Managing Hashimoto’s Thyroiditis
Hashimoto’s is the first autoimmune disease I was ever (correctly) diagnosed with… but I still knew I had it a good year before any of my doctors would agree with me. Like most autoimmune diseases, the medical community gets better and better every year at identifying and treating Hashimoto’s… but we’re learning new things every day and a lot of practitioners simply don’t keep up. It doesn’t help that there aren’t any specialists for autoimmune disease and the specialists recommended for Hashimoto’s are endocrinologists, most of whom specialize in diabetes these days. Finding a good practitioner is the biggest hurdle in diagnosing and treating Hashimoto’s, but there are a lot of things you can do at home and a lot of ways you can empower yourself to make sure you’re getting the best treatment available. My own recovery began with the book Why Do I Still Have Thyroid Symptoms? by Hashimoto’s expert Dr. Datis Kharrazian.
Diagnosis
Think you might have Hashimoto’s? The first thing you’ll want to do is test your TSH, free T3, free T4, TPO antibodies, and Tg antibodies. TPO and Tg antibodies are the diagnostic tests for the autoimmune thyroid diseases, Hashimoto’s and Graves’. Graves’ is diagnosed when antibodies are elevated and the patient tests hyperthyroid (too much thyroid hormone). Hashimoto’s is diagnosed when antibodies are elevated and the patient tests hypothyroid (not enough hypothyroid). Many doctors skip these tests because they don’t change the medical treatment; however, any autoimmune disease comes with a lot of potential complications (including food sensitivities and a predisposition to other autoimmune diseases), so knowing whether or not your thyroid problem is autoimmune in nature is a really good idea.
As for determining whether or not you have a thyroid problem in the first place, your doctor may only want to test your TSH, as this is the traditional measure of thyroid function. However, TSH is a hormone released by the pituitary gland, not the thyroid, and plenty of people with thyroid disease have perfectly fine TSH levels. Abnormal TSH can certainly indicate a thyroid problem, but normal TSH doesn’t rule one out. Free T3 and free T4 are a better measurement of thyroid function. TSH tells your body to produce the hormone T4, which is then converted into T3, which is used by various organ systems like the adrenal glands and sex organs. Some people have a problem at the top of the chain with TSH secretion, either too much or too little; some people have no problem with TSH but their thyroids don’t produce enough T4 anyway; some people produce plenty of T4 but don’t convert it into T3; and some people have trouble using the T3 they do produce. You’ll need to measure all three of these hormones to know what your thyroid is actually doing. Hypothyroid presents with an elevated TSH and low T4 and/or T3; hyperthyroid presents with a low TSH and elevated T4 and/or T3. It isn’t uncommon for thyroid patients to swing between the two, especially if they are taking thyroid medication.
Treatment
The autoimmune protocol
Start the autoimmune protocol. I know it’s a big change if you’ve been eating the standard American diet or even standard Paleo. I know it’s not a lot of fun changing your routine. But it’s never been easier to do. There are tons of cookbooks and meal plans out there. There are budget strategies, tips for sticking to it when your family isn’t on board, advice for fighting temptation, shopping lists, a literal textbook on the how and why, and support groups to walk you through it. Whatever your excuse for not starting the AIP immediately, I promise there’s an answer to debunk it. Your best shot at eliminating any autoimmune symptoms is eliminating environmental triggers–and giving your body tons of nutrients to help it repair itself. If Nike didn’t already have the “just do it” slogan, it’d make a good one for the AIP. Seriously, just do it!
Additional dietary concerns
You may read that thyroid patients should avoid cruciferous vegetables and/or iodine due to a goitrogenic (or thyroid-hindering) effect. This has been debunked. If you are following the autoimmune protocol, there are no additional restrictions for thyroid disease specifically. However, if you have other food sensitivities that are not addressed by the AIP (like a shellfish or strawberry allergy), you will need to eliminate those foods as well.
Thyroid medication
A lot of people, especially people who are into diet and lifestyle change to manage their symptoms, see taking medication as a sign of failure or a horrendous crutch that must be done away with if at all possible. I can’t stress enough that there is nothing wrong with taking medications that your body needs. If your thyroid has been damaged by years of autoimmunity and is no longer capable of functioning on its own, it needs hormone replacement and it may need it for the rest of your life. You may find that as you make lifestyle changes, you need less medication. Some people stop taking it altogether. But there is nothing wrong with not being one of those people.
There are a lot of natural and synthetic options for thyroid hormone replacement and dosages can be tailored to contain more or less T4 or T3 depending on what your numbers are. If you have low T4 but high T3, you may want to look into a T4-only medication. If you have high T4 but low T3, you may want a T3-only medication. Most people need something with a little bit of both and natural dessicated thyroid (NDT) like Armour or Westhroid is very popular. Which one is right for you and how much of it you might need should be discussed with your healthcare provider. Your numbers will need regular monitoring (every 3-6 months, depending on what your doctor says) and your medication may need adjusted depending on how you retest and how you feel. Your lab reports will contain the ranges that particular lab uses to determine whether or not your results are high or low, but there is a functional range at which most patients feel their best. For TSH, the ideal range is around or below 1. For T3 and T4, it’s toward the top 25% of the lab range.
Stress management
If you’re stressed out, your body is stressed out. A stressed-out body can’t cope as well with illness and it certainly can’t heal. Whatever’s causing your stress (it could be something as simple as exercising too much, eating too frequently, or not eating frequently enough), it’s time to do something about it. Relaxation techniques abound online. Meditation, yoga, laughing with your friends and family, playing with your kids or pets, taking some time for yourself… and so on. Consider seeing a therapist to help you find coping strategies if you feel you need help that you aren’t getting at home.
Quality sleep
A sleep-deprived body is a stressed-out body. In fact, not getting enough sleep, even for one night, can undo all the good you’re doing with your diet. Poor sleep reduces our ability to heal from disease, cope with stress, regulate our hormones, digest our food, and manage our blood sugar. It makes us sluggish and moody. It makes us crave sweets and caffeine for some fast energy. Do everything you can to make sure you go to bed at the same time every day and have enough time to get a good eight or nine hours of sleep before your alarm goes off in the morning. I know it’s hard with kids, a social life, street noise, irregular work hours, etc. But it’s more than worth whatever you have to sacrifice to make it happen. When I don’t sleep, I don’t tolerate as many foods, my mood plummets, and I’m less productive at work and get less enjoyment out of everything I do. And I honestly don’t think I’d have ever recovered as much as I have without prioritizing a good night’s sleep all the time.
Exercise
Exercise isn’t so much a weight-loss tool as a great way to regulate your hormones. (Sex is, too!) A good workout produces endorphines and other happy hormones… but one that’s too intense (either too long or too hard, or both) produces cortisol, the stress hormone. We don’t want any of that. So the trick with exercise is to do enough of it to get the benefits but not so much that your body can’t handle it. What exactly that is for you will probably take some tinkering. For some people, it’s a good long walk every day or half an hour of yoga before work. For others, it’s three or four weekly sessions of weight lifting. There’s swimming, biking, dance, rock climbing, HIIT, bowling…. I promise that there’s something for everybody. Find your groove and stick to it and be honest with yourself about whether you could do more or need to do less. For example, if endurance running gives you diarrhea or disrupts your cycles, it’s probably not worth doing, no matter how much you might love it!
Keep Your Health on Track
Whether you’re starting the autoimmune protocol, a new medication, an exercise routine or trying to get to the bottom of your headaches or indigestion, cataloging your activities and symptoms is a great way to gauge your progress. The Ultimate Health Journal can help you stay on track with diet, fitness, and other lifestyle changes you have begun or been prescribed, notice patterns in your health and lifestyle so you can enact positive changes, and provide a valuable tool for you, your family, and your healthcare team. I would never have noticed that cinnamon makes me sneeze or dairy gives me hiccups without keeping a written record during my elimination diet, which helped me see the patterns that solved my problems! The ebook is available as a digital download with printable template for $9.99.