Hashimoto's Thyroiditis

Hashimoto's thyroiditis is an autoimmune condition in which the cells of the thyroid are destroyed. Initially the destruction of the thyroid cells causes a release of larger than normal amounts of thyroid hormone, resulting in transient acute hyperthyroidism. As destruction of the thyroid cells continues, eventually too few cells will remain to produce normal amounts of thyroid hormone and the patient will develop a hypothyroid state.

Hashimoto's thyroiditis is associated with other autoimmune conditions, such as:

• Adrenal insufficiency (Schmidt's syndrome)
• Inflammatory bowel disease
• Celiac disease
• Pernicious anemia
• Diabetes Mellitus type I
• Graves disease

Please see conventional, complementary, and alternative medical treatments for important background information regarding the different types of medical treatments discussed on this page. Naturopathic, Complementary, and Alternative treatments that may be considered include:

• Chronic hypothyroid signs/symptoms: fatigue, weakness, cold intolerance, decreased memory, constipation, muscle and joint pain, hoarseness, weight gain, dry skin and sparse hair, depression, carpal tunnel syndrome, decreased sweating, swollen tongue, eyes, hands and feet, burning, prickling, itching, or tingling sensations, and hearing impairment. Slow heart rate, decreased pulse pressure, low body temperature, delayed relaxation of deep tendon reflexes.
• Acute hyperthyroid signs/symptoms: Nervousness and emotional distress, shortness of breath, increased sweating and heat intolerance, night sweats, rapid heart rate, heart palpitations, fatigue, weakness, weight loss despite increased appetite, tremors or inward trembling [Kharrazian2010], atrial fibrillation, loss of bone density, bulging eyes (exophthalmos).
• Physical Exam: Thyroid gland is usually non-tender, diffusely enlarged with fine nodularity, possibly asymmetrically.

• Hashimoto's thyroiditis may present as either an acute hyperthyroid or chronic hypothyroid condition in the standard thyroid screening panel (TSH, free T4).
• Elevated anti-thyroperoxidase (TPO) levels (95%).
• Elevated antithyroglobulin antibodies (60%).
• Thyroid gland nodularities upon palpation merit further evaluation (to rule out concomitant cancer) with ultrasound or fine needle biopsy, especially if isolated or unilateral, or patient has history of head/neck radiation exposure.
• Follow-up labs for associated conditions:
  • CBC (anemia).
  • Lipid panel (elevated cholesterol).
  • Metabolic Chemistry Panel (elevated CPK [creatine phosphokinase], LDH, AST, Hyponatremia).
  • IgA antiendomysial antibodies and IgA tissue transglutaminase (Celiac).
  • Adrenal Stress Index (adrenal insufficiency).
  • Intestinal Permeability Test (leaky gut).
  • Food Allergy Test (autoimmune triggers).
  •  >   
    Organic Acid Test (gut dysbiosis).

• With hyperthyroid symptoms:
  • Graves disease: Depressed TSH and elevated T4.
  • Pituitary tumor: Elevated TSH and elevated T4.
  • Pheochromocytoma: Elevated 24-hour urine VMA, catecholamines, and metanephrine.
  • Toxic multi-nodular goiter: (Iodine deprivation followed by repletion).
• With hypothyroid symptoms:
  • Iodine-deficient goiter.
  • Drug-induced: Lithium, amiodarone, propylthiouracil, methimazole, phenylbutazone, sulfonamides, interfereon-alpha, iodine, aminosalicylic acid, aminoglutethimide.
  • Genetic.
  • Ablation of thyroid gland.
  • Subacute thyroiditis: Elevated Erythrocyte Sedimentation Rate (ESR) and low antithyroid antibody titer.
  • Pregnancy or post-partum.

Naturopathic, Complementary, and Alternative Treatments