A Quick Thyroid and Autoimmune Primer

The thyroid gland produces the hormones thyroxine (T4) and triiodothyronine (T3). Every cell in the body has receptors for thyroid hormones and, after being produced, they are circulated to the various tissues of the body. T4 is converted to T3, the active form of thyroid hormone that the body uses in these tissues. The thyroid hormones regulate the rate of energy production in individual cells and therefore regulate several critical functions throughout the body, including heart rate, blood pressure, breathing, body temperature, digestive function, mood, bone metabolism, liver function, fertility, and more.⁴ The thyroid gland does not work alone, though. The hypothalamus in the brain senses changes in the body and sends messages to the pituitary gland, also in the brain, which in turn releases thyroid stimulating hormone (TSH), which is the signal to the thyroid gland to make more thyroid hormones. When there are enough thyroid hormones available, the same pathway turns off production of thyroid hormones. In a wellfunctioning body this feedback loop will keep the thyroid gland producing just the right amounts of hormones and the body running optimally. 

Unfortunately, in some people the thyroid gland produces too much or, more commonly, too little thyroid hormone, and in the United States (and most other Westernized countries) the most common cause of this dysfunction is an attack by the body’s own immune system on the thyroid gland. In the case of thyroid autoimmunity, the immune system makes antibodies (proteins to fight foreign invaders) to the thyroid gland. An immune system attack on the thyroid gland can result in Hashimoto’s disease (most cases are hypothyroid) or Graves’ disease (hyperthyroid). Hashimoto’s disease accounts for about 90% of the hypothyroid cases in the US, while Graves’ disease is believed to affect 1-1.5% of the general population.^{5 2}

How to Know if Your Thyroid Condition is Autoimmune

While Graves’ disease is well recognized as an autoimmune disease, many Hashimoto’s diagnoses are missed. Most people with hypothyroid symptoms and matching blood work are simply given medication to try to get their TSH levels back into a “normal” range without any investigation as to whether the immune system is responsible for the decline in thyroid hormone production. In conventional medicine it makes little difference whether hypothyroid is caused by autoimmunity or not since the treatment is the same—lifelong administration of synthetic thyroid hormone. However, not addressing the underlying cause (an immune system gone awry!) leads to continued thyroid damage and recurring or worsening of symptoms. Since about 90% of Americans with hypothyroid have thyroid antibodies, the best way to determine if a thyroid condition is caused by autoimmunity is to have a blood test for thyroid antibodies.⁶ There are, however, some common scenarios associated with Hashimoto’s that can be helpful in determining who should be tested. These include a person who dutifully takes their prescribed thyroid medication but continues to get worse or needs increased doses. Another common scenario is when the thyroid fluctuates between under- and overactive. This person may see their TSH levels high, low and even normal, and may have both hypo- and hyperthyroid symptoms. The last scenario is when a person exhibits Hashimoto’s symptoms and also has one of the following autoimmune conditions: pernicious anemia, gluten intolerance, and/or celiac disease. Even those who get an antibody test may get a false-negative result. This is because the immune system fluctuates and sometimes the condition is dormant. Therefore, when the symptoms are highly suggestive of autoimmune thyroid disease, it is sometimes necessary to test and retest for thyroid antibodies. 

What to do?

As you’ll see below, thyroid autoimmunity is a very complex topic that requires balancing and healing of multiple systems. This work is best done under the supervision of an experienced doctor or practitioner who can order tests, monitor progress, and possibly prescribe medication. To find a practitioner versed in treating autoimmune thyroid or to have an open discussion with your current doctor, check out the Customer Literature File Talking About Alternative Therapies with Your Doctor. 

As you begin to address an autoimmune thyroid condition it is important to remember that the actual cause of the thyroid issues is a malfunctioning immune system. While supporting the thyroid to address symptoms is an important step to feeling better, it is essential to bring the immune system back into balance to slow—or, ideally, stop—the destruction of the thyroid gland. The following areas should be addressed…

1. Eliminate Gluten – There is a strong correlation between autoimmune thyroid conditions and Celiac disease and gluten sensitivity.^{7 8 9} Some postulate that Celiac disease may be a trigger for other types of autoimmunity because it degrades the health of the intestinal barrier, alters the microbiota, and can activate the immune system to begin the autoimmune process.¹⁰ Furthermore, gluten looks very similar molecularly to the thyroid gland, and when the immune system is on alert for gluten, it can attack similar looking proteins. Nearly all functional medicine doctors who work with autoimmune thyroid conditions recommend lifelong avoidance of all gluten.^{5 4 11 12} Please see the Customer Literature Files Gluten, Gluten-Free Grains, and Gluten—Hidden Sources for more details.
2. Try an Elimination Diet to determine if you are reactive to any other foods that may be causing issues. Please see the Customer Literature File Elimination Diet for more information. 
3. Address Stress – Stress is considered to be a major trigger for autoimmune thyroid conditions.² Chronic and/or severe stress can impact the thyroid gland in several ways, including altering how the hypothalamic-pituitary-axis works, which can alter how the hypothalamus and pituitary communicate with the thyroid gland. Chronic stress also leads to elevated cortisol, which can impact how the liver clears estrogen from the body and lead to too much estrogen, which can inactive thyroid hormone.^{13 4} Stressful jobs, traffic, and money are commonly recognized stressors, but don’t forget about things like low-calorie dieting, low-carbohydrate diets, over exercising, sleep deprivation and/or heavy alcohol intake.¹⁴  Please see the Customer Literature File Stress Management and Stress Management— Supplements for more information. 
4. Balance Blood Sugar – The rollercoaster of high and low blood sugar can wreak havoc on the thyroid gland. It also further stresses the hypothalamic-pituitary-adrenal axis.^{4 11} If you’re on the roller coaster, make changes to keep your blood sugar balanced. Please see the Customer Literature File Blood Sugar Balance—Foods for more information.
5. Improve Gut Health – When the integrity of the intestinal lining is damaged (often called leaky gut), proteins that are not fully broken down can cross into the blood stream where the immune system flags them as an invader and mounts a response against them. Once on alert, the immune system can attack bodily proteins that look similar to these proteins, leading to autoimmunity.  Healthy gut microbiota, often disturbed when the gut is damaged or inflamed, also help to convert T4 to T3.4 Healing the gut, rebalancing gut microbiota and modulating inflammation in the gut are all critical steps in restoring thyroid and immune function. Please see the Customer Literature File Digestive Health—Leaky Gut for more information. 
6. Modulate Inflammation and Support the Healthy Function of the Immune System – Cleaning up the diet, removing any foods you are reactive to, managing stress, and balancing blood sugar all contribute to a healthy inflammatory response. You can further support the immune system with the following balancing supplements appropriate for anyone with an autoimmune condition:

• Vitamin D – Vitamin D helps to enhance the activity of regulatory T cells, which balance the immune system, and T-suppressor cells, that help turn off the immune attack.⁴ Low vitamin D levels are associated with Hashimoto’s disease and have been linked to relapse in patients with Graves’ disease.15 16 Please see the Customer Literature File Vitamin D—Testing and Dosing for more information. 
• Inflammation Modulating Fats – The omega-3 fats (EPA and DHA) and gammalinolenic acid (GLA) have long been known to modulate inflammation and support a healthy immune response. Please see the Customer Literature File Fats— Inflammation Modulation for more information. 
• Glutathione – As the body’s most powerful endogenous antioxidant, glutathione directly supports healthy immune function, but also supports gut health and detoxification.¹⁷
• For information on how to increase glutathione production please see the Customer Literature File Glutathione. 
• Probiotics – The beneficial bacteria that live in our guts are easily depleted through a poor diet, stress, antibiotic use and even pesticide and toxin exposure, yet they are hugely important for a healthy immune response.^{4 5} Please see the Customer Literature File Probiotics for more information. 

Symptom Relief – While you are undertaking the above work you may want to add some of the following supplements to support symptom relief. Work with your doctor or practitioner to determine if prescription medications are also necessary. 

• Avoid Iodine – While it is true that worldwide iodine deficiency is the leading cause of hypothyroid conditions, in iodine-replete areas, iodine should be avoided by anyone with an autoimmune thyroid disease. Iodine can actually increase the autoimmune attack on the thyroid gland. ^{6 5 15}
• Selenium – Those with autoimmune thyroid conditions are supported in many ways by the mineral selenium. It supports a healthy inflammatory response, supports a healthy stress response, boosts glutathione production (the body’s most important endogenous antioxidant), and helps to protect against iodine excess.^{4 11 17} Studies have found selenium supplementation to be beneficial in people with Hashimoto’s disease and people with Graves’ disease. ^{18 12 19}
• For a list of supplements that specifically support an underactive thyroid, please see the Customer Literature File Thyroid Health.

Supplements that support an overactive thyroid include:

• Bugleweed – A traditional herbal remedy for overactive thyroid. Although very little research has been done on humans, in in vitro and in animal studies bugleweed appears to inhibit thyroid hormone production and is recommended by the German Commission E for mild thyroid hyperfunction.^{20 21}
• Herbs that calm the nervous system, such as passionflower, valerian, and lemon balm. While not specific to Graves’ disease these herbs support a healthy nervous system response.^{22 21}

How Do You Know It’s Working?

You feel better! Symptom relief is perhaps the number one long-term goal of balancing the immune system and supporting thyroid health. Blood thyroid markers such as TSH, T4, and T3 should also normalize and thyroid antibody levels should be reduced. Don’t rely on TSH numbers alone, since a person can still be experiencing symptoms and the underlying destruction of the thyroid gland even when TSH levels are normal. 

How Long To Stay on an Autoimmune Thyroid Protocol

It can take time to rebalance a malfunctioning immune system, so be patient. Once you are consistently maintaining good numbers on your blood tests and you are feeling good, you may want to start experimenting with loosening the protocol. For instance, you may work with your doctor to adjust the dose of your medication or supplements. Or perhaps you want to experiment with adding in a few of the foods that you removed during the elimination diet. As you experiment, it is important to go slowly and only try one variable at a time. Watch closely for changes that may indicate a worsening of the condition, such as a return of symptoms. Nearly everyone with an autoimmune disease will need to maintain some level of the above steps for the remainder of their life, since once the genes for an autoimmune condition have been turned on, they aren’t easily turned off—but they can often be managed.   

Additional Resources

Autoimmune Paleo Cookbook by Mickey Trescott

Autoimmune Wellness Handbook by Mickey Trescott 

Wahls Protocol by Terry Wahls

References Available Upon Request