you have ever suffered from unusual fatigue, weight gain, dry skin, menstrual irregularities, or cold intolerance, hopefully you had your thyroid hormones checked. One of the most common conditions I treat in my practice is hypothyroidism, which is a very common hormone disorder involving a low-functioning thyroid gland.

Hypothyroidism affects up to 10% of women in North America. There are several causes of a low-functioning thyroid. The most common cause of hypothyroidism is due to a condition called Hashimoto Thyroiditis, which is what I’ll focus on in this article. This particular form of hypothyroidism is autoimmune in nature; meaning the body is attacking its own thyroid gland, resulting in inflammation and an under-functioning thyroid.

What does your thyroid gland do you for you?

The thyroid is a small gland at the base of your throat that produces hormones that play vital roles in metabolism, growth, mood maintenance, heart health, digestive function, brain and fetal development, among other critical roles in the body. Healthy thyroid function is important for:

• Feeling energized
• Having a balanced, positive mood
• Maintaining a healthy weight
• Proper digestive function
• The healthy development of a baby during pregnancy.

Thyroid problems

Hashimoto thyroiditis is the most common form of hypothyroidism in North America, and affects women 5-10 times more often than men. The most common time of life it is diagnosed in is between the ages of 45 and 65, though it can also be diagnosed in children.

Symptoms of Hashimoto typically arise as a slow onset of:

• Fatigue
• Constipation
• Dry skin
• Weight gain

More advanced symptoms may include:

• Cold intolerance
• voice hoarseness from an enlarged thyroid gland
• Slowed movements
• Memory loss or “brain fog”
• Joint pains and muscle cramps
• Hair loss
• Menstrual cycle irregularities, such as skipping periods
• Depression

Testing and Diagnosis

Hashimoto thyroiditis is diagnosed based on physical exam findings and laboratory blood testing results. Depending on the extent of the disease, physical exam findings may include a puffy face, cold and dry skin, thickened and brittle nails, slowed heart rate, altered reflexes, and increased weight, among others.

Blood testing will involve a thyroid panel, examining TSH (Thyroid Stimulating Hormone), free T4 and T3 in the blood to determine thyroid function. To understand whether the cause of your hypothyroidism is autoimmune or not, specific antibodies are tested in the blood. These are Anti-Thyroid Peroxidase (anti-TPO) and Anti-Thyroglobulin (anti-Tg). The presence of one or both of these antibodies means that there is an autoimmune process occurring. In some cases, a thyroid ultrasound may be used to assess thyroid size or to determine whether or not thyroid nodules (lumps) are present.

Medical Treatment

The most important step in managing Hashimoto is replacing the thyroid hormone that your body is not producing. This comes in the form of thyroid medication, most commonly levothyroxine (Synthroid). Providing your body with this replaced hormone helps to slow the inflammation occurring in the thyroid gland itself, and provides your body with the hormone it is missing. After being diagnosed, you’ll start taking medication daily, and your TSH will be re-tested every 8 weeks or so until ideal thyroid hormone levels are observed in the blood. Thyroid antibodies are conventionally never re-tested or monitored.

This is typically where medical management of Hashimoto stops. As a Naturopathic Physician, I always look deeper at other root causes that may be contributing to the autoimmune inflammation in order to support thyroid function, reverse symptoms, and prevent the development of other complications and diseases that are related to the presence of thyroid antibodies.

Addressing the root cause

The reason why this autoimmune thyroid condition arises in some individuals but not others is poorly understood. It appears that the combination of an immune defect in a susceptible person, accompanied by environmental factors seems to initiate a complex immune reaction resulting in the body attacking its own thyroid gland. Due to the genetic component, if you have a family member with autoimmune thyroid problems, you may be at higher risk and should be screened more regularly.

Why is it important to address the root cause of Hashimoto thyroiditis? For one, having one autoimmune condition may put you at a higher risk of developing another one. Hashimoto occurs significantly more frequently in patients who are suffering from other forms of autoimmune disease, including: Addison’s disease, type 1 diabetes, celiac disease, rheumatoid arthritis, or systemic lupus erythematosus (SLE). By treating the underlying autoimmune process, this may help to reduce your chance of developing other autoimmune conditions.

Secondly, the presence of autoimmune thyroid markers in your blood is associated with difficulties conceiving, recurrent pregnancy loss, and preterm labour. This is true even for women who have normal thyroid function, but have thyroid antibodies in their blood. If you have hypothyroidism and are trying to get pregnant, or if you have struggled with recurrent miscarriages, speak to your Naturopathic Physician about getting your thyroid assessed thoroughly and on a treatment plan to reduce markers and risks of pregnancy complications. For more information about preparing your body for pregnancy, check out this article.

How to heal your thyroid: specific nutrients and herbs for thyroid function

While we can’t control of genes, we CAN control our environment, food and supplements we put into our bodies. If you’ve been diagnosed with Hashimoto or hypothyroidism, here are a few of my top nutrition, herbal and lifestyle tips to help address the root cause of your thyroid problem.

Gluten

Studies have demonstrated a relationship between Hashimoto and celiac disease, both of which are autoimmune disorders. One meta-analysis suggests that all patients with Hashimoto should be screened for celiac disease, given the prevalence of coexistence of these disorders. Whether or not you have a diagnosis of celiac disease, I strongly recommend gluten avoidance for patients with Hashimoto. One small 2018 study examined the effects of a gluten-free diet on serum thyroid peroxidase and thyroglobulin antibodies, and found that the group on the gluten-free diet had lower antibody levels at the end of the 6 months compared to the group on a gluten-containing diet.

Vitamin D

Vitamin D acts as both a vitamin and a hormone in the body. Several studies have demonstrated that vitamin D deficiency is associated with thyroid autoimmunity. Ask your ND to check your vitamin D levels in your blood, and correct any deficiency with a vitamin D3 supplement.

Selenium

Selenium is an essential mineral for thyroid hormone function. Supplementation with selenium in patients with autoimmune thyroid problems seems to modify the inflammatory and immune responses. Foods rich in selenium include:

• Brazil nuts
• Oysters
• Tuna
• Whole-wheat bread
• Sunflower seeds
• Meat
• Mushrooms
• Rye

You can obtain your recommended daily intake of selenium by simply eating 2 Brazil nuts per day! 3 meta-analyses have demonstrated that the use of a supplement containing selenium called selenomethionine can reduce thyroid antibody levels in the blood. A typical dose is 200mcg per day. Ask your ND if this might be appropriate for you.

Iodine

Iodine is an essential mineral needed for thyroid function. A deficiency of this mineral was a common cause of hypothyroidism in the past, until this problem was resolved in many countries with the introduction of iodized table salt. If you use Himalayan sea salt rather than table salt, you can obtain iodine in the diet through foods such as:

• Seaweed
• Seafood, such as scallops, cod, sardines, shrimp, salmon and tuna
• Yoghurt, cow’s milk
• Eggs
• Certain fruits (strawberries and cranberries).

Autoimmune thyroid problems seem to occur more often in iodine-replete countries, suggesting that EXCESS iodine in the diet may be problematic. Work with your ND to assess your supplements to see if you are taking a healthy amount of iodine. The recommended adult daily intake of iodine is 150 mcg, increasing to 250mcg in pregnancy and lactation.

Cortisol

During periods of prolonged stress over weeks to months, this stress hormone has a ‘dampening’ effect on the thyroid gland. One study of non-autoimmune hypothyroidism found that patients with overt hypothyroidism have higher levels of cortisol (as tested in hair samples) compared to patients with normal thyroid function.

Supporting stress resilience in your life is an important part of a thyroid treatment plan. This may involve various tools and practices, such as exercise, meditation, yoga, and counselling or other stress relieving activities.

Your resilience to stress can be enhanced with the use of a family of herbs called “adaptogens” (they help you ‘adapt’ to stress). Ashwagandha (Withania somnifera) is an adaptogenic herb traditionally used to help support thyroid function in Ayervedic medicine. One study found that after 8 weeks of use, ashwagandha helped to improve TSH, T3 and T4 values in patients with subclinical hypothyroidism. Ashwagandha is my number one favourite herb to support thyroid function.

Next steps

If you have a thyroid problem, or suspect you have a thyroid problem, I recommend you do an in-depth thyroid assessment with myself or your local ND and identify any nutrient deficiencies discussed in this article and begin a targeted treatment plan to help heal your thyroid.

Wishing you the best in your healing journey,

Dr. Kathleen Mahannah, ND

References

Pyzik, A. et al. (2015) Immune Disorders in Hashimoto’s Thyroiditis: What do we Know so far? J Immun Research, vol 8.

Lee, S. (2018) Hashimoto Thyroiditis. Medscape. Obtained online from https://emedicine.medscape.com/article/120937-overview

Liontiris, M. and Mazokopakis, E. (2017) A concise review of Hashmioto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients. Points that need more investigation. Hell J Nucl Med, 20(1): 51-56.

Mehran, L., Tohidi, M., Sarvghadi, F., Delshad, H., Amouzegar, A., Soldin, O., and Azizi, F. (2013) Management of thyroid peroxidase antibody euthyroid women in pregnancy: comparison of the American Thyroid Association and the Endocrine Society guidelines. J Thyroid Research, vol 2013, article ID 542692.

Krysiak, R., Szkroba, W., and Okopien, B. (2019) The effect of gluten-free diet on autoimmunity in drug naive women with Hashimoto’s thyroiditis. Exp Clin Endocrinol Diabetes, 04: 189-184.

Abdulateef, D., and Mahwi, T. (2019) Assessment of hair cortisol in euthyroid, hypothyroid, and subclinical hypothyroid subjects. Endocrine, 63(1): 131-139.

Sharma, A., Basu, I., Singh, S. (2018) Efficacy and safety of Ashwingada root extract in sublinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. J Alt and Comp Ned, 24(3).