Help with Hashimoto’s Thyroidiitis: where to start

Do you need help with Hashimoto’s Thyroiditis?  Are feeling overwhelmed and don’t know where to start or what to do first?

With so much conflicting information, it can be confusing and overwhelming to figure out what to do to first.  Here is what I recommend if you don’t know where to start. 

autoimmune thyroid hashimotos

It is scary, overwhelming and very lonely when you are diagnosed with an autoimmune condition. After the initial shock wears off, most patients (and I did too) search on the internet for help, support, and solutions on what they can do to deal with the autoimmune condition. 

When I did this, I was so overwhelmed with information that I felt even more confused on what I should do and where to start.  There as so much to read up on, and so much that I can and should do, that I just didn’t know what to do first.  And my response?  I shut down.  For about another six months I did nothing but drink the thyroid hormone pills.  My symptoms of fatigue, weight gain, sleeplessness, brain fog, memory loss, and feelings of hopelessness continued.  And then I decided to just start somewhere.

So, if you are in a situation where you don’t know where to start, here are the steps or levels that I recommend.  My goal is that it gives you structure and guidance in your healing journey.

Level 1: Get your thyroid hormones optimised

The first step is to get your thyroid hormones at the right level for what your body needs.  Your doctor most likely did the full thyroid panel blood tests, including the thyroid antibodies, when you were diagnosed.  The full thyroid panel test includes TSH, Total T4, Free T3, Free T3, Tg antibodies and TPO antibodies.

When looking at the results, the “normal” ranges from the lab is usually too wide.  I strongly recommend that you work with a functional medicine doctor who will be using a different range, which is often also much narrower than the “normal” range. 

If you need to change your level of medication, do it in small increments and always with the knowledge of your doctor.  Remember that the medication is a hormone, and big changes can cause havoc in your body. Do the thyroid blood tests (TSH, Free T4 and Free T3) every three months until these are in the optimal range.

Also, speak with your doctor about taking a T4/T3 combination medication, T3 medication only or NDT. You may need to try out different medication to see which one works best for you.

Level: Replace nutrient deficiencies

The next level is to replace deficiencies. Vitamins, minerals, and phytonutrients play an important role in so many of our bodies’ biological processes, and a deficiency can severely hamper many processes. This is what I recommend to start taking next, as it is easy to implement and doesn’t require much effort from your side.

The following are the most important vitamins and minerals that I recommend you check and take a supplement for if needed.  Where there are other supplements that are also important, these are ones I recommend you start with:

  • Vitamin D plays an important role in modulating (regulating or balancing) the immune system and it helps to reduce antibodies if you are taking T4 hormone medication.  It is fat-soluble, so whatever you ingest stays in your body. It is therefore important to do a blood test to check your vitamin D levels before you start taking a supplement. Blood serum should be between 50 to 80 ng/ml.  Make sure it is a vitamin D3 cholecalciferol supplement (not vitamin D2 ergocalciferol) as it is more bio-available.
  • Iron and Ferritin are then the next minerals to check. Iron is a mineral that is present in the blood cells that carries oxygen to the cells of the body, while ferritin is the protein in which iron is stored. It is important to check both levels. If ferritin is low, you could have an iron deficiency. If iron is low, it could be due to a vitamin B12 or folate deficiency. If ferritin is too high, it may indicate an iron storage disorder such as hemochromatosis. It is also possible to have high levels of ferritin with low levels of iron. Ferritin can also increase due to inflammation, but have low iron levels due to a deficiency. Always do a blood test first before supplementing with iron.
  • Magnesium is called the mighty mineral, as it is an essential mineral and electrolyte that is used in more than 300 biochemical processes in the body. I believe that most people are deficient and magnesium and can benefit from taking a magnesium supplement. Luckily you don’t have to do a blood test first before starting to take a magnesium supplement. There are different types of magnesium, so you may need to check which type will work best for your body. Take your magnesium at bedtime, and do not take it at the same time as you take your thyroid hormone medication as magnesium blocks the absorption of thyroid hormones.
  • Omega-3 is anti-inflammatory and can even stop inflammation from occuring.  Look for high-quality fish oil that contains both EPA and DPA (two types of omega-3).  Do not take an omega-3 supplement if you are taking blood thinners or you have a bleeding disorder. 
  • Glutathione or NAC is a powerful antioxidant.   Glutathione also supports liver enzymes to break down mould toxins and heavy metals.  NAC (N-acetyl cysteine) is converted into glutathione in the body. If you rather take a glutathione supplement, make sure it is liposomal glutathione, which is not destroyed in your gut. 
  • Selenium plays an important role in metabolism, detoxification, and conversion of thyroid hormones from T4 to T3. If you have a deficiency, you may experience anxiety, fatigue, and depression.  
  • Zinc is anti-inflammatory, helps with detoxing, and helps with the conversion of T4 to T3 hormones.  People are at risk of being deficient in zinc include vegans, vegetarians, women who are taking birth control pills or who are receiving hormone replacement therapy, or people who struggle with digestive issues.  Stress and certain medications can also impact zinc levels.  Be aware that supplementing with zinc could lead to a deficiency in iron levels. 

The other supplements that you can also consider are the following:

  • Betaine with pepsin to help provide sufficient stomach acid, support liver function, and detoxification.
  • Vitamin B1 (thiamine) is responsible for converting carbohydrates into energy and digestion of proteins and fats.  Avoid taking benfothiamine, as it is fat-soluble (excess are not excreted) and you may risk overdosing on it. 
  • Vitamin B12 helps to produce red blood cells and DNA, and also helps with digestion.  
  • Vitamin E plays an important role in the immune system, and it works with selenium to help convert T4 to T3 hormones.  Stick to a maximum daily dose of 268 gm.  

Level 3: Remove inflammatory food from your diet

The next area of focus is your diet.  What we eat has a huge impact on our overall energy and health.  At this level, the focus is to remove the foods that contribute to inflammation in the body. 

Wondering which foods are highly inflammatory?  Here is my recommendation:

  1. Gluten.  Gluten is a group of proteins that are found in wheat, barley, rye and triticale. Gluten has an effect on the gut lining, leading to leaky gut, which can activate the immune system. Many foods contain gluten, including bread, pasta, cakes, pastries, and even chocolates! Most processed foods contain gluten, so it is important to start reading labels. Or even better, avoid processed foods altogether.  Be careful of gluten-free packaged food, as many of these contain other ingredients such as soy and added sugar. It may be gluten-free but loaded with other ingredients, often sugar.
  2. Dairy (that is all dairy, including cheese, yogurt and all milk products and products that contain milk).
  3. Soy and soy products, including tofu, edamame, tempeh, miso, tamari, and bean curd.  Soy is goitrogenic (it reduces thyroid function) and most soy is genetically modified, which impacts gut health. 
  4. Sugar (this is the obvious sugar – all the sugar you add to your coffee, other drinks, and food.)
  5. Artificial sweeteners (no aspartame, saccharin, sucralose, or acesulfame).  If you really must use a sweeter, consider small amounts of honey, xylitol, stevia, or erythritol.
  6. Processed foods are often loaded with soy, sugar, salt and inflammatory trans fats and partically hydrogenated oils.  
  7. Nightshade vegetables, including white potatoes, tomatoes, bell peppers and hot peppers, and the spices made with these peppers, such as paprika.
  8. Anything with the word “diet” or “lite” on it, including diet soda, “lite” foods, low-fat and fat-free products, as these are often heavily processed. 
  9. Alcohol.  Alcohol is often high in sugar and some beverages are made from wheat and barley products.  If you must have some alcohol (at social events), enjoy a low-sugar wine, and stick to one glass per day.  
  10. Foods rich in iodine.  The thyroid gland uses iodine to produce thyroid hormones, but if you have thyroid antibodies, by taking additional iodine you can make yourself worse.  
  11. Legumes, including peas, chickpeas, lentils, peanuts, and all the different types of beans.
  12. Coffee.  Coffee beans are sprayed with herbicides to protect crops, and may also have mould from storage.  Buy organic coffee if you must have your coffee!
  13. Unhealthy fats and oils.  Oils and fats that are high in omega-6 fatty acids are pro-inflammatory. Avoid vegetable oils, including canola, sunflower, soybean, peanut, and corn oil. Most commercial mayonnaise and salad dressings are made from vegetable oils. Avoid using margarine as well, as it is made from inflammatory vegetable and seed oils.  Trans fats and partially hydrogenated oils are used in fast foods and manufactured baked goods, and are very inflammatory. 

Level 4: Check the other hormones

There are many different types of hormones in the body, and these are the hormones I recommend you get checked:

  1. Estrogen
  2. Progesterone
  3. Testosterone
  4. Cortisol
  5. Insulin
All these hormones play an integral part in your overall health, as well as your thyroid health.  Many of these hormones regulate your response to food, and in turn, food also regulates hormones.  Many of these hormones also play a role in thyroid hormone conversion.  If your estrogen is too high (which is often associated with birth control pills or estrogen replacement therapy), the level of free hormones will be low, and the thyroid hormones may struggle to get into the cells.  If testosterone is too high (often associated with PCOS and insulin resistance), the level of free hormones could be too high, and the cells in your body may become resistant to the thyroid hormones. 
Depending on your specific health status, your doctor may also recommend testing other hormone levels.  Please consult with your doctor before you have any hormone level testing done.

Level 5: Reduce your toxin exposure

Now we get to the point where we start looking at how we can reduce the toxin load on our bodies.  Another word for toxins are chemicals.  The chemicals that are present in our environment has a huge impact on our bodies.  Some of these chemicals directly impact the functioning of the thyroid gland, while other chemicals disrupt your hormones, impacts your gut health and can even affect the immune system. 

Our bodies are working hard to remove toxins all (through sweat, breath, urine, and bowel movements), but with the onslaught of toxins, our bodies struggle to keep up.  Therefore, we need to look at our environment and clean it up so that we reduce our exposure to toxins.

Where do all these toxins hide?  The most obvious places are:

  • Fruits and vegetables.  Most commercially farmed fruits and vegetables are sprayed with herbicides and pesticides.  I recommend you buy organic where possible, and wash your produce with an organic fruit and vegetable wash before consuming it or cooking with it.
  • Drinking water.  Tap water is often loaded with chemicals and heavy metals.  Filter your water before drinking or cooking with it.
  • Teflon-coated cookware. Teflon-coated cookware leaches chemicals every time you use it.  Replace it with carbon steel, stainless steel or cast iron cookware. 
  • Amalgam dental fillings.  The “silver” dental fillings are a source of mercury.  Speak with your dentist (I recommend a biological dentist) to have your amalgam dental fillings replaced.
  • Air pollution.  The quality of the air we breathe at home and at the office is important.  Air pollution is not just from factory gasses and car exhaust pipes.  Pollen and VOCs (volatile organic compounds – from paint, thinners, cigarettes, cleaning products, air fresheners, adhesives, wood preservatives, glues and pesticides) all add to air pollution.  Add air-purifying plants to your home and office, and you can also use an air purifier. 
  • Mould. When you see (or smell) mould, remove it immediately, using a 1-8 bleach-water solution and protective clothing (use a face mask as well).  With large areas of mould or black mould, I recommend you get a professional to treat it. 
  • Plastic.  Plastic, even BPA-free plastics, can leach chemicals.  Focus on reducing your use of plastic, especially single-use plastics, which are used in hot beverage lids and plastic water bottles. In your kitchen, replace plastic cooking utensils with wood, bamboo, stainless steel or food-grade silicon, while plastic containers can be replaced by glass, ceramic, clay, stainless steel, and carbon steel cookware.  Stop using plastic wrap.
  • Personal care products and make-up.  Our personal care products and make-up are loaded with chemicals.  Switch to toxin-free skincare, soaps, lotions and make-up.  I have found an amazing range of natural skincare products at my local health shop.  
  • New clothes.  Have you ever smelled new clothes?  New clothes are sprayed with chemicals to protect it during transport and storage.  Always wash your new clothes before wearing it. 
  • Commercial home cleaning products.  Kitchen cleaners, bathroom cleaners, washing powders, softeners and floor cleaners are loaded with chemicals.  Switch to natural cleaning products, and you can even make your own using combinations of vinegar, water, lemon and even some essential oils.  

Level 6: Check for heavy metal exposure

All of the actions up to this level have been focusing on reducing the toxic load on your body and helping your body detoxify naturally.  However, there may still be instances where you may have been exposed to heavy metals and the body is not able to remove them effectively.  For example, if you had treatments such as an MRI with contrast. 

Consult with your doctor to test for heavy metal toxicity.  If you do have heavy metals present in your body, treatment options may include intravenous glutathione treatment or chelation therapy.  Chelation therapy must be done under the supervision of a licensed medical doctor, as there are risks involved. 

Level 7: Check for underlying infections

Undiagnosed infections can cause low-grade continuous inflammation, and it may also trigger an autoimmune flare up (worsening of symptoms).  Infections can hide anywhere in your body, including your thyroid gland.  

Some of the more common infections are Epstein Barr virus, E.coli, Lyme disease, Human parvovirus, Blastocystis hominis, Bartenella, Mumps, Rubella and SIBO. 

Speak with your doctor to do the tests, which may include blood tests, stool antigen and breath tests.  

Level 8: Low Dose Naltrexone

Low dose naltrexone (LDN) is a medication that has shown benefits to help regulate the immune system without the severe side effects that other similar medications may have.  It is an off-label drug (so no pharmaceutical company can patent it) and unfortunately there are not a lot of scientific studies.  The anecdotal evidence for using this drug is strong – some Hashimoto’s patients have been able to reduce or eliminate their antibodies and symptoms, and for some they have been able to reduce or stop their thyroid hormone medication.  But, it does work for some and not for others.  

Consult with your doctor about whether LDN could be useful to you.  It is only available on prescription. 

Level 9: Autoimmune Paleo Diet

Some people may prefer to start with the AIP (Autoimmune Paleo Diet) earlier in their health journey.  If you are struggling with symptoms that is just not going away, you may have a food trigger that haven’t been identified by removing the inflammatory foods.  

The AIP diet focuses on removing certain foods for a period of time, and then reintroducing those foods slowly and then seeing which foods causes a reaction.  During the elimination phase, the following foods are removed: grains and starches, beans and legumes, dairy, eggs, nuts, seeds, nightshades and alcohol.  

There are plenty of resources and recipes available online if you want to do the AIP diet. 

A final word

The levels above are what I would recommend you start with if you don’t know where to start.   You also don’t have to do these in the sequence that I suggested – do what you feel may work for you first.   Your doctor may recommend that you start at a different level, depending on your specific health status.  

The important thing here?  Just get started. 

Adele du Rand

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