The thyroid is a small gland located in the neck that has impressive influence over many areas of wellness. As such, conditions that impede thyroid function can lead to serious issues including chronic fatigue, weight gain, and reduced cognitive function. The two leading causes of decreased thyroid activity are hypothyroidism and Hashimoto’s thyroiditis. Both conditions share many traits which can make distinguishing between the two difficult. However, there are several distinct qualities that can aid in identification.
Familiarity with these conditions and their unique characteristics is essential for accurate diagnosis and effective treatment.
What is Hypothyroidism?
The thyroid gland regulates numerous bodily functions through the production of hormones. Thyroid hormones act like the gas pedal of a car in that it dictates the speed of many bodily processes. Hypothyroidism is a condition wherein thyroid function is slowed or disrupted leading to a drop in the number of circulating thyroid hormones. The result is a widespread decrease in bodily function, which is manifested through symptoms such as fatigue, loss of libido, depression, weight gain, constipation, poor memory and concentration, sensitivity to cold, reduced sleep quality, and more.
Causes of Hypothyroidism
There are several potential causes of hypothyroidism. Physical damage or trauma to the thyroid gland, stress and anxiety, nutritional imbalances, chronic illness, disrupted hormone transport or receptivity, genetics, and environmental or lifestyle factors can all contribute to the development of hypothyroidism. However, one of the leading causes of hypothyroidism is an autoimmune disorder called Hashimoto’s thyroiditis. Hashimoto’s will be discussed below in greater detail.
Proper Thyroid Testing
The most common method for assessing thyroid function is testing the amount of thyroid stimulating hormone (TSH) in the system. Unfortunately, even though this approach has been established as the medical standard, TSH-only testing is woefully inaccurate when it comes to identifying hypothyroidism. In fact, it is estimated that nearly 80% percent those with reduced thyroid function are not recognized by TSH-only testing. In part, this is because TSH only assesses how well the pituitary gland is communicating with the thyroid gland and not its actual functionality.
To accurately assess thyroid function and identify hypothyroidism a more thorough set of tests must be run. At minimum, a thyroid panel should include testing of the thyroid hormones T4, T3, and Reverse T3, sex hormone binding globulin (SHBG), leptin, and thyroid antibodies.
Optimal Thyroid Treatment
The primary goals of hypothyroid treatments are to make up for insufficient thyroid hormone production and maintain appropriate thyroid hormone values. The most common approach to treat hypothyroidism is thyroid hormone replacement therapy. This usually involves taking a once-daily oral tablet of synthetic or natural thyroid hormone. Depending on the individual’s specific needs, different formulations may be more effective than others. Some variations on the standard synthetic T4-only treatment which doesn’t work for many patients include, T3-only formulations, combination T4/T3, time-released T3, natural desiccated thyroid, and bioidentical thyroid hormone.
What is Hashimoto’s?
The immune system is the body’s primary line of defense. When working correctly, the immune system identifies harmful agents including viruses and bacteria then responds by producing antibodies to seek out and destroy them. This is highly effective and can quickly eliminate threats before they get the chance to harm the body.
Hashimoto’s thyroiditis, or simply Hashimoto’s, is an autoimmune thyroid condition wherein the immune system misidentifies certain proteins in the thyroid gland as a threat. Subsequently, the immune system releases antibodies to destroy the perceived threat. As the thyroid antibodies continue to assault healthy thyroid tissue, its function declines resulting in an ever-worsening case of hypothyroidism.
One of the main ways of identifying Hashimoto’s is its alternating symptoms. Hashimoto’s often presents symptoms of hypothyroidism interrupted by symptoms more akin to hyperthyroidism (accelerated thyroid activity). Hashimoto’s may cause temporary symptom flare ups including panic attacks, anxiety, accelerated heartbeat, diarrhea, and sudden weight loss. This phenomenon is known as Hashitoxicosis. The sudden change or alternation of symptoms is due to an influx of thyroid hormone that is released as antibodies destroy thyroid tissue.
Causes of Hashimoto’s
Currently there is no definitive answer regarding the causal mechanism of Hashimoto’s. However, some experts suggest that deficiencies of thyroid-related nutrients such as iodine, selenium, zinc, and iron may promote inflammation of the thyroid thereby increasing the risk of autoimmune malfunction. Genetics may also play a role in the development of Hashimoto’s. Those with a family history of Hashimoto’s have been found to have a greater risk of developing the condition. The most common cause of Hashimoto’s is other chronic illnesses, immune disorders, or chronic infections. These issues put significant strain on the immune system, which increases the likelihood of developing an autoimmune condition such as Hashimoto’s.
Testing for Hashimoto’s
Identification of Hashimoto’s usually involves running a thorough thyroid panel much like those done to test for hypothyroidism or other forms of thyroid dysfunction. However, diagnosis of Hashimoto’s relies heavily on data regarding thyroid antibodies. If levels of specific thyroid antibodies are elevated, it is almost assured that the patient has Hashimoto’s. Therefore, to accurately test for Hashimoto’s it is essential that thyroid panels include thyroid antibodies.
Treatment of Hashimoto’s typically includes hormone replacement similar to hypothyroidism. However, further steps must also be taken to resolve the underlying chronic dysfunction of the immune system. Because chronic illness and autoimmune disease are highly specific to the individual patient, there is no one-size-fits-all approach. Ideally, patients get individually optimized care that may involve some or all of the following practices:
- Alleviating nutrient deficiencies such as selenium or iodine
- Lifestyle changes to reduce physical and psychological stressors
- Resolving any underlying contributors such as viral or bacterial infection
- Supplementation with DHEA and/or testosterone to regulate antibody levels
- Therapy involving low dose naltrexone to reduce thyroid antibodies
- Treating chronic inflammation or immune disorders such as leak gut
In this interview with Dr. Kent Holtorf, he further explains the proper tests and treatments for Hashimoto’s.
The Connection Between Hypothyroidism and Hashimoto’s
The relationship between Hashimoto’s and hypothyroidism exemplifies how important proper thyroid testing and treatment is for protecting overall wellness.
Although not required for the development of hypothyroidism, Hashimoto’s is a leading cause of significant decline in thyroid function. As such, proactively testing for and treating Hashimoto’s may protect against the development of hypothyroidism. Ideally, Hashimoto’s is identified before or at the same time as hypothyroidism. If Hashimoto’s is caught before hypothyroidism is recognized, it may be possible to prevent damage to the thyroid and subsequent destruction of thyroid tissue.
Recognizing and Resolving Thyroid Disease through Active Testing and Treatment
Hypothyroidism and Hashimoto’s share many qualities. However, there are several important differences that have an influential role in the development of symptoms and requirements for treatment. Familiarity with both conditions allows for more accurate diagnoses and subsequently better treatment. Armed with the information provided above, you are better equipped to identify and distinguish between hypothyroidism and Hashimoto’s.
At Holtorf Medical Group, our physicians are trained to provide you with cutting-edge testing and innovative treatments to properly diagnose and treat your thyroid condition, optimize your health and improve your quality of life. If you have been diagnosed with hypothyroidism, but aren’t getting the treatment you need or if you have symptoms associated with thyroid dysfunction, call us at 877-508-1177 to see how we can help you!
1. Kent Holtorf, MD. “Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity).” https://www.nahypothyroidism.org/deiodinases/
2. Kent Holtorf, MD. “Thyroid Hormone Transport.” https://www.nahypothyroidism.org/thyroid-hormone-transport/
3. Kent Holtorf, MD. “Diagnosis of Hypothyroidism: Are we getting what we want from TSH testing?” https://www.nahypothyroidism.org/how-accurate-is-tsh-testing/
4. Kent Holtorf, MD. “Why Doesn’t My Endocrinologist Know All of This?” https://www.nahypothyroidism.org/why-doesnt-my-doctor-know-all-of-this/
6. LDN Trust. “Conditions that are helped by Low Dose Naltrexone (LDN).” https://www.ldnresearchtrust.org/conditions
How HMG Has Helped Others: Patient Testimonial
I don’t know where to begin. I am a 63 year old male who has been miserable for the past 12 years with Hashimoto’s. I have been seeing my family physician and a Endocrinologist routinely for the past 12 years with no relief of my symptoms other then what my T4 blood results. When I approached my doctors with my symptoms of abdominal pain, muscle and joint pain, muscle spasms and many other symptoms from time to time they had no answers.
Being desperate and on my way to Georgia to visit my grandchildren I began searching for a physician who specializes in treating Hashimoto’s. Thank god I came across the Holtorf Medical Group. I immediately made an appointment with Angel Nofzinger,NP and have had 2 appointments with her. At this time I can’t begin to tell you how great it is to not experience the abdominal or joint issues. I feel like a new person. I am looking forward to my next blood tests and adjustments in my Medicine to see if we can reach a new level of well being. – Paul S.