Hashimoto’s Thyroiditis: Causes, Symptoms and Support Strategies

Hashimoto’s Thyroiditis: Causes, Symptoms, and Support Strategies

Hashimoto’s thyroiditis is an autoimmune condition that leads to an underactive thyroid and consequent symptoms. Though it is most common in middle-aged women, Hashimoto’s may affect anyone, men, and women at any age, including children and teens. It is the most common form of hypothyroidism; therefore, it is very important to recognize its symptoms to receive treatment as soon as possible. It is just as important to understand its causes to prevent Hashimoto’s thyroiditis from happening in the first place.

In this article, you will learn what Hashimoto’s thyroiditis is, and understand its symptoms and causes. You will learn how to test for Hashimoto’s thyroiditis and other thyroid conditions. I will also share with you my top natural support strategies to repair your body and improve your overall health.

What is Hashimoto’s Thyroiditis

Hashimoto’s disease or Hashimoto’s thyroiditis is an autoimmune disorder that causes an underactive thyroid or hypothyroidism. Autoimmune diseases are a group of conditions in which your immune system mistakenly attacks your body causing all kinds of symptoms and health problems. In the cases of Hashimoto’s thyroiditis, your immune system attacks your thyroid (1, 2, 3, 4, 5).

Your thyroid is a small, butterfly-shaped gland located in the front of your neck below your Adam’s apple. It’s an essential part of your endocrine system, a system that produces hormones in your body to coordinate and carry out important functions. For example, your thyroid hormones influence how your body uses energy. As a result, they impact every organ in your body, including your heartbeat (1, 2, 3, 4, 5). 

If you have Hashimoto’s thyroiditis, your thyroid becomes enlarged. As a result, it’s simply unable to make enough thyroid hormones. Without having enough thyroid hormones and a functioning thyroid, many of your bodily functions slow down and your health becomes compromised (1, 2, 3, 4, 5).

In the United States, Hashimoto’s thyroiditis is the most common cause of hypothyroidism. While it can certainly affect men and women of any age and even occur in children and teenagers, it primarily affects middle-aged women. To determine whether or not you have Hashimoto’s thyroiditis, you need a doctor to test your thyroid function. However, it is important that you first know the major symptoms and causes of this autoimmune disease (1, 2, 3, 4, 5).

Major Symptoms of Hashimoto’s

If you have Hashimoto’s disease, you may not have any symptoms at first. However, as the disease slowly progresses, you may notice that your thyroid is getting larger and your neck looks somewhat swollen. This enlarged thyroid is also known as a goiter. It may lead to a feeling of fullness in your throat, but usually no pain (1, 2).

As Hashimoto’s thyroiditis progresses, you may start to notice some symptoms. The symptoms of Hashimoto’s thyroiditis may include (1, 2):

• Tiredness, fatigue, and sluggishness
• Unexplained weight gain
• Joint and muscle pain
• Constipation
• Increased sensitivity to cold
• Dry and thinning hair
• Brittle nails
• Puffy face
• Enlarged tongue
• Slowed heart rate
• Memory problems
• Depression
• Heavy or irregular periods
• Trouble becoming pregnant

Aside from common symptoms of Hashimoto’s thyroiditis, you may also increase your risk of long-term health complications and certain diseases. Hashimoto’s thyroiditis may increase your risk of (6):

• Addison’s disease and Graves’ disease
• Thyroid goiters
• Infertility, ovarian failure, pregnancy or birth complications, and birth defects
• Type 2 diabetes
• High cholesterol
• Heart disease 
• Brain problems
• Kidney problems
• Neurological damage
• Mental health disorders, such as depression

Major Causes of Hashimoto’s

While researchers are still not completely sure why autoimmune disorders, such as Hashimoto’s thyroiditis develop, based on evidence, they speculate that they are likely a result of a combination of issues. Poor diet, food sensitivities, poor lifestyle choices, infections, and toxins may all play a part in triggering autoimmune diseases. 

To prevent and repair autoimmunity, it is important to understand the factors that may cause it. Let’s look at them one by one.

Poor Diet and Food Sensitivities 

Your gut plays a critical role when it comes to autoimmune conditions, thyroid health, and Hashimoto’s disease. Poor gut health and a gut flora imbalance may lead to inflammation and trigger an immune response. People with autoimmune conditions are also more likely to have food sensitivity than others (7).

It is important that you get tested for food sensitivities or try an elimination diet yourself. The most common food sensitivities include gluten, sugar, dairy, corn, soy, refined vegetable oils, additives, and preservatives. These are also the most inflammatory foods that can harm your health, hence you may only benefit from staying away from them completely.  To learn more about food sensitivity testing, read this article.

Nutrient Deficiencies

To achieve optimal health, including optimal thyroid function, it is important that you eat a healthy and nutrient-dense diet. A poor diet and poor absorption may lead to nutrient deficiencies that may contribute to Hashimoto’s disease.

Some of the main nutritional deficiencies that may be the culprit behind your thyroid issues include vitamin D, A, E, B vitamins, zinc, selenium, magnesium, and omega-3 fatty acids. Later in this article, you will learn about each of the nutrients, and how to correct nutrient deficiencies.

Toxin Overload 

Toxins are all around us. They are in our food, our air, water, and our household, hygiene, and body products. They hide everywhere and silently contribute to many of our ailments

Environmental toxins are one of the main reasons behind autoimmune diseases and thyroid problems, such as Hashimoto’s thyroiditis. Plastic, heavy metals, glyphosate, mold, and even heavy EMF exposure may be dangerous and may lead to inflammation and disease. Hence reducing your toxic exposure is incredibly important to reduce your risk of and repair your body from Hashimoto’s thyroiditis.

Chronic Infections and Hashimoto’s

Viral and gut infections are one of the main reasons you may develop an autoimmune condition, such as Hashimoto’s thyroiditis. Viruses may actually lie dormant inside your body for many years before they flare up during a stressful or unexpected time later in life. 

Gut Infections, such as H. Pylori, and Blastocystis Hominis have been linked to Hashimoto’s disease. Research has also found a link between the Epstein Barr virus (EBV) and thyroid disease.

EBV has been found in several autoimmune participants and though EBV is not the only factor that leads to autoimmune thyroid diseases, researchers determined that it can be considered a contributory factor. Gut Infections, such as H. Pylori, and Blastocystis Hominis have also been linked to Hashimoto’s disease (8, 9, 10).

Leaky Gut and Hashimoto’s

Leaky gut is involved in all autoimmune conditions, not just Hashimoto’s thyroiditis. Eating a compromised unhealthy diet, exposure to toxins, food sensitivities, chronic stress, and gut dysbiosis may lead to leaky gut. 

Leaky gut happens when the gap junctions between the cells in your intestinal wall become too wide and allow large particles, such as toxins and undigested food molecules to enter your bloodstream.

Your immune system mistakes these molecules for foreign invaders and creates antibodies to fight them off. This immune response and your body’s way of attacking itself leads to chronic inflammation and autoimmunity.   

Chronic Stress and Poor Sleep

Research has found that stress is one of the main causes of thyroid problems. The increase of the stress hormone, cortisol may interfere with the healthy production of thyroid hormone and may lead to thyroid issues (11).

Poor sleep is incredibly stressful on your body. It may also lead to a more stressful day and an overall unhealthy life. The lack of sleep also prevents your body to rest and repair its cells, and as a result, may also contribute to thyroid issues. Hence, reducing stress and sleeping plenty is crucial for your thyroid and overall health.

Testing For Hashimoto’s Thyroiditis

If you suspect that you have Hashimoto’s thyroiditis, it’s very important to get tested so you can start an appropriate treatment regimen. Many conventional doctors only check your thyroid-stimulating hormone (TSH) levels. It’s their go-to test for thyroid function.

However, to fully understand your thyroid health and to make sure not to miss Hashimoto’s thyroiditis or any other thyroid dysfunction, it is important to get a complete panel and check your TSH, free T4, free T3, and reverse T3 levels along with some antibody testing (1, 12).

TSH

The best method to test your thyroid function initially is to check the TSH level in your blood. If your TSH levels are high, it may mean that your thyroid gland is not functioning well due to a problem affecting your thyroid, usually hypothyroidism.

However, if your TSH is low, you may have an overactive thyroid and deal with hyperthyroidism and too much thyroid hormones. Low TSH levels may also be the result of a pituitary gland problem. In most cases, normal TSH results mean healthy thyroid functioning.

T4 and Free T4

T4 tests are also an important step to check your thyroid function. T4 can be found in your blood in two forms: T4 which’s bound to proteins preventing T4 from finding its way into tissues in need of thyroid hormones, and Free T4 which can enter various target tissues. Free T4 is what we have to look at to evaluate your thyroid functions. If you have hyperthyroidism, you will have elevated Free T4 (FT4) or Free T4 Index (FT4I) levels, but if you have hypothyroidism, these levels will be too low. 

Combining your TSH and FT4 or FTI results may help to accurately determine whether or not your thyroid is functioning optimally. However, in the case of hyperthyroidism, T3 testing may also be helpful.

T3 and Free T3

T3 tests are usually used to diagnose hyperthyroidism, as well as to understand the severity of your hyperthyroidism. Free T3 (FT3) is an active form of thyroid hormone, whereas Reverse T3 (RT3) binds its receptors to FT3 to slow down metabolic processes.

When your body needs more energy, it converts T4 into FT3 to power your metabolic processes. However, if your body is not converting T4 to FT3 well, it may lead to hypothyroidism. High RT3 levels may mean that your body is converting T4 into RT3 and not FT3 which may lead to hypothyroid issues as well.

TPO and TG Antibodies For Hashimoto’s

In addition to checking your thyroid hormone levels, it is very important that your doctor is testing for two main types of thyroid antibodies: thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb). TPOAb attacks the enzymes that are responsible for synthesizing your thyroid hormones, whereas TgAb attacks thyroglobulin, which is used by your thyroid to produce its thyroid hormones. In Hashimoto’s thyroiditis, you will typically see either TPOAb or TgAb levels are elevated and in some cases, both will be elevated. 

Checking for these antibodies is absolute for determining if you have Hashimoto’s disease, which is an autoimmune condition, or an underactive thyroid without autoimmunity present. This is important not only to understand your thyroid problems but for your overall health. Once you have one autoimmune condition, your chances are much higher to develop another.

Normal Ranges

Some traditional doctors rely on too broad reference ranges even the American Association of Clinical Endocrinologists recommends narrower lab references that were used previously. Functional, holistic, and naturopathic doctors tend to be more conservative and use narrower lab references to help you catch the problem early on. Here are the normal reference ranges:

• TSH 1-2 UIU/ML or lower 
• FT4 >1.1 NG/DL
• FT3 > 3.2 PG/ML
• RT3 less than a 10:1 ratio RT3:FT3
• TPOab and TgAb < 4 IU/ML or negative

Comprehensive Blood Analysis

To diagnose Hashimoto’s thyroiditis or any other thyroid issues, I recommend a Comprehensive Blood Analysis. It is the most comprehensive and reliable lab test you can find. Besides testing your TSH, FT4, FT3, RT3, TPOab, and TgAb levels, it tests for other important factors that may affect your thyroid function. 

• Vitamin D (25 – OH) Levels: Low vitamin D3 levels are commonly found in those with thyroid disorders. 
• CBC and Chem Test: Anemia also commonly affects those with thyroid disorders. Elevated liver enzymes are also part of this test, since poor liver functioning may lead to altered T4-T3 conversion and metabolic problems.
• Homocysteine: Thyroid disorders are often complicated by poor methylation processes and elevated homocysteine.
• CRP-hs: Measuring C Reactive Protein tells us if you have increased inflammation in your body that may be the culprit behind your poor thyroid function.
• Magnesium: Low magnesium levels may also compromise your thyroid function.

Testing For Gut Infections 

Since gut infections may be the underlying cause behind your Hashimoto’s thyroiditis or other thyroid conditions, it is important to test for them. I recommend the GI Map Stool Analysis Test.

This test may determine if you have dysbiosis or bad bacteria balance in your gut and if you may benefit from dietary changes and supplementations to repair your gut infections and compromised gut microbiome that may be the culprit behind your thyroid issues.

Hashimoto’s Support Strategies

Now that you understand how diet, lifestyle, and environment may trigger autoimmunity and Hashimoto’s thyroiditis, you may realize that these are all important factors that may play a role in preventing the disease and repairing the damage improving or even reversing the condition.

While these support strategies are not FDA-approved to prevent, mitigate, treat, or cure Hashimoto’s, they can be important factors for supporting the immune system, gut, and thyroid health.  

Follow a Thyroid Healing Diet 

If you want to recover from Hashimoto’s thyroiditis and repair your thyroid, I recommend that you follow a Thyroid Healing Diet. At the heart of it, the Thyroid Healing Diet is a nutrition plan that is low in carbohydrates, high in healthy fats, fiber, clean protein, and plant and herb-based phytonutrients. 

Some of the best foods that you can eat on a Thyroid Healing Diet include sea vegetables, cooked cruciferous vegetables, bone broths, lemon, lime, organic grass-fed butter or ghee, coconut fats, avocadoes, apple cider vinegar, fermented foods, olives, olive oil, wild-caught fish, and pasture-raised animal products (13, 14, 15, 16). 

To learn more about the Thyroid Healing Diet, read this detailed article to guide you.

Consider an Autoimmune Diet 

Since Hashimoto’s disease is not just a thyroid dysfunction but an autoimmune disease, you may want to consider an Autoimmune Diet. It is a powerful way to reduce inflammation and autoimmune conditions. It may also be beneficial if you have other autoimmune conditions besides Hashimoto’s thyroiditis.

The goal of an Autoimmune Diet is basically to eat lots of anti-inflammatory foods and eliminate inflammatory foods from your diet. Anti-inflammatory foods that you may include on this plan include grass-fed, pasture-raised meat, poultry, and wild game, avocados, avocado oil, lemon, lime, berries, green tea, non-starchy vegetables, turmeric, apple cider vinegar, wild-caught fish, ginger, bone broth, vegetable broth, olive oil, fermented vegetables, coconut fat, healing herbs, garlic, onion, and chives.

Inflammatory foods you should avoid include refined grains, whole grains, grain and flour products, deep-fried foods, processed foods, most packaged foods, fast food, sodas, grain-fed meat and eggs, trans fats, margarine, refined oils, and most commercial salad dressings (17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29).   To learn more about this Autoimmune Diet, read this article for guidance. 

Reduce Stress

Chronic stress is one of the main root causes of inflammation, pain, and disease. A large percentage of people with autoimmune symptoms have experienced emotional stress before the onset of their symptoms. Stress may trigger symptoms, autoimmune flares, lower immune function, and alter the production of neuroendocrine hormones. However, research has also shown that stress reduction interventions may have a positive effect on people with autoimmune diseases, such as Hashimoto’s (30). 

Reducing your stress levels is incredibly important in resolving the underlying causes of Hashimoto’s disease and other autoimmune issues. I recommend meditation, relaxation exercises, breathwork, yoga, Epsom salt detox baths, spending time in nature, nurturing meaningful connections, spiritual practices, journaling, and adaptogenic herbs to reduce stress.

Adaptogenic herbs are incredibly helpful when it comes to reducing stress hormones and balancing your body. Ashwagandha, for example, is particularly beneficial for reducing thyroid and adrenal issues. It may help to balance your hormones naturally and to boost your ability to cope with stress. Other adaptogens include maca, Rhodiola, Chaga, tulsi, ginseng, and Reishi mushrooms (31).

Correct Nutrient Deficiencies 

Nutritional deficiencies may lead to all kinds of problems in your body, including gut flora imbalance, inflammation, pain, and disease. Nutritional deficiencies may lead to thyroid dysfunction and Hashimoto’s thyroiditis. 

B Vitamins

B vitamins, especially B12, are also crucial when it comes to your cellular, metabolic, and thyroid functions. No wonder that vitamin B12 is also called the ‘energy vitamin’ (32).

Vitamin B12, folate, B2, and other B vitamins are important for thyroid health. Eat plenty of foods that are rich in vitamin B, including leafy greens, avocados, eggs, nuts, and seeds.

If you have high homocysteine levels or were tested to have low B12 levels it would be beneficial to take a b complex supplement.  Look for one with pre-activated forms of B vitamins such as methyl-folate, methyl-cobalamin (B12), Pyridoxal-5-Phosphate form of B6, and Riboflavin-5-phosphate form of vitamin B2.  The methyl groups are in the active form and will be better utilized by the body.

Selenium

Selenium is another mineral that is incredibly important for your thyroid function. It helps to regulate your T3 and T4 hormones, and may even reduce the risk of thyroid issues during pregnancy.

When it comes to selenium, one of the easiest ways to meet your body’s requirements is to eat a few Brazil nuts each day and a few servings of wild-caught seafood each week.  Alternatively, you may try a selenium supplement on a daily basis (33, 34).

Zinc

Zinc is an important mineral that is a part of the enzyme deiodinase, which converts T4 into T3. Research has also linked zinc deficiency with hypothyroidism.

Meat, eggs, nuts, and seeds are all fantastic sources of zinc.  Due to the high rates of zinc deficiency in individuals with Hashimoto’s, it is a good idea to supplement with 20-40 mg of zinc daily to ensure optimal levels for your thyroid health (35).

Vitamin A

Research has shown that vitamin A may help to regulate thyroid hormone metabolism and healthy TSH levels. The best sources of vitamin A include cod liver, eggs, dark leafy vegetables, orange and yellow vegetables, and fruits. However, you may also benefit from supplementation (36).

Vitamin E

Vitamin E is an important antioxidant. Vitamin E deficiency has also been linked to thyroid problems. The best sources of vitamin E include dark leafy greens, nuts, and seeds. However, if you are deficient in vitamin E, supplementation may be a good idea (37).

Vitamin D

Vitamin D is one of the main vitamins that most people are deficient in. Vitamin D helps to regulate your immune system and is very important for your thyroid function. A large percentage of people with Hashimoto’s thyroiditis and thyroid problems are low in vitamin D (38).

To correct this deficiency, it is important that you spend at least 15 – 20 minutes outside in the sun with some bare skin exposed. However, a short time outside is not enough. Eating foods rich in vitamin D, such as fatty fish, liver, and egg yolks, is important, but not enough. Daily supplementation is important.

Using only vitamin D supplements is not enough, however, you also need vitamin K2 for proper absorption and calcium utilization. This is why, I recommend a daily Vitamin D3/K2 supplement to optimize vitamin D levels.

Typically taking 1,000 IU per 25 lbs. of body weight will help you get your levels into a healthy range.  You want to test your vitamin D levels at least 1-2 times each year and get your levels between 50-100 ng/ml.  It has been hypothesized that a therapeutic level for diseases like prostate cancer is going to be between 70-100 ng/ml.

Magnesium

Without adequate levels of magnesium, your thyroid cannot function properly. Magnesium deficiency has been linked to goiters and thyroiditis.  In addition, many common symptoms associated with hypothyroidism such as fatigue and constipation may also be caused by a magnesium deficiency.  

It is important that you eat a magnesium-rich diet with nuts, seeds, avocados, and cacao, and also supplement with magnesium (39).  My favorite forms of magnesium include magnesium citrate, malate, orotate, glycinate, and L-threonate.  

Omega 3

Omega 3 fatty acids are incredibly important in reducing inflammation in your body. Deficiencies have been linked to thyroid problems. The key omega-3 fatty acids we want are the very long chain EPA and DHA that we find in fish, krill, and algae as well as pasture-raised meats. 

While I do recommend eating a lot of fish, algae, and sea vegetables as well as pasture-raised meats, considering our busy, modern-day lifestyle, I recommend taking a high-quality Omega 3 supplement as well (40).  

However, if your health is compromised, meeting your omega-3 needs may be difficult via diet alone, and you may benefit from supplementation.  Plant based omega 3’s such as flax oil only contain the small chain omega 3 called ALA and do not have any DHA.  It is very hard for our body to convert ALA into DHA so it is best to get a high quality fish or krill oil that is rich in EPA and DHA.  You want to find a brand that is molecularly distilled to take out any heavy metals and other unwanted contaminants.

Prioritize Good Sleep To Heal Hashimoto’s

Sleep is absolutely essential and non-negotiable when it comes to your thyroid and overall health. Remember, stress can result in thyroid problems, and sleepless nights put a lot of stress on your body. Getting seven to nine hours of sleep is incredibly important to support your thyroid function and overall well-being (41). 

To support a healthy sleep cycle, exercise regularly and eat a healthy diet. Avoid caffeinated drinks and processed sugars, especially late in the afternoon or evening. Stick to a regular sleep schedule. Develop a nighttime routine that works for you. Turn off electronics a few hours before bedtime. Engage in calming nighttime activities, such as meditation, reading, journaling, and board games.

Reduce Exposure to Toxins

Toxins are hiding everywhere. They are in your food, household, beauty and body products, cleaning products, and the air you breathe. While eating a nutrient-dense, organic, whole foods diet is a great step to eliminate toxins from your food, it’s not enough. You have to pay attention to your non-food products as well.

Avoid plastic bottles and plastic packaging that may be full of toxins, endocrine disruptors, xenoestrogens, and carcinogens. Read every ingredient on each product. Buy organic and natural household, beauty, and hygiene products, or make your own. Avoid Teflon coated dishes.

If you are a smoker, stop smoking, and avoid second-hand smoking as much as possible. Make sure that there is no mold in your house. Use a good HEPA air filter (42). 

Eliminate Gut Infections

As you know already, gut infections may be the major cause of your thyroid issues and autoimmunity. These infections may lie dormant in your body without you knowing it. They may flare up to fuel inflammation, autoimmunity, and thyroid problems.

Support your immune system and gut health through a nutrient-dense anti-inflammatory diet. Reduce stress in your life and sleep plenty.  It is important to work with a functional health practitioner to identify any chronic gut or viral infections and address these conditions.  

Heal Leaky Gut and Support Digestive Health 

Some of the underlying reasons that may lead to leaky gut syndrome are Small Intestinal Bacterial Overgrowth (SIBO), Candida, and parasites due to a compromised diet, toxic exposure, stress, and other reasons. It is important to address these underlying issues to repair leaky gut. 

It is absolutely important that you follow a diet that supports your digestive health and helps to repair leaky gut. Eat lots of healthy fats, prebiotic foods, fermented foods, fiber-rich greens, vegetables and fruits, and clean protein. Bone broth, coconut oil, apple cider vinegar, ginger, peppermint, grass-fed ghee, pumpkin seeds, beef gelatin, and fermented veggies are important foods that may support your digestive health and support your healing from leaky gut (43, 44, 45, 46, 47, 48, 49, 50, 51, 52). 

Help your body to rebuild your microbiome with the help of gastric mucosa-supporting supplements. A great combination to soothe an irritated gut lining and reduce inflammation includes the amino acid l-glutamine, along with aloe vera, arabinogalactan, quercetin, curcumin, and licorice. This powerful combination helps to support gut and immune function and to reduce inflammation in the gut.

Lastly, make sure to take high-quality probiotics to support your healthy gut flora. There are four types of probiotics you may use:

• Food-based probiotics, such as lactobacillus and bifidobacterium species
• Probiotic yeast, such as saccharomyces boulardii
• Soil-based (SBO) probiotics, bacillus spore forming strains
• Combination probiotics, lacto, bifido, S boulardii and bacillus strains

Not everyone deals with each of these probiotics the same. Depending on your body and health issues, one works better than others. If you have SIBO, for example, soil-based probiotics are the safest choice as certain other probiotics may trigger your symptoms.

Improve Liver Health and Detoxification

Your liver is an incredibly important organ that serves an array of functions in your body, yet we rarely give enough credit for its important roles. When it comes to your thyroid health and Hashimoto’s disease, your liver is partly responsible for the conversion of T4 into T3. Without this conversion, you may develop thyroid issues (52).

Your liver health may become compromised due to an unhealthy diet, exposure to environmental toxins, lack of nutrients, chronic infections, and low glutathione. It is important to support your liver health through a healthy diet and detoxification.  

Final Thoughts on Hashimoto’s

Hashimoto’s thyroiditis is an autoimmune disease that causes an underactive thyroid and consequent symptoms. It is the most common form of hypothyroidism; therefore, it is very important to know its causes to prevent it and recognize its symptoms to receive treatment as soon as possible.

Following my powerful natural support strategies in this article may help you to protect your thyroid, repair your health, and live the life you deserve full of energy, vitality, and happiness.  

If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. On our website, we offer long-distance functional health coaching programs. For further support with your health goals, just reach out—our fantastic coaches are here to support your journey.

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