Hypothyroidism and Autoimmune Disease: What’s the Link?
Hypothyroidism in the United States is usually autoimmune
Medically reviewed by Kelly Wood, MD
Most people in the United States with hypothyroidism, low levels of thyroid hormone, have it because of an autoimmune condition called Hashimoto’s disease. Hypothyroidism is a condition that can occur on its own or as a result of Hashimoto’s disease. The best way to tell if you have Hashimoto's is through blood tests interpreted by an endocrinologist (hormone specialist).
This article discusses how you might learn your hypothyroidism is from Hashimoto’s disease. It also shares aspects of managing the condition.
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Link Between Hypothyroidism and Autoimmune Disease
Hashimoto’s disease is an autoimmune condition that can cause hypothyroidism. Autoimmune conditions are those in which the immune system acts abnormally, attacking healthy tissue in the body. Another name for Hashimoto’s is “chronic autoimmune thyroiditis.”
In Hashimoto’s disease, the immune system gets inappropriately activated against part of the thyroid gland. Antibodies against parts of the thyroid gland may form, and the gland may become inflamed. In turn, it may not produce as much thyroid hormone as usual.
With Hypothyroidism, How Do You Know If You Have Autoimmune Disease?
Some people who have hypothyroidism from Hashimoto’s disease don’t realize that they have an autoimmune condition. They may have just been told that they have hypothyroidism without a more complete explanation.
Ask you healthcare provider for the cause of your hypothyroidism. Although Hashimoto’s is the most common cause of hypothyroidism in the United States, some other causes are possible, including the following:
Medications: Some people develop hypothyroidism from the medication they have been taking. In this case, you may not necessarily have an autoimmune issue. Other people can have hypothyroidism as a side effect of surgery or radiation treatment.
Other medical conditions: Sometimes, different medical issues can cause hypothyroidism. It may happen in response to a rare infection. Uncommonly, it can happen because of specific brain problems, such as pituitary adenoma.
Iodine deficiency: It’s uncommon in the United States, but in parts of the world where iodine deficiency is a problem, not getting enough of this mineral can also cause hypothyroidism.
Temporary causes: Some people have temporary hypothyroidism, which might happen from viral infections or during pregnancy.
If a healthcare provider can rule out these and other causes, they may assume that Hashimoto’s is the cause of your hypothyroidism.
If you are diagnosed with Hashimoto’s disease, you do have a kind of autoimmune disease.
How to Get a Thyroid Panel to Test Hormones and Antibodies
The best way to definitively diagnose Hashimoto’s is through blood work. This often includes a group of tests called a thyroid panel, which can provide a healthcare provider with information about your thyroid function. The test helps providers look at the hormone signals the thyroid receives and a potential immune response against the thyroid.
The exact components of this panel can vary but often include the following:
Thyroid-stimulating hormone (TSH): A hormone that is usually high in the context of hypothyroidism, including Hashimoto’s, but low in some rare causes
Thyroxine (free T4): A thyroid hormone that is often low in hypothyroidism from any cause
Thyroid antibodies: This helps providers determine if you’re experiencing an autoimmune response. Often, providers look at specific antibodies called thyroid peroxidase antibodies (TPO)
TPO is especially helpful in diagnosing Hashimoto’s disease. If you have positive TPO antibodies in the context of low thyroxine levels and a high TSH, Hashimoto’s disease is the likely cause of your hypothyroidism.
However, it’s a little more complicated than that. A small percentage of people may have Hashimoto’s without positive antibodies. Some people are positive for antibodies even when they don’t have symptoms of hypothyroidism.
Although some at-home test kits are now available, the best way to get such a thyroid panel is through a healthcare provider who can help interpret your results.
Do I Need a Medication for Hypothyroidism?
You’ll need to discuss your health with a medical professional. If your symptoms, exam, and tests indicate hypothyroidism, you’ll want to pursue treatment to feel better.
The standard of treatment for hypothyroidism is Synthroid (levothyroxine). This is an oral, synthetically made version of one of the thyroid’s most important hormones, thyroxine (T4).
Most people with hypothyroidism from any cause will need such treatment. However, treating the underlying cause of hypothyroidism might be sufficient in a few cases. For example, if a medication is causing hypothyroidism, stopping the drug might be a viable option to treat hypothyroidism. Or, someone deficient in iodine might receive iodine supplementation to treat their hypothyroidism.
With Autoimmune Disease
The treatment approach for people with Hashimoto’s disease as the cause of hypothyroidism is thyroid hormone replacement with Synthroid (levothyroxine).
Unfortunately, scientists haven’t yet developed treatments to address the underlying cause of the autoimmune response to reverse the disease. For now, the best approach is replacing the low thyroid hormone.
Because hormone replacement effectively treats hypothyroidism from Hashimoto’s, scientists don’t recommend medications that directly affect the immune system to tone down inflammation. This differs from the treatment approach for many other autoimmune conditions, such as rheumatoid arthritis or lupus.
Other Treatment Options and Considerations
Experts are still debating some of the optimal ways to manage hypothyroidism from Hashimoto’s disease.
Using T3
Scientists aren’t clear on the use of additional thyroid hormones in treating hypothyroidism. For example, a different synthetic thyroid hormone, Cytomel (liothyronine), imitates the natural thyroid hormone triiodothyronine (T3). It may make sense to add Cytomel to Synthroid in some people if they still don’t feel well after starting and adjusting their Synthroid dose.
Switching From Name Brand and Generics
More than for some other drugs, staying on the same form of thyroid hormone replacement, such as Synthroid, may be helpful. Several brand-name and generic products are available, but these products may not be equivalent in how your body uses them and breaks them down.
Because of this, current guidelines from the American Thyroid Association recommend that people stick to the same form of thyroid hormone replacement that they start with, if possible. If you have to switch, work with a healthcare provider to find the proper dose.
Subclinical Hypothyroidism
Subclinical hypothyroidism is another evolving topic. Although their lab tests show that they don’t have overt hypothyroidism (i.e., relatively normal T4 levels), people with subclinical hypothyroidism may show signs that the thyroid gland is working harder than usual (e.g., high TSH levels).
People with subclinical hypothyroidism often don’t have symptoms, although they may be more prone to problems like depression. And around 50% of them have positive TPO antibodies. In other words, they have subclinical hypothyroidism from Hashimoto’s disease.
Although many people with subclinical hypothyroidism don’t need to be treated with thyroid hormones, some may benefit, so you should discuss it with a healthcare practitioner.
Working With a Specialist
Many people do very well managing their thyroid autoimmune disease with the help of a primary care provider. However, getting the expertise of an endocrinologist—a specialist trained in glands such as the thyroid—can be helpful, especially if you are unsure about your diagnosis or treatment. You might need to get a referral from a primary care physician first.
Supporting Immune Health With Autoimmune Disease
Unfortunately, learning to manage your immune health with Hashimoto’s disease can take some trial and error. However, there are some things you can do to support your overall health and your energy levels as someone with an autoimmune disease.
Choose foods that give you sustained energy (e.g., fruits and vegetables containing fiber and vitamins over heavily processed, sugary foods).
Find an exercise you enjoy that you can pursue regularly—but not to the point of exhaustion.
Prioritize getting enough sleep. Most people need seven to nine hours of sleep to feel at their best.
Find ways to reduce and manage stress by spending time with friends, meditating, engaging in relaxing hobbies, or seeing a counselor.
Complementary and Alternative Medicine (CAM) Approaches
You can find many promotions for products claiming to help Hashimoto’s disease on the internet. Experts might eventually find some of these products helpful, but they have not gone through the rigorous studies needed for approval by the Food and Drug Administration (FDA). So, there isn’t clear evidence that they are safe and effective.
Some people find some CAM approaches, like hypnotherapy, acupuncture, or yoga, quite helpful, and in some cases, a limited amount of research might support their use. However, you’ll need to use common sense.
Be especially cautious with herbal or other oral products. For such approaches, it’s best that you check in with a medical doctor, as some herbs and supplements might interfere with your treatment or harm you in some other way.
Summary
Hashimoto’s disease is the most common cause of hypothyroidism in the United States, although it’s not the only cause. Some people have hypothyroidism but don’t realize that it’s from Hashimoto’s, an autoimmune disease. Thyroid antibody tests, along with other standard thyroid tests, are helpful in diagnosing Hashimoto’s, but it can be a little tricky to understand your results. You’ll need the help of a healthcare professional to determine the right treatment.
Read the original article on Verywell Health.
