Hashimoto’s Disease – The What, Why, and How.

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Hashimoto’s Disease is an autoimmune disease in which your own immune system attacks your thyroid gland.

There are several types of Hypothyroidism, and Hashimoto’s Disease is one of the types I see quite often in private practice. Hashimoto’s Disease is an autoimmune disease in which your own immune system attacks your thyroid gland.  Initially Hashimoto’s Disease causes overactive thyroid hormone production but soon the inflammation caused by the autoimmune attack on the thyroid gland results in an underactive gland as the thyroid is destroyed by white blood cells. The thyroid gland located in the neck right above the collar bone, often swells from the inflammation and causes what is called a “goiter”.

There are many symptoms associated with Hashimoto’s Disease that are listed below, and many of them are the same symptoms as seen in all forms of hypothyroidism, but several are unique to Hashimoto’s Disease.

Symptoms of Hashimoto’s Disease (Those unique to Hashimoto’s Disease are starred*)

  • Weight Gain
  • Hair loss
  • Constipation
  • Low body temperature
  • Slow pulse and low blood pressure
  • High cholesterol
  • Brittle nails
  • Enlarged tongue
  • Fatigue
  • Muscle pain *
  • Joint pain and stiffness*
  • Depression
  • Memory sluggishness
  • Abnormal menstrual cycles
  • Generalized swelling or retention of fluid
  • Hoarse voice from thyroid enlargement
  • Trouble swallowing

The initial cause of Hashimoto’s disease is unknown but there are several theories about why some people get this disease.  The theories include a bacterial or viral infection that triggers antibodies to kill the virus or bacteria, but the antibodies get “confused” and attack the thyroid gland as well.  This is the most popular belief about the origin of Hashimoto’s thyroid disease. There is a consensus that besides the infection that triggers the attack of antibodies, there is a genetic weakness that sets certain people up to be at risk for getting this disease. Patients who get Hashimoto’s also are frequently beset with other autoimmune diseases like Lupus or Rheumatoid Arthritis. The third risk is radiation exposure to the neck and or chest.  Lastly, trauma to the neck can cause thyroid cells to be damaged and “leak” the contents of the gland resulting in an autoimmune reaction that begins a domino effect that attacks all the thyroid cells.

What Happens When a Person has untreated Hashimoto’s Thyroid Disease? Not all people go to the doctor when they experience symptoms of low thyroid.  Often healthcare is not available, or they are not insured or afraid of doctors. However, it is important to treat Hashimoto’s thyroid disease, or it can cause more severe disease than just hypothyroidism.  These diseases include:


  • Heart disease cardiomyopathy and Heart Failure
  • Depression
  • Poor sexual functioning and Low Libido
  • Myxedema—a severe swelling of the body that results in drowsiness, and finally in unconsciousness.


How do we Diagnose Hashimoto’s Disease? 

  1. Blood Tests to diagnose any hypothyroid disease, TSH Free T3 and Free T4


  1. Blood Test called TPO Antibody test, which is the enzyme that is generally contained inside the thyroid but is released from the thyroid gland when it is damaged by trauma, radiation or attacked by antibodies that are misdirected when killing a virus. The test we do measures the level of Antibodies that attack the Thyroid Peroxidase Enzymes.


Blood tests are the way to measure the level of the antibodies that attack the thyroid gland. We test for TPO antibodies as well as the TSH Thyroid Stimulating hormone, Free T4 one of the thyroid hormones, and Free T3.  By measuring these tests as well as the antibody test, we can both diagnose and measure the success of our treatment. TPO antibodies are specific for Hashimoto’s Disease and don’t disappear with time but generally stay stable if the disease is adequately treated.

What is the Treatment for Hashimoto’s Disease?

The treatment of Hashimoto’s Disease is to replace the missing thyroid hormone with oral thyroid medication. At BioBalance we treat Hashimoto’s Disease with Armour Thyroid (pig thyroid) the most natural form of thyroid medication. If that is not effective, we adjust the treatment to another type of thyroid medication (NP Thyroid, Levothyroxine, Synthroid or Tirosant) and adjust the dose until the symptoms of hypothyroidism and Hashimoto’s Disease goes away.

It is not enough to give a Hashimoto’s patient a pill form of thyroid, but it is important to make sure the pill is absorbed in the stomach and intestine, and to ensure that it can be absorbed by cells all over the body to truly treat Hashimoto’s.  In general, we follow blood levels of Free T3 and T4, after a patient has been on thyroid for a few months, but that doesn’t always tell us if the thyroid medication is attaching to the receptors and stimulating cells to do the job of a person’s normal thyroid.

We make sure the Thyroid replacement is being taken properly Absorbed through the intestines.

To ensure absorption and the activation of receptors we do several things. First, we make sure our patient is taking her thyroid medication on an empty stomach with only water and waiting for 20 minutes, at the minimum, to eat or drink anything.  She can’t take other pills or supplements with it either.

Insure the absorption of the thyroid medication through the stomach and intestines

Some patients take medication to lower stomach acid which prevents them from dissolving and absorbing some of their oral thyroid medication. Patients taking thyroid require normal stomach acid to absorb their thyroid meds, and a proton pump medication for reflux will make it impossible for a patient to get her medication into her bloodstream.  If it is necessary for my patient to take her Protonix or other drug like it, then our patient must wait 1 hours after taking the thyroid before taking any type of acid reducing medications.

If my patient has low stomach acid naturally, I can tell because she usually has trouble eating dense proteins like steak, then she may also have trouble absorbing her thyroid medication.  We advise those patients to take digestive enzymes with the thyroid medication to help them absorb their thyroid medications.

If the beneficial gut bacteria is insufficient or abnormal from GI disease like Crohn’s disease and or Gastric Bypass, then thyroid medication cannot be absorbed.  We treat our thyroid patients who have intestinal disease with probiotics and a few months of prebiotics to assist in the GI absorption.

The last step in the effectiveness of thyroid medicine is to make sure once the medication has been absorbed into the blood from the intestines it must penetrate the cells that require thyroid hormone. The cells with receptors for thyroid hormone require Iodine. In my area of the country, the Midwest, we do not have Iodine in the soil or in the water so the lack of Iodine both affects the production of thyroid hormone for which Iodine is required and the receiving and penetration of thyroid hormone by the cells.  I advise my patients to take 12.5 mg of Iodoral daily to make up for the lack of iodine in our environment. Without it thyroid may get all the way to the bloodstream only to be blocked from cell absorption because of lack of Iodine.

Iodine is not contraindicated in Hashimoto’s disease when it is given in moderate amounts. Dr. Brownstein has written a book called Iodine, which explains the reason we give Iodine to all our hypothyroid patients, even those with Hashimoto’s disease.

 The choice of thyroid medication is critical to treatment goals

I always start women on Armour Thyroid or Nature Thyroid because in my experience during the last 40 years of medical practice, women do better on Armour thyroid than a synthetic like levothyroxine, Synthroid.   Armour Thyroid contains combined thyroid hormone, both T3 and T4, and the Endocrinology Society has finally come to that same conclusion.   Without taking combined thyroid the only lab test that doctors are trained to test is TSH, and it will look normal, even when it is not making the patient better. This fact is because most women cannot make T4 (what is in Synthroid and levothyroxine), into T3 the active form of the hormone, and doesn’t make patients with Hashimoto’s better.

When I rarely take care of men for this problem, I start them on Synthroid, and they do very well because men can convert their T4 (what Synthroid contains) into the active form of Thyroid (T3).  Men respond very well to Synthroid and Levothyroxine and therefor are more effectively treated with what most doctors use.

Hashimoto’s Disease Thyroid Treatment medical maintenance  

Once you have been diagnosed with Hashimoto’s disease you cannot stop taking your thyroid medication. Iodine will always be necessary as well.   My method of following a Hashimoto’s patient includes following their Free T3 and Free T4 as well as TSH, and reverse T 3 in certain circumstances and always a yearly TPO antibodies.  Adjustment of the dose occurs if the labs reveal hyper or hypothyroidism, if the antibodies are increasing, and or if the symptoms of low thyroid come back.

If you have Hashimoto’s disease you may have other autoimmune diseases or symptoms from the Hashimoto’s even if it is sufficiently treated. The most common autoimmune effect of Hashimoto’s disease is hair loss from the antibodies killing hair follicles.  In this case we ask our patients to see a dermatologist to prevent future hair loss and we optimize the dose of thyroid and Iodoral as well.

To our patients: Remember, if your symptoms are not improving on the thyroid medication or dose, you are on for Hashimoto’s Disease, you should find a doctor who will manage your thyroid to help you feel normal and ask you if your symptoms are better rather than just looking at the lab values.


This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author.   www.BioBalanceHealth.com  (314) 993-0963

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