Hypothyroid, Hashimoto’s Thyroiditis, and Gluten: An Autoimmune Trifecta

Autoimmune thyroiditis, with Hashimoto’s thyroiditis being the most common form, is a condition where the body’s immune system attacks the thyroid gland. The thyroid is a hormonal gland located in the front of the neck that helps to create hormones that regulate and control many essential bodily functions such as metabolism, heart rate, hair/skin/nail growth, and body temperature. In fact, nearly every cell in the body requires thyroid hormone in order to remain healthy. When thyroid hormone levels are too low, and there is an imbalance that slows the thyroid down, it is called hypothyroidism. It is estimated that 90% of individuals with hypothyroidism, also have autoimmune antibodies to the thyroid, complicating the management of this condition. Addressing Hashimoto’s as an autoimmune imbalance, in addition to the hormonal effects that manifest with this condition.

The purpose of this article is to explore the complexity of hypothyroidism (specifically looking at Hashimoto’s autoimmune thyroiditis due to it’s prevalence among individuals that have been diagnosed with a slow thyroid), the advantages and disadvantages of the conventional medical approach, the relationship of gluten (and other potential autoimmune triggers), and natural ways to support the complex nature of this particular symptomatic presentation.

Basic Thyroid Physiology

The thyroid gland, shaped like a butterfly in your neck, is a major player in metabolism. It produces hormones, T3 and T4, that act like messengers telling your cells how quickly to burn fuel. This process is controlled by another hormone, TSH, from the pituitary gland in your brain. This feedback loop ensures the right amount of thyroid hormone is circulating for optimal function, influencing everything from growth to energy levels.

Hashimoto’s disease is an autoimmune disorder that targets the thyroid gland. In an autoimmune disease, the immune system, normally our defense against germs, or other foreign invaders, mistakenly attacks healthy tissues. In Hashimoto’s, the target is the thyroid gland. This attack can lead to decreased hormone production, causing a variety of symptoms. A blood test can diagnose Hashimoto’s autoimmune thyroiditis, and it is estimated that nearly 90% of individuals that have previously been diagnosed with hypothyroidism, also express positive Hashimoto’s antibodies.

Diagnosing Hypothyroidism and Hashimoto’s Autoimmune Thyroiditis

Symptoms of Hashimoto’s Thyroiditis

Symptoms of hypothyroidism and Hashimoto’s can vary from person to person and may overlap with other conditions. Some common symptoms include:

• Fatigue
• Weight gain
• Unexplained hair loss
• Dry skin
• Brittle nails
• Intolerance to cold
• Irregular menstrual cycles
• Difficulty concentrating
• Depression
• Infertility
• Mood swings
• Food intolerances and reactions
• Constipation
• Hair loss
• and more…

Diagnosing Hashimoto’s thyroiditis involves a multi-pronged approach, combining information from a patient’s medical history, physical exam, and specific laboratory tests. Here’s a breakdown of the key steps in diagnosing this condition:

Medical History and Physical Exam:

A thorough clinical history and basic physical exam are essential for evaluating someone with hypothyroidism, and possible Hashimoto’s, as they provide critical insights into the patient’s symptoms, lifestyle, and overall health. This comprehensive approach helps the clinicians in our office to identify key signs such as fatigue, weight gain, and cold intolerance, and other symptoms which are commonly associated with thyroid imbalance. Additionally, the physical exam can reveal specific findings such as dry skin, bradycardia, and a goiter (swelling of the thyroid gland), which are crucial for diagnosis and management of thyroid conditions. In conjunction with the medical history and physical exam findings, clinicians in our office are well versed in a variety of manual muscle testing techniques which can help to identify additional thyroid associated imbalances in the patient.

Blood Tests for Hypothyroidism and Hashimoto’s:

Blood tests play a crucial role in diagnosing Hashimoto’s and differentiating it from other causes of hypothyroidism (underactive thyroid). Even though there are other thyroid tests that are included in a more comprehensive assessment of the thyroid, these tests are most often associated with Hashimoto’s:

• Thyroid-Stimulating Hormone (TSH): This hormone, produced by the pituitary gland, acts like a conductor, stimulating the thyroid gland to produce thyroid hormones (T4 and T3). In Hashimoto’s, as the thyroid gland becomes damaged, it produces less T4 and T3. This drop in thyroid hormones triggers the pituitary gland to release more TSH in an attempt to stimulate the thyroid and increase hormone production. Therefore, a high TSH level is indicative of hypothyroidism, and elevated TSH is often seen in Hashimoto’s.
• Free Thyroxine (FT4): This test measures the circulating level of the main thyroid hormone, free T4. In Hashimoto’s, due to the damaged thyroid, FT4 levels may be low or borderline low. However, in some early cases, FT4 levels might still be within the normal range.
• Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb): These tests measure antibodies directed against enzymes (TPO and Tg) involved in thyroid hormone production. In Hashimoto’s, the immune system mistakenly attacks the thyroid gland, leading to elevated levels of these antibodies. While not definitive for Hashimoto’s, elevated TPOAb and/or TgAb strongly suggest an autoimmune process affecting the thyroid.
• Free Triiodothyronine (FT3) / reverse Triiodothyronine (rT3) Ratio: FT3 is the active form of thyroid hormone, playing a significant role in metabolism and energy regulation, while rT3 is an inactive form that can block the action of FT3. The FT3/rT3 ratio is particularly useful in assessing tissue-level thyroid hormone activity, as a low ratio may indicate impaired conversion of Thyroxine (T4) to the active FT3, often seen in chronic stress or illness. Monitoring these levels and their ratio can provide deeper insights into thyroid function and guide more precise management of hypothyroidism and Hashimoto’s, beyond the traditional TSH and T4 measurements.

Thyroid Ultrasound as a Tool to Understand Thyroid Inflammation:

Ultrasound of the thyroid is a valuable tool in the evaluation and management of hypothyroidism and Hashimoto’s thyroiditis. It allows precise measurement of thyroid size and can identify the presence of goiters, which are common in these conditions. Additionally, ultrasound can detect characteristic patterns of inflammation and tissue changes consistent with Hashimoto’s, providing crucial information for diagnosis and monitoring. This imaging modality enhances clinical assessment by offering real-time, non-invasive visualization of thyroid abnormalities, aiding in more accurate and effective treatment planning.

Putting the Pieces Together:

Accurately identifying symptoms is crucial in diagnosing thyroid conditions, as they often mimic other disorders. Performing a thorough history and medical exam helps uncover underlying issues and provides context for the symptoms presented. Laboratory tests, including thyroid function tests, offer quantitative data on hormone levels, essential for confirming or ruling out specific thyroid diseases. Additionally, thyroid ultrasounds can detect structural abnormalities, such as nodules or inflammation, ensuring a comprehensive evaluation and accurate diagnosis. Coupling these diagnostic tools, with techniques and concepts in Functional Medicine and Applied Kinesiology allows the clinicians in our office to get to the root cause of the symptoms in our patients.

Gluten, Hypothyroidism, and Hashimoto’s Autoimmune Thyroiditis

Understanding Gluten

Gluten is a protein found in wheat, barley, rye, and triticale (a cross between wheat and rye). It gives bread its doughy texture and helps food maintain its shape. For many people, gluten is harmless, and does not appear to create an inflammatory response. For these individuals, gluten is digested without any problems. However, for individuals with Celiac Disease or gluten sensitivity, gluten can trigger an immune response that leads to increased inflammation throughout other tissues, including the small intestines, brain, thyroid, reproductive tissues, pancreas, and heart to name a few.

Gluten and Hashimoto’s Thyroiditis

The potential link between gluten and Hashimoto’s thyroiditis is a topic of ongoing research, with some studies suggesting a connection that may worsen symptoms or contribute to the development of the disease in some individuals. Some researchers go as far to claim that Hashimoto’s should be renamed Celiac Disease of the thyroid due to the autoimmune response triggered by gluten, which can exacerbate thyroid inflammation and dysfunction. Here’s a closer look at the proposed mechanisms by which gluten might play a role:

Molecular Mimicry: A Case of Mistaken Identity

Our immune system is designed to protect us from foreign invaders like bacteria and viruses. It achieves this by recognizing and attacking molecules specific to these invaders. Unfortunately, in some cases, certain components of our food can resemble these foreign molecules, leading to confusion and mistaken identity. This phenomenon is called molecular mimicry, and it has been tied to autoimmune thyroid concerns for over 40 years.

In the case of Hashimoto’s and gluten, a specific protein in gluten called gliadin shares structural similarities with proteins found in the thyroid gland, particularly thyroglobulin peroxidase (TPO). When the body breaks down gluten, the immune system may mistakenly identify these gliadin fragments as thyroid tissue. This triggers an autoimmune response, where the immune system attacks both the gluten and the thyroid gland, leading to inflammation and damage to thyroid tissue. Molecular mimicry is a common concern with many autoimmune conditions, and is not unique to Hashimoto’s.

Leaky Gut and Gluten Exposure:

The gut lining acts as a barrier separating the inside of our intestines from the bloodstream. It allows for the absorption of essential nutrients while restricting the passage of harmful substances such as metals and chemicals, infections, and undigested food particles. When this barrier weakens and becomes more permeable, a condition known as leaky gut can develop. The leaky gut response allows for particles that would normally be expelled from the body to enter into the blood stream, creating an inflammatory response with the immune system.

Gluten consumption, particularly in individuals with gluten sensitivity, can contribute to leaky gut. This increased permeability allows larger particles, including partially digested gluten and other inflammatory molecules, to pass through the gut lining and enter the bloodstream. Due to the previously discussed concept of molecular mimicry, gluten can then become exposed to an overactive immune system that believes the gluten protein to be a part of the thyroid gland. The immune system then mobilizes a response to increase thyroid antibody activity to fight off the new “thyroid tissue” [gluten] that it found. This triggers a systemic inflammatory response throughout the body, potentially impacting the thyroid gland as more antibodies are generated to fend off the continual bombardment of “thyroid tissue” [gluten] that is being consumed in the daily diet, and worsening Hashimoto’s symptoms.

Leaky gut and molecular mimicry are not limited to gluten, though gluten is the most common trigger that can aggravate the cross-reaction. In the presence of leaky gut, other common foods that can stimulate a similar response to gluten include dairy, corn, soy, nightshades, eggs, and legumes. In addition to food proteins, exposure to heavy metals, chemicals, and microbes such as yeast, fungus, mold, bacteria, and parasites can perpetuate leaky gut issues. Laboratory testing through Cyrex labs can help to identify foods that cross-react through molecular mimicry.

Inflammation as a Result of Gluten Exposure:

Regardless of the mechanism (molecular mimicry or leaky gut), gluten consumption (and other autoimmune stimulants) can trigger inflammation in the body. This inflammation can be localized in the gut or become systemic, affecting various organs and tissues. Chronic inflammation is a hallmark of autoimmune diseases like Hashimoto’s. It can disrupt the delicate balance of the immune system and contribute to the ongoing attack on the thyroid gland.

Studies suggest that a gluten-free diet may help reduce inflammation in some individuals with Hashimoto’s, potentially leading to improved laboratory tests, symptom relief, and overall well-being. However, it’s important to note that research in this area is ongoing, and the benefits of a gluten-free diet may vary depending on individual circumstances. Through specific laboratory testing, we can help identify food and microbe related issues that can contribute to increased immune activation and inflammation in the body.

Additional Considerations When Going Gluten-Free

The exact mechanisms by which gluten might influence Hashimoto’s are still being unraveled though gluten sensitivity appears to have a strong relationship with autoimmunity of the thyroid. More research is needed to fully understand the complex interactions between gluten, the gut microbiome, and the immune system in Hashimoto’s, but starting on a gluten-free diet is a good starting point for many individuals.

It is important to keep in mind that not everyone with Hashimoto’s will benefit from a gluten-free diet. This is one of the values of using specific laboratory testing to identify a wheat or gluten related immune response. The most comprehensive way to evaluate for a wheat/gluten immune response is performed though Cyrex Laboratories.

Understanding the potential connection between gluten and Hashimoto’s can help individuals with this condition have a more informed approach to taking their health into their own hands and implementing dietary modifications. For some individuals, incorporating a gluten-free diet might be beneficial for managing their symptoms, while others may need to investigate additional food or environmental triggers that stimulate a molecular mimicry response within the immune system.

The Best Way to Identify Gluten Intolerance

Diagnosing gluten intolerance involves a combination of blood tests and sometimes an endoscopy with a biopsy. While no single blood test can definitively diagnose gluten intolerance, several tests can help assess the immune response to gluten. The Tissue Transglutaminase IgA (tTG-IgA) test is commonly used for celiac disease, an autoimmune disorder triggered by gluten, but it can also be positive in some individuals with gluten sensitivity. Another set of tests, Deamidated Gliadin Peptide (DGP) IgA and IgG, detect antibodies against deamidated gliadin, a component of gluten.

In some cases, confirming celiac disease may require an endoscopy with a biopsy of the small intestine. During an endoscopy, a thin, flexible tube with a camera is inserted through the mouth to examine the lining of the small intestine. Biopsy samples are then analyzed for damage caused by gluten.

For individuals with Hashimoto’s thyroiditis, testing for gluten intolerance can be particularly valuable. Due to the growing evidence suggesting a link between gluten and autoimmune thyroid disorders discussed earlier, many individuals benefit from testing for gluten sensitivity, even if they are not a classic celiac disease patient. Since gluten can potentially exacerbate the immune response in those with Hashimoto’s, leading to increased thyroid inflammation and dysfunction, testing for the need to avoid gluten is sometimes preferred by patients instead of going gluten-free “just in case.”

For the individuals that would like to know if their body is creating an immune response to wheat and gluten proteins, a more comprehensive approach to diagnosing wheat and gluten issues is the Cyrex Labs Array 3. Unlike traditional tests that primarily focus on celiac disease, the Cyrex Labs Array 3 evaluates a broader range of immune responses to various components of wheat and gluten. This includes tests for multiple gluten proteins, wheat germ agglutinin, and other related peptides. By providing a detailed profile of the body’s reaction to gluten, the Cyrex Labs Array 3 can identify non-celiac gluten sensitivity and other wheat-related disorders that might be missed by conventional testing. This makes it a valuable tool for those with Hashimoto’s who suspect gluten-related issues but do not have classic celiac disease. Identifying and managing gluten intolerance can help reduce autoimmune activity and improve overall thyroid health for these individuals.

Non-pharmaceutical Options to Support Hashimoto’s

Most individuals diagnosed with Hashimoto’s thyroiditis are prescribed synthetic T4 (levothyroxine), even though this does not address the autoimmune component to the condition. There are several non-pharmacological options to support those with Hashimoto’s in order to support the inflammatory and immune related imbalances that are commonly identified. These include dietary modifications to eliminate common inflammatory foods and prevent molecular mimicry, nutritional supplementation, herbal and botanical support, stress reduction, and improved sleep. These adjunct therapies can significantly enhance the quality of life for someone with Hashimoto’s.

Diet and Nutrition Modifications for Hashimoto’s

While research on the specific role of diet in managing Hashimoto’s is ongoing, some dietary changes may be beneficial:

• Gluten-Free Diet: As discussed earlier, eliminating gluten may improve symptoms in some individuals with Hashimoto’s, especially those with concurrent gluten sensitivity. Some individuals prefer to complete an elimination diet, looking for symptomatic improvement through restricting gluten intake. Other individuals prefer to perform laboratory tests to confirm gluten’s role in triggering an immune response before making dietary changes.
• Autoimmune Paleo Protocol (AIP): This elimination diet removes foods commonly associated with inflammation and gut issues. While not specifically designed for Hashimoto’s, it might help identify food triggers that exacerbate symptoms. The AIP diet is sometimes used before laboratory testing looking for molecular mimicry of foods that are gluten-free, but in which your body still reacts to them as if they are gluten containing.
• Focus on Whole Foods: Prioritizing a diet rich in fruits, vegetables, whole grains (if tolerated), lean protein, and healthy fats provides essential nutrients to support overall health and thyroid function. Attempting to consume foods that are high in trace minerals can be a great place to start.
• Consider a Low-Glycemic Index Diet: This approach focuses on foods that release glucose slowly into the bloodstream, potentially helping to regulate energy levels and mood swings. Balancing the effects of blood sugar swings in the diet can also be an effective way to lower inflammation throughout the body.

Nutritional Supplements for Hashimoto’s Thyroiditis

While there’s no magic pill for Hashimoto’s, certain nutritional supplements may offer support by addressing potential nutrient deficiencies and promoting overall thyroid health. However, it’s crucial to discuss supplementation with your doctor before starting any new regimen.

Common Micronutrients for Thyroid Support

• Selenium: This mineral plays a vital role in thyroid hormone metabolism by assisting enzymes that convert inactive T4 to the active form, T3. Studies suggest that selenium deficiency can be associated with autoimmune thyroiditis, and supplementation may improve thyroid function in some individuals with Hashimoto’s. However, high doses of selenium can be toxic, so it’s essential to get your doctor’s guidance on appropriate dosage.
• Zinc: Zinc is another crucial mineral involved in thyroid hormone conversion and immune function. Deficiency can worsen Hashimoto’s symptoms like fatigue and mood swings. Research suggests that zinc supplementation may be beneficial for individuals with Hashimoto’s.
• Vitamin D: Deficiency of vitamin D is quite common and can contribute to fatigue, a prominent symptom of Hashimoto’s. Studies suggest a link between low vitamin D levels and autoimmune diseases like Hashimoto’s. Supplementation with vitamin D may improve mood, energy levels, and overall well-being in individuals with Hashimoto’s who are deficient.
• B Vitamins: B vitamins are essential for energy production, nerve function, and maintaining a healthy metabolism. Research suggests that individuals with Hashimoto’s may have lower levels of certain B vitamins, particularly B12 and folate.
• Tyrosine: This amino acid is a precursor to T4, the main thyroid hormone. Supplementation with tyrosine has been proposed to increase thyroid hormone production.

Herbs and Botanicals for Hashimoto’s Support

• Ashwagandha: This adaptogenic herb is known for its stress-relieving properties. Early research suggests that ashwagandha may help manage stress and improve thyroid function in individuals with Hashimoto’s.
• Licorice Root: Licorice root has potential anti-inflammatory benefits, which might be helpful for Hashimoto’s. However, licorice root can interact with some medications and raise blood pressure. The caveat with this herb is it is important to avoid this herb if you have high blood pressure or are taking medications that can interact with it as some individuals will have a negative reaction to licorice.
• Coleus Forskohlii: This herb is believed to stimulate thyroid function and may support the production of thyroid hormones. It has been traditionally used to support metabolic health and may be beneficial for individuals with Hashimoto’s experiencing sluggish thyroid activity.
• Guggul: Guggul has been shown to have anti-inflammatory and thyroid-stimulating properties. It may help improve thyroid function and reduce inflammation in individuals with Hashimoto’s. Guggul also supports healthy cholesterol levels and overall metabolic health.
• Black Cumin Seed: Black Cumin Seed has been traditionally used for its medicinal properties, including anti-inflammatory, antioxidant, and immune-modulating effects. For individuals with Hashimoto’s thyroiditis, black cumin seed may offer several benefits.

Consulting your doctor before starting any new supplements or herbs is essential to ensure they meet your individual needs, avoid potential interactions, and determine appropriate dosages. A comprehensive medical history, physical exam, laboratory testing, and consulting with a health care provider that in knowledgeable in functional medicine can help pinpoint nutrient imbalances that targeted supplements can address. A diet rich in fruits, vegetables, whole grains (if tolerated), and lean proteins is crucial for optimal nutrition, with supplements serving to correct specific deficiencies, not replace a healthy diet. The effectiveness of supplements and herbs in managing Hashimoto’s depends on factors such as disease severity, medication use, and overall health.

Lifestyle Modifications for Thyroid Patients

Healthy lifestyle habits can significantly impact overall well-being and potentially improve symptoms of Hashimoto’s. Even though many of the following recommendations are discussed in the context of Hashimoto’s autoimmune thyroiditis, they are valuable tools for anyone looking to improve their overall wellbeing.

• Stress Management: Chronic stress can significantly impact the progression and severity of Hashimoto’s thyroiditis. The body’s stress response, driven by cortisol and other hormones, can disrupt immune function and exacerbate inflammation, both of which are critical factors in autoimmune conditions like Hashimoto’s. Adopting stress management techniques such as yoga, meditation, or deep breathing exercises can help mitigate these effects by promoting relaxation and reducing cortisol levels. These practices not only aid in stress reduction but also support overall immune health, potentially alleviating symptoms and improving the body’s ability to manage autoimmune responses.
• Regular Exercise: Engaging in regular exercise is essential for individuals with Hashimoto’s thyroiditis to enhance energy levels, mood, and overall physical well-being. Moderate-intensity exercise, performed most days of the week, can help regulate immune function, reduce inflammation, and improve metabolic health—all of which are beneficial for managing autoimmune conditions like Hashimoto’s. Exercise promotes the release of endorphins, which can elevate mood and reduce stress, further supporting mental and emotional resilience. Additionally, maintaining a consistent exercise regimen can contribute to weight management efforts, which is crucial as obesity can exacerbate symptoms of Hashimoto’s thyroiditis.
• Maintain a Healthy Weight: Achieving and maintaining a healthy weight through a balanced diet and regular exercise is crucial for managing Hashimoto’s thyroiditis effectively. Obesity and excess weight can contribute to inflammation and insulin resistance, both of which can exacerbate autoimmune activity and thyroid dysfunction. By adopting a nutrient-dense diet that supports thyroid function and immune health—such as one rich in fruits, vegetables, lean proteins, and healthy fats—individuals can help mitigate symptoms and optimize overall well-being. Combined with regular physical activity, which aids in weight management and metabolic health, maintaining a healthy weight supports optimal thyroid function and may reduce the severity of Hashimoto’s symptoms over time.
• Quality Sleep: Adequate sleep is fundamental for individuals with Hashimoto’s thyroiditis as it plays a vital role in hormone regulation, immune function, and overall health. During sleep, the body repairs tissues and balances hormone levels, including those involved in thyroid function and immune response. Getting 7-8 hours of quality sleep per night supports these processes, helping to optimize thyroid hormone production and mitigate autoimmune activity. Sleep deprivation, on the other hand, can disrupt these delicate balances, potentially worsening symptoms of Hashimoto’s. Establishing a regular sleep schedule, creating a calming bedtime routine, and ensuring a comfortable sleep environment are essential strategies for promoting restorative sleep and enhancing overall well-being.

Hashimoto’s thyroiditis is a complex autoimmune condition. While there’s no single solution, a combination of traditional and functional medicine approaches can be beneficial to those with symptoms. Dietary changes, nutritional support, herbal supplementation, and healthy lifestyle habits can significantly improve well-being and manage symptoms. A comprehensive approach to patient care allows the clinicians at The Hayden Institute to support the individual needs of the patients that come to our office for hypothyroidism, Hashimoto’s and gluten related concerns. We look forward to helping you achieve the level of health you deserve.