Autoimmune Thyroid

by Dr. Nikolas Hedberg on February 10, 2011

The number one cause of hypothyroidism in the world is Hashimoto’s autoimmune thyroiditis.  Autoimmune thyroiditis is also the most common undiagnosed autoimmune disease in the world.  More women are diagnosed with this condition than men.  Many patients do not receive a thorough evaluation of their thyroid gland and are put on thyroid medication without adequate testing for autoimmune thyroid.  Patients with autoimmune thyroid usually do not respond to medication and their doctors are continually adjusting their medication based on lab tests.  The TSH test can significantly fluctuate in autoimmune thyroid due to the immune system’s attack causing inflammation of the thyroid.  Traditional medicine does not check for autoimmune thyroid routinely which leaves patients with true autoimmune thyroid in limbo for months and even years before their doctor finally decides to run tests for autoimmunity.  Even in these cases it is sad because the treatment for autoimmune thyroid is medication.  That’s right, the treatment is the same for you whether you have autoimmune thyroid or thyroid dysfunction that is not autoimmune.

There is definitely a familial factor in autoimmune thyroiditis but not necessarily a genetic factor.  Habits of living tend to run in families such as food choices, lifestyle, acid-forming diets, and eating patterns that promote poor digestion, all of which can contribute to the development of autoimmune disease.

In autoimmune thyroiditis, thyroid cells are attacked by the body’s own immune system causing destruction of the thyroid gland and chronic inflammation.  It can cause an overactive thyroid or underactive thyroid – the latter being the most common.  Most frequently, the thyroid is slowly attacked over time leading to hypothyroidism with an elevated TSH (thyroid-stimulating hormone).  Traditional medicine treats Hashimoto’s with synthetic T4 (thyroxine) and when the TSH is in the normal range, the patient is considered to be treated successfully.  The autoimmune component is rarely addressed which does the patient a great disservice because the body’s attack can be greatly reduced sparing the thyroid gland for a much longer period than without treatment.  Many of these patients continue to take synthetic thyroid hormone but still have symptoms of hypothyroidism.

Graves’ disease is another form of autoimmune thyroiditis which is characterized by hyperthyroid activity with symptoms of anxiety, insomnia, eye-bulging, weight loss, swelling in the thyroid gland, and either increased or decreased energy depending on what stage.  Graves’ is more prevalent in women with an 8:1 ratio of female to male.  It usually occurs between the ages of twenty and forty.  Hyperthyroid symptoms include anxiety, nervousness, sweating, weight loss, fatigue and insomnia.  The thyroid is producing too much thyroid hormone in these cases which will result in signs of increased metabolism in the beginning; however, over time as thyroid receptors become saturated and the gland begins to lose function, signs of hypothyroidism begin to emerge.  The underlying cause of Graves’ and Hashimoto’s can be the same so we still approach these cases not from a disease model but from a cause-effect model.  What triggered the autoimmunity in the first place?

Graves’ disease is treated with medications that shut down thyroid function including methimazole, propylthiouracil and radioactive iodine obliteration.  Instead of trying to heal the thyroid gland, some traditional physicians will destroy the thyroid gland with radioactive iodine.  Once this is done, the patient must remain on thyroid hormone forever.  I have saved many thyroids from radioactive iodine treatment and the patients have not required thyroid hormone replacement to function optimally.

Carnitine and Graves’ Disease (Hyperthyroidism)

L-carnitine is a di-peptide that shuttles fat into the cell’s mitochondria (mini energy-producing factories) so it can be burned to make energy.  A paper was published in 2004 in the Annals of the New York Academy of Sciences in which the authors found:

L-carnitine is a peripheral antagonist of thyroid hormone action.  In particular, L-carnitine inhibits both T3 and T4 entry into cell nuclei.  This is relevant because thyroid hormone action is mainly mediated by specific nuclear receptors.  In the randomized trial, we showed that 2 and 4 grams per day of oral L-carnitine are capable of reversing hyperthyroid symptoms.  L-carnitine was acting in the periphery, namely as an inhibitor of thyroid hormone action in thyroid hormone target tissues, and not at the level of the thyroid gland as an inhibitor of thyroid hormone synthesis.  Overall the two doses of carnitine (2 and 4 grams) were equally effective in reversing hyperthyroid symptomatology; asthenia, nervousness, and palpitations were the symptoms that benefited the most.  Amelioration occurred 1 or 2 weeks after commencement of carnitine.

So as you can see, L-carnitine is a must for all Graves’ disease patients.  I use a liquid form that delivers high doses and is cost-effective as L-carnitine tends to cost more than most supplements.

Autoimmune thyroiditis tends to be an innocent bystander with other autoimmune diseases such as Type 1 diabetes, rheumatoid arthritis, lupus, etc.  Most doctors chase these other autoimmune diseases ignoring the possibility that the thyroid is also being attacked.

Patients with autoimmune thyroiditis tend to have symptoms that lead them to explore abusive and addictive behaviors to help deal with the devastating effects of this condition.  Depression, anxiety, hopelessness, extreme fatigue and weight gain can be very difficult to deal with.  Alcohol is one outlet for such people as it is readily available and provides instant results when one is feeling down.  The problem is of course an increasing need to drink regularly to deal with like symptoms.  These people truly need help and can be led  to full recovery.  These are also the patients who are sent to a psychiatrist for medication specific to their symptoms.  They end up on thyroid hormone and then antidepressants or anxiety meds which further impair thyroid and immune system function.  How I wish I could get these patients to see me before they become entangled in the toxic traditional medical system.

Autoimmune thyroiditis can begin when the thyroid gland becomes more permeable meaning that there is increased blood flow into the gland as well as substances that should not enter the thyroid.  This is a sign that the blood-thyroid barrier has been breached and white blood cells enter the gland and attack it.  This also indicates that the body can no longer keep up and repair the damage that is done by the immune system.  This can many times be traced to an intestine that is hyperpermeable allowing unwanted substances and toxins into the blood further exhausting the body’s repair reserves.  As the gut becomes more permeable or “leaky,” so do the rest of the body tissues including organs such as the thyroid, brain, kidneys etc.  It’s important to understand that autoimmune thyroiditis is not a singular disease process but a symptom of a broken down immune system due to a variety of possible causes which we will cover in detail.

We have already covered the symptoms of hypothyroidism which include mainly fatigue, difficulty losing weight, temperature dysregulation, loss of memory and hardship getting started in the morning.  When you wake up, it is the T4 (thyroxine) and T3 produced by the thyroid gland that increase your temperature.  If there is an autoimmune attack on the thyroid, this will impair its ability to make the relevant hormone which leads to low body temperature and difficulty getting going in the morning.  Remember that stress hormones can inhibit thyroid hormone receptors so even if there is normal thyroid hormone production, you may still have all the symptoms of hypothyroidism.  This is why the adrenal glands are so important in all types of thyroid dysfunction.  Thyroid hormone receptors can become dysfunctional due to not only stress hormones but also metabolic acidosis, environmental toxins, toxic heavy metals or antibodies that specifically attack the receptors.  This further emphasizes the importance of a thorough investigation into the causes of your symptoms and not just a TSH blood test.

Many patients with autoimmune thyroiditis seek care for other problems in the beginning of their disease process.  Some of these include increased allergies, asthma, irritable bowel syndrome, sleep problems and weight gain.  They go to specialists such as allergists, gastroenterologists, sleep clinics, etc. but end up without help.  This is due to the fact that specialists only look at these diseases and symptoms from their myopic view of health and disease.  If only the body were not compartmentalized by these physicians but looked at as one entity that is fully connected in every way with every part of itself, people would have answers to their health problems.

A skilled physician will be able to feel your thyroid gland to see if it is enlarged or if there are nodules.  I have encountered some traditional physicians who do not think it’s possible to feel nodules on the thyroid.  After telling them to perform an ultrasound to confirm my findings, there have always been nodules on the thyroid that I have felt.  The swelling occurs due to increased water in the thyroid due to the inflammation caused by the immune attack on the thyroid.  Usually the thyroid gland is the most swollen in the beginning stages of disease and then slowly shrinks in the advanced stages due to an inability to compensate.  Can the thyroid gland regain its original size and function?  The answer is yes as long as everything is done right to remove all underlying causes of autoimmunity and to provide the thyroid with the proper nutrition that it needs.

As a natural physician, it is my goal to find the underlying causes of disease and correct the imbalances.  It is important to understand that once the gene is expressed causing autoimmune disease, it will never turn off.  At least at this point, no one knows how to manipulate our genes in such a way.  What we can do is balance the immune system which greatly reduces the immune attack on the thyroid cells.  We will now discuss the many faces of autoimmune thyroid.

Candida

Candida and other yeasts can contribute to the development and perpetuation of autoimmune thyroiditis.  Yeasts that grow in the intestine suppress immune function and acidify the digestive environment.  Yeasts also impair absorption of important nutrients that are required for immune function.  In some cases the yeast is so bad it regurgitates into the stomach causing chronic heartburn and impaired digestion.  Yeasts can also hold onto toxic chemicals and metals which are released when commencing an anti-yeast program.  This is one of the reasons why some people get sick when following such regimens.  Patients with yeast overgrowth also have impaired intestinal barrier function allowing these toxins to freely enter the bloodstream further taxing the immune system.

Yeast overgrowth is a sign of poor diet, impaired immune function and a diet that is too acidic.  In some cases, the yeast must be slowly killed as the immune system is supported simultaneously.  Multiple probiotic strains of at least forty billion viable organisms must be consumed each day during this process.  If the immune system is still weak, the diet is poor, and supplements are not taken, then the yeast can quickly grow back.  Constipation can further worsen this problem as yeasts feed on sugars that are produced from food that is fermenting in the intestine due to a prolonged transit time.  Food should pass through the entire digestive system in twelve to eighteen hours so it does not have time to ferment.

Increasing transit time is a first order of priority when eradicating yeast overgrowth.  A stool analysis will provide data on the type of yeast and what natural compounds will kill the yeast.  This test is very important as some yeasts are completely resilient to natural medicines that are known to kill yeast.  The lab report contains what is known as a “sensitivity” meaning the yeast has been exposed to multiple natural agents looking for what works and what doesn’t.  For example, the lab may report that garlic does not work for a particular yeast but oil of oregano does work.

Molecular Mimicry

Molecular mimicry is an important aspect to understand as a possible cause of Hashimoto’s disease.  The body’s immune system works by recognizing amino acid sequences which make up protein but the foreign invader looks the same as self tissue.  Amino acids are the building blocks of protein and make up body tissues, foreign invaders and of course dietary proteins such as gluten and casein from milk.  Molecular mimicry occurs when a dietary protein or infection contains protein that the body’s immune system attacks but is identified as the same protein found in body tissue such as thyroid cells.  According to Tomer et al. in the journal Endocrine Review (1993), “Molecular mimicry has long been implicated as a mechanism by which microbes can induce autoimmunity.”8

Yersinia enterocolitica is a bacterium we can get from contaminated food and water and is one example of an infectious agent that can trigger autoimmune thyroid.  The protein that makes up the outer shell of Yersinia can lead to cross-reactivity or molecular mimicry of thyroid tissue resulting in an immune attack on Yersinia and the thyroid gland.  Yersinia has actually been found to have TSH binding sites on its surface.  As long as the Yersinia infection resides in the intestine, the body will continue to produce antibodies that attack the bacteria and the thyroid.  Eradication of the infection will eliminate or significantly reduce the autoimmune attack on the thyroid gland. I have found that most of my patients with autoimmune thyroiditis have a chronic infection that is driving the autoimmunity.  Lyme disease and it’s associated co-infections (Babesia, ehrlichia, bartonella, mycoplamsa etc.) tend to be the most common infections that trigger autoimmunity.

Examples of infections that can induce autoimmune thyroid include:

  • Epstein-Barr Virus- causes mononucleosis or “mono.”
  • Lyme disease spirochete (Borrelia burgdorferi)- bacteria transmitted by biting insects.
  • Rickettsia- bacteria transmitted by biting insects.
  • Hepatitis C – virus that resides in the liver.
  • Herpes virus – incurable virus found in the nervous system.
  • Parvovirus B19 – virus that causes “fifths disease” in children and can affect adults.
  • Influenza B – The classic “flu” virus.
  • Rubella – virus that causes German measles.

Insulin Resistance and PCOS

Insulin resistance that leads to polycystic ovarian syndrome (PCOS) can lead to autoimmune thyroid.  PCOS is not only the most common cause of infertility in the US but also the most common female hormone disorder.  PCOS is identified by increased cholesterol, triglycerides and blood sugar in routine blood testing.  In addition, an elevated testosterone hormone test is diagnostic for PCOS.  As the name suggests, PCOS can present with one or many ovarian cysts.  Chronic surges of blood sugar causing insulin surges lead to increased androgen production in the ovaries leading to PCOS.  Insulin receptors no longer respond to insulin causing the pancreas to release excess levels of insulin further feeding the vicious cycle.  Elevated testosterone and insulin have been shown to result in autoimmune thyroid.  Your natural physician will have a protocol for insulin resistance which has been extremely successful in a short period of time in my practice.

Vitamin D

Adequate vitamin D levels can be achieved only by sunlight exposure or supplementation.  Vitamin D has been found to be associated with autoimmune thyroid.  Vitamin D helps to balance the immune system that is out of balance and attacking the thyroid gland.  Patients with autoimmune thyroid disease have been shown to be deficient in vitamin D with genetic abnormalities in their vitamin D receptors.  Even normal levels of vitamin D in these individuals will not be enough leading to requirements of much higher doses of supplementation.  Lack of sunlight, gastrointestinal inflammation, aging, darker skin and elevated cortisol can cause a vitamin D deficiency.  All autoimmune thyroid patients must be tested for vitamin D deficiency but the traditional laboratory reference ranges are not optimal and miss many deficiencies.  Your natural physician will know how to interpret these tests and guide you with proper supplementation.  2,000 IU is the absolute minimum daily dose for vitamin D supplementation.  Autoimmune patients need between 2,000-10,000IU/day especially if their receptors are genetically abnormal requiring higher doses.

Gluten

It has been proposed that the immune system tags certain foods such as gluten but also TSH receptors on the thyroid gland resulting in attack on not only the food but the thyroid gland as well.  Gluten is a protein found in many grains including wheat, barley, rye, oats, and spelt.  Celiac disease is a disease that first appeared approximately 10,000 years ago during the development of agriculture in the Fertile Crescent.  The first symptoms that were documented were chronic diarrhea, abdominal distension and muscle wasting.  It was not until 1950 that a young Dutch pediatrician named Dicke made the association between gluten and disease.  He was the first to implement the gluten-free diet as a cure for celiac disease.  It was then in the 1960s that the genetics of gluten intolerance began to emerge in research.

Celiac patients have approximately ten times the rate of autoimmune thyroid diseases such as Hashimoto’s and Graves’ disease as non-celiac individuals.  It has been shown in the literature that 26.2 percent of celiac patients have autoimmune thyroid disease.9 Celiac disease and gluten intolerance are not the same condition.  Celiac disease is the devastating autoimmune condition that significantly breaks down the intestinal barrier causing immune dysfunction, malabsorption of nutrients and many problems outside of the intestine.  In fact, 70 percent of gluten’s effects can be outside of the intestine including multiple organ system disorder which results in dysfunction of organs such as the thyroid, liver, adrenals, pancreas, sex organs, heart, brain, bones, and kidneys.

Gluten intolerance may not have an autoimmune component so the effects are not as devastating as celiac disease.  Gluten intolerance can still result in damage to the intestine and extra-intestinal organ dysfunction but is usually not as severe.  Many people live their entire lives with gluten intolerance but never even know it.  They may suffer from mild to moderate health problems such as osteoporosis, nutritional deficiencies, hypothyroidism, digestive problems and even autoimmune thyroid.  The degree of gluten intolerance depends on genetics, environment, nutrition and, of course, how much gluten is consumed.

Gluten is hidden in many packaged foods and commercial products.  Gluten intolerance has an extremely strong link to autoimmune thyroid disease.  The body will produce antibodies to gluten but they will cross-react and also attack the thyroid gland.  This is called molecular mimicry.  Many people are gluten-intolerant and are not aware of it.  It is a mistake to think that if you don’t have any digestive problems, you don’t have a gluten issue.  Remember, 70 percent of gluten’s negative effects occur outside of the intestine affecting other tissues including the thyroid gland.

Patients who have celiac disease or gluten intolerance must avoid gluten indefinitely.    A strict gluten-free diet must be followed in these cases.  Gluten-free guidelines are presented in the thyroid diet chapter.

Vitamin B12

Hashimoto’s patients have been shown to be deficient in vitamin B12 which causes a condition known as pernicious anemia.  Vitamin B12 requires a substance called intrinsic factor to be absorbed but sometimes the body produces antibodies to intrinsic factor resulting in a lack of B12 absorption.  Many times, gluten intolerance and B12 deficiency go together because gluten sensitivity affects the three main factors in vitamin B12 absorption:

  • Adequate hydrochloric acid production in the stomach.
  • Pancreatic enzymes.
  • A healthy small intestinal lining.

Your doctor will order intrinsic factor antibodies if you are unresponsive to vitamin B12 supplementation.  Sublingual B12 bypasses the gut and is an excellent delivery system to raise B12 levels.  B12 injections provide the most efficacious route of administration.

Iodine

As discussed in a previous chapter, iodine is a very important nutrient for the health of the thyroid gland.  Too much iodine or iodine consumption in autoimmune thyroid can exacerbate the immune attack on the thyroid gland.  The enzyme in the thyroid that is under attack is stimulated by iodine thus leading to an increased attack on the gland.  It has been shown that iodine supplementation in an autoimmune thyroid patient leads to increases in the thyroid peroxidase antibody.  It has also been found that when iodine is added to table salt in iodine-deficient areas, the rate of autoimmune thyroid illness increases.  There is a tremendous amount of controversy at this point on the use of iodine for thyroid function and other parts of the body.  Until there is more definitive research available, iodine is not recommended in most cases for autoimmune thyroiditis at this point due to the potential of worsening the condition.

Mercury

A 2006 study found that removal of mercury-containing dental amalgam resulted in decreased levels of thyroid antibodies thus reducing the intensity of the attack on thyroid cells.10  Patients with autoimmune thyroid were tested for mercury sensitivity and those that were positive had their dental amalgams removed resulting in decreased antibody levels after six months.

Mercury is one example of how an environmental toxin can trigger autoimmune disease.  Toxins disrupt normal immune function and can alter tissue proteins making them look foreign to the immune system cells.  Continuous exposure to a toxin such as mercury can lead to immune system dysfunction, culminating in autoimmune disease.  Mercury is one of the best examples because it binds to proteins and enzymes altering their structure which confuses the immune system.

These toxins get into the system by passing through the barrier systems of the body.  These include the intestinal barrier, lung barrier, skin barrier and blood-brain barrier.  Leaky gut is a major problem in our society due to high stress (cortisol eats away at the intestinal barrier), poor diets, toxins, infections and gluten sensitivity.  Leaky gut can increase the chances of autoimmune disease.

If the blood-brain barrier is leaky, toxins such as mercury can pass into the brain and cause immune cell dysfunction in the neurons of the brain.  Treating the barrier systems of the body with natural medicine is an integral part of overcoming the negative effects of autoimmune disease.  It is important to understand that we are all exposed to environmental toxins on a daily basis but our overall health and genetics determine how we handle and detoxify them.  Some individuals can live a long healthy life despite constant exposure and some will suffer from severe debilitating sickness with even the smallest exposure.

The Barrier Systems

Understanding the barrier systems is vital to understanding the onset of autoimmune disease in some cases.  The barrier systems are composed of four parts:

  1. Intestinal barrier
  2. Lung barrier
  3. Skin barrier
  4. Blood-brain barrier

The gut has mucosal barriers that prevent the entry of foreign invaders into the body.  They are called the barrier system because they are the first line of defense from the outside world.  When the gut barrier breaks down, the result is a localized or systemic inflammatory cascade by the immune system.  “Leaky gut” or gut hyperpermeability describes this condition and it is not only related to autoimmune thyroiditis but also psoriasis, autoimmune diseases, allergies, asthma, malabsorption, inflammatory bowel and skin problems such as eczema and dermatitis.  There are a few laboratory tests that will diagnose this condition and all are readily available.  The first is the lactulose/mannitol test.  The patient drinks a solution of the two sugars, lactulose and mannitol, and then urine is collected for six hours.  Lactulose is a very large sugar and if it ends up in the urine in sufficient quantities, this indicates leaky gut.  Mannitol is a small sugar and should pass through easily but if it doesn’t, this indicates malabsorption.  You can have a leaky gut and also malabsorption.  The second test is the intestinal barrier function blood test.  This is a direct measure of aerobic and anaerobic bacteria, dietary proteins and yeast activity in the intestinal barrier.  If these markers are sufficiently elevated, then we can say the intestinal barrier is broken.  The third test is an indirect measure of the gut barrier known as food sensitivity testing which we will discuss in more detail.

Aristo Vojdani, Ph.D. has said, “When the barriers are broken, the results will be autoimmunity.”  Stress (high cortisol), infections (bacteria, parasites, viruses, yeast, fungi), drugs, antibiotics, NSAIDS (non-steroidal anti-inflammatories such as aspirin, ibuprofen, etc.), steroids, antacids, antibiotics, alcohol, allergens, constipation, immune system imbalances,  xenobiotics, dietary proteins such as gluten, enzymes, constipation due to inadequate fiber intake, poor digestion and environmental toxins can all break down the intestinal barrier which is 70 percent of your body’s immune system.  NSAIDS cause bleeding and inflammation in the GI tract resulting in significant mucosal barrier damage.  Antacids impair normal stomach acid function causing compromised protein digestion.  This leads to large undigested proteins entering the small intestine which are then absorbed into the bloodstream taxing the immune system.  Low stomach acid also causes mineral deficiencies in calcium and magnesium.  Antibiotics disrupt normal flora not only in the intestinal tract but also the skin, vagina, and mouth, potentially leading to yeast infections in these areas.  The yeast that overgrows in the intestine can result in bloating, gas, chronic fatigue, depression and gut inflammation.

The following nutrients can become depleted due to leaky gut:  vitamins A, C, E, B-complex, zinc, selenium, CoQ10, magnesium calcium, essential fatty acids, choline, inositol, glutathione and sulfur amino acids.  Disorders such as cirrhosis of the liver, hepatitis, irritable and inflammatory bowel, ulcers, colon cancer, low stomach acid and diverticulosis/itis can all lead to gut hyperpermeability as well.  The cells that line the intestine have the highest turnover rate and thus are the most vulnerable to nutrient deficiencies.  These cells mainly feed on the amino acid glutamine, which when supplemented, has been shown to reverse leaky gut.

When the gut bacteria become out of balance, the intestinal barrier is adversely affected.  This can occur from antibiotic use which eliminates not only good but bad bacteria and can result in yeast overgrowth as well.  Replenishing “good” bacteria such as lactobacillus and bifidobacter can reverse this imbalance and help heal the intestinal barrier.  Prebiotics known as fructooligosaccharides (FOS) provide food for beneficial strains of bacteria.  Diets high in simple sugars and excess meat can lead to constipation thus increasing the amount of time that the gut barrier is exposed to toxins.

Chronic inadequate stomach acid production can lead to depressed intestinal immune function and can result in small intestinal bacterial overgrowth.  As the intestinal barrier breaks down, food allergies begin to increase, the immune system begins to function abnormally and the result can be autoimmunity.  The intestinal barrier is composed of tight gap junctions that allow nutrients from the food we eat to pass into the bloodstream.  When the intestinal barrier breaks down, a condition known as “leaky gut” or “hyperintestinal permeability” can occur.  This means that undigested food particles and foreign invaders can pass into the system without resistance.  This constant overload of foreign invaders is a continuous stress on the immune system that over time will lead to immune system dysfunction.  Your immune system knows exactly what is going on in every part of your body but it can only do so much.  If it constantly has to “clean up” what shouldn’t be there, it may eventually break down from overwhelming stress.

The lung barrier is constantly exposed to air pollution, secondhand smoke and off-gassing of toxic chemicals from products such as new automobiles (that new car smell is not good!), carpeting, dry-cleaned clothes, paint, solvents, furniture, wrinkle-free clothes, new plastics, and many building materials.  These will stress the lung barrier and break it down leading to increased toxin exposure into the blood.

The skin barrier’s main enemy is excessive washing practices by those in industrialized nations.  Bathing and washing excessively can break down the skin barrier leading to increased absorption of environmental toxins.  Many of the commercial products available today are loaded with chemicals that break down the skin barrier and contain thyroid-disrupting chemicals.  Cosmetics, soaps, body wash, shampoos, conditioners, lotions, after-shave, etc. are extremely toxic and a broken skin barrier will only allow increased absorption of these chemicals into the bloodstream.

There are two very important things to consider when discussing what products to use.  The first is that if something is on your skin, you are basically drinking it.  Your skin will absorb almost everything you put onto it.  The second thing to consider is that you shouldn’t put anything on your skin unless you would eat it.  Use only all-natural products made from plants that won’t harm your skin or your insides.

The blood-brain barrier begins to break down after the intestinal barrier has begun to break down.  The blood-brain barrier is extremely selective in what it allows to pass in and out of the brain.  This should be quite obvious as brain tissue is very delicate.  As the blood-brain barrier breaks down, substances that wouldn’t normally pass into the brain end up passing through causing an immune response and inflammation in the brain.  The immune cells of the body begin to attack what has crossed the blood-brain barrier but unfortunately, they don’t always attack the foreign substance and harm normal brain tissue as well.

So as you can see, the barrier systems are very important in maintaining a healthy immune system and preventing autoimmunity.  Addressing the barrier systems is a key factor in overcoming autoimmune disease including autoimmune thyroid.  The main target is the intestinal barrier which can be measured through a blood test called the “intestinal barrier function” test.  This test tells your natural physician the integrity of the intestinal barrier and can gauge treatment time and level of aggressiveness.

The first aspect that needs to be addressed when healing the intestinal barrier is to eliminate any infections that may reside in the intestine.  This can be a parasite, bacterium, virus or yeast overgrowth such as candida.  It is also important to take beneficial bacteria to replenish the healthy colonies that may have been disrupted from the infection.  And finally, supplements that have been shown to rebuild the intestinal barrier should be taken through this process.  Daily physical exercise that is not too strenuous is important in healing the gut.  Massage and therapeutic biofeedback are passive modalities that can help to reduce stress.  A high-fiber diet to ensure proper transit time of food through the gut as well organic, whole, unprocessed foods are mandatory for healing. Identify and avoid toxic exposures from chemicals, metals and allergens to facilitate healing.  It will be very difficult to heal the gut as long as there is intake of NSAIDS, antacids, steroids or antibiotics.  Essential nutrients such as fatty acids, vitamins, minerals, and amino acids in fully bioavailable form should be supplemented.

One of the main causes of intestinal barrier breakdown is stress.  Counseling and group therapy can greatly aid in stress reduction.  You must perform regular stress-reduction techniques such as meditation, yoga, tai chi, prayer, exercise.

Food Sensitivities

The next most important thing in repairing the intestinal barrier and improving immune function is to avoid food sensitivities.  Each time you eat a food to which your body’s immune system reacts, it further breaks down the intestinal barrier and taxes the immune system.  This can increase the autoimmune attack on the thyroid gland.  There are a few different ways to find out if you are sensitive to a particular food.  The first is to have a blood test that measures a large number of different foods and the level of reaction your body is having to each one.  This is a fast and easy way to pinpoint what foods you should avoid while your intestinal barrier is healing.    This is an excellent measure of the integrity of the intestinal barrier and immune function.   The second way is to go on an elimination diet which is done by avoiding the most common food allergens which include:  dairy, gluten, soy, tomato, peanuts, corn and eggs.  This is done for three to six months while the intestinal barrier is healing.  The purpose of this diet is to remove immune stresses on the intestine so it can heal.  Each time you eat a food that your immune system is sensitive to, it stresses the intestinal barrier further breaking it down.  Testing usually consists of a blood sample taken and analyzed for a large number of food reactions.  Each food is graded on a scale indicating a mild, moderate or strong response.  The more food sensitivities that show up as well as the number of moderate-to-strong responses can indicate the integrity of the intestinal barrier.  As the foods are eliminated and the barrier heals, the immune system will no longer react to these foods as before.  Some foods need to be avoided indefinitely or on rotation even when the barrier is healed to prevent a relapse.

Alcohol, NSAIDS (non-steroidal anti-inflammatories) and aspirin should be avoided as they contribute to the breakdown of the intestinal barrier.  Constipation must also be eliminated which can be done with increased fiber intake, drinking half your bodyweight in ounces of water each day, doing a “vitamin C flush”, and taking probiotics (acidophilus, bifidobacter etc.), FOS, and magnesium.  If this doesn’t resolve the constipation, then there are other underlying causes that need to be evaluated.  Seven to nine hours of sleep each night should be a top priority when healing the gut lining.  This is when the majority of healing takes place, so do whatever you can to get adequate sleep.  Coffee, tea and soda must be eliminated or extremely restricted during this process as well.  The following supplements have been shown to repair and aid the intestinal barrier in healing:  L-glutamine, Zinc-carnosine, Vitamin A, Aloe Vera, MSM, Folate, DGL (licorice), Slippery Elm, Marshmallow Root, Quercetin, Prunus, N-Acetyl Glucosamine, Cat’s Claw, Okra, Mucin, and Chamomile.

Diagnosis & Treatment

Many patients with symptoms of thyroid dysfunction are not properly tested for the causes of imbalance.  There are two antibodies that should be tested by blood:  thyroid peroxidase and anti-thyroglobulin antibodies.  These antibodies are elevated in 85-90 percent of chronic thyroiditis patients.  Thyroid peroxidase is the enzyme required for thyroid hormone synthesis and if these antibodies are positive, it indicates the body’s immune system is attacking this enzyme.  Thyroglobulin is a protein found in the thyroid gland and if these antibodies are positive, it indicates that the immune system is attacking this particular protein in the thyroid gland.  In either case, if one or both are elevated, then the diagnosis of autoimmune thyroiditis can be made.  In addition, ANA (anti-nuclear antibody) can be elevated in cases of Graves’ disease.

Thyroid nodules can occur in autoimmune thyroiditis due to inflammation and damaged thyroid tissue cells.  Nodules can appear in four to seven percent of the US population but have also been found in up to fifty percent of the population upon autopsy.  Thyroid nodules can be felt by a skilled physician.  If a nodule is found on physical examination, an ultrasound should be performed to provide more detailed diagnostic information.  Thyroid cancer can result from autoimmune thyroiditis and should be ruled out.

Conclusion

Many people ask the question if the thyroid can regain normal function once there is autoimmunity.  The answer is yes in a vast majority of cases.  If the attack on the thyroid has been too intense and prolonged, then the thyroid cells may simply be dead and cannot regenerate.  If however, the imbalances are found before this happens, the thyroid may achieve full recovery.  As with all patients, it is my main goal to find the underlying physiological imbalance through laboratory testing, correct the imbalances through nutrition, lifestyle and proper supplementation, and to teach each patient how to maintain a high level of health removing dependency on myself or any other physician.

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