Thyroid autoimmunity aka Hashimoto’s is the most common cause of hypothyroidism in westernized countries. Dr. Ruscio discusses what thyroid autoimmunity is, how it effects your thyroid gland and how it may affect other parts of your body. He also shows us what a healthy versus unhealthy thyroid gland looks like. He ends his discussion with what labs tests can be used to identify thyroid autoimmunity.
How Hashimoto’s Autoimmunity Damages Your Thyroid – What You Must Know
Dr. Michael Ruscio: Hello. This is Dr. Ruscio and welcome to the next video in our Thyroid Solutions Series on thyroid autoimmunity. This is a really, really important topic because, as we’ve discussed previously, autoimmunity is a primary cause of hypothyroidism in the United States.
Back to our model here, we’ve already covered functional causes, or functional types of hypothyroidism. Now let’s move on to autoimmune – Hashimoto’s being the most common, which causes hypothyroidism. There’s also Graves’, which we aren’t going to talk about in this video, but is also autoimmune and causes hyperthyroidism.
Now as we’ve discussed, one of the treatments for Hashimoto’s hypothyroidism is medications – but medications do not treat the cause of the hypothyroidism itself, and many patients still don’t feel well even when on medications as we’ve discussed in one of our prior videos for reasons why your medications might not be working for you.
So, what is Hashimoto’s? Quoting, “Hashimoto’s is the most common cause of hypothyroidism in the United States…” And here are a few of the references: Mayo Clinic, The Journal of Surgical Research, The Journal of Clinical and Nuclear Medicine, and The Journal of Clinical Dermatology. Essentially, what I am trying to get across here is this is not controversial – it is well established that Hashimoto’s, which is the autoimmune form of hypothyroidism, is the most common form or most common cause of hypothyroidism.
Continuing on, quoting Guyton’s Textbook of Medical Physiology, “The thyroid glands of most of these patients first have autoimmune “thyroiditis,” which means thyroid inflammation. This causes progressive deterioration and finally fibrosis of the gland, with resultant diminished or absent secretion of thyroid hormone.”
Essentially what this is saying is when you have this Hashimoto’s, or this thyroid autoimmunity, you have inflammation in the gland which causes damage and irritation, and eventually causes the gland to become fibrotic, or infultrated with scar tissue.
And to show you a diagram here: Here is what a healthy thyroid gland should look like.
And when we have prolonged thyroid autoimmunity, here’s what the thyroid gland can look like. Healthy gland/end-stage Hashimoto’s with scarring and fibrosis of the gland. Even though this gland is larger, it actually produces much less thyroid hormone.
So, in summery, it is a process in which your body produces immune cells – hence, autoimmunity – that attack and damage your thyroid, also know as Hashimoto’s. As you see here depicted, these little character immune cells actually come in and slice, and cut into, and attack, and damage your thyroid.
Now, what this can often look like in terms of lab work and symptoms is overtime
someone’s thyroid values kind of go like this – they go up and down, up and down, up and down, up and down with the general trajectory of going downward.
The way you can think of this is thinking back to the visual of the thyroid with the little guys with knives coming in and cutting it, picture a vine of grapes. Each grape is analogous to what’s called a ‘thyroid follicle’ or small piece of your thyroid gland. Each grape contains grape juice, and follicle of your thyroid contains thyroid hormone. So, when an immune cell comes in and attacks, as part of this autoimmune attack, you can actually have a little spill out of the grape juice, or this thyroid hormone.
So, when people are experiencing Hashimoto’s, we can see this fluctuation where they go a little bit hyperthyroid, hypothyroid, a little bit more hyper, a little bit more hypo – hyper, hypo. And this is why people can have oscillations of having hyperthyroid symptoms and then hypothyroid symptoms, and their TSH levels can go and down and their medication dose needs to be adjusted. It follows this pattern where, as you have flares of this autoimmune process, you have more damage to your gland, some thyroid hormone spills out, you go hyperthyroid, and then, when the autoimmune attack calms down, you have less have less healthy thyroid tissue and can’t produce as much hormone.
This is what the diagram is showing here.
Autoimmune conditions are very important, and they are very under-appreciated. To give you an idea of this,
I will quote the National Institute of Health, the NIH, Autoimmune Diseases Coordinating Committee; so this is as mainstream and conventional as you can get: “Collectively, they (referring to autoimmune conditions) thought to affect approximately 5-to-8 percent of the United States population – that’s 14-to-22 million people.”
Continuing with the quote: “To provide a context to evaluate the impact of autoimmune diseases, cancer affects approximately nine million people in the United States (in 1997); heart disease affects approximately 22 million people in the United States (in 1996).”
So, what you are seeing here is autoimmune conditions taken together are as common as heart disease, and more common than cancer. So, you can pretty much rank autoimmune disease as tied for the leading disease in this country. So it’s a very common, prevalent condition. One of the reasons that it is so important to treat an autoimmune condition at the cause is because most autoimmune conditions share a core group of causes. If you treat that core group of causes, you can see benefits in numerous autoimmune conditions.
Some of these other autoimmune conditions that may be helped from treating your thyroid autoimmune condition are: Rheumatoid arthritis, where the body attacks joint tissue; multiple sclerosis, the body attacks nerve tissue; ulcerative colitis, the body intestinal tissue; lupus, attacking various healthy connective tissue; Crohn’s would be the colon tissue; psoriasis would be skin tissue; celiac would again be intestinal tissue; Graves’ would have given me thyroid, but this time causing hyperthyroidism; myasthenia gravis, where you attack your aceytle choline receptors.
So, autoimmune conditions are fairly common, and that’s why it is important not to just gloss over the fact that your hypothyroidism may be caused by autoimmunity and just medicate over that symptom. It’s very important to figure out if your hypothyroidism is autoimmune. If it is, take steps to treat that autoimmunity.
Now, ways you can identify if this present are with four lab markers – two are specific for Hashimoto’s – these are our TPO and thyroid globulin, TPO and TG, as you see here; and there are two for Graves’ – TSI and TR.
This is a series of thyroid peroxidase
or TPO antibody test we do with a patient in the clinic. As you see here, this patient goes from high, or Hashimoto’s, to non-Hashimoto’s through her course of care.
So, it is possible to turn off, or turn down, or to dampen, or to put the fire out on the autoimmune process, as you see here with this patient’s lab work. This is one of the markers that we track over time to make sure our treatment is being effective.
Hopefully that helps you understand autoimmunity. Our next video will then go into
causes and treatment for autoimmunity. And now that you know what autoimmunity is and why it’s so important, hopefully this information will carry a little bit more weight.
This is Dr. Ruscio, and I hope you find this helpful. Thanks.
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