Autoimmune Thyroid Symptoms and Gluten Sensitivity: Is There a Connection?
Multiple autoimmune disorders as associated with celiac disease (CD). Recently, researchers have documented a more frequent association between celiac disease and autoimmune thyroid problems. Celiac disease involves an autoimmune condition in which the body attacks the small intestines, and is aggravated by eating the dietary protein called “gluten.” Gluten (more correctly labeled gliadin) is one of the proteins found in wheat, barley, and rye.
Due to the increased association between autoimmune thyroid conditions and celiac disease, some researchers have stated, “The greater frequency of CD in association to autoimmune thyroid disease suggests that all subjects with TPO should be routinely screened for CD.“
Why is there an association between autoimmune thyroid disease and gluten?
Unfortunately, the relationship between autoimmune thyroid disease and celiac disease is not fully known. There are a few things that are understood though:
- Autoimmune conditions appear to be linked to genetics. When one autoimmune condition is present, there is an increased chance of developing another autoimmune condition
- Celiac disease and certain types of thyroid conditions have an increased association because both can be autoimmune diseases
- There is evidence that celiac disease may predispose individuals to develop other autoimmune conditions
- Thyroid disease is more often diagnosed before celiac disease because it is more common, and a greater number of medical providers screen for thyroid imbalance verses celiac disease.
- Even though there is ample research linking thyroid conditions to celiac disease, additional testing to evaluate for celiac disease are rarely pursued
What is the role of the thyroid gland?
The thyroid gland is a small gland located just below the Adam’s apple in the front of the neck. The thyroid produces various hormones that help to regulate metabolism, control body temperature, hair and nail growth, digestion, energy production, and a wide variety of other metabolic processes.
Thyroid Disease Results from Thyroid Dysfunction
For a variety of reasons, the thyroid can become dysfunctional. Imbalance within the thyroid glad can result in abnormal thyroid hormone production, weight gain or weight loss, fatigue, heart palpitations, and more.
When the thyroid glad stops producing appropriate amounts of thyroid hormones, the bodily functions begin to slow down. This is known as hypothyroidism.
If the thyroid gland begins to produce an excess of thyroid hormones, it can cause the body’s metabolism to significantly increase. The result is a condition called hyperthyroidism.
In certain situations, the body’s immune system will attach the thyroid, resulting in autoimmune thyroiditis. Hashimoto’s autoimmune thyroiditis is a common diagnosis of autoimmune hypothyroidism, whereas Grave’s Disease is an autoimmune hyperthyroidism condition.
Hashimoto’s Disease (aka Chronic Lymphocytic Thyroiditis)
When the body’s immune system attacks the thyroid gland, causing a decrease in thyroid production (hypothyroidism), certain antibodies can measured through blood tests. Usually the thyroid stimulating hormone (TSH) will be elevated, and antibodies to the thyroid gland will be present. The thyroid peroxidase antibody (TPO) test and the anti-thyroglobulin antibody (TGA) test are the most common antibody tests for Hashimoto’s.
Symptoms can be very subtle and non-specific, mimicking other illnesses, therefore, a doctor trained in thyroid imbalance will evaluate your symptoms, and request the appropriate laboratory tests. Common symptoms of Hashimoto’s autoimmune thyroiditis include:
- Tiredness
- Weight gain
- Dry skin
- Often feeling cold and low body temperature
- Coarse, dry hair or hair loss
- Enlarged thyroid gland in the neck
- High cholesterol
- Dizziness
- Depression
- Muscle cramps
- Constipation
- Decreased ability to concentrate or difficulty remembering things
- Slowed heartbeat
- Yellowish skin
- Nausea
- Lack of coordination
Grave’s Disease
Another autoimmune thyroid condition, which leads to hyperthyroid symptoms (rather than hypothyroid symptoms), is Grave’s Disease. This condition results in accelerated thyroid activity, and a low TSH laboratory test. Additionally, the thyroid antibody test, Thyroid-stimulating immunoglobulin (TSI), is frequently assessed to diagnose Grave’s Disease. Hyperthyroidism is not as common as hypothyroidism.
Symptoms often associated with Grave’s Disease include:
- Weight Loss
- Rapid pulse
- Protruding eyes
- Feeling too warm
- Nervousness
- Insomnia
- Irritability
- Heart palpitations
- Diarrhea
- Muscle weakness
Treatment for Autoimmune Thyroiditis, including Hashimoto’s and Grave’s Disease
The treatment options for thyroid conditions are unique to each diagnosis. Hypothyroidism conditions, whether autoimmune in nature or not, frequently include thyroid hormone replacement therapy. Examples of thyroid hormone replacement include Synthroid, Levothyroxine, Armour, etc. A more natural approach may include supplementing iodine and/or thyroid glandular tissue (or a variety of other thyroid supporting agents) if appropriate.
Hyperthyroidism treatment is more complex, and may include a variety of anti-thyroid medications. If these medications are not enough, surgically removing the thyroid, or using a radioactive iodine substance to “kill” the thyroid may be appropriate.
A Gluten Free Diet Can Help Thyroid Conditions
As discussed earlier, there is a strong association between celiac disease (a gluten associated problem) and autoimmune thyroid problems. Even though “gluten free” diets are all the rage today, there is strong evidence that individuals with a thyroid problem should be eliminating gluten from their diet.
In the office, I will frequently ask patients to avoid gluten (and sometimes dairy) “as if your eternal salvation depends on it.” The patient will eliminate gluten from their diet for at least 30 days, many times resulting in a significant improvement in their symptoms. After avoiding gluten for a while (30+ days), we will slowly reintroduce gluten containing foods back into the diet, looking for their symptoms to return. If their symptoms return, we can safely assume that gluten is contributing to their health related symptoms. On the other hand, if they are able to reintroduce gluten, and remain symptom free, it would indicate that gluten may not be as big of a problem.
Selected Research Associating Gluten with Thyroid Conditions
Some of the peer reviewed published research associated with gluten and thyroid conditions is pretty significant. Below are some of the statements directly from the medical researchers looking for the link between gluten and thyroid issues:
- “To our findings, a high prevalence of anti-tissue transglutaminase and IgA anti-gliadin antibodies and their positive relationship with antithyroid antibodies in patients with Hashimoto’s thyroiditis were reported. These findings further warrant the need for interventions to reduce the prevalence of these antibodies in Hashimoto’s thyroiditis for preventing the occurrence of celiac disease in these patients. “
- “Patients with an underlying autoimmune endocrine disorder are at an increased risk of developing other autoimmune diseases. We describe a patient with idiopathic autoimmune hypoparathyroidism who developed hyperthyroidism due to Graves disease and subsequently was diagnosed with celiac disease. “
- “The gluten-free diet reduced thyroid antibody titers, as well as slightly increased 25-hydroxyvitamin D levels and the SPINA-GT index…. The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease.”
- “The close relationship between celiac disease and glandular autoimmunity can be largely explained by sharing of a common genetic background. Further, between 10 and 30% of patients with celiac disease are thyroid and/or type 1 diabetes antibody positive, while around 5⁻7% of patients with autoimmune thyroid disease, type 1 diabetes, and/or polyglandular autoimmunity are IgA anti-tissue transglutaminase antibody positive. While a gluten free diet does not reverse glandular autoimmunity, its early institution may delay or even prevent its first manifestation. “
- “Non celiac gluten sensitivity (NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease (CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as ‘foggy mind’, headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported”
- “The association between autoimmune thyroid disorders (AITD) and coeliac disease (CD) is well known, however, most of the literature concentrates on hypothyroidism and CD.”
Needless to say, there is a lot of association between thyroid conditions and inflammatory food proteins, specifically gluten.
Do you have a thyroid condition? Remove gluten from your diet for a month or so and see how you feel. Not sure if you have a thyroid problem? Get tested. Not sure how to remove gluten from your diet? Talk to a doctor that is trained in nutritional approaches to health and wellness. If our office can be of any assistance, we invite you to contact us and speak with one of our doctors.