You may be wondering, what even is Hashimoto’s? What’s the difference between Hashimoto’s & Hypothyroidism? How do I go about healing Hashimoto’s and Hypothyroidism?
Let’s Dive in! I present to you, the NO BS Guide to Healing Hashimoto’s and Hypothyroidism.
*please note that Hashimoto’s is an autoimmune disease that can’t technically be “healed,” but it can be put into “remission” by decreasing symptoms and antibodies*
Table of Contents
The difference between Hashimoto’s and hypothyroidism
Hypothyroidism is decreased activity of the thyroid gland, which can affect your metabolism along with your mental and physical health. This is because your thyroid affects almost all cells and organs of your body!
This includes primary and secondary hypothyroidism, which are NOT autoimmune conditions, but have the same symptoms as Hashimoto’s- which IS an autoimmune disease. Hypothyroidism can be caused by the same issues as Hashimoto’s, noted below, but also includes other pituitary causes.
Primary hypothyroidism involves the thyroid itself. Secondary hypothyroidism involves disease or malfunction of other organs that then affect thyroid function or levels, such as pituitary or hypothalamus related issues.
A common condition seen in 2-7% of adults in the US is subclinical hypothyroidism, in which TSH is mildly elevated or normal, with normal or slightly decreased thyroid levels.
Hashimoto’s Disease is an autoimmune disease that flares up due to the body attacking its own thyroid tissue.
It can result in either depletion of T4 and/or T3 levels on the body or prevent conversion of T4 (inactive) to T3 (active) by turning to reverse T3. TPO antibodies tend to sky rocket in this scenario, which gives a diagnosis of active Hashimoto’s.
Antibodies bind to thyroid peroxidase enzyme, thyroglobin, and TSH receptors, inhibiting thyroid hormone synthesis and availability. TSH typically sky rockets in this case, signaling that thyroid levels are below optimal levels.
How does the thyroid gland work?
The thyroid is a butterfly shaped gland located just below your larynx.
T4 is released by the thyroid and converted to the active thyroid hormone, T3, in multiple tissues, including the liver, gut, and brain. T4 has the ability to convert to Reverse T3, which is metabolically inactive in times of stress or inflammation.
TSH, Thyroid Stimulating Hormone, is a pituitary hormone that signals the thyroid to either decrease or increase thyroid hormone production. The pituitary is controlled by your hypothalamus, which produces TRH, thyrotropin-releasing hormone, to control TSH levels.
Typically when T4 is low, the pituitary produces more TSH to signal to the thyroid to produce more T4. When it senses high T4 levels, the pituitary will produce less TSH, in an attempt to bring thyroid levels back down to normal.
Essentially, the thyroid and pituitary work together to control thyroid levels in the body like a thermostat. If it gets “too cold” and thyroid hormones are low, TSH will go up. If it gets “too hot” and thyroid hormones are high, TSH will go down.
However, there can be multiple conditions and reasons for the thermostat not “reading” properly. It is possible that TSH levels are normal while either T4 or T3 levels are low, such as with low TBG (thyroid binding globulin, commonly caused by high testosterone) or thyroid resistance.
Hypothyroidism and Hashimoto’s Symptoms Checklist
- Weight gain
- Hair loss
- Chronic fatigue
- Low heart rate
- Digestive problems like chronic bloating, constipation, or diarrhea
- Joint and muscle pain
- Irregular menstrual cycles (or no period!)
- Cold intolerance
- Dry skin
- Brain fog
- Elevated cholesterol levels can also be common
It is important to note that these are also symptoms seen in other conditions!
Root Causes of Hashimoto’s and Hypothyroidism
Some common root causes of Hashimoto’s and hypothyroidism are:
- Nutrient deficiencies (specifically Selenium, Iodine, B vitamins, Vitamin D, Iron, thiamin, Zinc, magnesium, Omega 3’s)
- Environmental Toxins (BPA, heavy metals, xenoestrogens, parabens)
- Gut infections (SIBO- Small Intestine Bacterial overgrowth, Candida, Fungal overgrowths, parasites)
- Food Intolerances
- Intestinal permeability (leaky gut)
- Chronic infections (EBV and lupus are the most common)
- Hormone dysfunction (estrogen dominance, low progesterone, low or high testosterone)
- Adrenal dysfunction (high cortisol or low cortisol both can happen!)
The KEY to HEALING Hypothyroidism and Hashimoto’s is FINDING THE ROOT CAUSE.
How do you find it?
Medical health history assessment, symptoms, and lab work!! So let’s chat what labs to get and why.
How to test for hypothyroidism
It’s a good idea to get a full thyroid panel if you want to check thyroid function alone. Testing TSH, Free T3, and Free T4 would be a great start to save money (team frugal here so I get it!).
Sadly many conventional doctors will just check TSH these days. Remember that TSH is a pituitary hormone. It does not tell you how your active thyroid levels are acting in the body (your T3!)
I suggest these labs when testing for thyroid function:
- TSH = Thyroid Stimulating Hormone, typically increased when thyroid levels are low, and decreases when they are high (But not always!)
- T4 and T3 = Thyroid hormones. T4 is inactive and T3 is active. You want to check FREE levels because this is what indicates what is unbound by proteins and active in your blood. Low levels indicate Hypothyroidism, and high levels, hyperthyroidism. Some people have poor conversion from T4 to T3 due to nutritional deficiencies, stress/cortisol, gut or stealth infections (check last post).
- Reverse T3 = Inactive form of thyroid. What happens is an infection, stress, high cortisol, poor thyroid conversion will move T4 to Reverse T3 instead of T3. Which means your active thyroid levels will be very low yet T4 may look normal.
- TPO and TgAB Antibodies = Helpful in diagnosis of Hashimoto’s Hypothyroidism, and indicates current autoimmune attack.
- Vitamin D, Iron, B12, Folate, Magnesium = Common deficiencies seen
- Salivary Cortisol = Important to test for adrenal causes. This could be hypopituitary, adrenal insufficiency, or just adrenal dysfunction.
- Sex Hormones = important to test for hormonal causes (though of course the thyroid condition itself could be a cause of the hormonal imbalance or vice versa) Test these on day 3 of your cycle ladies!
*Note – I am not an MD but I have full legal authority to order and review lab work for my patients. Benefits of being a Dietitian*
Please always remember to TEST, don’t GUESS!
Best supplements for Hashimoto’s and Hypothyroidism
The focus should first be on diet for optimizing your thyroid levels and removing food intolerances, however there are several key supplements I like to suggest for all of my Hashimoto’s and Hypothyroid clients!
Of course not ALL are for everyone – your needs are highly individual! So keep in mind that this list is just a good common list of a few suggestions – NOT a comprehensive or individualized list for you. These are typically more or less what I suggest based on somebody’s personal ROOT cause.
Best supplements for Hashimoto’s and Hypothyroidism:
- Vitamin D
- Omega 3’s
Vitamin D: you want one with K2 which works synergistically. Dose is between 2,000 IU-5,000 IU for most people (but if you are LOW in vitamin D with levels below 30, you may need more). Helps boost mood, improve insulin sensitivity, and increase immune function.❗️COMMON DEFICIENCY❗️
Multivitamin: helps to bridge the micronutrient gap many people have. If you have the MTHFR mutation, look for METHYLATED folate and B vitamins.
Omega 3’s: help to decrease inflammation and supplement low omega 3’s in the diet. Look for at least 350mg EPA and DHA per serving and 1000mg Omega 3. Can do fish oil or cod liver oil.
Iodine: **Should only be taken in deficiency and be careful if you have an autoimmune disease or Hashimoto’s as this can make things worse. I wouldn’t add iodine unless you have been tested for deficiency. Iodized salt is an easy and cheap option. Many don’t need to supplement, and a multivitamin-mineral will have some.
Selenium: Aids in the conversion of T4 (inactive) to T3 (active). Dose is 200mg or you can eat 3 Brazil nuts.
Curcumin: Incredible for reducing inflammation which can trigger autoimmunity. Need black pepper for proper absorption. Dose is 1000mg.
Probiotics: **Not for someone with a gut infection!!! So this is case by case dependent. Can help increase immunity and improve digestion. Probiotic type depends on whether or not there is an overgrowth. If no overgrowth- I tend to suggest Renew Life Ultimate Flora 30 billion or Align.
Iron: **Only take if deficient! Your dose will be determined by your doctor based on your iron levels.
N-acetyl-cysteine: Helps to improve immunity through boosting glutathione levels (your body’s main antioxidant!) and aids in normal body detoxification. Dose is 1200mg/day.
Adaptogens: helps to soothe and nourish the adrenals. We will make a separate adaptogen blog! There are many adaptogens and they have different mechanisms. I personally am a fan of KSM 66 Ashwaghandha.
Best diet for Hashimoto’s and Hypothyroidism
There is no “Hypothyroid” Diet!
Why? Because there are multiple causes for Hypothyroidism & individual needs matter!
As a dietitian, it’s my goal to make sure each person I work with gets the best diet for THEIR root cause. Someone with SIBO may need low FODMAPs and low carb, someone with Adrenal dysfunction may need more carbs, blood sugar balance, and nutrient repletion.
So even though there isn’t ONE best approach… there is definitely a best approach for YOU❗️
Foods to avoid with Hashimoto’s or Hypothyroidism
Regardless of the root cause of your hypothyroidism, there are some things that I typically suggest that should be AVOIDED.
- Foods and ingredients that YOU are sensitive to (based on an elimination protocol and food journals) Common sensitivities = gluten, wheat, soy, dairy, eggs, nuts, nightshades, grains
- Gluten (studies show that gluten, through cellular mimicry, can cause autoimmune attack of the thyroid. Most Hashimoto’s patients should avoid gluten. Some people can tolerate sprouted grains)
- Dairy and soy for some – can be inflammatory (although some do well on organic dairy)
- Too many vegetable oils (can be inflammatory)
Best foods for thyroid health
Here are some foods to focus on eating regardless of root cause:
- Leafy greens
- Cooked cruciferous vegetables (provide DIM and indol 3 carbinol- which can help in natural liver support and elimination of environmental toxins and excess estrogen)
- Variety of fruit and vegetables (eat the rainbow!)
- Lean proteins (organic if possible, as they have increased omega 3 content compared to conventional)
- Healthy fats (avocados, eggs, seeds, nuts, with some full fat dairy and coconut in moderation)
I hope you found this article helpful! You should now understand the best methods for healing Hashimoto’s and hypothyroidism.
To learn more, please check out my podcast here or click “Podcast” on the top of my web page to listen and see the show notes!
Further resources for learning include:
Here’s to all the Thyroid Warriors!
Xoxo Lacey Dunn, MS, RD, LD, CPT
*Fellow hypothyroid warrior*