Hashimoto: the most common form of an underactive thyroid

Hashimoto? Bless you! What sounds like a hearty sneeze is in fact an autoimmune disease. Put in strictly scientific terms: the thyroiditis (inflammation of the thyroid) becomes chronic (long lasting) and damages the cells of the thyroid until a permanent hypothyroidism (underactive thyroid) develops. That is why it is also called chronic immune thyroiditis, or Hashimoto for short. Too complicated? We will go through it again, slowly and calmly. Why? This autoimmune disease accounts for around 80 per cent of all cases of thyroid disease, and it affects women nine times more often than men. It is time to talk openly about Hashimoto.

What is an autoimmune disease?

Roughly speaking, you could put it like this: the body fights itself. The immune system no longer recognises the body’s own structures and acts against them as though they were foreign. It is, in the classic sense, “confused”.

What happens with Hashimoto?

When your body notices that foreign proteins are entering the bloodstream, pathogens or allergens for example, antibodies are formed. These antibodies are specifically matched to their target, so they are directed specifically against certain bacteria or certain allergens. With Hashimoto the body forms antibodies against thyroid cells, hormones or proteins, in other words against the body’s own structures, which really ought to be left to do their work undisturbed. But if they are attacked again and again by the antibodies that have been formed, at some point those structures are damaged. In the long run this leads to an underactive thyroid.

How can I find out whether my thyroid is working properly?

You can, for example, have your thyroid values checked by a doctor, or test at home with a kit, for instance from Cerascreen.

A little insider knowledge on the side

The disease was named after the Japanese physician Hakaru Hashimoto. He came from a family with a long medical tradition and described it as early as 1912, of all places in a German specialist journal. He wanted to make sure it would become known internationally. In his home country, by contrast, he was almost unknown.

There are many names for Hashimoto’s thyroiditis: chronic thyroiditis Hashimoto, chronic lymphocytic thyroiditis, Hashimoto’s disease, autoimmune thyroiditis, Hashimoto syndrome, Hashimoto illness, or the short form we use, Hashimoto.

In the autoimmune disease Hashimoto the body forms antibodies against the proteins of the thyroid hormones. One of them is thyroglobulin, the protein on which the synthesis of the thyroid hormones thyroxine and triiodothyronine takes place (you can read more about this in our article “Everything about the thyroid“). Because these proteins are destroyed, a disproportionate amount of hormones (thyroxine and triiodothyronine) is released. That leads to the symptoms of an overactive thyroid. It is as though a water bomb suddenly burst. For a short while everything is wet, but no new water follows. This state is called Hashitoxicosis. In the long run it leads to an underactive thyroid.

There are two courses that Hashimoto can take:

• In the classic form the thyroid becomes larger, because the underactive thyroid forces it to work harder. A struma forms (the technical term for the enlargement of the thyroid), in everyday language also called a goitre.
• In the atrophic form thyroid tissue is destroyed and the organ shrinks. Here too the long term consequence is an underactive thyroid.

In Germany the atrophic form of Hashimoto’s thyroiditis is observed more often than the classic form.

Hashimoto can bring on a range of symptoms, and they vary from person to person. At the beginning of the disease many people go through a phase of an overactive thyroid (hyperthyroidism), which later turns into an underactive thyroid (hypothyroidism). Some people notice nothing or very little of their Hashimoto’s thyroiditis and are given the diagnosis by chance during a routine examination.

People who already have other autoimmune diseases, such as type 1 diabetes mellitus, are at particularly high risk. Because the immune system is already malfunctioning, other organs or body structures can be damaged as well.

With type 1 diabetes mellitus, for instance, the cells of the pancreas are attacked by the immune system first, and over the years a wider attack on the thyroid can follow. Other autoimmune diseases that often occur in connection with Hashimoto are Addison’s disease, coeliac disease or a severe form of anaemia (pernicious anaemia). Hepatitis C, an inflammation of the liver, also appears to play a part in how the disease develops.

Women develop Hashimoto’s thyroiditis far more often than men, roughly nine times as often. It is thought that women are more strongly affected because of hormonal processes in the body. Above all oestrogen, the most important female sex hormone, has a great influence on the thyroid and on the thyroid hormones it produces.

Then there is prolactin, a hormone that, among other things, stimulates milk production in the mother’s mammary gland after birth. Because prolactin influences the immune system, it is assumed that it is generally connected with autoimmune diseases. In women with Hashimoto a lowered progesterone level is often found as well. This hormone influences menstruation and the maintenance of a pregnancy. In most cases the disease appears between the ages of 40 and 50.

Since Hashimoto’s thyroiditis often occurs several times within one family, it is also assumed that there is a genetic predisposition for the condition.

A pathological genetic make up (genetic disposition) is the basic requirement for being at risk of developing an autoimmune disease such as Hashimoto’s thyroiditis. The genes involved belong to the so called HLA complex (human leukocyte antigen complex). This complex is responsible for the immune system’s competent distinction between the body’s own cells or proteins and foreign ones. Added to this are immunoregulatory genes such as CTLA4 or CD40 and thyroid specific genes such as TSHR or Tg. But not everyone who carries this genetic make up develops Hashimoto’s thyroiditis in the course of their life. Only when certain triggering factors are added do the gene carriers fall ill with Hashimoto. So unfavourable external influences have to join the inborn susceptibility before the autoimmune disease breaks out:

• Too high an iodine intake (the compulsory iodisation of our foods)
• Stress and psychological strain
• Smoking
• Hormonal fluctuations (puberty, pregnancy, menopause)
• Severe viral illnesses (such as glandular fever)
• Severe illnesses (for example carcinomas, heart attack)
• Alcohol
• A lack of selenium, iron, zinc, vitamin D3, coenzyme Q10, omega 3 fatty acids
• Disturbances of the microbiological gut flora with damage to the intestinal wall
• Dysfunction of the adrenal cortex
• Environmental influences

The exact causes are different for every person affected. In most cases Hashimoto arises through a combination of different causes. This individual character of Hashimoto’s thyroiditis makes optimal treatment all the more difficult.

Unfortunately there is no therapy that addresses the cause of Hashimoto. The symptoms of an underactive thyroid can, however, be treated in tablet form. The artificial hormone levothyroxine replaces the missing thyroid hormones. If the disease has led to an enlargement of the thyroid, it can be removed in an operation.

In addition to the medical options, you can support the body with a diet tailored individually to you.

A very clear yes! There are foods and ingredients that tend to stir your immune system up rather than calm it down and counteract the chronic inflammation. Others support and soothe it.

For all the advice, one thing holds true: testing for yourself is the best method for recognising intolerances and tolerances with Hashimoto.

An AIP, an autoimmune protocol, can help you find the right foods for your individual diet. For at least 30 days you leave out all the “tricky” foods, such as nuts, eggs, pulses, dairy products and foods containing gluten and grains. After those 30 days you reintroduce them step by step in ever larger amounts, until you know for every group whether and how much of it you tolerate well.

Even though treatment by a doctor is always necessary and important, you can achieve a great deal with Hashimoto through the right diet. If you are interested in a plan created individually for you: our nutrition experts are there for you.