Did you know approximately 5% of Americans are diagnosed with hypothyroidism? Hashimoto’s Disease/Thyroiditis is the most common cause of hypothyroidism^6. It is an autoimmune disease that causes the body to make antibodies which attack the thyroid. This results in reduced production of thyroid hormones. You may think “slow metabolism” when you hear hypothyroidism, but that’s not all. Thyroid hormones are vital to the function of our entire body system. This includes the central nervous system, heart, bone, muscles, lungs, and gastrointestinal tract. The small butterfly shaped organ has a big impact. It is important and we must care for it as such!

I will discuss common symptoms, complications, potential causes, diagnosis, and treatment of hypothyroidism. And the crucial bit: how to maintain thyroid health!

Common Symptoms of Hypothyroidism

• Weight gain
• Slow heart rate
• Fatigue
• Constipation
• Cold intolerance
• Hair loss

Severe, untreated hypothyroidism (myxedema coma) is a medical emergency with a high mortality rate. Myxedema coma results in profound decreased mental status and critical body system dysfunction.

Causes

The exact cause of Hashimoto’s Disease is unknown. But there are a few proposed mechanisms.

1. Genetic
2. Environmental exposures
   • infection
   • radiation exposure
   • excessive iodine intake
   • inadequate protein, unsaturated fats, and/or fiber
   • iron, selenium, and zinc deficiencies
   • vitamin B and D deficiencies
   • excess heavy metal and trace element exposures (i.e. lead, fluoride, manganese, aluminum, nickel)

It is most common in middle-aged women, those with other autoimmune disease, family history, prior pregnancy, excessive iodine intake, and/or radiation exposure.

Who Should Have Their Thyroid Tested?

The U.S. Preventive Services Task Force (USPSTF) doesn’t recommend routine thyroid screening for everyone because it has not found sufficient evidence that testing thyroid hormone levels in large groups of people without symptoms is cost-effective. Additionally, there are no known long-term benefits of treating asymptomatic hypothyroidism².

However, someone may present with non-specific symptoms. So how do you know if you should have your thyroid checked? If you have the following you should have your thyroid hormones tested:

1. Specific symptoms (as mentioned above)
2. A family history
3. Unexplained weight gain
4. Increasing LDL cholesterol
5. Symptoms and belong to a high risk group**

**High Risk Groups

1. Female
2. >60 years old
3. Low iodine levels (unlikely in the US)
4. Taking medications which contain iodine (i.e. amiodarone)
5. Have an autoimmune disease
6. Prior radiation treatment to head, neck, or chest
7. Prior thyroid surgery
8. Are pregnant or have recently been pregnant

Testing typically includes bloodwork: thyroid stimulating hormone (TSH), T4, T3, and antibodies (specifically for Hashimoto’s). Symptomatic hypothyroidism should be treated with thyroid hormone replacement.

Clinical hypothyroidism in symptomatic patient seen below:

Treatment

Fortunately, there is effective treatment readily available. This includes daily replacement of thyroid hormones in pill form. The most effective formulation is levothyroxine, which is equivalent to T4. T4 is converted to T3 (active thyroid hormone) in the body. Another medication, liothyronine, is equivalent to T3. However, the American Thyroid Association (ATA) recommends against routine use of levothyroxine + liothyronine as studies have found no clinical benefit. There may be the question of using liothyronine alone. Studies have found some short-term benefit, but long-term clinical trials are lacking.

Armour Thyroid is another medication used to treat hypothyroidism. I will emphasize that levothyroxine is the gold standard. Armour Thyroid contains a combination of T3 and T4. There may be appeal that the medication is made from animal and not synthetic. However, there are also potential risks with this including: differences in effectiveness and risk of contamination. Additionally, it is not FDA approved so it has not officially been evaluated for efficacy and safety. There are limited trials adequately comparing levothyroxine to Armour Thyroid. However, in some individuals who cannot tolerate levothyroxine or remain symptomatic, this may be a viable option.

Potential Medication/Supplement Interactions- the following may decrease the absorption of thyroid hormone supplementation:

• Calcium
• Iron
• Antacids
• High soy products
• Grapefruit
• Coffee

Separate at least 4 hours from time of thyroid hormone ingestion.

Maintaining Thyroid Health

Unfortunately, with an unknown cause it is difficult to prevent such disease. But there are things that you can do to maintain and optimize thyroid health.

1. Diet– eating a well-balanced diet is important for overall body function, including the thyroid!
   • Consider adding foods rich in selenium (tuna, grass-fed beef, Brazil nuts) and B vitamins (legumes, dairy products, eggs, lean meats)
   • Adequate vitamin D intake (which can sometimes be difficult without supplementation)
   • Eliminate refined sugar– READ those labels. Sugar is hiding in unexpected places.
   • Eliminate saturated and trans fats
   • Eliminate/minimize alcohol use
   • Eliminate/minimize processed meats
   • Gut health– this is an entire topic alone, but adding in probiotics may be of benefit. I don’t mean supplementation but getting enough in your diet. Adding in yogurts, kefir, miso, sauerkraut, pickles, etc. Identify food sensitivities and eliminate.
2. Exercise– For more specifics check out my post on exercising effectively. https://lrxwellness.com/how-to-exercise-effectively/
3. Medication when indicated– with appropriate monitoring and follow up with your healthcare team.

In Conclusion

Hypothyroidism results in reduced production of thyroid hormones, leading to serious body system dysfunction. Hashimoto’s is an autoimmune disease and the most common cause of hypothyroidism. The exact cause is unknown but there are several proposed mechanisms which include genetics and environmental exposures. If you are diagnosed with Hashimoto’s Disease there is effective treatment, which is oral thyroid hormone replacement. Additionally, there are things you can do to maintain thyroid health, in conjunction with proper treatment when indicated.

As always, please reach out with questions, comments, discussion, and topic requests.

Lindsey, PharmD, BCPS

References:

¹Danailova, Y., Velikova, T., Nikolaev, G., Mitova, Z., Shinkov, A., Gagov, H., & Konakchieva, R. (2022). Nutritional management of thyroiditis of Hashimoto. International Journal of Molecular Sciences, 23(9), 5144. https://doi.org/10.3390/ijms23095144

²Do you need a thyroid test? (2019, February). https://www.health.harvard.edu/womens-health/do-you-need-a-thyroid-test

³Healthy eating for a healthy thyroid. Harvard Health. (2017, November 17). https://www.health.harvard.edu/staying-healthy/healthy-eating-for-a-healthy-thyroid

⁴Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., & Sawka, A. M. (2014). Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid, 24(12), 1670–1751. https://doi.org/10.1089/thy.2014.0028

⁵Mayo Foundation for Medical Education and Research. (2022, January 15). Hashimoto’s disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/diagnosis-treatment/drc-20351860

⁶U.S. Department of Health and Human Services. (n.d.). Hashimoto’s disease – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease