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November 13, 2018

Hashimoto’s Disease – The Cause, Symptoms, Labs and First Steps to Take

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Hashimoto’s Disease is a form on thyroid disease that’s rising at an alarming rate, especially in the United States. An estimated 14 million people in the US alone have Hashimoto’s, making it one of the most common forms of thyroid disease.

Today, we’re taking a look at Hashimoto’s from a holistic perspective. So let’s dive in…

Hashimoto's Disease - The Cause, Symptoms, Labs and First Steps to Take

What is Hashimoto’s Disease?

Hashimoto’s is an autoimmune condition in which your immune system attacks your thyroid tissues.

Hashimoto’s is most often diagnosed when TPO (thyroid peroxidase) antibodies and/or TgAb (thyroglobulin antibodies) are elevated. 

These antibodies can be present even when TSH, T4, T3, FT4 and FT3 levels are normal. 

What are TPO antibodies (anti-TPO), and what is a “normal” level?

TPO (thyroid peroxidase) is the key enzyme that helps your thyroid make thyroid hormones. Anti-TPO is an antibody that attacks TPO. This is the lab that is most often used to diagnose Hashimoto’s.

A normal anti-TPO level is usually below 30.

Keep in mind that it’s normal to have a small amount of TPO antibodies in the blood.

What is TgAb and what is a “normal” level?

TgAb (thyroglobulin antibodies), sometimes referred to as TAA (thyroid antithyroglobulin antibody) are antibodies that attack thyroglobulin. Thyroglobulin is a protein produced and used by the thyroid to make T3 and T4.

A normal TgAb level is 0.

What is TSH and what is a “normal” level?

TSH is a hormone that the pituitary sends out to tell the thyroid how much or how little thyroid hormones to produce. 

Please note: TSH levels tell you what your pituitary is up to, but it’s not telling you what the thyroid is doing.

When it comes to Hashimoto’s, TSH levels can change a lot, swinging back and forth between hypothyroidism and hyperthyroidism.

Everyone is biochemically individual, but in our practice we’ve found that a TSH level between 0.5-2.0 is the range where people feel healthy and vibrant.

What is free T4 and what is a “normal” level?

Free T4 is a hormone produced by the thyroid. 

You want free T4 to be in the middle of the lab range. So if the range is 1.0-3.0, you want your free T4 to be 2 or close to it. Each lab has a different range, so you have to look at what the specific range is to know what number to look for. 

What is free T3 and what is a “normal” level?

Free T3 is a hormone that mostly comes from T4. The thyroid makes T4 and sends most of it to the liver to be converted to free T3. 

You want free T3 to be in the middle of the lab range. So if the range is 1.0-3.0, you want your free T3 to be 2 or close to it. Each lab has a different range, so you have to look at what the specific range is to know what number to look for. 

What are the symptoms of Hashimoto’s Disease?

There are hundreds of symptoms, but here is a list of some of the most common symptoms: 
Hypothyroidism
Hyperthyroidism
Depression
Exhaustion
Brain fog
Unexplained or excessive weight gain or loss
Loss of outer third of eyebrows
Dry or coarse hair
Nervousness
Irritability
Increased sweating
Heart racing
Hand tremors
Muscle cramps
Anxiety
Difficulty sleeping
Reduced libido
Hives
Rashes
Anemia
High cholesterol
Constipation
Thinning of your skin
Fine, brittle hair or hair loss
Weakness in your muscles—especially in the upper arms and thighs
More frequent bowel movements
Low Vitamin D
Low B12 or ferritin 
Excessive appetite or loss of appetite
Irregular menstrual cycles
Water retention
Lots of energy (often too much)

Why is my TSH too high or too low?

The pituitary, hypothalamus, and adrenals (also called the HPA axis) are all part of the endocrine system and communicate with one another throughout the day. When the body perceives stress, the hypothalamus tells the pituitary to make more or less TSH so that the thyroid will produce more or less thyroid hormones to keep the body functioning. 

So, a low or high TSH level isn’t actually a thyroid problem. Instead, it’s often an imbalance in the HPA axis. Your practitioner’s job is now to figure out why there is an imbalance. 

Why is my free T4 high or low?

Most often, free T4 is high because there is a severe form of either emotional or environmental stress (from things such as synthetic pesticides, toxic metals, and possibly glyphosate). 

Most often, free T4 is low because the thyroid doesn’t have the resources to produce the proper amount of T4. The thyroid needs iodine and tyrosine to produce thyroid hormones. Increasing the consumption of iodine-rich foods, reducing exposure to chlorine, fluoride and bromine (this is incredibly important!), and taking an iodine supplement can often help improve this imbalance.

If you’re concerned about taking iodine when you have thyroid disease, read this post and it should answer your questions.

Free T4 can also be low when antibody levels are elevated. When antibodies attack the thyroid tissues, this can make it difficult for the thyroid to produce enough fT4.

Another common cause of low FT4 is anemia. The body needs iron to make TPO, which is then used to make a thyroid hormone (FT4). When the body is deficient in iron, FT4 levels can drop, putting the body in a hypothyroid state. To read more about this, and see what steps you can take to reverse the issue, click here.

Remember to talk to a nutritionist or health practitioner who’s had lengthy training in nutrition to help you figure out how much iodine or iron your body needs. Self-diagnosing often doesn’t go well, so it’s worth paying a practitioner for their expertise.

Why is my free T3 too high or too low?

Most often, free T3 is high because the thyroid is making too much T4 that is being converted to free T3. 

The are three common reasons why free T3 can be low:

1. Free T3 can be low because there isn’t enough free T4 being produced by the thyroid to be converted into free T3.

2. If there are adequate levels of free T4, but there isn’t enough free T3, then this often indicates liver congestion.

Let me explain. . .

Your thyroid produces T4 and sends most of it to the liver to be converted into the active form, free T3. If you have enough free T4, but not enough free T3, then you don’t necessarily have a thyroid problem, instead, you may need to support your liver so it can efficiently convert T4 to T3 for you.

Liver congestion is pretty common nowadays, and can not only cause low T3 in the body, it also can cause estrogen dominance, severe headaches, blood sugar imbalance, chemical sensitivities, skin issues, and dark circles under the eyes, among other things. Here is an article I wrote with specific steps you can take to improve this issue.

3. Free T3 can also be low becuase there is excess cortisol (from adrenal imbalance) that is blocking the conversion of free T4 to free T3 and instead creating an excess of reverse T3.

What are the root causes of Hashimoto’s disease?

There are many different root causes for thyroid autoimmune disease, but here is the basic list (click here for a more comprehensive list):
Stress
Diet
Synthetic chemicals or toxins
Food additives
Heavy metals
Infections
Digestive Issues (intestinal hyperpermeability)
Dental Infections

What steps can you take to improve your symptoms if you’ve been diagnosed with Hashimoto’s Disease?

1. Ask your practitioner for a thyroid panel. Getting a look at what’s actually going on with your thyroid will give you and your practitioner more insight as to what steps to take next. 

Here’s the list of labs to ask for (if your doctor won’t order labs for you, you can order them here):
TSH
TPOab
TgAB
Free T3
Free T4
Reverse T3

I also recommend getting a CBC, CMP with phosphorus, lipid panel and Vitamin D.

2. Take steps to improve your digestion. The first way to do this is by eating in a relaxed state and making sure your body is producing enough stomach acid so it can properly break down and utilize the nutrients in your food.

Stomach acid (also known as Hydrochloric acid or HCL) is a necessary part of the digestive process. The acid is our first line of defense against pathogens, bacteria, parasites, etc. It also helps us digest our food properly.

This may sound like a trivial step, but I’ve never seen a client at our practice with Hashimoto’s disease that wasn’t also dealing with low stomach acid. Here’s an article I wrote that explains the steps to take.

3. Take steps to support your adrenals. Why? Because anyone with thyroid disease is also dealing with some kind of adrenal issue. I can’t tell you how many people have taken the steps I list in this article and come back a month or two later telling me how much better they are already feeling!

4. Reduce your sugar intake. Sugar and stress basically do the same thing in the body (minus the calories), so to help balance your TSH and reduce antibodies, you need to watch your sugar intake. If you’ve got massive sugar cravings right now (I’ve been there before!), make this recipe for buttermints and follow the directions listed.

5. Use castor oil packs to gently detoxify the liver and thyroid. Here’s an article I wrote that explains why they are so helpful, lists the supplies you need, and explains exactly how to do one.

6. Remember that your practitioner is working for you, not the other way around. It’s ok to ask them questions about the root cause of what’s going on. If they don’t treat you respectfully when you ask them questions about what’s going on with your body, then it’s ok to find another practitioner to work with. It took me 9 months of going doctor-to-doctor before I found someone who would listen to me and run tests. Being persistent to find the right practitioner to work with pays off!

7. Start moving away from processed foods and eat real, grain-free, nutrient-dense foods. Gluten and grains will only add more inflammation at this point, so it’s very important to remove them from your diet.

When you’re sick, I know this can feel completely overwhelming (I’ve been there!) but removing all gluten and grains from your diet can make a significant difference in your symptoms and antibody levels.

The good news is that I’ve got hundreds healthy recipes here on my site and another 125 in my cookbook, The Grain-Free Family Table. Eating healthy foods will reduce the strain on your body and help bring things back into balance. 

One last note – Most people have various root causes, and it can take a while to figure out exactly what they are. This is why I always recommend that my clients first take steps to improve their stress, digestion, liver drainage, and diet. It’s pretty incredible how many symptoms can improve by working on these four main areas of health. Sometimes, that’s all that’s needed to reduce symptoms and see labs improve, but then there are other times when more testing and additional steps need to be taken. It’s all about baby steps!

If you’d like to learn from first steps you can take to help support your thyroid, check out my class, “3 Keys to Thyroid Hormone Balance”. It’s just 45 minutes and I promise you’ll learn something new!

Disclaimer: The purpose of this post is to give an overview of hashimoto’s from a holistic perspective. Due to biochemical individuality there can be many various reasons for the root causes of thyroid disease, and many ways to help improve thyroid in balance in the body. This information is not intended to take the place of your doctor’s advice.

 

Filed Under: Thyroid Disease, Thyroid Disease | 35 Comments

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35 Comments

  1. Marion Moore Ellenburg

    November 14, 2018 at 9:35 am

    Hashimotos and all thyroid conditions are caused by the ebstein barre virus. This is not known to modern medicine. Check out the book Thyroid Healing by Anthony William.
    to Marion Moore Ellenburg" aria-label='Reply to this comment to Marion Moore Ellenburg'>Reply to this comment
    • Deliciously Organic

      November 14, 2018 at 10:39 am

      While I realize his books are very popular, he has no medical or nutritional credentials and claims to get all of his info from a spirit. In his book he talks about how thyroids can talk to one another and heal each other and that we should hold water to the light to make it have special powers. I do not find him to be a credible source.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
    • Lisa

      October 1, 2020 at 12:31 pm

      Good evening My daughter (17) was diagnosed with Hashimotos a year ago. She has had extensive blood tests done to identify her food intolerances. We have been told exactly what foods she needs to avoid. She is not intolerant to rye or oats. My question: she eats rye and oats. Is this ok? Or would it be better for her to cut out all gluten including rye and oats. At the moment she is going through a flare up. Triggered by severe exam stress She is having PRP therapy to help with the inflammation. Should she go off all gluten???
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      • Deliciously Organic

        October 8, 2020 at 2:44 pm

        I recommend that anyone with Hashi's avoid all grains, but I would talk to her practitioner who put her on the elimination diet so you can know what's best for her.
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  2. Kimberly

    November 14, 2018 at 9:52 pm

    Would going gluten free also be one of the first steps after receiving a Hashimotos diagnosis?
    to Kimberly" aria-label='Reply to this comment to Kimberly'>Reply to this comment
    • Anne-marie

      December 28, 2018 at 11:29 am

      That is what my ND recommended. It has not reversed it by has halted the progression. I was diagnosed as subclinical Hoshimotos over 3 years ago and my levels are still very near normal. I also went dairy free.
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  3. Debbie

    November 15, 2018 at 1:40 pm

    What does it mean if you have high Free T3 (4.4), (range 2.0-4.4) and low free T4 (1.5), (range 1.2-4.9)? Also, TSH was .069 and Reverse T3 was 16.5, (range 9.2-24.1). I was on Armour thyroid when labs were done and now have switched to NP Thyroid. Also, I can't tolerate too much T4 as it spikes my Reverse T3. Any ideas? Thanks for your thoughts!
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    • Deliciously Organic

      November 19, 2018 at 9:59 am

      I can't give personal advice on lab work unless you are a client (for legal reasons). But I can say in general that low T4 indicates the need for iodine. I would recommend following the steps I've listed below and continue to work with your practitioner to bring things back into balance.
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  4. Safiyya

    December 14, 2018 at 2:12 pm

    Thank you for this! I love the fact that you say don't allow your diet to paralyze you. I often feel so scared to eat because it may be something that will harm my thyroid. I walk into the kitchen at breakfast and feel so unmotivated by the limited things that I am allowed. But like you say this worsens the cortisol levels as well. Thank you again
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    • Deliciously Organic

      December 15, 2018 at 8:24 am

      I completely understand. I have to constantly remind myself that getting stressed over the food will actually create more health issues, so it's better to just do the best I can. :)
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  5. Sam

    January 22, 2019 at 8:21 pm

    As far as heavy metal toxicity is concerned, I feel that my remaining dental amalgams (5 total) are an issue for me as I have the APOE 3/4 genotype with a MTHFR A1298C variation. From what I’ve read, it would be difficult to correct hypothyroidism until the amalgams are replaced. Talk about dropping some dollars!!! I have an appointment with the biological dentist on April 30th and I am hopeful to get started on that part of my healing process. As an infant, I required multiple rounds of anabiotic’s my first year of life due Chronic your infections. I couldn’t wear regular diapers so my parents had to hire a cloth diaper service. I had rounds of allergy shots for several years after ear tubes and a tonsillectomy’s at age 2. By age 7 I had multiple teeth “drilled and filled” all in one day. I’m going to say it was at least four or five. Because most of my adult teeth and molars had already come in extremely early, these amalgams were there to stay. Within the year I had a fever of 106° intermittently for over a month. Living in Atlanta we had access to Emory Hospital and many good doctors. Believing that I had leukemia possibly, I underwent testing including a painful spinal. It’s 40 years later and I will never forget that day. Within the past few years, having done extensive research on my own, I realize now that most likely, I my toxic body burden is Probably astronomical. My question is this, what would you suggest as a good thyroid support while I tackle the amalgam replacement? I’m always afraid to put supplements in any type a combination into my body because I’m also suffering from some gastrointestinal issues, which comes as no surprise due to all of the systems in the body that mercury affects. It’s mindnumbing actually. Anyway, I did see your picture on another website the other day. I can’t remember which one it was but when I saw your face tonight I was very excited to read your blog. Thank you for your contribution and sharing your story.
    to Sam" aria-label='Reply to this comment to Sam'>Reply to this comment
    • Deliciously Organic

      January 23, 2019 at 11:11 am

      Legally, I can't give personal nutritional advice unless you are a client, but in general, I would make sure to take steps to do a dental detox before and after the removal to support the body. Here's the info on how to do that:https://deliciouslyorganic.net/detox-amalgam-mercury-filling-removal/
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  6. Ginalee Hansen

    June 14, 2019 at 11:30 am

    Hi thank you so much for sharing. Great info! Can you say where exactly the liver is. I would like to do the castor oil packs. I appreciate your advice!
    to Ginalee Hansen" aria-label='Reply to this comment to Ginalee Hansen'>Reply to this comment
    • Deliciously Organic

      June 17, 2019 at 3:19 pm

      On the right side under the ribcage.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  7. Cammie

    August 22, 2019 at 6:34 pm

    I am experiencing all of these including thinning skin, I feel like no one talks about this. Do you have any personal experience or tips? It definitely upsets me and I feel like no one can relate, thanks!
    to Cammie" aria-label='Reply to this comment to Cammie'>Reply to this comment
    • Deliciously Organic

      August 23, 2019 at 9:49 am

      Yes, I personally walked through Hashimoto's and know how frustrating and painful the symptoms can be. I'd start with the steps I list above in this article!
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  8. Irene

    August 28, 2019 at 10:20 am

    I am curious why in your list of labs to have performed you mentioned phosphorus? I have hypophosphatemia of unknown cause and only recently thought it could be due to thyroid issues. My parathyroid glands have been evaluated and ruled out as the cause.
    to Irene" aria-label='Reply to this comment to Irene'>Reply to this comment
    • Deliciously Organic

      August 30, 2019 at 11:58 am

      It's important to see the ratio between calcium and phosphorus when analyzing labs so that's why it's on the list.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
      • Irene

        August 30, 2019 at 6:33 pm

        How would this be associated with the Thyroid? I ask because I wonder if that could be the cause of my issues. Thanks.
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  9. Joanne Forst

    January 3, 2020 at 10:51 am

    Where are you located.
    to Joanne Forst" aria-label='Reply to this comment to Joanne Forst'>Reply to this comment
    • Deliciously Organic

      January 6, 2020 at 1:37 pm

      Our office is located in Solana Beach, CA. But, I work with all clients long-distance.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  10. Christa

    February 27, 2020 at 2:37 pm

    I have had a skin itchiness(like major itchness) and skin prickles for over 9 years now. No one can determine what is wrong or why. Could this be related to my Hashi's? Any ideas on what it could be or how to stop it.
    to Christa" aria-label='Reply to this comment to Christa'>Reply to this comment
    • Deliciously Organic

      April 20, 2020 at 2:28 pm

      Without knowing your full health history and reviewing your labs, it's hard to say what the root cause is. I recommend talking to your practitioner.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  11. Francesca

    May 26, 2021 at 4:51 pm

    Hi Carrie, it seems that I have Hashimoto. In January my gynecologist prescribed some routine lab work and came out my T4, free (direct) was low, so she suggested I looked for an endocrinologist. My son has T1 diabetes, so I asked his doctor to be referred to a colleague of her but I couldn’t get an appointment before July. In the meantime I looked for another endocrinologist for more exams. This time I got the TPA checked and they came high but other values normal, also I got a thyroid ultrasound and came out normal. This doctor told me: your thyroid is ok, come back in 6 months but I kept asking, so what does this high antibodies mean? He said: ah, that, you have Hashimoto but situation could be like this forever. Now, I have the other appointment in July. I don’t eat the standard American diet but I do eat gluten, a very varied diet with a lot of wild fish and less meat than before, just a natural preference, lot of fruit and vegetables and I don’t have a particular sweet tooth. I am a foodie, really. And love to exercise. I’ve always had high cholesterol and low vit D. I have a healthy metabolism and no skin or stomach issues. Sleep and anxiety is a different topic. I feel uncomfortable about following some of the advices on internet, I feel what is good for a person could damage another...my trick has always been variety, the poison is in the quantity my idea. So this going gluten free, I am dubious, I tried many years ago (at the time I tried also a couple of your recipes that I found delicious btw and kept making although went back on gluten). From my gluten free experience back then, I didn’t really feel it make a difference for me. So unsure where to go now, or just wait for my appointment in July. Do you have any suggestion for me. Thanks
    to Francesca" aria-label='Reply to this comment to Francesca'>Reply to this comment
    • Deliciously Organic

      May 27, 2021 at 9:01 am

      I'm so sorry you are struggling. The molecular structure of gliadin, the protein portion of gluten, closely resembles that of the thyroid gland. When gliadin breaches the protective barrier of the gut, and enters the bloodstream, the immune system tags it for destruction. These antibodies to gliadin also cause the body to attack thyroid tissue. So this means if you have Hashi's and you eat foods containing gluten, your immune system will attack your thyroid. This is why it's important to avoid gluten. I recommend starting with the tips I listed here and definitely check out my online thyroid course and protocol!
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  12. Laurie

    November 26, 2021 at 7:57 pm

    I have Hashimotos/Hypothyroid a cousin gave me this book to help heal myself, I was tested for the ebv and my results were negative, I also followed his protocol and became very ill.
    to Laurie" aria-label='Reply to this comment to Laurie'>Reply to this comment
    • Deliciously Organic

      November 29, 2021 at 9:43 am

      I'm so sorry you are struggling. I hope you're able to find the help you're looking for.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  13. Julie

    November 21, 2022 at 6:53 pm

    I’m curious if sourdough bread is ok for hashimoto’s? I suppose it would need to be gluten free sourdough if so? The carbs is what get me because I know those need to be minimized. Any suggestions on this for me? Would love to get back to bread have taken it out for a few years now. Thank you for everything!
    to Julie" aria-label='Reply to this comment to Julie'>Reply to this comment
    • Deliciously Organic

      November 28, 2022 at 9:47 am

      I recommend a grain-free diet until symptoms have greatly improved, all gut issues have been healed and antibodies are back to normal ranges.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  14. Brooke Bardaxe

    December 15, 2022 at 11:39 am

    What is the reason someone with IBS should not do a castor oil liver pack
    to Brooke Bardaxe" aria-label='Reply to this comment to Brooke Bardaxe'>Reply to this comment
    • Deliciously Organic

      December 16, 2022 at 10:38 am

      It could cause worsening of symptoms.
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment
  15. Trena Turner

    January 17, 2023 at 7:28 pm

    Can you clarify grain-free? Quinoa? Oats? Rice? Corn? I have eliminated gluten, but wanting to go grain free, and have been using some of the gluten free flours. Do you have a particular menu protocol for Hashimoto's? What about supplements that are helpful with thyroid meds/ without thyroid meds?
    to Trena Turner" aria-label='Reply to this comment to Trena Turner'>Reply to this comment
    • Deliciously Organic

      January 18, 2023 at 9:09 am

      If you do a quick search on grains, you can find which ones qualify. I recommend checking out my cookbook, "The Grain-Free Family Table", my meal plans and then my article about thyroid supplements. All of those things can be found here on the site! :)
      to Deliciously Organic" aria-label='Reply to this comment to Deliciously Organic'>Reply to this comment

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    February 22, 2019 at 11:17 am
    […] Hashimoto’s Disease – The Cause, Symptoms, Labs and First Steps to Take […]
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  2. 10 Essential Nutrients for the Thyroid - Hypothyroid, Hashimoto's and more says:
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    […] can help improve thyroid function and balance hormones, whether you struggle with hypothyroidism, Hashimoto’s, hyperthyroidism, or […]
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