In this article:
Hypothyroidism and Hashimoto’s affect millions of people worldwide – and yet almost half are undiagnosed. In this article you’ll learn about causes and risk factors, symptoms and possible complications. And since 90% of hypothyroidism cases are caused by Hashimoto’s disease – an auto-immune condition, that’s what we’ll discuss here. Although there’s no official cure for Hashimoto’s, it can certainly be managed to the extent of full recovery.There are many factors that play a role in the development of Hashimoto’s including genetic and environmental factors.
Hashimoto’s Causes and Risk Factors
Autoimmune diseases can attack anybody. However, there is a high risk population that can be affected with it – women, and typically appears after giving birth. Autoimmune diseases are also common in people experiencing high physical or emotional stress. It appears in periods of hormonal changes and may even appear after accidents. Autoimmune diseases also run in families. If your immediate family members are affected with it, you may be at higher risk of acquiring an autoimmune illness.
In Hashimoto’s patients family history of thyroid disorders is common, with the HLA-DR5 gene most strongly implicated. The cause of Hashimoto’s is thought to be a combination of a genetic predisposition along with an environmental trigger that starts the process of autoimmune destruction. Some scientists think a virus or bacterium might trigger the immune response. Additional factors including gender and age also play a role in developing this disorder.
Normally, the immune system acts to protect against viruses, bacteria, and foreign substances (antigens) that invade the body. In instances of autoimmune disease, the immune system mistakenly attacks parts of the body itself. In the case of Hashimoto’s disease, the immune system attacks the thyroid gland. The autoimmune process causes inflammation of the thyroid gland (thyroiditis), resulting in an impaired ability of the thyroid gland to produce hormones, leading to hypothyroidism. The pituitary gland responds by increasing TSH and attempting to stimulate the thyroid gland to produce more thyroid hormones. This can cause growth of the gland, or a goiter.
Bacterial Infections That Jumpstart the Auto-Immune Process
In 2001 the journal Clinical Microbiology and Infection published a study that seemed to demonstrate a link between the bacteria Yersinia enterocolitica and Hashimoto’s disease. From a total study group of 785 people, 71 had Hashimoto’s disease, 250 had non-postinfectious rheumatic disorders and 464 were healthy. The study groups were tested for class- specific antibodies to Yops Yersinia (plasmid-encoded outer proteins).
The prevalence of class-specific antibodies to Yops was 14 times higher (20 of 71; 28.2%) in people with Hashimoto’s thyroiditis than in the two control groups. The study concluded that “There is strong clinical and seroepidemiologic evidence for an immunopathologic causative relationship between Yersinia enterocolitica infection and Hashimoto’s thyroiditis”.
This seemed to confirm an earlier study from Japan which also indicated an association between thyroid autoimmune disease and antibodies to Yersinia enterocolitica. The disease, however, has been linked with several different infections, including hepatitis C, EBV, and HTLV-1.
Excessive Fluoride Intake
In the U.S. about 70% of public water supplies are fluoridated. And while some countries with high natural fluoride levels in the water like China and India are taking measures to remove fluoride from their water because of the health problems that fluoride can cause, US is adding it to the public water supplies. Read about the damaging effects of water fluoridation here.
Numerous studies have shown that fluoride exposure can impact thyroid function. Up through the 1950s, doctors in Europe and South America prescribed fluoride to reduce thyroid function in patients with over-active thyroids (hyperthyroidism).
In February 2015, British scientists reported that fluoridated water in Britain is associated with elevated rates of hypothyroidism. Supporting the fluoride/hypothyroidism connection are a number of studies from China, India, and Russia that have found alterations in thyroid hormones, including reduced T3 and increased TSH, in populations exposed to elevated levels of fluoride in the workplace or in the water.
Too Much or Too Little Iodine
The healthy thyroid needs the right amount of iodine in order to function properly. Too much or too little iodine can cause hypothyroidism.
Other causes of hypothyroidism include:
- radiation therapy in cancer patients
- treatment for hyperthyroidism which can result in permanent hypothyroid condition
- medications like the ones used in treating psychiatric disorders
- removal of the thyroid gland that results in permanent hypothyroidism
- congenital disease (in rare cases)
- pregnancy (abnormality in hormones)
- pituitary disorders that may result in the hyposecretion of hormones
The Auto-Immune Disease – Gut Connection
Most doctors nowadays want you to believe that treating hypothyroidism is as simple as taking a pill every day. The body doesn’t really work that way. There’s always a reason behind a condition and there are many different factors that affect the health of your thyroid. Even though your hypothyroidism might have been caused by one initial problem, that one problem quickly creates a domino effect and before you know it, you could be dealing with a number of problems that all need to be fixed in order to heal your thyroid.
Your gut wall houses 70 percent of the cells that make up your immune system. The leaky gut syndrome is a name given to a very common health disorder in which the basic organic defect is an intestinal lining which is more permeable (porous) than normal. The abnormally large spaces present between the cells of the gut wall allow the entry of toxic material into the blood stream that would, in healthier circumstances, be repelled and eliminated.
You might think you don’t have leaky gut because you have no digestive problems. The truth is if you have Hashimoto’s, you do have a problem within your digestive system. You might not realize it but there is a connection between your thyroid and your digestive system, and a food intolerance can also present with inflammation in the joints, skin, respiratory tract and brain, without any obvious gut symptoms.
The gut becomes leaky in the sense that bacteria, fungi, parasites and their toxins, undigested protein, fat and waste normally not absorbed into the bloodstream in the healthy state, pass through a damaged, hyperpermeable, porous or “leaky” gut. This can be verified by special gut permeability urine tests, microscopic examination of the lining of the intestinal wall as well as the bloodstream with phase contrast or darkfield microscopy of living whole blood.
The leaky gut syndrome is almost always associated with autoimmune disease and reversing autoimmune disease depends on healing the lining of the gastrointestinal tract. Any other treatment is just symptom suppression.
Physicians are increasingly recognizing the importance of the gastrointestinal tract in the development of allergic or autoimmune disease. Understanding the leaky gut phenomenon helps us with safe and effective therapies to bring the body back into balance. Due to larger than normal spaces between the cells of the gut wall, larger than usual protein molecules are absorbed before they have a chance to be completely broken down as occurs when the intestinal lining is intact.
The immune system starts making antibodies against these larger molecules because it recognizes them as foreign, invading substances. The immune system starts treating them as if they had to be destroyed. Antibodies are made against these proteins derived from previously harmless foods. Human tissues have antigenic sites very similar to those on foods, bacteria, parasites, Candida or fungi.
The antibodies created by the leaky gut phenomenon against these antigens can get into various tissues and trigger an inflammatory reaction when the corresponding food is consumed or the microbe is encountered.
Autoantibodies are thus created and inflammation becomes chronic. If this inflammation occurs at a joint, autoimmune arthritis (rheumatoid arthritis) develops. If it occurs in the thyroid gland, autoimmune thyroditis is the result. If it occurs in the brain, myalgic encephalomyelitis (a.k.a. chronic fatigue syndrome) may be the result. If it occurs in the blood vessels, vasculitis (inflammation of the blood vessels) is the resulting autoimmune problem. If the antibodies start attacking the lining of the gut itself, the result may be colitis or Crohn’s disease. If it occurs in the lungs, asthma is triggered on a delayed basis every time the individual consumes the food which triggered the production of the antibodies in the first place. It is easy to see that practically any organ of the body tissue can become affected by food allergies created by the leaky gut. Symptoms, especially those seen in conditions such as chronic fatigue syndrome, can be multiple and severely debilitating.
For example, Hashimoto’s sufferers are often advised to eliminate gluten from their diet. Several studies show a strong link between autoimmune thyroiditis (both Hashimoto’s and Graves’) and gluten intolerance. The link is so well-established that researchers suggest all people with thyroiditis be screened for gluten intolerance, and vice versa. What explains the connection? It’s a case of mistaken identity.
The molecular structure of gliadin, the protein portion of gluten, closely resembles that of the thyroid gland. When gliadin breaches the protective barrier of the gut, and enters the bloodstream, the immune system tags it for destruction. These antibodies to gliadin also cause the body to attack thyroid tissue. One reason gluten intolerance goes undetected in so many cases is that both doctors and patients mistakenly believe it only causes digestive problems. But gluten intolerance can also present with inflammation in the joints, skin, respiratory tract and brain – without any obvious gut symptoms.
Most common symptoms include:
- Modest weight gain
- Cold intolerance
- Excessive sleepiness
- Dry, coarse hair
- Dry skin
- Muscle cramps
- Increased cholesterol levels
- Decreased concentration
- Mental fog
- Aches and pains
- Swelling of the legs
- Blurred vision
- Paresthesia (a sensation of tickling, tingling, burning, pricking, or numbness of a person’s skin)
As hypothyroidism becomes more severe, there may be puffiness around the eyes, a slowing of the heart rate, a drop in body temperature, and heart failure. In its most profound form, severe hypothyroidism may lead to a life-threatening coma (myxedema coma). In a severely hypothyroid individual, a myxedema coma tends to be triggered by severe illness, surgery, stress, or traumatic injury. This condition requires hospitalization and immediate treatment with thyroid hormones given by injection.
There are some patients who may undergo a hyperthyroid phase (too much thyroid hormone), called hashitoxicosis, before eventually becoming hypothyroid. For others, things may return to normal for a period of time (as was in my case) after the initial onset of symptoms, followed by hypothyroidism. Other symptoms and signs include:
- Swelling of the thyroid gland (due to the inflammation), leading to a feeling of tightness or fullness in the throat
- A lump in the front of the neck, (the enlarged thyroid gland) called a goiter
- Difficulty swallowing solids and/or liquids due to the enlargement of the thyroid gland with compression of the esophagus
Hashimoto’s and Other Diseases
Another important reason to address the root cause of Hashimoto’s is the fact that if you have one auto-immune disease you’re likely to develop more. Hashimoto’s often coexists with other autoimmune diseases and conditions, including: Sjogren syndrome, rheumatoid arthritis, Systematic Lupus (SLE), type 1 diabetes (T1D), celiac disease, rheumatoid arthritis, multiple sclerosis (MS), vitiligo, ataxia (memory loss), encephalopathy (stroke-like episodes, myoclonus, and cognitive impairment), and it confers an increased risk of lymphoma. This means that if you have Hashimoto’s, you have a greater risk of developing one of these conditions because of your malfunctioning immune system.
A number of other health problems may result as a complication of hypothyroidism. This includes heart problems, goiter, myxedema coma, birth defects, mental health issues, and infertility. That’s why an early diagnosis is essential so that you can begin treatment immediately and lower your risk for complications.
Heart – Thyroid hormones, notably triiodothyronine (T3), affect the heart directly and indirectly. They are closely linked with heart rate and heart output. T3 provides particular benefits by relaxing the smooth muscles of blood vessels. This helps keep the blood vessels open so that blood flows smoothly through them.
Unhealthy cholesterol levels – Hypothyroidism raises levels of total cholesterol, LDL (the so-called bad cholesterol), triglycerides, and other lipids (fat molecules) associated with heart disease. Treating the thyroid condition with thyroid replacement therapy can significantly reduce these levels.
Mild high blood pressure – Hypothyroidism may slow the heart rate to less than 60 beats per minute, reduce the heart’s pumping capacity, and increase the stiffness of blood vessel walls. All of these effects may lead to high blood pressure. Indeed, patients with hypothyroidism have triple the risk of developing hypertension. All patients with chronic hypothyroidism, especially pregnant women, should have their blood pressure checked regularly.
Heart failure – Hypothyroidism can affect the heart muscle’s contraction and increase the risk of heart failure in people with heart disease.
The evidence for subclinical hypothyroidism and heart disease is mixed. Some studies suggest that subclinical hypothyroidism increases the risks for coronary artery disease and heart failure. The only randomized controlled trial dealing with subclinical hypothyroidism and heart disease evaluated only the thickness of atherosclerosis in the blood vessels and not whether patients actually had clinical heart disease. Many doctors believe that treatment of subclinical hypothyroidism will not help prevent or improve heart problems. More research is underway.
Depression is common in hypothyroidism and can be severe. Hypothyroidism should be considered as a possible cause of any chronic depression, particularly in older women.
Mental and Behavioral Impairment – Untreated hypothyroidism can, over time, cause mental and behavioral impairment and, eventually, even dementia. Whether treatment can completely reverse problems in memory and concentration is uncertain, although many doctors believe that only mental impairment in hypothyroidism that occurs at birth is permanent.
Pregnancy and Infertility – In premenopausal women, early symptoms of hypothyroidism can interfere with fertility. A history of miscarriage may be a sign of impending hypothyroidism. (A pregnant woman with hypothyroidism has a fourfold risk for miscarriage.) Studies suggest that even if thyroid levels are normal, women who have a history of miscarriages often have antithyroid antibodies during early pregnancy and are at risk for developing autoimmune thyroiditis over time.
Other Health Effects – The following medical conditions have been associated with hypothyroidism. Often the causal relationship is not clear in such cases:
- Iron deficiency anemia
- Respiratory problems
- Kidney function
- Glaucoma (Some research has associated hypothyroidism with an increased risk for glaucoma.)
- Headache (Hypothyroidism may worsen headaches in people predisposed to them.)
- Thyroid lymphoma. (Patients with Hashimoto’s thyroiditis are at higher risk for this rare form of cancer.)