If I were to poll my readers to see how many of you have been diagnosed with Hashimoto's hypothyroid, or underactive thyroid, I’d guess it would be more than just a few. I’ve been curious about this condition ever since I was diagnosed with it a few years back, and it turns out that I have quite a bit of company.
An estimated 5% of the population, mostly women over 50, have been diagnosed with hypothyroidism. Millions more have some form of thyroid disease but are unaware of it.
The most common form of hypothyroid is Hashimoto’s thyroiditis. It's also the most common autoimmune disease in humans. Interestingly, among men, only 2.2 per 100,000 men per year are diagnosed. Among women, it’s 498 per 100,000 women per year. There’s some thought that it’s linked to leptin, a hormone made by fat cells.
What is Hypothyroidism?
The thyroid is a small gland in your neck. It produces hormones that regulate many of your body’s functions. When it produces too little hormone, the body’s processes slow down, which leads to a wide range of symptoms including:
- Weight gain
- Feeling cold intolerant
- Muscle cramps or carpal tunnel syndrome
- Sexual dysfunction
- Problems sleeping
- Dry skin and hair
- Memory problems
- High cholesterol
Hashimoto’s hypothyroidism is more common in people with a family history, of autoimmune disorders like celiac disease, type 1 diabetes or lupus. It sometimes occurs after pregnancy, or after a viral infection. Your risk also increases with menopause.
The thyroid requires iodine from the diet to make hormones, so an iodine deficiency can also cause hypothyroidism. However, that’s fairly rare in the US.
Diagnosis and Treatment
The tricky thing about hypothyroid (whether it’s autoimmune or not) is that the symptoms can be related to so many other things. Weight gain, depression, feeling tired, problems sleeping can be caused by stress, diet, or just aging, so unless your doctor does specific thyroid tests, it can go undiagnosed for a long time.
Here’s what they’ll look for:
- Thyroid-stimulating hormone (TSH) - this tells your body how much thyroid hormone to make. If it’s high, that means your thyroid isn’t making enough hormones, so it keeps cranking out TSH, and the levels build up in your blood. This is usually the first test most doctors do to check your thyroid function.
- Free T3 and Free T4 –These are your two main thyroid hormones. Low levels of one or both signal an underactive thyroid.
- Thyroid antibodies – if you have Hashimoto’s (autoimmune) hypothyroidism, you’ll have high antibodies. With an autoimmune disease, your body attacks healthy cells, and in this case, it’s attacking thyroid cells.
The good news is that there is an effective treatment in the form of synthetic thyroid hormone medication – usually levothyroxine or Synthroid. The medication is the same whether it’s an autoimmune condition or not. The bad news is that you’ll have to take it forever – and have your thyroid levels checked regularly to make sure your dose doesn’t need tweaking.
Diet and Alternative Therapies
Even if your doctor prescribes synthetic thyroid hormones, there are some things you can do in terms of your diet, lifestyle, and supplements, if needed, that can provide complementary treatment and support a healthy thyroid.
Eat a healthy, plant-forward diet, but keep it consistent. Try to avoid eating huge amounts of raw cruciferous vegetables like kale, arugula, broccoli, Brussels sprouts and cauliflower – that goes for those green smoothies too. Cruciferous vegetables have lots of health benefits, so they shouldn’t be eliminated, but they do contain compounds called goitrogens, that may interfere with the thyroid’s ability to make hormones from iodine, so you probably shouldn’t eat excessive amounts at any one time.
Cooking them reduces the amount of the goitrogenic compounds, and an average size serving even a few times each week is usually fine, as long as your thyroid hormone levels remain consistent.
Cut out gluten. I'm not one to jump on the gluten-free bandwagon, but I've read enough research to get behind this one. It seems that for people susceptible to autoimmune diseases, gluten can be a trigger because it increases inflammation. Studies on women with Hashimoto's who eliminate gluten suggest that it does help the thyroid to work better. It can also help your thyroid meds to be more effective. Gluten is a term for the proteins in any type of wheat, rye, or barley-based food. Oats are gluten-free, but they're often cross-contaminated with gluten.
Exercise can help keep everything in your body working better and prevent weight gain, fatigue and depression, whether it’s the result of an underactive thyroid, or just getting another year older. Aim to get at least 30-45 minutes of heart-pumping exercise most days of the week.
The minerals iodine, zinc, copper, and selenium are important for normal thyroid function, but taking these as individual supplements can lead to toxicity. Vitamins and minerals have to work together and in the right doses to be effective. I like this Thyroid Energy Supplement by NOW Foods. It’s got a nice blend of all of the thyroid support nutrients.
In addition, make sure you eat lentils, chickpeas, cashews and pumpkin seeds for zinc and copper, and fish or just one Brazil nut a day for selenium. The average American diet has adequate amounts of iodine, but if you don’t eat any iodized salt or processed foods, try to include some sea vegetables like seaweed, kombu or wakame, which are all rich in iodine.
Manage your stress. Stress is a major precipitating factor in many autoimmune diseases, including Hashimoto’s. When you’re under chronic stress, your body is constantly struggling to stay afloat. It’s pretty good at making things run well, but sooner or later, something has to give.
Stress management includes saying NO to things that don’t serve you; making time for self-care, like a night out with friends, a mani-pedi, or just a movie and a cup of tea whenever you need it. I also find mind-body therapies, like yoga, meditation, or a massage extremely helpful – especially if you do them regularly.
I’m also a huge fan of adaptogenic herbs. They’re an Ayurvedic treatment, used for thousands of years, that strengthens your immune system and helps your body adapt to any kind of stressors. My personal favorites are Holy Basil (also known as Tulsi) tea – 1-2 cups per day, and Ashwagandha. Look for one that provides a standardized amount of the active ingredient.
Things to Know About Thyroid Medication
If you take medication to correct an underactive thyroid, be sure to take it on an empty stomach – at least 30 minutes before breakfast, or 4 hours after dinner if you’re a night owl. It’s best absorbed when taken with water and be aware that coffee (especially espresso) and soy products may interfere with absorption, so don’t drink or eat them too close to the time you take your medication.
Also, if you take a calcium supplement, multivitamin with iron, or magnesium-containing antacid, don’t take it along with your thyroid medication.
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