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Hashimoto's Thyroiditis

Hashimoto's Thyroiditis is an autoimmune disease in which the body's own


immune system attacks and gradually destroys the thyroid gland. In 90% of all
hypothyroidism cases the cause is Hashimoto's disease.

1 - The hypothalamus scans the body for any changes


including the rise or drop of thyroid hormones. If they drop it
instructs the pituitary gland to tell the thyroid to make more.
It does that by releasing Thyrotropin-releasing hormone
(TRH). 
2 - The pituitary takes these instructions from the
hypothalamus and tells the thyroid to produce thyroid
hormones by releasing TSH. The less thyroid hormone there
is in the system, the more TSH it will release to reiterate that
more hormone needs to be produced.
3 - The thyroid gland produces thyroid hormones accordingly
and releases them into the blood stream. It produces
different thyroid hormones, mostly T4 and a little bit of T3. T4
is a pro-hormone with little physiological effects whereas T3
is the more bioactive hormone the body can actually utilise.
This means T4 needs to be converted into T3 before it
becomes useable.
4 - T4 gets converted in peripheral tissues like the liver,
kidneys, gut and brain. T4 is also called Thyroxine or
Tetraiodothyronine and is made out of 4 iodine atoms. T3 is
called Triiodothyronine and is made out of 3 iodine atoms.
The conversion of T4 into T3 happens with the help of
enzymes called Deiodinases that remove one iodine atom
from T4.

5 - T3 then gets released into the blood stream to be used by


different organs and tissues in the body. Some of thyroid
hormone in the body is bound to protein and some is
circulating in the blood. With blood tests we can check for
Free T3 (fT3) or Free T4 (fT4), these are levels of thyroid
hormone in the blood, ready to be used. We can also check
for Total T4 and Total T3 and those results represent the
levels of thyroid hormones both free and bound.

In a healthy individual these processes run quite smoothly In people with Hashimoto's the immune system produces
and the body keeps functioning properly. The thyroid antibodies, also called immunoglobulins, that attack the
regulates your metabolism and energy expenditure, thyroid gland. Antibodies are Y-shaped proteins that are a
influences body temperature regulation, heart rate, digestive normal part of the immune system as they attack pathogens
system and muscle function and has a profound effect on like viruses, bacteria and chemicals. In Hahismoto's disease,
fertility, the menstrual cycle and pregnancy. however, they attack the thyroid gland, more specifically two
things in the thyroid gland: an enzyme called Thyroid
Peroxidase (TPO) and a protein called Thyroglobulin (Tg).
These two antibodies are called anti-TPO andibodies and
anti-Tg antibodies. If either of the two are elevated, the
diagnosis is Hashimoto's.

A diseased thyroid has a different texture and a decreased


echo (response) during an ultrasound. Its cells have been
attacked and destroyed and it is therefore physically unable
to produce adequate amounts of thyroid hormones. This is
why it's important for people with hypothyroidism to
supplement with thyroid medications.
There are many symptoms of hypothyroidism and they all suck. You can have all of them, just one or none if the disease is in
its initial stage. For some people it starts with dry skin, hair loss or weight gain and for some with low mood, mood swings,
anxiety or feeling easily overwhelmed. For women it can start with menstrual cycle issues or fertility & pregnancy problems
and for some Hashimoto's will develop after giving birth. The longer you are undiagnosed or undermedicated, the more of
these symptoms you are likely to pile up. A collection nobody really wants.

What causes this insanity? There are many different causes but most often it is a combination of factors that contribute to the
development of autoimmunity. Those factors are infection, genetic predisposition, chemicals, stress, intestinal permeability,
food intolerances, radiation etc. 

To diagnose Hashimoto's five blood markers must be tested:


TSH or Thyroid Stimulating Hormone
free T3 (fT3) or free Triiodothyronine
free T4 (fT4) or free Tetraiodothyronine
anti-TPO antibodies or antibodies against Thyroid Peroxidase
anti-Tg antibodies or antibodies against Thyroglobulin

Here is the problem...

Most doctors will only order a TSH or a TSH + fT4 test. As explained in point , the most bioactive hormone is fT3 so it is of
utmost importance that fT3 gets tested. Why is fT3 not tested routinely? It is assumed that if a person has enough fT4 they will
consequently have enough fT3 as a result of the conversion process explained in point . However... A lot of people have a hard
time converting fT4 into fT3 due to different issues, one of them being a Deiodinase deficiency, the enzyme described in point
These people can not make enough fT3 on their own. Additionally, if both antibodies are not tested, you cannot know whether
or not you have Hashimoto's. There are other causes of hypothyroidism but remember, in 95% of the cases it is Hashimoto's.

Here is the the other problem...

Test results come with reference ranges and most doctors will consider everything to be "normal" if your
numbers fall within those ranges. Unfortunately those ranges are based on a bell curve and are very
wide. In reality, a healthy person's thyroid levels will be in a much more narrow range. Study link.

The range for TSH that is considered normal is typically


between around 0.4 and 4 mU/mL. The optimal range for
healthy unmedicated individuals is much narrower and lower
on the scale, between 0.4 and 2 mU/mL.

The ranges for fT3 and fT4 vary but are also too wide. In a
healthy individual fT3 will be in the upper half of the range
and fT4 in the upper 1/2 to 1/4 of the range.
Additionally, someone who has trouble converting fT4 to
fT3 will have lower fT3 levels with fT4 levels appearing
normal or high enough.

There are different types of thyroid medication available and it will depend on the person which one will suit them best.
Normally there is a period of trial and error when first starting thyroid medication but the most important thing is that the
dose is adjusted until optimal fT3 and fT4 levels are achieved.
The medication prescribed by default is called Levothyroxine. It comes under different names like Synthroid, Eltroxin, Euthyrox
etc. This is a T4-only medication and it may suit people who convert T4 to T3 well. Those who don't have other choices like
bovine or porcine Natural Desiccated Thyroid (NDT) that contains both T4 and T3. Unfortunately, NDT is often not subsidized
and the patient needs to pay for her/himself. There is also a T3-only medication available and some do best on that and then
there is a compounded T3+T4 option that some also have access to.
Another drug that can be taken by people with autoimmune thyroid disease is called Low-Dose Naltrexone or LDN. This is not a
hormone replacement medication but rather an immune system modulator that in many cases helps to bring antibodies down.

Find a knowledgeable doctor and be your own health advocate.