If you have Hashimoto’s thyroiditis, there are two very different reasons why you may be experiencing symptoms:
Immune system activation (inflammation)
Low thyroid function (hypothyroid)
Standard treatments for Hashimoto’s disease tend to focus on treating hypothyroidism. But this is only part of the equation and it leaves many patients struggling with unresolved symptoms.
In this article, we’ll explore how you can calm your immune system, lower inflammation, and feel better. But first, let’s take a closer look at the two distinct reasons for Hashimoto’s symptoms.
Immune System Activation
Hashimoto’s disease is an autoimmune disorder that affects thyroid function. As with all autoimmune diseases, the body’s immune system attacks its own tissues in a case of mistaken identity. With Hashimoto’s, this overzealous immune response causes thyroid inflammation or thyroiditis.
When you experience symptoms of Hashimoto’s flare-up, it’s likely that you are having an autoimmune flare. This means that your immune system has gone into overdrive and is generating inflammation.
Over time, the inflammatory process can damage the thyroid gland and impair thyroid function, eventually leading to hypothyroidism.
If you are hypothyroid, your thyroid gland does not produce enough T4 thyroid hormone. This causes your metabolism to slow down. Symptoms of hypothyroidism (low thyroid function), include:
Decreased heart rate
Hypothyroidism is easily treated with thyroid replacement hormone. Levothyroxine (Synthroid) is the most commonly prescribed thyroid medication.
If you are taking thyroid medication and your lab results are normal, you shouldn’t experience symptoms of hypothyroidism. However, many patients do continue to struggle with tiredness, brain fog, poor mood, and other symptoms, despite taking medication.
In this case, your symptoms are likely caused by inflammation and dysfunction in the gut-thyroid connection, not a lack of thyroid hormone.
The Gut-Thyroid Connection
Fatigue, brain fog, and mood issues aren’t just associated with thyroid disease. They are also common symptoms of gut disorders. For example:
More than 50% of IBS (irritable bowel syndrome) patients have symptoms of fatigue, according to a meta-analysis of 17 studies [X Trusted SourcePubMedGo to source].
Sixty-eight percent of patients with suspected non-celiac gluten sensitivity reported a lack of well being [X Trusted SourcePubMedGo to source]. These patients also reported tiredness (64%), headache (54%), anxiety (39%), brain fog (38%), and other non-digestive symptoms.
In a systematic review, IBS patients were three times as likely as healthy subjects to have either anxiety or depression [X Trusted SourcePubMedGo to source].
Eliminating common trigger foods can also be helpful for some thyroid patients. In one study, lactose restriction led to a significant decrease in TSH levels for thyroid patients with lactose intolerance [17 Trusted SourcePubMedGo to source]. Another study found that a gluten-free diet reduced the need for thyroid medication in patients with atypical celiac disease [18 Trusted SourcePubMedGo to source].
Improving your gut health is an important part of an overall plan for better thyroid health.
How To Prevent Hashimoto’s Flare-Ups
If you have Hashimoto’s disease and are struggling with symptoms of Hashimoto’s flare-up, there’s a lot you can do to feel better and regain your energy.
Take a step-by-step approach to address the most fundamental health foundations first. For some patients, symptoms will start to resolve after taking a few steps. Other patients will need to complete more steps.
1. Get Your Thyroid Hormone Levels in Range
An important first step is to resolve true hypothyroid symptoms with medication.
If you want to follow a specific diet template or meal plan, the paleo diet is anti-inflammatory, lower in carbs and trigger foods, and suitable as a long-term diet.
If a paleo-type diet doesn’t resolve all of your symptoms, the AIP diet(autoimmune paleo or autoimmune protocol) is a good next step. The AIP diet is an elimination diet intended to help you identify food triggers that cause inflammatory symptoms.
Some thyroid patients may benefit from iron supplementation. If your blood tests show serum ferritin (the storage form of iron) levels significantly below 100 mg/l with iron, supplementing with iron may help to improve fatigue [43 Trusted SourcePubMedGo to source].
6. Treat Gut Infections
If lifestyle improvements, diet, and probiotics haven’t fully resolved your symptoms, the next step is to look for hidden gut infections.
Thyroid tests for TPO antibodies measure the degree of autoimmune activity in Hashimoto’s disease . TPO levels over 35 IU/mL are generally considered positive for autoimmunity.
Many patients are able to significantly reduce TPO levels through diet and lifestyle changes or by treating a gut infection. However, it’s not necessary to reduce your TPO levels to zero. In fact, striving to do so can create stress and be counterproductive.
Research shows that patients with TPO levels below 300 are unlikely to become hypothyroid [13 Trusted SourcePubMedGo to source] and patients with TPO levels below 500 have minimal risk of becoming hypothyroid [9 Trusted SourcePubMedGo to source]. Essentially, there is not enough autoimmune activity to significantly damage the thyroid gland at these levels.
If your TPO levels are high, a sensible goal is to get your TPO level below 500.
You Don’t Need to Be Tired and Frustrated with Hashimoto’s
If you struggle with symptoms of Hashimoto’s flare-up, don’t expect thyroid medication to solve all of your problems.
Poor gut health is a very common cause of symptoms like fatigue, brain fog, poor mood, weight gain, and more. This may be a bigger contributor to your symptoms than your thyroid hormone levels.
Luckily, focusing on your gut health and attending to your daily habits like sleep or stress management can help you manage and resolve symptoms of Hashimoto’s flare-ups.
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