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Thyroid 101 Part 3- Treatment of Hashimoto's and hypothyroidism

Thyroid 101 – Part 3 Treatment of Hashimoto’s and Hypothyroidism

This articles rounds out the Thyroid 101 article series. In article one we broke down what the thyroid was and how it worked. Then in the second part of this series we dove into the assessment of the thyroid gland and investigations for hypothyroidism and Hashimoto’s disease. Now, it’s time to dive into to the basic understanding of Hashimoto’s treatment.

How to treat Hashimoto’s?

The goal of Hashimoto’s treatment is to maintain the level of thyroid hormones, so the symptoms related to hypothyroidism can be controlled. Treatment with pharmaceutical medication is the usual approach to control symptoms, but surgical intervention may be recommended for an enlarged goiter [12].

What medications are used?

The medications used in the treatment of Hashimoto’s disease are as follows:

  • Levothyroxine is a synthetic oral T4 that is used to control hypothyroidism by providing the precursor hormone, T4. This also lowers TSH and stimulation of the thyroid [16].
  • Liothyronine (Triostat) [17].
  • Triiodothyronine-levothyroxine (T3-T4) combination therapy can also be recommended for some patients [16].
  • Research shows that Selenium (Se) supplementation is useful as an adjunctive therapy to levothyroxine (LT₄) in the treatment of Hashimoto’s thyroiditis (HT) [18]. More on this later!

 

Levothyroxine Side Effects

There are some possible side effects of using Levothyroxine [19]. It is necessary to consult a doctor about the following side effects if they appear.

Serious Side effects include:

  • Allergic reactions, such as itching, inflammation in face or hands, tingling sensation in mouth or throat, chest tightening, breathing difficulty.
  • Irregular, fast and throbbing heartbeat.
  • Chest pain and related discomfort such as breathing difficulty, unexpected perspiration, nausea, unconsciousness.
  • Convulsion or seizure.
  • An extreme headache, blurred vision, double vision, nausea, vomiting.

Less serious side effects include:

  • Altered food cravings.
  • Sudden weight changes.
  • Changes in the menstrual cycle.
  • Hair loss.
  • Heart palpitations.
  • Increased heat sensitivity.

Alternative Treatment Options

Desiccated Thyroid for Hashimoto’s

According to the United States Pharmacopeia (USP), desiccated thyroid can be defined as “the cleaned, dried, and powdered thyroid gland previously deprived of connective tissue and fat. It is obtained from domesticated animals that are used for food by humans.” All commercially available prescription desiccated preparations are derived from pigs [17]. Clinical trials have reported that desiccated thyroid extract is effective to treat goiters developed due to Hashimoto’s(lymphocytic) thyroiditis [20].

Desiccated vs levothyroxine

Desiccated thyroid was the primary therapy used to treat hypothyroidism before synthetic T4 hormonal therapy was invented.  The ratio of T4 to T3 in desiccated thyroid preparations is 4.2:1, which is considerably lower than the thyroxine and triiodothyronine ratio of 14:1 in the human physiological thyroid gland. Therefore, the thyroid extract has a supraphysiological amount of triiodothyronine (T3).

Important to note is that treatment with desiccated thyroid extract may not maintain a constant  level of T3 over the course of the therapy. This is because T3 has a shorter half-life and it reaches peak levels shortly after taking your medication. This increases the risk of thyrotoxicosis with desiccated thyroid preparations if thyroid hormone levels are not monitored periodically [17]. Also, there is little evidence to show that it is more effective than levothyroxine[16].  In my opinion there is little incentive to run these experiments though, and clinically many patient who do not properly convert T4 to T3, which is many people, feel significantly better on desiccated thyroid support. Please take warning though, you should work with an educated healthcare provider to both assess and monitor your desiccated therapy. This has been supported in the literature, as hyperthyroidism is a real, and serious, consequence of improperly dosed desiccated thyroid hormone [17].

Diet and Lifestyle Changes

Nutrients to maintain thyroid health

Nutrients obtained from the diet are important factors for maintaining thyroid health. Evidence provided below discusses dietary patterns and nutrients to be aware of.

  • Dietary iodine intake can be done through the use of dairy products, sea weed, iodized salt etc as they are rich in iodine isotopes. It provides protection against environmental exposure to radiation, as well as deficiency, which are some of the causes of hypofunction of the thyroid gland [21].
  • Regular and sufficient iodine intake can help to maintain thyroid health, although sudden shifting from a low iodine containing diet to high iodine intake may increase the risk of thyroid autoimmune disease [21]. Iodine should not be supplemented without a prior understanding your iodine sufficiency and careful monitoring.
  • Soy protein, soy phytoestrogens, and isoflavones present in soybean have been associated with reduced T4 absorption, interference in the action of thyroid hormone, impaired thyroid status and possibly an increased risk of thyroid autoimmune disease. Individuals with normal thyroid functioning and an intake of some soy in the diet do not have related adverse effects [21, 22].
  • Vegan diets have been suggested to provide protection against hypothyroidism by lowering body weight and controlling BMI [22]. Monitoring protein intake in these diets must be carefully done in order to see these benefits. Despite this, a vegan diet also has an association with increased risk of thyroid disease due to high intake of soy products, cruciferous vegetables, and low iodine intakes. The chance of iodine deficiency is less common with Lacto-Ovo vegetarians who eat eggs and dairy products [22].
  • Deficiency of selenium and vitamin B12 have also been implicated in autoimmune thyroiditis [23].
  • Patients taking levothyroxine should maintain a regular dosing schedule, along with implementing specific dietary strategies. A levothyroxine oral dose must be taken on an empty stomach for optimum absorption of the drug. It has also been suggested that patients taking Levothyroxine should avoid foods containing lactose, acacia, and gluten [17].

 

Hashimoto’s and Gluten

The coexistence of Celiac disease, or gluten sensitive enteropathy, and autoimmune thyroid disease is relatively common. The exact connection between Hashimoto’s disease and Celiac disease is not fully understood. Despite this, there is the possibility that a genetic predisposition and/or mucosal changes may be involved [24,26]. Patients with Celiac disease have a greater chance of developing autoimmune thyroid disease in response to chronic exposure to gluten. Clinical trials also support that patients with coexistence of Celiac disease and autoimmune thyroid disease have improved on a gluten-free diet with a reduction in hypothyroidism symptoms and a thyroxine dose reduction.  The advantage of a gluten-free diet can be observed in early adoption, ie the sooner you begin, the better the benefits[26]!

 

 

Hashimoto’s and Goitrogens

Goitrogenic foods suppress thyroid function and may increase thyroid immunogenicity, influencing the production of thyroid autoantibodies. This can contribute to the development of Hashimoto’s disease [21, 22]. Goitrogens are found in legumes, plants, lithium, amiodarone. The most commonly discussed goitrogens include cabbage, broccoli, cauliflower, turnip, cassava root etc. and most of these influence anti-TPO activity. Green tea is also considered as a goitrogen, as animal data showed that high doses of green tea significantly reduce T3 and T4 levels and increase TSH levels in the serum. Along with this, green tea decreases TPO and deiodinase activity [23]. When consuming green tea choose the steeped tea format and avoid, or limit your exposure to powdered green tea supplements.

 

Take Home Points

Ultimately, the thyroid is a gland that is often misunderstand, and patients with thyroid conditions are often confused about their options for health. Here I outlined how the thyroid works and some of the main medications, diet and lifestyle components to consider in your treatment. Ultimately though, what I hope that you achieve from reading this is a feeling of empowerment, knowing that there are so many ways to feel well, and be healthy, in the face of thyroid disease!

Beginning to implement these changes will inevitably start your journey towards health. Many people with thyroid disease have individual nutrient deficiencies, that is outside of the scope of this article. These will be discussed other places on the blog, but never hesitate to reach out to a Naturopathic Doctor or functional medicine doctor if you feel like you need more support to lose weight, improve your energy, your hair, your digestion or to further lower your thyroid anti-bodies. It can be done 🙂

 

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