Fatigue, dry skin and hair, constipation, cold hands and feet: these are just a few of the many symptoms associated with Hashimoto’s thyroiditis, also known as Hashimoto’s disease. Hashimoto’s is an enfermedad autoinmune, in which the immune system malfunctions and begins to not only attack infections, but the healthy cells, organs, and tissues of the body as well.
Other autoimmune diseases include Type I diabetes, multiple sclerosis (MS), and lupus (among several others). Notably, women suffer disproportionately from autoimmune diseases, with “up to a fourfold increased risk for autoimmune diseases compared to men.” Hashimoto’s alone is actually seven times more likely to occur in women than it is in men [1]. While the exact mechanism that makes autoimmunity more common in women is not precisely known, current research has begun to shed more light on how genetics play a role. (We also know that hormonal birth control use is associated with the development of multiple, various autoimmune diseases.)
Hashimoto’s disease, which affects 10 million Americans, is a significant issue for millions of women in the United States today.
What is Hashimoto’s thyroiditis?
Tiroiditis de Hashimoto, like all autoimmune conditions, occurs when the immune system attacks healthy cells in the body (in this case, thyroid cells). The tiroides, which is a small butterfly-shaped organ at the base of the neck, is a key part of the endocrine system which controls the body’s metabolism. An attack on these thyroid cells typically causes hypothyroidism, which is when the thyroid becomes underactive and does not produce enough thyroid hormone, thus slowing metabolism. In some cases, Hashimoto’s can also cause instances of hyperthyroid (which means too much thyroid hormone), but this more commonly occurs with Graves’ disease, which is a separate autoimmune condition.
So, if Hashimoto’s often causes hypothyroid, is it the same thing as hypothyroidism? It depends. Hypothyroidism simply means having an underactive thyroid, which is also the main result of Hashimoto’s. A person who has Hashimoto’s, however, has anticuerpos—proteins which the immune system forms to attack what it believes to be a foreign invader like a virus—which attack the thyroid gland and often cause it to become underactive (hypothyroid). This leads to thyroid hormone levels becoming too low, which then triggers a diagnosis of hypothyroid.
A person who has Hashimoto’s, however, has antibodies—proteins which the immune system forms to attack what it believes to be a foreign invader like a virus—which attack the thyroid gland and often cause it to become underactive (hypothyroid). This leads to thyroid hormone levels becoming too low, which then triggers a diagnosis of hypothyroid.
While it is possible to be hypothyroid without having Hashimoto’s, many thyroid researchers reclamar that the vast majority of hypothyroid patients in western nations such as the United States also have Hashimoto’s. Notably, people with Hashimoto’s are not always hypothyroid, especially if the disease is well-controlled or in the earliest stages when the thyroid gland has not been attacked for long enough by the antibodies to show an effect.
Síntomas del Hashimoto
People in the earliest stages of Hashimoto’s may have little to no symptoms, but as the disease progresses and more of the thyroid is destroyed by antibodies, they begin to experience some or all of these hypothyroid symptoms. These incluir:
- Fatiga
- Weight gain or inability to lose weight
- Dry hair, skin, and nails
- Joint and muscle pain
- Trouble tolerating cold
- Cold extremities (hands and feet)
- Constipation
- Heavy or irregular periods
- Depresión
- Slow heart rate and decreased body temperature
While it isn’t a symptom, it’s also important to note that if you have Hashimoto’s, you also have a higher chance of developing other autoimmune diseases down the road. This is called polyautoimmunity or multiple autoimmune syndrome. The reasons for polyautoimmunity are still being researched, but we do know that those individuals with one autoimmune disease should keep an eye on any symptoms that may point to another type of autoimmunity.
Can Hashimoto’s cause infertility?
As Hashimoto’s affects the endocrine system, it can play a factor in infertility, especially if there are other comorbidities such as other autoimmune diseases, high BMI, or other conditions such as polycystic ovary syndrome (PCOS). The effect that Hashimoto’s has on fertility is “multifaceted… thyroid dysfunction, particularly autoimmune thyroiditis, has been associated with a 2- to 4-fold increased risk of miscarriage and preterm delivery in pregnant women positive for anti-thyroid antibodies” [2]. Indeed, “thyroid autoimmunity can influence female reproductive health through multiple interconnected mechanisms, including subtle thyroid hormone imbalances, reduced ovarian reserve, altered endometrial receptivity, and dysregulated immune responses.”
On the flip side, having a baby can also be a trigger for hypothyroidism, which is called postpartum thyroiditis. Especially for women who already had some Hashimoto’s antibodies but had not yet experienced symptoms, the massive hormonal shifts which occur postpartum can trigger the thyroid to become more inflamed, causing a decrease in thyroid hormones.
Testing and treating Hashimoto’s
If you are experiencing the above symptoms, you have a family history of Hashimoto’s, or if you are in a higher risk category for Hashimoto’s (you’re a woman, middle aged, or have another autoimmune condition), then it’s a good idea to be tested for Hashimoto’s. Luckily, testing is quite simple: a blood panel with a few markers. While it can be common for doctors to only test TSH (which stimulates the thyroid to produce more thyroid hormone), it’s actually best to receive a full thyroid panel which includes the following levels:
- TSH (thyroid stimulating hormone)
- Free T4 hormone
- Free T3 hormone
- Reverse T3
- Thyroid antibodies—these are the ones which cause Hashimoto’s. Doctors will typically test for thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb)
Again, it’s possible to have the thyroid antibodies which indicate Hashimoto’s, but to still have a functioning thyroid without low hormones. However, if you are dealing with hypothyroidism, then your doctor will probably want to discuss some potential treatments.
Pharmaceutical treatments
If you are hypothyroid (especially if you’re experiencing symptoms alongside low lab results), then your doctor will likely recommend thyroid replacement hormones. The most common type of thyroid hormone medicación is synthetic T4, which is known by its generic name levothyroxine. Levothyroxine is usually taken as a once a day pill and is the second most prescribed medication in the United States.
However, levothyroxine is not the only medication which can be used for hypothyroid symptoms. Since levothyroxine is the T4 hormone only and your body must convert the T4 hormone into the T3 hormone in order to use it, there is another synthetic T3 hormone replacement medication called liothyronine which can also be used. Especially for those whose lab results show poor conversion from T4 to T3, it might be beneficial to take a combination of T4 and T3 hormonal therapy.
Finally, there is another treatment option that is non-synthetic, known as natural desiccated thyroid (NDT), made out of the thyroid glands of pigs [3]. NDT is typically sold under the brand name Armour Thyroid. NDT has pros and cons, as it is currently undergoing revise by the FDA and is not currently FDA-approved due to questions about its efficacy and potential for under- or overdosing due to the less easily measurable nature of natural medications. That being said, NDT has been used for decades and patients overall report feeling mejor using it than they do synthetic meds like levothyroxine [4].
In some forms of restorative reproductive medicine, low dose naltrexone (LDN) is often used for infertility, especially for women with autoimmune pathology. The Hormone Genius podcast notas that “LDN pushes endorphins and reduces inflammatory chemicals, modulating the immune system.” LDN also reportedly brings down serum levels of thyroid antibodies.
Diet and lifestyle changes
If you have Hashimoto’s, the idea of taking hormonal medication for the rest of your life can seem daunting, but there are some changes to diet and lifestyle that you can make which may help naturally boost your thyroid hormones or decrease your antibodies. There is a lot of information out there concerning these various diet and lifestyle changes (too much to include in this introductory article!), but here are a couple of ideas if you want to optimize your health with Hashimoto’s:
- It’s actually possible to help your thyroid medication work better by decreasing inflammation, exercising, managing stress, and making sure that you are getting nutrientes clave for thyroid health [5]. There is a laundry list of supplements that you can take for thyroid health, but some of the main vitamins and minerals include vitamin D, vitamin A, magnesium, selenium, zinc, B vitamins, and iron.
- As Hashimoto’s causes inflammation and is intertwined con salud intestinal, undergoing a gut health protocol can also be helpful [6]. One of the key changes which many cite as beneficial for Hashimoto’s patients is going on a gluten-free diet, which has been shown to reduce antibodies [7]. Studying gluten-free diets and Hashimoto’s has produced mixto resultados, but many thyroid researchers do cree that many (or most) Hashimoto’s patients also experience gluten sensitivity, which worsens their inflammation and Hashimoto’s symptoms, and that cutting out gluten can help with symptoms [8].
- Overall, a great resource on the topic of Hashimoto’s and hypothyroidism is Dr. Izabella Wentz, who has written a number of books on the subject. She has appeared en muchos podcasts as well, which might be helpful if you’re looking to dip your toes into her content.
The bottom line on Hashimoto’s
Hashimoto’s disease can feel like a daunting diagnosis, especially when many of the symptoms can feel debilitating. However, there are options if you are looking to optimize your health and reduce your medications. A great place to start is connecting with a healthcare professional who takes your symptoms seriously and allows you to be in the driver’s seat with treating your condition. It can be common for Hashimoto’s to go sin diagnosticar (especially when doctors only test for TSH levels instead of a full thyroid panel), so if you are having symptoms, it’s important to advocate for the testing and care that you need.
