Hypothyroidism or Hashimoto’s?

Posted by on October 31, 2013 in Thyroid Disease
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Finding Out is the First Step to Treatment

Sarah first came to see me one year ago for a combination of symptoms; she was feeling tired, depressed, having trouble sleeping, not thinking as clearly as she used to and having difficulty concentrating at work. At the same time, she was gaining weight, even though she claimed she was eating less than she used to. Normally a go-getter and the life of the party – Sarah blamed her symptoms on menopause and aging – she was 57 – and said to me ‘I guess I just have to come to terms with the fact that I’m no longer a spring chicken.’ She had been to several other doctors who had affirmed her conclusion, after finding nothing wrong with her. When she arrived in my office, she was a bit hopeless about her situation, skeptical about natural medicine, but motivated to try a different approach.

Sarah had been diagnosed with hypothyroidism fifteen years prior to seeing me. Hypothyroidism is when your thyroid gland – the gland that controls your metabolism and your internal thermostat – is not working as well as it should. Usually the symptoms are fatigue, weight gain, depression, constipation, dry skin, and occasionally hair loss. Conventional medical doctors only diagnose hypothyroidism on the basis of one lab – TSH (thyroid stimulating hormone which is released by the pituitary gland in the brain). When TSH is high, conventional medicine says you are hypothyroid. Even if you have all the symptoms of a low functioning thyroid but your TSH is normal – most conventional MDs will say there is nothing wrong.

Sarah had been put on hypothyroid medication and for a while had felt much better. Then she went through menopause, and after that had not been the same. The old symptoms of fatigue and brain fog had come back with a vengeance. Her conventional medical doctor increased her thyroid medication but this had little effect. She changed her diet, went to boot camp, but to no avail. She got even more tired.

As she said “I just assumed that my hormones were out of whack.”

Our first step was to order some blood work for Sarah. The most common cause of hypothyroidism in the United States is actually due to Hashimoto’s Thyroiditis, an autoimmune disorder where the immune system attacks the thyroid. Initially people who have this disorder may go through a period of anxiety, headaches and even weight loss – but this can quickly change to hypothyroid symptoms. We ran a test to check for thyroid antibodies – immune complexes in the blood that attack the thyroid. This came back positive for Sarah, which explained why her thyroid medication was no longer working. Her thyroid wasn’t the problem – it was her immune system.

Often there is no one causative event for Hashimoto’s. It is thought to be the result of an accumulation of assaults on the body such as infection, certain drugs and environmental exposure, stress and physical trauma. Some new reports describe a correlation between celiac disease (an allergy to gluten which is a protein in some grains including wheat) and Hashimoto’s. We do know that the cumulative effect is an inflammatory load on the body that attacks and causes progressive and irreversible damage to the thyroid gland.

In my practice, almost every Hashimoto’s patient has some kind of digestive problem, ranging from constipation and gas to diarrhea and bloating. Recent research has highlighted a clear connection to small intestine bacterial overgrowth as a cause for Hashimoto’s. In naturopathic medicine, the gut is seen as one of the controllers of overall inflammation in the body because the majority of the immune system is found there. When the gut is compromised by insufficient or imbalanced microflora, the intestinal lining becomes hyper permeable, allowing inflammatory molecules to migrate throughout the body. What this also means is that by reestablishing a functional intestinal barrier, further damage can be prevented.

When I asked Sarah about her digestion – she rolled her eyes and told me she was ‘sensitive to everything’. One day she couldn’t eat almonds, the next day almonds were ok but she couldn’t do dairy. Our second step was to order a Comprehensive Digestive Stool Analysis (CDSA) to see how her gut was doing overall. The results? Sarah had lots of ‘bad bacteria’ in her gut, her pancreas wasn’t releasing the enzymes she needed to digest her food and her small intestine was inflamed.

Based on these results, we got to work and developed a treatment plan for her over the next three months. This basic plan is outlined below.

  1. Remove dietary causes of inflammation. Based on the known correlation between gluten and Hashimoto’s, and with the evidence of inflammation in the gut, we began an elimination diet for Sarah. She ended up taking out gluten, dairy, tomatoes, potatoes, peppers and corn. We also wanted to get rid of the bad bacteria, which we did with a combination of potent antifungal herbs and supplements. She focused on eating a diet rich in fish, poultry, vegetables, avocado, rice, quinoa, olive oil and coconut oil.
  2. Restore proper gut flora balance. A superior probiotic with 20-30 billion live organisms given in high dose for two weeks, and a smaller daily dose thereafter were necessary to improve intestinal immune function.
  3. Repair the gut. Fish oil, glutamine and other soothing herbs were necessary to help Sarah’s gut heal from years of the wrong foods, oral birth control pills and multiple rounds of antibiotics.
  4. A few other things we did: biotherapeutic drainage to detoxify her liver, adrenal support with herbs, superfood smoothies to provide energy and aid in detoxification, and stress reduction techniques such as meditation.

Sarah stayed on this plan for several months, which she complemented with weekly acupuncture. In that time, her fatigue disappeared, her skin cleared (a symptom she hadn’t told me about). She had regular bowel movements for the first time in her adult life! She began to sleep soundly, and lost 15 pounds (no boot camp!) Her brain fog completely lifted and her libido came back.

A few days ago Sarah came into the clinic accompanied by her husband. They had just returned from a 3 hour hike, something she couldn’t have dreamed of in the year before coming to see me. She was, her husband said, an entirely different person from the one I had started working with. ‘You gave me my wife back, ‘ he said. To which Sarah added – “I’ve never felt better in my adult life!”

Finding out the root cause of what is going on truly is the first step to getting better.