Functional Medicine for Hashimoto's Thyroiditis

What is Hashimoto's thyroiditis?

Your thyroid is a gland in the front of your neck that makes thyroid hormone. In Hashimoto's, the immune system makes antibodies that attack the thyroid. Large numbers of white blood cells, which are part of the immune system, also build up in the thyroid. Over time, the gland can become damaged and may not make enough hormone. This is called hypothyroidism, or an underactive thyroid. Rarely, Hashimoto's causes an overactive thyroid instead.^{1, 2}

Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body, even the way your heart beats. Your thyroid is controlled by a gland in your brain called the pituitary gland. The pituitary makes thyroid-stimulating hormone (TSH), which tells your thyroid how much hormone to make. If the thyroid hormone level in your blood is too low, the pituitary makes more TSH to tell your thyroid to work harder.^{1, 4}

Hashimoto's is also called chronic lymphocytic thyroiditis or autoimmune thyroiditis. It often develops slowly, over many years. Some people have the antibodies for a long time before their hormone levels change.^{1, 2}

It is 4 to 10 times more common in women than in men. It more often develops in women ages 30 to 50 than in teens or young women, but it can start at any age, including in childhood. It often runs in families. People with other autoimmune conditions, such as celiac disease, lupus, rheumatoid arthritis or type 1 diabetes, are also more likely to develop it. The exact cause is not known. Several factors may play a role, including genes and viruses such as hepatitis C.^{1, 2}

Common symptoms of Hashimoto's

Many people have no symptoms at first. Some people notice a goiter, which is an enlarged thyroid. A goiter can cause swelling, fullness or a feeling of pressure in the neck, and sometimes trouble swallowing. It is usually not painful.^{1, 2}

When the thyroid does not make enough hormone, symptoms can include:^{1, 3}

• Tiredness (fatigue)^{1, 2}
• Weight gain^{1, 2}
• Feeling cold more easily than others^{1, 3}
• Constipation^{1, 2}
• Dry skin and thinning hair¹
• Joint and muscle aches^{1, 2}
• Low mood or depression^{2, 3}
• Heavy or irregular periods, or trouble getting pregnant¹
• A slow heart rate^{1, 3}

How Hashimoto's is diagnosed and treated

Diagnosis starts with your medical history and a physical exam, including a check of your neck for a goiter. Blood tests measure thyroid-stimulating hormone (TSH), thyroid hormones such as T4, and thyroid antibodies. Most people with Hashimoto's have thyroid peroxidase (TPO) antibodies. A thyroid ultrasound is sometimes used as well.^{1, 2}

An underactive thyroid shows up on blood tests as a high TSH level, with or without a low T4 level. A TSH test shows how well your thyroid is working, but it can't show what is causing a problem. Thyroid antibody tests help diagnose an autoimmune thyroid condition, such as Hashimoto's. Hashimoto's can be diagnosed even if you have no symptoms, when your thyroid antibody levels are high but your thyroid hormone levels are normal.^{2, 4}

Not everyone with Hashimoto's needs medicine right away. If your thyroid hormone levels are normal, your doctor may simply check them over time. Left untreated, hypothyroidism can lead to other health problems, such as high cholesterol, heart disease, heart failure and high blood pressure. It can also cause problems during pregnancy. If you develop hypothyroidism, the recommended treatment is levothyroxine, a medicine identical to the natural thyroid hormone T4. It has been prescribed as a pill for many years and is now also available as a liquid and a soft gel capsule. These newer forms may help people with digestive problems that affect how the pill is absorbed. Most people with hypothyroidism from Hashimoto's need treatment for life.^{1, 2}

Your dose is adjusted based on blood tests, which are repeated after starting or changing a dose and then on a regular schedule. Too little medicine can leave you with symptoms. Too much can cause serious problems, such as an irregular heartbeat called atrial fibrillation, or bone thinning (osteoporosis). This is why regular follow-up with your endocrinologist (a doctor who specializes in hormone problems) or the doctor who manages your thyroid matters.^{1, 2, 5, 6, 7}

How our care fits alongside your endocrinologist

Avicenna Functional Medicine does not replace your endocrinologist, your primary care doctor, or the thyroid medicine they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as gut health, nutrition, environmental exposures and immune regulation, alongside the care you already receive. Our aim is to understand the whole picture of your health and to support your overall wellbeing.¹

Please do not stop or change your thyroid medicine, or any other prescribed medication, without talking to the doctor who prescribed it. Some foods and supplements, such as multivitamins with iron or calcium, can affect how well levothyroxine is absorbed. High-iodine products, such as kelp and iodine supplements, may cause hypothyroidism or make it worse. Researchers are still studying how diet and supplements, such as vitamin D and selenium, may affect Hashimoto's, and there is no specific guidance yet. Check with your doctor before starting a new supplement.¹

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Contact your doctor if you have symptoms of an underactive thyroid. If you are already being treated, contact them if you have chest pain or a fast heartbeat, if your symptoms get worse or do not improve, or if you notice new symptoms.³

Rarely, very low thyroid hormone levels can lead to myxedema coma. This is a life-threatening emergency that needs hospital care. It can be set off by an infection, illness, cold exposure, certain medicines such as opioids, or missed thyroid medicine. Call 911 right away for warning signs such as a low body temperature, slow breathing, unusual moods or behavior, or being unresponsive.^{1, 3, 8}

Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:⁸

• Chest pain or pressure that lasts two minutes or more⁸
• Trouble breathing or shortness of breath⁸
• Sudden confusion, unusual behavior or trouble waking up⁸
• Fainting or passing out⁸
• Sudden dizziness, weakness or changes in vision⁸
• Being unable to speak⁸
• Severe belly pain, or sudden severe pain anywhere in the body⁸
• Coughing up or vomiting blood⁸
• Thoughts of suicide or of harming someone else (you can also call or text 988)⁸