Patients often present to our clinic with blood work showing +TPO antibodies or anti-thyroglobulin antibodies and symptoms of an under-active thyroid. This is also termed hypothyroidism. As you may know, the thyroid gland is located in the front of the neck and is a butterfly shaped gland that affects metabolism, mental health, sex hormone production, and much, much more! When the thyroid gland is under attack from the immune system, it eventually slows production of thyroid hormone. (This process may take 10 years before patients have symptoms.) The thyroid hormones are made up of Iodine molecules. If a patient is low in iodine, they may also be struggling to make enough thyroid hormone.
For the purpose of this blog, I am going to focus on how you can turn off the autoimmunity that is present in autoimmune thyroiditis or Hashimoto’s.
First, Hashimoto’s is just one Autoimmune condition among a list that includes: Type 1 diabetes, Psoriatic Arthritis, Rheumatoid Arthritis, Ankylosing Spondylitis, Sjogren’s, Relapsing Polycondritis, Lupus, ALS, MS, Crohn’s, Ulcerative Colitis, Celiac disease and many other conditions. We have evidence that PANDAS and Autism Spectrum Disorder are also autoimmune conditions. Much of what will help the immune system to calm down or stop attacking your own body when you have Hashimoto’s, will also prevent these other conditions from developing. However, most patients that I meet already have signs of a second autoimmune condition at the first visit. In this country, most people develop another autoimmune condition every 5 years, which means that if you are 30 years old when you are diagnosed with thyroid disease, then be the time you are 50 years old, you will have five autoimmune conditions. This is what we call the Autoimmune “march” because until we address the underlying causes (and there are often more than one), patients will continue to gather diagnoses.
By now, we have thousands of research studies evaluating the role of the human microbiome in the development of Autoimmune diseases. Because so much of the immune system – 70-80% – surrounds the intestines, if there is leaky gut syndrome or gut dysbiosis, then healing your gut is the most important step in turning off Hashimoto’s. You must eliminate foods that cause leaky gut: sugar, corn syrup, alcohol, gluten, dairy, pesticide laden corn and soy. The most evidence-based diet for thyroid disease is a Mediterranean diet that is rich with omega 3 fatty acids, leafy greens, cruciferous vegetables, 30 grams of fiber per day, and at least 70 grams of protein per day. We do not recommend cutting out carbohydrates completely, as many patients need to be sure to eat enough squash, sweet potatoes, and gluten free whole grains to avoid causing further issues with cortisol imbalance. The antioxidants in one serving of organic berries are also beneficial to consume daily.
Vitamin D deficiency affects all of our patients with Autoimmunity and Hashimoto’s. It turns out that Vitamin D is more of a hormone than it is a Vitamin. It is one of the few supplements that we can take that will increase a part of the immune system called T regulatory cells. This “arm” of the immune system will help to balance out Th1 (T helper 1) and Th2 (T helper 2) cells. When Vitamin D level are below 50, there is a risk of immune system imbalance, which is not what you want when you have Hashimoto’s. Ideally, 25-OH Vitamin D levels will be checked every 2-3 months as patients taking high levels of Vitamin D do have a risk of overdose. The ideal level is around 75 ng/mL. We often recommend Vitamin D3 with vitamin K2 as the vitamin K provides additional absorption and gut healing benefits. Patients taking Vitamin D should also have vitamin A levels tested, as these fat soluble vitamins complete for absorption and occasionally, high dose Vitamin D can deplete Vitamin A levels.
LDN stands for Low dose Naltrexone. This is a pharmaceutical – an old, repurposed drug, that works to balance out the Th1 and Th2 arms of the immune system. While a patient is sleeping, the naltrexone works to increase endorphins in the brain that signal to the immune to stop the autoimmune attack. In other words, taking LDN can decrease the level of detectable TPO and anti-TG in the blood.
Rosemary tea or essential oil contains Rosemarinic Acid. This is one of the few compounds that is found in nature that helps to increase Tregs and will help to lower autoimmunity and allow the thyroid gland to do it’s job again. I have patients apply a drop of rosemary essential oil on the skin in front of the thyroid once daily, or, if they have more sensitive skin, I ask them to drink 1-2 cups of Rosemary Tea every day.
Epstein Barr Virus is a common virus that often causes mononucleosis. Many of our patients have EBV without realizing that they have had symptoms, but some of our patients remember a month of extreme fatigue and swollen glands with a sore throat. This virus lies dormant and often will become reactivated during times of high stress of poor quality of sleep. Some women find that perimenopause is when the Epstein Barr Virus flairs, due to immune system changes from premature estrogen level decreases. Unfortunately, the genetic structure of EBV appears similar to the genetic structure of the thyroid. Therefore, after months to years of the immune system attacking the virus, it can sometimes “make a mistake” and begin to attack the thyroid gland, creating TPO and anti-TG antibodies and the symptoms of Hashimoto’s.
Gluten also contains a genetic structure that can mimic the structure of the thyroid gland. For this reason, our patients with thyroid antibodies often find remission of their autoimmunity through a gluten free diet. However, we urge patients to keep in mind that gluten free products can contain more sugar and less protein than typical gluten products. Therefore, a diet that is Mediterranean based, and mostly plants, will be more healing than one that contains processed foods.
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By : Kate Godly PA-C owner of The Functional Medicine Center