Causes & Treatments of Hashimoto’s Thyroid Autoimmunity
Dr. Michael Ruscio: Hi. This is Dr. Ruscio and welcome to the next video in our Thyroid Solutions Series, Causes and Treatments of Autoimmunity.
Now, on our prior videos, we discussed that autoimmunity is one of the most common causes – or it is the most common cause – of hypothyroidism in the United States. Now let’s discuss the things that cause autoimmunity, because if we can determine cause, we can treat cause. And when we treat cause, we can have the best possible outcome.
This diagram I’ve borrowed from the Journal of Hormonal Research And Pediatrics, and I’ve actually added to it. So this model, plus the references I’ve added to it as you can see here, is fairly
well-developed, and there are a number of references supporting this model.
Now, there are certain genetic factors, as you see here – there are these HLADR, HLADQ-2 and DQ-8. Without going into copious detail on this, HLA stands for Human Leukocyte Antigen. These are just different immune cell variants that may indicate that people are more prone to form a overzealous immune response. The same thing, actually, happens with the CTLA, which stands for cytotoxic T-cell lymphocyte antigen. These are just antigens that actually may have been protective many, many years ago. These people may have had a higher resistance to infection because these genotypes actually respond very strongly from an immune perspective. But, this day in age, for reasons that are beyond the scope of this video, these people because they respond so strongly, and they have this misguided immune attack against their thyroid, actually may be a detriment.
To give a little more background, there is a correlation here with the genes and certain dietary factors also. So the CTLA and HLADQ-2 and DQ-8 genes – all three of these genes have been correlated with a greater or lesser extent with celiac disease or gluten sensitivity.
But, we can’t really treat the genes. But we can treat the environmental factors because we can change that. Now, iodine and selenium being the first two on our environmental factors list; it’s been fairly well documented in population-wide observational studies that populations with the highest intake of iodine are at the highest risk, or have the highest incidence of autoimmunity. So, we have to be very careful with giving iodine to those who have autoimmunity. The other side of the coin for iodine may be selenium. Selenium in randomized clinical trials has been shown to help shut off or dampen the autoimmune process.
Now, also infections is a very important one, and one that we spend quite a bit of time looking at and treating in the clinic. Just to give you a very exciting piece of research here: At the top you will see the reference – decreases in thyroid autoantibodies after eradication of H. pylori infection. This was published in the Journal of Clinical Endocrinology in 2004. Essentially what this study was asking was, if patients who have Hashimoto’s hypothyroidism, so thyroid autoimmunity, also have a bacterial infection called H. pylori, can we have a beneficial affect on their thyroid condition by treating the bacteria. The thinking here was most likely this: this Hashimoto’s, as we’ve been discussing, is a condition in which the immune system as bad aim and accidentally starts attacking your own tissue, your thyroid tissue. So, if we know that the immune system in these people has bad aim, we know that anything that would increase the amount of shots fired could increase the amount of shots at the thyroid gland. But, if we can do something to tell the army or the soldier to stop firing – ‘Hey, the war‘s over’ kind of thing – then we might be able to have a positive impact on thyroid autoimmunity.
So, what these researchers said was, ‘Well, we know that your immune system, or your army, will be firing lots of shots if there is a bacterial infection. But if we treat the bacterial infection – the infection goes away – maybe all of the soldiers or all immune cells will stop attacking because there is not really anything left to attack.
Hopefully you are following this analogy.
What these researchers found, as you’ll see here (above slide), after treating patients for the bacterial infection – you’ll see patients 1, 2, and 3 here – all had a marked decrease in their levels of thyroid antibodies. In fact, the average score was 2,389 to 724. So, that’s a significant reduction in antibody levels. Whereas in the red, the three patients that had Hashimoto’s and had the bacterial infection, but were not treated, saw almost no change at all in their antibody levels.
So, while this study was small, it’s a great intervention study showing that by treating infections, we can dampen the level of thyroid autoimmunity. And H. pylori is one of the infections we routinely find in our clinic. Patients do experience quite a bit of improvement after this treatment.
So, coming back to our model here, one of the other things that we see is, and I’m not going to go through every one, (but) another important one is gluten. We see gluten, and if we go over here on the other side of the factors, we see gut microflora.
Let’s talk for a moment here about infections, gluten, and the gut microflora. All of these things go back to some extent to the gut. Many infections live in the gut. If you have an allergy to gluten, that will of course affect your gut when you eat it and the gut microflora affects the gut.
Now this is a slide from the American Journal of Pathology. What this slide is showing – and this tube that you are seeing here is actually the outline of your intestinal tract – the blue and green that you are seeing are actually immune cells. You can see
there are a tremendous amount of immune cells in your intestinal lining. Remember, this Hashimoto’s, or this autoimmunity, is an immune condition. So, we know that because there are so many immune cells in the gut, anything that affects the gut can have a strong impact on your immune system. In fact, some studies have shown that over 20 percent of your immune system is actually contained in your gut. This is how things like diet, gut infections, and then your gut microflora or probiotic balance, have such strong impact on autoimmune conditions. Even though the gut and thyroid are not proximal to one another, the gut that influences your whole systemic immune system. And so, it’s a very important thing to look at.
Coming back to our model here, a few other things that are noteworthy and important are vitamin D. Not to go on and on about vitamin D, but vitamin D is one of the nutrients that we know is very, very impactful on autoimmune conditions.
There are a few other things here: pregnancy – some women will notice that they become Hashimoto’s after pregnancy, or menopause, or puberty; any period of rapid growth due to hormonal fluctuations may have a provocatory influence on autoimmunity.
Now here’s an important quote: “In autoimmune diseases, biologic onset precedes the development of clinical symptoms, often by months or years.”
So again, what this is showing is that your antibodies will go high months or years before you have symptoms. This is why proper screening for Hashimoto’s is important.
Additionally here, “Molecules called predictive autoantibodies appear in the blood years before people show symptoms of various disorders. Tests that detected these molecules could warn of the need to take preventative action.”
So, essentially what these two quotes are saying, and these two quotes come right out of the peer-reviewed medical literature, is that antibodies will elevate years before you see symptoms in your thyroid. So, if we can identify these thyroid antibodies early and treat them, we can prevent problems from happening years down the road. So, this is one of the truest forms of preventative medicine that we could ever practice.
So in summary, what can you do? Well, you can get yourself to someone who can evaluate the causative items that we’ve discussed. Once you’ve evaluated what items are affecting you, then you can treat those items, and you will experience quite a marked improvement in your condition if you do that. Because remember, if we can identify what is causing the autoimmunity, and then treat that, we will have a very good clinical outcome.
In our next video, we will be talking about thyroid and your gut, another very problematic area. We will be talking more specifically in Part 1 about gluten, food allergies and your thyroid, and then infections in your thyroid.
This is Dr. Ruscio, and I hope you find this helpful. Thanks.
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