Hashimoto's Disease Puts Patients on a Thyroid Rollercoaster

The slowly progressing condition is one of the most common autoimmune disorders in America.



Illustration By Michele Melcher

Losing hair and gaining weight? Exhausted but can’t sleep? There’s a good chance your thyroid has gone berserk. This butterfly-shaped gland inside the throat produces hormones that regulate the way our bodies use energy. An overactive thyroid leads to hyperthyroidism; an underactive thyroid causes hypothyroidism.

Both can be symptoms of Hashimoto’s disease, now one of the most common autoimmune disorders in America. Left untreated, its symptoms can have a negative impact on quality of life and lead to fertility problems and birth defects.

“Hashimoto’s is a slowly progressing condition,” says Dr. Seema Bonney of Rosemont’s Anti-Aging Longevity Center of Philadelphia. “The immune system attacks the thyroid, impacting production of thyroid hormone and leading to an underactive thyroid gland.”

Hashimoto’s occurs in men and women of all ages, though there’s a preponderance of the disease in females over 30. It can be tricky to identify because its symptoms overlap with those of other autoimmune disorders, not to mention menopause. “Unless physicians do full blood testing, patients can have symptoms for years before Hashimoto’s is caught,” says Dr. Lisa Hamaker, an endocrinologist at Einstein Healthcare Network in King of Prussia.

Even blood work doesn’t always do the trick. “Patients need to be evaluated thoroughly, looking not only at levels of free T4 and free T3, but also for the presence of TPO antibodies,” says Bonney.

Every cell in our body needs T3—without it, we don’t function properly. Thyroid glands are supposed to convert the hormone T4 into T3. But one of Hashimoto’s hallmarks is a low level, or absence, of T3. “The production of hormones and even the conversion can become impaired if the immune system is attacking the thyroid gland,” says Bonney.

Conventional medicine treats Hashimoto’s with a synthetic T4 hormone. “Patients’ bodies are supposed to convert it to T3,” says Hamaker. “If that doesn’t happen, we’ll have to give them some T3 as well.”


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Generally, patients begin to feel better in two weeks, with marked improvement in six weeks. Bonney adds that low-dose naltrexone is also showing promise in treating Hashimoto’s and other autoimmune diseases. Commonly used to alleviate the symptoms of opioid withdrawal, it’s being used off-label as an anti-inflammatory medication. “New research is showing that low doses enhance immune function by increasing our own endogenous endorphins, reducing the inflammation caused by autoimmune diseases,” Bonney says.

Identifying the source of that inflammation is the goal of Bonney  and integrative medicine specialists like Dr. Georgia Tetlow. Often, it originates in the gastrointestinal tract. “It’s where 80 percent of our immune cells reside,” says Tetlow. “It’s the highway of the outside world moving through your body.” Immune systems typically discern “self from other,” she says. “But when that intelligence is lost, the immune system attacks ‘self.’”

That leads to inflammation, which often starts in the GI tract. That’s why Tetlow, who practices at Philadelphia Integrative Medicine in Wayne, does a comprehensive diagnostic stool study in addition to thorough blood testing. The stool test gives Tetlow information about her patients’ microbiome and their GI tracts’ ability to absorb nutrients. Many Hashimoto’s patients have intestinal permeability. “Food particles are coming into the system, but they are considered enemies by the GI tract, so they’re not getting absorbed,” Tetlow says. “That creates inflammation instead of repair.”

GI inflammation can be properly detected through biomarkers that appear in a stool study. Then doctors can work to correct intestinal permeability. For her treatments, Tetlow never relies solely on medication. “We don’t become ill because we’re deficient in a pharmaceutical,” she says. “To get better, we need to see our own role in our lifestyle choices.”

Bonney is of the same mindset. She points out that food can play a big role in improving GI health and reducing symptoms of Hashimoto’s disease. “We can optimize that T4-T3 conversion by replacing micronutrients—and some people can make those conversions on their own,” she says.

Both physicians work with their Hashimoto’s patients to develop plans that include healthy food choices, specific vitamin and mineral supplements, and regular exercise. With holistic plans, many Hashimoto’s patients can feel better in eight weeks.

But Hashimoto’s is usually not reversible. In many cases, patients’ thyroids have been damaged beyond repair. “Sometimes we can’t recover cell death that’s occurred in the gland, but we can improve thyroid function and metabolism and stop additional damage from occurring,” Tetlow says.

While most of Bonney’s patients must remain on medication for the rest of their lives, their quality of life does improve. The first step, the physicians agree, is for anyone experiencing symptoms to get properly diagnosed.