, Moattari A, Amirghofran Z, Karamizadeh Z, Feizi H. Effects of hypo- and hyperthyroid states on herpes simplex virus infectivity in the rat. Endocr Res. 2014;39(2):50-5. doi: 10.3109/07435800.2013.808208.
- Tomer Y, Blackard JT, Akeno N. Interferon alpha treatment and thyroid dysfunction. Endocrinology and metabolism clinics of North America. 2007;36(4):1051-1066. doi:10.1016/j.ecl.2007.07.001.
- Center for Disease Control. Hepatitis C FAQs for the Public. CDC. https://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ21. Published October 17, 2016. Accessed February 27, 2018.
- Antonelli A, Ferri C, Pampana A, Fallahi P, Nesti C, Pasquini M, et al. Thyroid disorders in chronic hepatitis C. Am J Med. 2004 Jul 1;117(1):10-3.
- Jadali Z. Autoimmune thyroid disorders in hepatitis C virus infection: Effect of interferon therapy. Indian Journal of Endocrinology and Metabolism. 2013;17(1):69-75. doi:10.4103/2230-8210.107856.
- Dong B. How medications affect thyroid function. Western Journal of Medicine. 2000;172(2):102-106.
- Center for Disease Control. Cytomegalovirus (CMV) and Congenital CMV Infection. CDC. https://www.cdc.gov/cmv/index.html. Published June 17, 2016. Updated June 5, 2017. Accessed February 27, 2018.
- Söderberg-Nauclér C. Autoimmunity induced by human cytomegalovirus in patients with systemic lupus erythematosus. Arthritis Research & Therapy. 2012;14(1):101. doi:10.1186/ar3525.
- Huang TS, Lee JJ, Cheng SP. No evidence of association between human cytomegalovirus infection and papillary thyroid cancer. World Journal of Surgical Oncology. 2014;12:41. doi:10.1186/1477-7819-12-41.
- Rajič B, Arapović J, Raguž K, Bošković M, Babić SM, Maslać S. Eradication of Blastocystis hominis prevents the development of symptomatic Hashimoto’s thyroiditis: a case report. The Journal of Infection in Developing Countries. 2015;9(07):788-791.
- Burek CL, Talor MV. Environmental triggers of autoimmune thyroiditis. Journal of autoimmunity. 2009;33(3-4):183-189.
- Molnár I, Kelemen E, Somogyiné-Vári E. The Prevalence and Characteristics of Allergy in Autoimmune Thyroid Diseases. J Clin Cell Immunol. 2015;6(306):2.
- Lerner A, Jeremias P, Matthias T. Gut-thyroid axis and celiac disease. Endocrine connections. 2017;6(4):R52-R58.
- Zaletel K, Gaberscek S. Hashimoto’s thyroiditis: from genes to the disease. Current genomics. 2011;12(8):576-588.
- Iddah MA, Macharia BN. Autoimmune thyroid disorders. ISRN endocrinology. 2013.
- Yeoh N, Burton JP, Suppiah P, Reid G, Stebbings S. The role of the microbiome in rheumatic diseases. Current rheumatology reports. 2013;15(3):314.
- Patil AD. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian journal of endocrinology and metabolism. 2014;18(3):307.
- Kiefer D, Ali-Akbarian L. A brief evidence-based review of two gastrointestinal illnesses: irritable bowel and leaky gut syndromes. Alternative therapies in health and medicine. 2004;10(3):22.
- Chatzipanagiotou S, Legakis JN, Boufidou F, Petroyianni V, Nicolaou C. Prevalence of Yersinia plasmid-encoded outer protein (Yop) class-specific antibodies in patients with Hashimoto’s thyroiditis. Clinical microbiology and infection. 2001;7(3):138-143.
- Janegova A, Janega P, Rychly B, Kuracinova K, Babal P. The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases. Endokrynologia Polska. 2015;66(2):132-136.
- Varani S, Landini MP. Cytomegalovirus-induced immunopathology and its clinical consequences. Herpesviridae. 2011;2(1):6.
- Cohen JI. Optimal treatment for chronic active Epstein–Barr virus disease. Pediatric transplantation. 2009;13(4):393-396.
- Ercolini AM, Miller SD. The role of infections in autoimmune disease. Clinical & Experimental Immunology. 2009;155(1):1-15.
- Center for Disease Control. Hepatitis C – Why People Born Between 1945-1965 Should Get Tested. CDC. https://www.cdc.gov/knowmorehepatitis/media/pdfs/factsheet-boomers.pdf. Published 2016. Accessed April 11, 2018.
- Prummel MF, Laurberg P. Interferon-α and autoimmune thyroid disease. Thyroid. 2003;13(6):547-551.