The following real life scenario demonstrates how Hashimoto's thyroiditis, a common disease that often goes undiagnosed, may have been affecting one of my patients. Her story is relatable to many:
Cara, 38, had been gaining weight for months even though she hadn’t changed her food or exercise patterns one bit. She was tired all the time, sometimes needing to nap on weekend afternoons and she could tell that her mental concentration was off. Even though she’d been moisturizing, she couldn’t seem to kick the dry skin that was causing her to feel itchy, and constipation was now becoming a bit of a problem. And she was way more anxious and unable to tolerate stress than usual.
She went to see her doctor who told her she was probably just depressed from being a mom with young kids, and that even though her thyroid test number was close to the upper edge of normal, it was still in the normal range, so he wouldn’t treat her. She could come back in six months, but in the meanwhile he recommended she start a diet and consider starting Prozac.
One year of suffering later she landed in the chair opposite from mine in my medical practice. I listened to Cara’s story, which included another year of fatigue and weight gain, as well as an increasing sense that maybe she really was just depressed. I ordered some tests and within a week, we had the answer – Cara did indeed have Hashimoto’s Thyroiditis – an autoimmune thyroid condition, affecting 90% of people with hypothyroid (low functioning thyroid) in the US. Over the next few months Cara and I worked together to find her root causes – which for her was gluten and Epstein Barr virus – as well as find the best medication for her, and at the right dose. This took a few adjustments but within 3 months, her energy was back, she felt happy and hopeful, her mind was focused again, and she began to drop that weight she’d picked up.
Clearly this wasn’t just “all in her head” – and there was a solution, just as there is for most of you.
Are You Suffering from Hashimoto's Disease?
If you’re suffering from fatigue, unexplainable weight gain, aching joints, constipation, dry skin, hair loss, feeling cold all the time, poor sleep, or a host of other symptoms, there’s a very good chance it’s your thyroid talking. Thyroid problems, especially the most common of these – Hashimoto’s thyroiditis – are more widespread than you might imagine, and it especially affects women. Unfortunately, it is commonly under diagnosed.
Here are my Top 10 Tips for helping you get to the bottom of your symptoms and healing Hashimoto's:
1. Know that this is not all in your head.
While depression and other mood issues can cause many of the symptoms of hypothyroidism, it’s important to absolutely make sure that you don’t have a thyroid condition before you just chalk your symptoms up to depression. A healthy thyroid is essential to literally thousands of key functions in your body, including metabolism and the ability to keep your weight and cholesterol in a healthy range, mental clarity, sleep, heart function, digestion, and hormonal balance – including normal menstrual cycles, fertility, and pregnancy.
2. Believe that you can feel great again.
So many women just give up and give into their symptoms when they don’t get a proper diagnosis. They assume they just have to live like this and they stop seeking answers. You’ve got to stay hopeful, advocate for yourself, and believe in yourself if you’re going to find the answers – and treatment – you need! You can feel great again – I’ve seen it thousands of times!
3. Find a practitioner who is willing to look for the root causes and help you regain your health.
Medical research is constantly changing, but unfortunately, medical doctors are often slow to adopt new ways! So even though the evidence is there that we doctors should be thinking more broadly about diagnosing and treating thyroid disease, that we should be using nutrition and other natural approaches to help our patients, and that we shouldn’t be patronizing and telling our patients that their condition is probably all in their heads – well, you might have experienced a doctor who is less than sympathetic before! There are, however, more progressive docs out there – you have to just dig a little to find one.
Integrative and Functional Medicine MDs, and licensed naturopathic physicians (NDs) are knowledgeable about diagnosing Hashimoto’s and helping you to find the best treatment for you. If you just can’t find someone in your area, there are doctors that will see you at a distance through phone consultations, if you’ve made an initial visit to their office; this can be a viable option though is often more costly. And in the least, you can advocate for yourself by telling your current doctor what you really want to try and why – you might just find yourself with a new partner in your health care by being honest and having the conversation.
4. Check the thyroid important labs and get these interpreted by your awesome doctor!
As I talk about here, it’s important to check the right labs to know what’s really going on. The 5 key labs are: TSH, Free T3, Free T4, TPO, and Anti-Thyroglobulin antibody. It is also sometimes helpful to get a Reverse T3 and an iodine level. Your new awesome doctor should be able to interpret these accurately for you.
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5. Rule out other causes of your symptoms.
While hypothyroidism is very common, other conditions can cause similar symptoms. The most common of these are iron deficiency anemia and other nutritional deficiencies, especially if your diet is limited or restrictive, fatigue from stress or overwhelm, adrenal fatigue, new or chronic viral infection (especially Epstein Barr virus), Lyme disease, and yes, depression can also be a legit cause of these symptoms.
6. Take a WHOLE WOMAN approach – Look for the root causes.
One thing I’ve learned for sure is that Hashimoto’s disease doesn’t usually “just happen” out of nowhere. It is typically triggered by a stressful life change, a major hormonal and immune change like pregnancy and having a baby, or it may be a symptom of something triggering your immune system. Getting to the root cause of your thyroid condition can help you to remove triggers that may also be affecting other aspects of your health and being to heal your body.
Even if you do ultimately need to remain on thyroid hormone replacement long term, by addressing the triggers, you can heal and prevent many other conditions from arising down the road.
The most common root causes of Hashimoto’s that I see in my practice are gluten, Epstein-Barr virus (the one that causes mono – which can actually get reactivated so be highly suspicious of this if you’ve had mono in the past!), major stress and adrenal fatigue, gut/digestive problems, nutritional deficiencies, overall low immune function (you get sick a lot) and just having had a baby (Hashimoto’s is very common in the first year postpartum).
An integrative, functional, or naturopathic physician can offer you insights and tests to help uncover and address your root causes and triggers. Many doctors also find that heavy metals in the body that we’ve picked up from our environment can have an impact on the thyroid, so this is something you might want to have your doctor check for, too.
7. Eliminate food triggers.
Gluten: Gluten intolerance is far more commonplace than was previously known and is now recognized as a major trigger for autoimmune conditions. So if you haven’t already, I highly recommend going not only gluten free, but also avoiding the foods that can cross react with gluten in your body, triggering inflammation and autoimmunity similarly to gluten. This means removing wheat, barley, and rye products, as well as corn, oats, millet, and coffee. Give it a 3-month try to really see if there’s a difference.
Eat only low mercury seafood: Heavy metals can bind to your thyroid and thyroid hormone receptors, and interfere with thyroid function. One of the most common is mercury, which is abundant in certain seafood. Tuna, mackerel (King), marlin, orange roughy, shark, swordfish, and tilefish are the highest in mercury and should be completely avoided.
Hidden food sensitivities: Numerous food sensitivities can, over time, lead to an autoimmune reaction that eventually attacks your thyroid. Learn more about healing food sensitivities here.
8. Use the right supplements and avoid foods and supplements that could be counterproductive.
While not everyone with Hashimoto's has nutritional deficiencies, many do, and healthy thyroid function requires specific nutrients. The most important thyroid nutrients and their doses (for adults) are zinc (30 mg/day), selenium (200 mcg/day), iodine (150 mcg), and iron (18 mg). The uber-cool thyroid pharmacist Izabella Wentz also suggests that low thiamine (vitamin B1) may be an issue for Hashimoto’s sufferers, and that supplementing this nutrient may be helpful. Keep in mind that grains are one of our biggest dietary sources of B vitamins, so if you are grain free, you might want to supplement with B-complex, and give a little extra attention to thiamine.
Most of these can be gotten from food, and over supplementing can actually be harmful. Working with a nutrition savvy doctor or functional nutritionist can help you to identify your unique needs. In general, supplementing in the above doses is safe for most women (avoid iodine supplements if you have a true iodine allergy!). Of note, too much iodine, and also even a daily green drink made with kale or broccoli can be a problem for your thyroid. Green leafies are still important for your health, but if you have Hashimoto’s, keep green drinks to 1-2 times/week at most, and instead, eat steamed and sautéed greens, as this is a less concentrated way to get them.
9. Find the best medication for you.
It is well known in medicine that different people respond to different medications, whether the formulation, the brand, the dosing, or the combinations. This is probably the most true when it comes to thyroid medications! While I am not going to do a thorough review of thyroid medications here, it is important that you know that there is life beyond just Synthroid – the drug most frequently recommended by conventional doctors. There are various combinations of T3 and T4, T3 and T4 come in various solo medications, there are time-released versions, and product ingredients vary which is important as some of you with environmental allergies may be sensitive to one or another filler or additive. While sometimes you hit the jackpot with your first medication, it can take as long as 6 months to really find the right medication and dose for you, but with persistence and a good medical partner, you can find it!
10. Hang in there – working with Hashimoto's disease a process.
Figuring out your root causes and triggers, changing your diet, finding the right supplements, and getting on the right medication at that right dose doesn’t usually happen overnight. But I can tell you from experience, my patients do get their thyroid function – and their lives – back in swing every single day. Have confidence in your body, and find a great support group and online resources from not only health professionals, but also educated women who themselves have gone through what you’re experiencing.
There is light at the end of the Hashimoto’s tunnel!
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