Early Diagnosis is Key For Hashimoto's Disease

They say that, sooner or later, every girl turns into her mother. Well, I haven't turned yet (my house would be a lot cleaner if I had), but there is some truth to the saying. Each of us inherits half of our genetic makeup from our parents.

From my mom, I got the uncanny ability to fall asleep the second my head hits the pillow, really nice hair, and, on the downside, I also inherited Hashimoto's thyroiditis.

What exactly is Hashimoto's thyroiditis?

Hashimoto’s thyroiditis is an auto-immune disease where your body’s immune system attacks your thyroid. The disease is named after a Japanese physician who first described the symptoms in the early 1900s.

The thyroid is part of your endocrine system, a gland located at the front of your neck, responsible for the release of hormones that control metabolism and other vital functions of your organs.

A healthy thyroid gland uses the iodine from the foods we eat to “manufacture” two hormones: Triiodothyronine (T3) and Thyroxine (T4). Those hormones reach cells of your body through the bloodstream, regulating the speed of your metabolism and mechanisms such as heart rate, body weight, temperature, nervous system, menstrual cycles, cholesterol levels, and more.

In the case of Hashimoto’s, as a result of your antibodies attacking it, the thyroid is damaged and becomes under-responsive and can no longer produce enough hormones that your body needs. That’s when the Hashimoto’s thyroiditis becomes hypothyroidism and this auto-immune disease is actually the main cause of hypothyroidism in developed countries such as the United States. People diagnosed with it need to take synthetic hormones to compensate for the thyroid not working properly.

Is hypothyroidism hereditary?

Hypothyroidism has two main causes:

  • Diet low in iodine an issue mostly solved in developed countries, where iodine is added to salt, flour, and other basic foods.
  • Auto-immune – Hashimoto’s disease, the most common cause of hypothyroidism. Scientists are not completely sure what triggers Hashimoto’s, but it’s clear that the disease has a strong genetic, hereditary component, as it runs in families.

There are a few factors that increase the chances of being diagnosed with the disease, and the first and most important is having family members with the same affliction. Also, women, especially middle-aged women, are a lot more prone to developing this auto-immune condition than other categories of the population.

The good news is that both Hashimoto’s and hypothyroidism are easily manageable through proper treatment (synthetic hormones, prescribed by an endocrinologist) and through a healthy diet and lifestyle. The most important thing is to pay attention to the signals your body sends and to get an early diagnosis.

Symptoms of Hashimoto’s thyroiditis

As I said before, I know first-hand about the wreck that Hashimoto’s can cause inside your body. As your metabolism is affected by the hormonal imbalance, all your body’s major systems bear the brunt. Hashimoto’s symptoms are multiple and can vary a lot form one person to the other, but, generally, we’re talking about:

  • Fatigue – feeling exhausted all the time, even when doing perfectly normal activities. One of my first symptoms was becoming extremely short of breath while climbing stairs or walking uphill. It’s the symptom that motivated me to get an appointment with an endocrinologist and measure the level of thyroid hormones in my body. I already knew that was an important clue, because my mom had the same issue for years, before being diagnosed with Hashimoto’s. It’s a very subtle symptom in the beginning and people ignore or pass it off as something else (such as being out of shape). But, if you start noticing that activity suddenly exhausts you more than it did in the past, you should mention it to your doctor so they can perform a physical exam.
  • Weight gain – generally, people with an under-active thyroid gain around 10-15 pounds without changing anything in their diet and lifestyle.
  • Sensitivity to cold – if you’re always cold while the rest of the people around you are not (and are annoyed with you for setting the thermostat higher) it might be a sign that something’s off. Sometimes, in the middle of the winter, I go to wake up my son in the morning and I find him sleeping with his window wide open. He’s a little bit of a polar bear, and I need at least 75 degrees Fahrenheit in my home to feel comfortable, so you could say that reaching middle ground is challenging. Fortunately, he’s moving away soon, and my husband seems to have adjusted to the environment – he stopped complaining about the house being too hot years ago!
  • Irregular or unusually heavy menstrual cycle – changes in the pattern of the menstrual cycle are a frequent symptom for women.
  • Constipation, pale skin, puffy face, brittle nails – each of those symptoms, on its own, might not mean too much, but, when combined, it’s definitely something to consider.
  • Joint and muscle pain, muscle stiffness – noticeable pain in your joints and stiffness in your muscles that prevents you from doing daily activities.
  • High cholesterol – one of the most insidious effects of this auto-immune disease is increased levels of bad (LDL) cholesterol. In time, high cholesterol levels affect your blood pressure and heart and you end up on medication for both issues. When a middle-aged patient goes to the cardiologist with high blood pressure, the cardiologist should suggest a consult with the endocrinologist, but it doesn’t always happen. My mother was on blood pressure and anti-cholesterol medication that wasn’t working for years before her cardiologist suggested blood work for thyroid hormones. She was finally diagnosed with Hashimoto’s (the underlying condition) and, once her hormones were under control, her blood pressure and cholesterol medication started working much better and was even reduced significantly.

Hashimoto’s symptoms, especially in the early phases of the condition, are pretty subtle and most people dismiss them. I mean, weight gain, fatigue, high blood pressure – must be age, right? Or must be the long work hours, lack of sleep, lack of exercise. And, many times, that’s true. But, just to be on the safe side, once you’re in your mid-thirties, early-forties and you get such symptoms, ask your doctor for a thyroid blood panel.

If you have family members that were already diagnosed with the illness, you should have your thyroid tested regularly (once every two years, or as often as your family doctor or endocrinologist recommend).

Treatment for Hashimoto's

Hashimoto’s treatment, if there is no evidence of hormone deficiency yet, will probably include observation rather than medication, a sort of wait-and-see approach. But it’s extremely important that you check the level of your antibodies and of your thyroid hormones regularly.

The condition can remain in the same stage for years, then progress rapidly over a short period of time.

There are serious complications of untreated hypothyroidism, including goiter, infertility, mental health issues and even a life-threatening disorder called myxedema. Myxedema is when hypothyroidism has progressed for a long time without treatment and is very rare because people usually recognize the symptoms and get help. However, it can occur, and myxedema can slow your metabolism to the point you fall into a coma. If you experience symptoms such as intense fatigue and intolerance to cold, seek medical help immediately.

What is the outlook for Hashimoto's disease?

Once you have been diagnosed with Hashimoto’s disease, it’s likely that you’ll eventually develop hypothyroidism, and that condition is generally permanent. If your thyroid slows or stops working, you can’t restart it, and you need to take daily medication.  You may also need to adjust the dosage of the medication through regular blood tests – once every six months is usually recommended by doctors.

However, there is no need for despair – with the help of a good endocrinologist, you can lead a perfectly normal life.

If you’re planning to have a baby or if you’re in early pregnancy, ask your doctor for a thyroid blood panel. Not only is conceiving challenging for women with Hashimoto’s or hypothyroidism, but children born to mothers with both conditions have a higher risk of birth defects and developmental delays. Also, both conditions carry a higher risk of miscarriage.

Diet and lifestyle can help control the condition

The onset of hypothyroidism can be delayed through a healthy diet, dietary supplements, and an active lifestyle. Here are some of the best foods and supplements for people diagnosed with Hashimoto’s:

  • Selenium – the thyroid is the organ that contains the most selenium in your body. People with Hashimoto’s that take selenium supplements generally report a decrease in the level of antibodies attacking the thyroid, even if no large-scale studies have confirmed it. However, selenium supplements are quite safe, so you should at least try it. Foods rich in selenium, such as eggs, nuts, tuna, and sardines are also recommended.
  • Iodine – the thyroid needs iodine to work, but if you live in the United States or Europe, there’s probably iodine already added to the salt and bread you eat. You might add iodine-rich foods to your diet: seafood, potatoes, milk. In case you don’t know if adding iodine to your foods is mandatory in the area where you live, you should ask your doctor about it. Find out more about the importance of iodized salt and its use in different countries.
  • Zinc is another micro-element that helps your thyroid. There are dietary supplements that combine selenium, zinc and other minerals and vitamins that support thyroid function. Talk with your doctor or with a pharmacist to find a product that works for you. You can also add foods rich in zinc to your diet: lentils, beans, oysters, shellfish or beef.

Food to avoid - gluten and certain vegetables

There is a debate raging about Hashimoto’s and gluten. Some specialists say that gluten, a protein found in wheat and barley, makes all auto-immune conditions, Hashimoto’s included, worse. The argument is that gluten is an inflammatory substance, so it is logical it would trigger a higher auto-immune response.

Scientists haven't reached a definitive answer on whether gluten makes Hashimoto’s worse or not. But, since gluten usually means bread, and pasta, and cookies, and cake, you might as well reduce these types of foods in your diet. Gluten kind of goes hand in hand with carbs, so if you decide to forgo gluten, it means you’re also reducing carbs and sugar, which, let’s be honest, is good for you. Let’s not forget, you’re also dealing with a slow metabolism and a tendency to pile on weight, so choosing veggies, legumes and lean meats over bread and pastries is a good strategy.

Speaking of veggies, not all of them are recommended, or at least not in high quantities. Cruciferous vegetables (cauliflower, cabbage, broccoli) contain a class of chemicals called goitrogens, substances that prevent the thyroid from functioning properly. Of course, a coleslaw won’t kill you, just don’t eat a lot of cruciferous vegetables every day. Shouldn't be too hard. For most people, probably a lot easier than giving up on gluten.

In summary, a Hashimoto’s diet should include plenty of lean meats, fish and seafood, legumes, nuts, fruits and vegetables, and only small quantities of bread, pastries, or sweets.

Hashimoto’s and exercise

Sport helps a lot with Hashimoto’s. The main symptom of the disease is a slow metabolism, and physical exercise is known to increase the rate of your metabolism.

However, too intense or too frequent exercise might put a strain on your thyroid. Leave two or three days between workouts, to allow your thyroid hormones to recover. Also, if you feel extremely tired after a workout, it could mean that it’s too intense for your body.

Swimming is a great sport for people with hypothyroidism, as it doesn’t put any strain on the joints (which tend to get painful and inflamed). Also, yoga is very helpful, because it improves mobility and relaxes the muscles.

Your body always tells you when something’s wrong. If you notice even a small change in the way you deal with physical activities, or a change in your digestion, in the quality of your skin or your nails – don’t ignore it! Go get your blood work done, your treatment might need an adjustment. Also, find a good specialist, one that listens to you. It’s a condition you’ll have to deal with for the rest of your life, and having a doctor who's always in your corner makes a world of difference.