Natural Management of Hashimoto's Disease
If you have been diagnosed with hypothyroidism and are looking for natural ways to manage your thyroid, including diet, herbal, and vitamin/mineral recommendations, or if you have a family member who has been diagnosed with hypothyroidism and are wondering about your risk of developing it, learn more about having low thyroid production and ways to manage it at Vitalia Health Care in Vancouver.
The Naturopathic Physicians at Vitalia Health Care are experienced in both conventional and Naturopathic management of hypothyroidism. Book an appointment with Dr. Tasreen Alibhai ND or Dr. Elizabeth Miller ND to learn more about natural treatment options.
Book Here >>What is Hypothyroidism and Hashimoto's Thyroiditis?
Hypothyroidism is where the thyroid gland produces an insufficient amount of thyroid hormone. Approximately 90% of adult hypothyroidism is due to the presence of antibodies known as Thyroperoxidase (TPO) and Thyroglobulin (TG) (1). The presence of these antibodies in a blood test confirms a diagnosis of Hashimoto's Thyroiditis which is an autoimmune condition. The majority of Hashimoto's patients are women between the ages of 20 and 60. (1)
Symptoms of Hypothyroidism include:
Hashimotos Is An Autoimmune Condition
Hashimoto's is an autoimmune disorder affecting the thyroid gland. A person is diagnosed with Hashimoto's when they have the presence of thyroid antibodies. They may or may not have symptoms initially. The treatment and management of Hashimoto's is different from a hypothyroid condition that does not involve the immune system. Naturopathic medicine offers natural options for the management of Hashimoto's Thyroiditis.
If you would like to learn more about the diagnosis, treatment, and management of Hashimoto's Thyroiditis, you can book an appointment with a Naturopathic Physician at Vitalia Health Care. Dr. Tasreen Alibhai ND or Dr.Elizabeth Miller ND can help you explore your treatment options.
Book an Appointment Here >>The 3 Stages Of Progression Of Autoimmunity In Hashimoto's
There are 3 stages seen in the progression of HM, starting as a silent autoimmunity with no symptoms and eventually progressing to stages with symptoms. The goal of Naturopathic management is to slow down this progression by treating the hypothyroid state with thyroid replacement AND managing both progression and symptoms with natural therapies that include diet, lifestyle, herbal and supplement recommendations.
Stage One
Stage one can be considered Silent Autoimmunity. There may be a genetic predisposition meaning a family member may have Hashimoto's or hypothyroidism. But there are no signs and symptoms.
Stage Two
Stage two is the Autoimmune Reactivity. In Stage 2 thyroid antibodies may be elevated but TSH, Free T3 and Free T4 are normal.
Stage Three
Stage three is the Subclinical Hypothyroid state; TSH is elevated and antibody levels increase. There is now inflammation in the thyroid gland. There may be slight or no symptoms.
Stage Four
Stage four is Overt Hypothyroidism. TSH levels are high, Free T4 and Free T4 levels are low. Antibodies continue to increase and there is thyroid gland destruction. There are usually symptoms at this stage.
Stage Five
Stage five is the progression to other autoimmune diseases.
Naturopathic Medicine offers options for the management of Hashimoto's to reduce symptoms and to slow down progression of this autoimmune condition. These natural management options are aimed at reducing the inflammation seen in Hashimoto's, thereby reducing the damage to the thyroid caused by the high thyroid antibodies. Patient with Hashimoto's are also at a higher risk of developing other metabolic conditions such as blood sugar problems, high cholesterol and obesity. Naturopathic treatments are also aimed at managing these metabolic conditions.
Conventional Management Of Hypothyroidism And Hashimoto's Thyroiditis
The conventional management of hypothyroidism focuses on bringing an elevated TSH back to reference range with improvement in symptoms. However, every patient is different, so medical management may vary. A common management from symptoms to treatment may involve the following steps:
In some cases this works well for the patient and they remain on maintenance and yearly monitoring. However, in some cases the patient may not feel better even though their TSH is within reference range. This is where a functional medicine practitioner can dig deeper and investigate other areas of a patient's health and check for thyroid antibodies.
Laboratory Testing Available At Vitalia Health Care
At Vitalia Health Care in Vancouver we offer comprehensive testing for thyroid function including TSH, fT4, fT3, Thyroperoxidase & Thyroglobulin antibodies, and Reverse T3. This will give you and your Naturopathic Physician a complete evaluation of your thyroid hormone function.
TSH levels are mostly influenced by T4 levels. However, T3 is the thyroid hormone that is more metabolically active. Therefore, TSH levels may be within range, but if T3 levels are low the patient may experience low thyroid symptoms with a normal TSH.
A person may also experience low thyroid symptoms if they have elevated Thyroid antibodies which is the diagnostic criteria for Hashimoto's Thyroiditis or Grave's Disease. This may occur even if the TSH levels lie within reference range. Treatment at this stage is focused on both keeping TSH within range and reducing the ‘flares' seen in Auto-immune thyroiditis.
ADDITIONAL LABORATORY TESTING
We offer different laboratory tests. Your Naturopathic Doctor may recommend additional tests based on the information discussed during the initial assessment.
This may include:
Management Of Hashimotos Include Thyroid Hormone Replacement
Dr Tasreen Alibhai ND and Dr Elizabeth Miller ND at Vitalia Health Care in Vancouver prescribe various forms of Thyroid replacement therapy.
The first priority with any Hypothyroid patient (defined as an elevated TSH) is to balance the thyroid and reduce TSH. An elevated TSH contributes to inflammation and oxidative stress within the body. Generally a patient does not feel well with an elevated TSH. They may feel fatigued, "puffy" as their body is inflamed, they may experience brain fog and generally feel unwell.
Thyroid replacement is the first place to start with an elevated TSH. Options for thyroid replacement include commercially available or compound T4 only, T3 only, or Dessicated thyroid. Treatments are customized for the patient. Some patients feel better on a combination of T4 and T3. Regular monitoring of thyroid hormone levels is important to determine what dosage and combination works for you. Your Naturopathic Physician will discuss her recommendations for dosage and a schedule for monitoring.
Natural Treatment Options For Managing Hashimoto's Thyroiditis
The first place to start is to book an Initial consultation with Dr Alibhai ND or Dr Miller ND. During this approximate one-hour initial consultation, our Naturopathic Physicians will dive deep into your current and past medical history. You are unique! Your health history is unique. Your treatment recommendations are customized for you. She will discuss your current symptoms, ask you questions related to your family history of hypothyroidism, discuss your diet, stress management, and learn about YOU!
Other questions that your Naturopathic Doctor may ask include:
- Digestive health: do you have a bowel movement every day? Do you have gas and bloating? Do you have heartburn? Do you have loose stools or hard pebble-like stool?
- Female Hormone health: do you have a regular menstrual period? Do you get PMS? Do you have acne? Do you have endometriosis or PCOS?
- Nutrient levels: do you have thinning hair, shortness of breath when climbing stairs and fatigue which may indicate low iron levels? Do you have numbness in your fingers or toes which may indicate low B12 levels? Do you get sick frequently? What are your vitamin D levels?
These are all very important questions and may provide important clues about how different systems in your body may be affecting the progression of autoimmune Hashimoto's and areas to focus for management.
Our Naturopathic Physicians take the time to listen to you. To answer your questions. To diagnose using laboratory testing. To educate you on how your thyroid is affecting your overall health. Lastly, we take the time to discuss treatment options based on your unique health.
Book an appointment today with Dr Tasreen Alibhai, ND or Dr Elizabeth Miller ND
Book Here >>Dietary Recommendations For Hashimoto's
An anti-inflammatory diet may be a great place to start for managing Hashimoto's. This is generally a diet high in fruits, vegetables, whole grains, lean protein, healthy fats and legumes. Avoid foods that are processed, refined, high in sugar, contain preservatives and high in saturated fats. Limit alcohol. The Mediterranean Diet or Autoimmune Paleo Diet may be discussed during your appointment with your Naturopathic Doctor.
General diet and lifestyle recommendations may help patients feel better, control their symptoms and reduce the flares in Hashiomoto's Thyrodidits.
Be careful with iodine. There is controversy related to the recommendation of iodine to patients with Hashimoto's. Historically iodine has been recommended for hypothyroid patients to help the thyroid gland make more thyroid hormone.
The most recent research indicates iodine supplementation may NOT be helpful for Hashimoto's patients and may actually contribute to a flare of this Auto-immune thyroid condition. Hashimoto's is not caused by an iodine deficiency. The reason Hashimoto's patients are not producing enough thyroid hormone is because their immune system is producing Antibodies that are damaging the thyroid cells.
There are several studies that indicate even small amounts of iodine supplementation (250 mcg) which is equivalent to about 1 tsp of salt, may contribute to subclinical hypothyroidism, elevated TPO antibodies and autoimmune thyroiditis is susceptible individuals. (3) (4) (5)
The Naturopathic Doctors at Vitalia Health Care INC in Vancouver are experienced in treating patients with Hashimoto's Thyroiditis and follow the research related to diet and nutrition recommendations. This will be discussed during the initial and/or follow up consultation.
Gluten and Hashimoto's
Patients with Hashimoto's may feel better following a Gluten free or Low Gluten diet. Many of our patients say they feel they have more energy, experience less brain fog and have improved digestion when they reduce gluten in their diet. This will be discussed in the initial consultation if your Naturopathic Doctor feels it is appropriate for you.
A great study on Gluten: some people with Hashimoto's notice their symptoms improve when they go on a gluten free diet. One review study found a gluten free diet reduced serum anti-TPO antibodies, thyroglobulin antibodies, and also increased 25- hydroxy vit D (6) (7)
Celiac Disease and Hashimoto's
If you have been diagnosed with Hashimotos thyroiditis (HM), consider a gluten free diet. Research is emerging that indicate patients with Hashimoto's may feel better when they follow a gluten free diet. A 2022 review article looked at the most relevant literature associating Celiac disease and Hashimoto's. They did find an interesting link in the prevalence of Celiac Disease in patients with Hashimoto's. If you have been diagnosed, are taking thyroid replacement and still experience symptoms, consider a trial of a Gluten free diet. It may help ! (9)
Celiac disease is associated with about 2-5% of Hashimoto's (10) However, some patients who are Gluten intolerant, but do not have Celiac disease, may also experience improvement in symptoms following a Gluten free diet.
A study published in European Journal of Endocrinology found almost half of patients with Hashimoto's studied had biopsy changes to their gut lining similar to what is seen in patients with Celiac disease (11)
The Importance Of Balancing Blood Sugar And Hashimoto's
Management of blood sugar is important when managing Hashimoto's. Too high or too low blood sugars may impact how you feel and may trigger symptoms. We suggest testing HBA1C, the average 3-month blood sugar level, and fasting insulin to rule out Insulin Resistance. Proper management of blood sugar dysregulation includes dietary counselling (including meal timing, avoid simple and processed carbohydrates, ensuring adequate protein consumption, adding healthy fats to your diet, and exercise recommendations. Supplements may also be prescribed to assist in treating hyper (too high) or hypoglycemic (too low) blood sugar levels.
LIFESTYLE RECOMMENDATIONS
The natural management of Hashimoto's includes lifestyle recommendations. This is an auto-immune condition that goes through flares and remissions. Our immune system is affected by our stress levels. Worrying too much, over-doing things without getting adequate rest, even over-exercising and under eating is stressful to the body and may lead to a worsening of symptoms. Try to get at least 7-8 hours of sleep, find time to rest, avoid over-exercising. "Listen" to your body. If you cannot finish your workout because you get too tired or need a few days to recover after exercise, you may want to consider the intensity and how often you engage in high intensity exercise. Consider yoga or walking on recovery days. Your Naturopathic Doctor will discuss her recommendations during your initial or follow up consultation.
DIGESTIVE HEALTH AND HASHIMOTOS
The digestive system is an important area to evaluate and manage in patients with Hashimoto's. Especially with a patient who has a hard time managing their symptoms or balancing their thyroid medication (TSH is consistently going too high or too low) AND they have digestive symptoms.
Another "flag" to assess digestive health is when a patient also has body symptoms that seem to come and go, move around, and may not seem related. These include symptoms such as rashes, brain fog, muscle aches, chronic allergies, tinnitus, blurry vision AND digestive symptoms such as gas, bloating, loose stools and/ or constipation, heartburn and abdominal pain. Your Naturopathic Physician will discuss your digestive health and may recommend further testing including:
H.PYLORI & HASHIMOTO'S
An important bacteria to rule out is H Pylori, especially if you experience symptoms such as Heartburn, Acid Reflux or have been diagnosed with GERD. There may be cross-reactivity between H Pylori antibodies and thyroid Antibodies through a process known as Molecular Mimicry.(8) If you have an H Pylori infection, it may make your Hashimoto's symptoms worse. Your Naturopathic Doctor will discuss if this testing is appropriate for you.
SUPPLEMENTS AND HERBAL MEDICINE
Your Naturopathic Doctor, Dr Alibhai ND or Dr Miller ND, may recommend certain vitamins or herbal medicine in your treatment plan for Hashimoto's. During your initial consultation, Vitamin levels will be discussed and measured. If you have had these levels measured within the past 3 months, please bring the results with you to your first appointment.
Specific Vitamins and Minerals that may be discussed include:
Vitamin B12
Vitamin B12 is an essential water-soluble vitamin that may play a role in Hashimoto's. A study that included 130 patients diagnosed with Hashimoto's found 46% were deficient in Vitamin B12. Thyroid antibodies were also significantly higher in those patients with low Vitamin B12 levels. According to these researchers, patients with Hashimoto's should have their Vitamin B12 levels tested at the time of diagnosis and monitored as a part of follow up testing (12)
Iron
Iron is an important mineral found in our body. It is necessary for the formation of red blood cells and to carry oxygen to our cells. Symptoms of iron deficiency include hair loss, fatigue, shortness of breath upon exertion and mood changes.
Iron deficiency may be found in up to 60% of hypothyroid patients (13) In a study of 180 female patients with positive thyroid antibodies, anemia and iron deficiency were more common compared to controls (14)
At Vitalia Health Care in Vancouver, we routinely recommend testing an Iron Panel which includes a CBC, Total Iron Binding Capacity (TIBC) and Ferritin to get a complete picture of your iron levels. We have seen many patients with Hashimoto's experience improved energy and improved thyroid function once their iron levels are optimized. To increase iron levels, our Naturopathic Doctors will discuss dietary sources and may recommend an iron supplement.
Vitamin D
Vitamin D is produced from sunlight exposure. We are at a higher risk of having a Vitamin D deficiency during the winter months. There is also a higher risk if we have limited sun exposure (such as spending more time indoors) or avoid sun exposure.
Low Vitamin D levels may be correlated with the presence of Hashimoto's. In a study of 261 people, Vitamin D deficiency was higher among patients with Hashimoto's compared to those without Hashimoto's. (15)
Selenium
Selenium is an important mineral and may be beneficial in managing Hashimoto's. It is critical for the proper functioning of the thyroid gland. It is a powerful antioxidant that protects the thyroid gland during the production of thyroid hormone. It is naturally found in some foods, or it may be taken as a supplement. Patients with Hashimoto's and Grave's disease have lower levels of selenium (16)
A great study in 2019 evaluated 102 patients with Hashimoto's. After 3 months of daily supplementation of selenium at 200 mcg as well as 500mg of Vitamin C, they noted a significant reduction in TPO antibody levels. The Antibody levels in the placebo group did not change (17)
Overall selenium supplementation may help to reduce TSH levels and, as stated by the authors of this study,
"The literature suggests that selenium supplementation of patients with autoimmune thyroiditis is associated with a reduction in antiTPO antibody levels, improved thyroid ultrasound features, and improved quality of life. Selenium supplementation in Graves' orbitopathy is associated with an improvement of quality of life and eye involvement, as well as delayed progression of ocular disorders (18)"
Selenium supplementation may be beneficial for those who have subclinical hypothyroidism, where you have the symptoms of low thyroid function, and all laboratory values are within normal range. Your Naturopathic Doctor will discuss if selenium supplementation is right for you.
Please DO NOT start any new supplement program until you have discussed this with your Naturopathic or Medical doctor as they may not be appropriate for you.
If you have been diagnosed with Hypothyroidism or Hashimoto's Thyroiditis and would like to learn about how Naturopathic Medicine can help you manage your thyroid condition, call us today! Dr Tasreen Alibhai, ND and Dr Elizabeth Miller ND in Vancouver are available to meet with you. Check out their availability.
FAQ
During your initial appointment, your Naturopathic Physician will review your current health history, current symptoms, family history and any other pertinent information. If you do have previous labs from your doctor or another health care provider, please do bring them for review.
At this time, based on the information gathered, your Naturopathic Physician will develop the first step in your treatment plan. This may include diagnostic testing including a comprehensive thyroid test. This may also include diet, nutrition, lifestyle and supplement suggestions. Your Naturopathic Doctor will discuss these recommendations with you.
At the follow up appointment, the results of the lab tests will be discussed. Your progress based on any other recommendations from the initial appointment, will also be discussed. At this time, if indicated, Thyroid hormone replacement may also be prescribed. This may include a T4, T3 or T4/T3 combination. More specific diet and supplements may also be recommended. This will be based on your test results and the recommendations from your Naturopathic Physician.
Both Dr Tasreen Alibhai ND and Dr Elizabeth Miller ND are trained and experienced in managing thyroid conditions. They are licensed by the College of Naturopathic Physicians of BC and authorized to prescribe Thyroid hormone replacement in BC.
The first initial appointment is $225. The follow up appointments are $125. Brief appointments are $65.
Yes! A Naturopathic Physician who holds a certification in Prescriptive Authority is able to prescribe Thyroid Hormone Replacement in BC.