“Hashimoto’s is the most common cause of hypothyroidism in the United States 1-4”
From Guyton’s Textbook of Medical Physiology regarding hypothyroid patients, “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. 5”
“Hashimoto’s thyroiditis (HT) is a common disease, and is the most prevalent cause of hypothyroidism.” 6
Hashimoto’s is the most common cause of hypothyroidism in the US. Hashimoto’s or Hashimoto’s disease is an autoimmune disease in which the body makes antibodies or immune cells that attack and damage the thyroid. Why does this matter? Well, if this process occurs long enough you can experience non-repairable damage to your thyroid gland and become hypothyroid.
In recap, Hashimoto’s is an immune disease that causes thyroid damage and eventually hypothyroidism. What is an autoimmune disease? Autoimmune diseases are immune diseases in which the body is making antibodies, or immune cells, that attack tissues of the body. Usually we make anti-bodies that attack foreign invaders like pathogenic bacteria or viruses. But, if you have autoimmunity, your immune systems can malfunction and then start attacking your own tissue, like your thyroid. This is especially important because if you have one autoimmune disease you have a heightened risk for eventually developing another autoimmune disease 7-14. This is one reason why it is so important to treat the cause of autoimmunity and not the symptoms of it. Thyroid hormone replacement medications, like Synthroid and Levothroid, do not treat the cause of autoimmunity. Here are some examples of other autoimmune diseases, remember if you have Hashimoto’s you are more likely to develop one of these conditions, especially if you do not treat the cause of autoimmunity.
- Rheumatoid arthritis: attacking of your joint tissue
- Multiple sclerosis: attacking the myelin surrounding of your nerves
- Ulcerative colitis: attacking your colon
- Lupus: attacks against various healthy tissues
- Crohn’s: attacks against your colon
- Psoriasis: attacks against your skin cells
- Celiac disease: attacks against intestinal tissue
- Graves disease: attacks against thyroid tissue, causing hyperthyroidism
- Myasthenia gravis: attacks against your aceytle choline receptors
- Pernicious anemia: attacks against parietal cells in your stomach
It is estimated that there are a total of 88 autoimmune diseases. Here are some other diseases where autoimmunity may be implicated
- Depression: In my weekly newsletter I reviewed a study published showing that 54.1% of people with depression had autoimmunity against their serotonin receptors 15.
- Transient joint pain: many people have reported that after eating foods they are intolerant to or allergic to they will experience transient joint pain. This may be caused by an acute flare up of the immune systems causing increased immune cell attacking of joint tissue, results in pain.
- Gas or digestive discomfort: when people who have celiac disease eat gluten, they will often experience gas, bloating and digestive discomfort. This happens because eating gluten causes and autoimmune attack in the intestines.
- Brain fog: we know when there is inflammation in the intestines it can also cause inflammation in the brain. This is the gut-brain connection (more on this later). But for now think of it this way, your intestines are like your second brain (in fact that is a nickname for the nervous system contained in your gut…aka the enteric nervous systems). If you think about it, your intestines almost look like your brains…. So long story short, they are connected.
- Macular degeneration: some evidence is suggesting that macular degeneration is an autoimmune disease. In a small number of patients I have seen remarkable improvement in macular degeneration by employing the same foundational concepts used to treat autoimmune thyroid disease.
- Eczema: while this is not yet well defined, many case reports have noted eczema disappearing after addressing some of the foundation therapies known to arrest autoimmunity.
- There are reports of autoimmunity against virtually every tissue of the body. Everything from testicular cells to skin cells. Some of more well established than others, and some are more closely studied than others. In my opinion this will be one of the most important areas of medicine in the next decade.
If autoimmune diseases were measured as one group, they would be tied with heart disease as the leading cause of disease in our country (more common than cancer). In cancer for example, we add up all cancer types to measure how many people have cancer. We add breast cancer, to ovarian cancer, to prostate cancer, etc.. to get our grand cancer total. Since we do not do this for autoimmune diseases the statistics may be misleading.
Here is a statement from the National Institutes of Health’s Autoimmune Diseases Coordinating Committee regarding autoimmune disease,
“…collectively they are thought to affect approximately 5 to 8 percent of the United States
population – 14 to 22 million persons. To provide a context to evaluate the impact of autoimmune
diseases, cancer affected approximately 9 million people in the United States in 1997 and heart disease
affected approximately 22 million people in the United States in 1996. 16”
These estimates are considered to be conservative; meaning the actual percentage of people with autoimmune diseases is likely higher than this. These statistics are important because the most common cause of hypothyroidism is autoimmunity and because if you have one autoimmune disease you are at risk to develop another; so we want to have a sense for how common this stuff is.
At this point it should be clear that autoimmunity is not a good thing. One would think that if you have Hashimoto’s and are seeing an endocrinologist then you would have your bases cover. It is important to note this is not necessarily the case. Generally speaking the conventional healthcare system does not treat the autoimmune component of hashimoto’s. healthy_thyroid_tissueI’m not trying to step on the endocrinologist toes, but it’s important you know the truth. In the more conventional paradigm TSH and T4 are monitored and your dose of medication is adjusted over time as your thyroid is damaged by the autoimmune process and loses its ability to produce thyroid hormone. So over time you lose more and more healthy thyroid tissue and need medication adjustments as this plays out.
This diagram shows that as time passes, the amount of healthy thyroid gland tissue decreases and so does the output of thyroid hormone, T4. Please note TSH will correspondingly increase as your T4 decreases.
This is not speculation folks, we know as Hashimoto’s progresses your thyroid gland tissue can become damaged and replaced with scar tissue; we have ultrasound studies to prove it 17. Shortly we will discuss exciting research showing what causes autoimmunity and more importantly ways to stop the damage and even partially reverse it.
Before we discuss the causes and treatment of autoimmune thyroid aka Hashimoto’s, lets discus how we can identify if you have it. There are four lab markers that can be used to identify if thyroid autoimmunity is present.
- TPO (Thyroid peroxidase antibodies): diagnoses Hashimoto’s, most commonly found, these are antibodies against an enzyme in your thyroid
- TG (Thyroglobulin antibodies): diagnoses Hashimoto’s, attacks a protein in the thyroid gland, not as common as TPO
- TSI (Thyroid stimulating immunoglobulin): diagnoses Graves
- TR (Thyroid receptor antibodies): diagnoses Grave’s
The higher the level of antibodies, the worse the autoimmune damage likely is. All my thyroid patients perform lab testing for thyroid antibodies. We then track the levels over time. TPO is the most commonly elevated marked. Here is the good news; it is absolutely possible to dampen the autoimmune process, normalize your lab values, stop the damage to your thyroid and save your thyroid. It is possible to almost completely turn of the Hashimoto’s process. Here is one patient’s TPO lab testing over one year. As you can see she went from 172 to 21. Normal is considered anything under 35. So in 1 year we nearly turned off her Hashimoto’s. To see more case studies you can visit www.DrRuscio.com.
Disclaimer; according to the FDA only a drug can treat a disease. So we cannot say we are treating Hashimoto’s. Many have said this is a derivative of the cozy relationship between the FDA and the pharmaceutical companies. Unfortunately pharmaceutical companies have much political influence. If this is new to you, entire books have been written on this topic. Dr. Marcia Angell, former editor of the New England Journal of Medicine wrote a book entitled The Truth About Drug Companies, which is an eye opening account of pharma’s influence on medical practice in this country. So while we are not ‘treating’ Hashimoto’s we are achieving some very impressive results with this condition.
Now hopefully you have a better understanding of autoimmunity and how it relates to your thyroid. But what you can do? Well strap on your science hat, grab an espresso, do a few pushups, get ramped up for the academics and join me in the next section, Causes & Treatments for Autoimmunity.
- Mayo Clinic – http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=causes
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