Thyroid Autoimmune Disorders
By Lisa Wells, RN
The term autoimmune refers to the body's abnormal immune response whereby it mistakenly attacks its own cells, organs, or tissues. There are at present over 80 known autoimmune diseases and there are ailments that are suspected of having an autoimmune origin.
All autoimmune disorders are serious but some are more debilitating than others and some are potentially fatal.
Of all the known autoimmune disorders immune dysfunction against the thyroid gland is the most common. The two main autoimmune thyroid disorders are Hashimoto's Thyroiditis and Grave's Disease. More women than men develop these ailments and Hashimoto's is the most common.
What is the Thyroid Gland?
The thyroid gland is a butterfly shaped gland that is located in the front of the neck over the trachea just below the larynx. It produces hormones that affect most organs and those hormones are responsible for regulating the metabolism and temperature of the body.
The Thyroid Hormones
The thyroid gland makes several hormones. These include:Monoiodotyrosine (T1)
Tetraiodothyronine, also called Thyroxine (T4)
Of the four hormones T1 through T4 only T3 and T4 are active and it is T3 that can enter the cell nucleus and bind to the nuclear receptors. However, T3 and T4 require binding globulins (proteins) to carry them in the bloodstream to the needed tissues. These binding globulins are thyroxine-binding globulin (TBG), transthyretin (TTR), and albumin. However, T3 and T4 cannot cross the cell membranes without an intercellular transport carrier so they rely on thyroid hormone transporters (THTs), the most efficient of which include MCT8, MCT10, OATP1C1 and SLC17A4, to carry them into the cells.4
Once inside the cell active T3 binds to the thyroid hormone receptors (TRs) in the cell nucleus and provides biological activity.
This autoimmune disease is named after the Japanese physician Hakaru Hashimoto (1881−1934) of Kyushu University Medical School who first discovered it. He called it struma lymphomatosa and described the symptoms as an intense infiltration of lymphocytes within the thyroid. His article was published in the German journal called Archiv für Klinische Chirurgie in 1912.
Thyroid peroxidase (TPO), an enzyme, and thyroglobulin (TG), a protein, are essential for the production of the thyroid hormones thyroxine (T4) or triiodothyronine (T3). When a patient has Hashimoto's thyroiditis their immune system builds antibodies to attack the thyroid peroxidase and/or thyroglobulin resulting in decreased thyroid hormones (hypothyroidism) and the slow destruction of thyroid function.
Did you know? It is estimated that about 90% of hypothyroidism cases are due to Hashimoto's Thyroiditis.
The Symptoms of Hashimoto's
Hashimoto's may be first noticed as a gradual enlargement of the thyroid gland resulting in the neck appearing swollen. The patient may also begin to experience hoarseness, and they may feel the need to clear their throat often, especially when talking. Tenderness/soreness may begin to manifest in the area. As the thyroid gland becomes more damaged the patient will start to experience symptoms of hypothyroidism such as:
Sluggish digestion, constipation
Low body temperature, sensitivity to cold
Susceptibility to colds
Decrease in heart contractility, feeling of heart heaviness
High cholesterol and/or triglycerides
Mental sluggishness with poor memory
Hair loss or thinning hair
Dry, dull hair
Loss of outer part of eye brows
Low back pain
Irregular menstrual cycles
The Problem With the Diagnosis
When a patient presents with symptoms of hypothyroidism the doctor will usually check the TSH and perhaps a free T4. They may or may not test for Hashimoto's. Some doctors won't ever check for TPO and TG antibodies (TPOAb and TGAb), which are the tests used to diagnose Hashimoto's because they believe that the treatment will be the same regardless. Other doctors will check the antibody tests once and if positive they won't ever recheck them, again because they believe the treatment will be the same. They will prescribe the patient a thyroid hormone medication, which is usually levothyroxine, and send the patient home with instructions to make a follow-up appointment in three months to recheck their TSH.
Some Hashimoto's patients may present with both hypothyroid and hyperthyroid symptoms. The reason this can happen is because when the thyroid cells are destroyed the hormones they were holding are released all at once into the bloodstream. This causes a temporary hyperthyroid state.
This is one reason why doctors who place these patients on thyroid medications such as levothyroxine (Synthroid, Levoxyl), liothyronine (Cytomel), or desiccated thyroid (Armour, Nature-Throid) may have trouble finding their correct dose.
Example: At one doctor visit the patient may be told that he/she is getting too much thyroid medication and so the doctor lowers the dose, and at the next visit the doctor says he/she is now not getting enough medication and so the dose is increased again. Some patients go through this for years without their doctor ever checking to see why they cannot find a stable dose, such as testing to see if they have Hashimoto's. There are also doctors who are aware their patient has Hashimoto's yet they don't offer any advice to the patient on how to properly manage their autoimmune disorder.
Enlightened functional and integrative medicine practitioners know that proper management of Hashimoto's goes beyond just prescribing a thyroid replacement medication.
This autoimmune disorder is named after Robert James Graves, an Irish doctor who described it in 1835. German physician Karl Adolph von Basedow described the same symptoms in 1840 so in Europe the term Basedow disease is more common than Graves' disease. Another term used for this autoimmune disease is exophthalmic goiter.
In Graves' Disease the immune system builds antibodies to attack the thyroid stimulating hormone (TSH) cell receptors, and then they mimic the actions of TSH, which is the hormone that is normally released by the pituitary gland to stimulate the thyroid gland to make more thyroid hormone when needed. These antibodies, called thyroid-stimulating immunoglobulins (TSI), then stimulate the thyroid gland to grow in size causing a goiter, and resulting in too much thyroid hormone being released.
Graves' Disease usually causes hyperthyroidism, where the patient is receiving too much thyroid hormone. Symptoms include:
More emotional than usual
Feelings of increased tension
Cannot gain weight
Protrusion of eyes
Increased heart rate
Sensitivity to heat
Hashimoto's and Graves' Are Immune Disorders
It's my opinion, and it's also the opinion of many integrative and functional medicine colleagues that practitioners who treat thyroid autoimmune patients should also focus on healing and balancing the immune system so it decreases the attack on the thyroid rather than just treating the thyroid itself. In the case of an autoimmune disorder the thyroid gland is the victim which is being attacked. Of course the patient's thyroid hormone levels need to be managed, but by only prescribing thyroid or anti-thyroid medications and not addressing the immune system that is attacking its own self the main reason for the disease is being ignored, and unfortunately this can lead to the patient developing more serious autoimmune diseases outside the thyroid.
Advanced Treatments For Thyroid Autoimmune Diseases
All the specifics related to the latest treatments for Hashimoto's and Graves' are beyond the scope of this article. However, I will touch on the basics and I'll give you the names of books that I believe contain important information that should help those who are struggling with these conditions.
The immune system is responsible for building antibodies to fight all types of infections and stop pre-cancer and cancer cell growth. It is supposed to protect all the normal cells in the body, not attack them. When the immune system turns on itself and starts trying to destroy its own thyroid it's not because the immune system has gone rogue. It's because the immune system mistakenly believes that the thyroid is the enemy and needs to be destroyed.
We Need to Find the Culprit!
There can be genetic predispositions to autoimmune diseases but many believe that the main reasons why people develop autoimmune disorders are toxins in the body and ingesting foods that can drive immune dysfunction. If doctors do not address the immune dysfunction then the attack on the thyroid will continue until it is completely destroyed, and, as previously mentioned, the immune system may move on and attack other parts of the body.
One of the first things a good thyroid doctor will do is to instruct the patient that he/she needs to be completely gluten-free. The reason gluten is such a problem is because the molecular structure of the gluten protein is similar to that of the thyroid.
It is believed by specialized practitioners that most patients with autoimmune diseases have an intestine that is over-permeable. We call this leaky gut syndrome. With leaky gut some of the gluten can leak into the bloodstream, where it does not belong. This then causes the immune system to build antibodies to get the gluten out of the bloodstream. Then, because the thyroid molecules are so similar to the gluten the antibodies attack the thyroid thinking it is gluten.
If gluten is the culprit that is driving the immune response the attack will continue to destroy thyroid function until the gluten is removed from the body. Unfortunately this does not mean you can stop eating gluten today and by next week your immune system should stop the attack. It is estimated that ingesting any minuscule amount of gluten by an autoimmune patient is like throwing gasoline on a fire and it will take about six months for the effects of that tiny amount of gluten to wear off to where the immune system calms down somewhat.
There are many other potential culprits such as dairy, soy, mercury, lead, vitamin deficiencies, inflammation, estrogen fluctuations, polycystic ovary syndrome (PCOS), insulin resistance, and others.
We Need to Balance the Immune System
There are several protocols available that focus on repairing leaky gut, finding the reason for the attack, cleansing the body of toxins, and replacing deficient vitamins and minerals in order to restore balance to the immune system.
Dr. Datis Kharrazian, in his book Why Do I Still Have Thyroid Symptoms? provides valuable information about the immune system and the TH-1 and TH-2 pathways. The "TH" stands for T-helper cells, which are messenger cytokines. He explains how these two pathways become unbalanced.1
Patients whose immune system is causing too much natural killer cell and cytotoxic T-cell activity is believed to be TH-1 dominant. Patients whose immune system has too much B-cell activity is believed to be TH-2 dominant. Blood tests can help to confirm whether the patient is TH-1 or TH-2 dominant.1
Once the diagnosis is made Dr. Kharrazian gives recommendations about what should be done to re-balance the pathways. He recommends both take vitamin D3 (cholecalciferol) and glutathione cream and then he provides a list of nutrients that should or should not be taken depending on whether the patient is TH-1 or TH-2 dominant.1
Izabella Wentz, a pharmacist and Hashimoto's patient herself, set out to find the reason for the hypothyroidism she had suffered with for years. She had seen various doctors but without much success. She gives her experiences and provides information about her road to recovery using lifestyle changes and natural medicine in her book Hashimoto's Thyroiditis - Lifestyle Interventions For Finding and Treating the Root Cause. She explains how gut dysfunction, adrenal insufficiency, inflammation, and thyroid hormone release abnormalities come together to make a vicious cycle of immune system overload. She says that this cycle is self-sustaining and will advance unless an outside factor intervenes. She, like Dr. Kharrazian, believes that the culprits that drive the autoimmune attacks must be removed and then the immune system needs to be restored to equilibrium.2
As a nurse I have spoken with many hypothyroid patients over the years who felt they were not living their best life. They were following their doctor's instructions by taking their levothyroxine but they just didn't feel well. Also, I have Hashimoto's myself and so I remember the symptoms and all the doctors I went to trying to find help. I was first placed on levothyroxine, which I could not tolerate. I then set out to look beyond the traditional treatment provided by endocrinologists. What I found was another way of thinking about autoimmune diseases and it made perfect sense to me. If the immune system is making mistakes and is attacking its own body then we need to find out why and remove the instigator so the immune system calms down and starts focusing on defending the body against the real invaders such as viruses, bacteria, cancer cells, etc.
I hope this article will stimulate those who are suffering with mismanaged or undiagnosed thyroid issues to start on the road to discovery. There are fine doctors out there who can help you to tame the beast of autoimmunity so you can rediscover the feelings of your old self, when you had plenty of energy and motivation and you were enjoying every minute of your life.
Why Do I Still Have Thyroid Symptoms When My Lab Test Are Normal? by Dr. Datis Kharrazian.
Hashimoto's Thyroiditis - Lifestyle Interventions For Finding and Treating the Root Cause by Izabella Wentz, PhD.
What Your Doctor May Not Tell You About Autoimmune Disorders by Dr. Stephen Edelson.
1. Datis Kharrazian, "Why Do I Still Have Thyroid Symptoms When My Lab Test Are Normal", Morgan James Publishing, 2010.
2. Izabella Wentz, Marta Nowosadzka, "Hashimoto's Thyroiditis - Lifestyle Interventions For Finding and Treating the Root Cause," Izabella Wentz, PharmD, 2015.
3. Stephen B. Edelson, Deborah Mitchell, "What Your Doctor May Not Tell You About Autoimmune Disorders," Wellness General Hachette Book Group, 2003.
4. Stefan Groeneweg, Ferdy S van Geest, Robin P Peeters, Heike Heuer, W Edward Visser, "Thyroid Hormone Transporters," Endocrine Reviews, Volume 41, Issue 2, April 2020, Pages 146–201, https://doi.org/10.1210/endrev/bnz008