What is Hashimoto’s Disease?

Written By Rachel Hilts

Co-Written by Megan Churchill, Dietetics Student

June is Thyroid Awareness Month! Let’s talk about Hashimoto’s thyroiditis.

Hashimoto’s thyroiditis is an autoimmune disorder where your immune system attacks your thyroid (1). This causes your body to be unable to make enough hormones in your thyroid, and can lead to an underactive thyroid – known as hypothyroidism (1).

 

So, Hashimoto’s affects your thyroid, but what is the function of the thyroid?

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The thyroid is a butterfly shaped gland that is located in the front of your neck (2). The thyroid’s major role is to help maintain metabolism, growth, and development in the body, in addition to regulating thyroid hormones released into our blood (2). The thyroid releases 3 hormones: T3, T4, and Calcitonin (2). Iodine is important in the production of thyroid hormones, therefore one of the reasons we need adequate amounts of iodine in our diet is for the production of these hormones (2)! However, too much iodine can also be harmful for our thyroid (4). The role of iodine will be discussed more below.

Hashimoto’s affects approximately 5% of the population, and is approximately 8 times more likely in women than in men (1,4).

Hashimoto’s is caused by your body mistakenly attacking your thyroid gland instead of bacteria’s and viruses which causes a decrease in thyroid hormone production (5). People who are at increased risk of having Hashimoto’s include(1,5):

  • Women

  • Those between the age of 40-60 years old

  • Those who have a family member with Hashimoto’s

  • Having another autoimmune disease

Common symptoms of Hashimoto’s thyroiditis include (1):

  •  Enlarged thyroid gland

  • Fatigue

  • Constipation

  • Weight gain

  • Muscle pain

  • Thinning hair

  • Sensitivity to cold temperature

  • Irregular menstrual cycle

  • Infertility

 

Diagnosis: 

Hashimoto’s is typically detected by an enlarged thyroid gland along with other symptoms listed above (6,7). A physical examination will be done which will detect the enlarged thyroid. Along with a physical examination, laboratory testing will be done to test the levels of your thyroid hormones. When testing for Hashimoto’s, health care practitioners are looking for an elevation in thyroid stimulating hormone (TSH), or thyroid peroxidase (TPO) antibodies, and low levels of free T4 (6,7).

 

Treatment:

Hashimoto’s can be treated with both medication and dietary interventions.

The most common medication used to treat Hashimoto’s is synthetic levothyroxine (6). Synthetic levothyroxine is an oral medication that works to normalize thyroid hormone levels, and also works to improve symptoms of Hashimoto’s (6).

Additionally, our diet can be used to treat symptoms of Hashimoto’s.

If you are interested in using your diet to help stabilize Hashimoto’s, it would be beneficial to work with a dietitian. They will help to balance hormones, and to improve your overall health.

 

Dietary interventions that may help to reduce symptoms of Hashimoto’s include (8):

  • Limiting consumption of raw cauliflower, broccoli, cabbage, brussel sprouts, turnip, and radish. These foods can still be included in your diet however they should be cooked or steamed, or consumed in smaller amounts if eaten fresh.

    • These foods contain a compound known as goitrin, which can interfere with thyroid hormone synthesis.

  • Consume iron rich foods (meat, fish, and legumes)

  • Consume selenium rich foods (meat, fish, eggs, nuts, and legumes)

  • Consume magnesium rich foods (seeds, nuts, legumes, fish)

  • Include foods rich in vitamin D (eggs, dairy products, and fatty fish), or include a vitamin D supplement

It’s also important to rule out celiac disease, as this condition can be much more common in those with Hashimoto’s (8). In those with celiac disease a gluten free diet would be important. In some people with Hashimoto’s without celiac disease, a gluten free diet still may be beneficial, but this is by no means a recommendation for everyone with this condition – it’s important to work with a dietitian to follow an appropriate elimination diet trial to identify food related sensitivities that may impact your thyroid function (8).  

Although iodine is important for thyroid function, supplementing with iodine can potentially increase the symptoms of Hashimoto’s (8). People with Hashimoto’s typically have elevated TPO antibodies, and iodine works to stimulate the production of TPO. Therefore, if you have Hashimoto’s and are taking an iodine supplement your body could have an overload of TPO (8). In Canada, we iodize our table salt, which helps make sure the majority of Canadian’s have adequate intake of iodine. If you are consuming iodized table salt, and fish, it is likely that you are consuming a good amount of iodine. However, it is important to talk to your health care provider to make sure you shouldn’t increase OR decrease the amount of iodine in your diet.


Additionally, if you are trying to become pregnant and have Hashimoto’s be sure to include your health care team. They will test your thyroid hormone levels frequently, and make sure you have sufficient iodine intake (8).

If you have questions about Hashimoto’s, or have been recently been diagnosed with Hashimoto’s and would like to include dietary interventions in your treatment, contact me to book an appointment! 

 

References:

1.     National Institute of Diabetes and Digestive and Kidney Diseases. Hashimoto’s Disease [Internet]. 2017 [Cited 22 June 2021]. Available from: https://www.niddk.nih.gov/healt h-information/endocrine-diseases/hashimotos-disease  

2.     InformedHealth. How does the thyroid gland work? Institute of Quality and Efficiency in Health Care. 2018 [Cited 22 June 2021]. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK279388/

3.     Wojtas N, Wadolowska L, Bandurska-Stankiewicz E. Evaluation of Qualitative Dietary Protocol (Diet4Hasi) Application in Dietary Counseling in Hashimoto Thyroiditis: Study Protocol of a Randomized Controlled Trial. Int J Environ Res Public Health. 2019; 16(23): 4841.

4.     Wiersinga WM. Hashimoto’s Thyroiditis. In: Vitti P., Hegedus L (ed). Thyroid Diseases. Springer, Cham. 2018.

5.     Johns Hopkins Medicine. Hashimoto’s Thyoiditis. 2021 [Cited 23 June 2021]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hashimotos-thyroiditis

6.     American Thyroid Association. Hashimoto’s Thyroiditis (Lymphocytic Thyroiditis). 2021 [Cited 25 June 2021]. Available from: https://www.thyroid.org/hashimotos-thyroiditis/

7.     Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: An Integrated Approach. Am Fam Physician. 2014; 90(6): 389-396.

8.     Morrow K, Raymond JL. Krause and Mahans’s food and the nutrition care process. 15th ed. St. Louis: Elsevier; c2021.

 

Rachel Hilts
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