Written by Renata Filiaci, MSHW

Introduction

Hashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis, was first discovered by Hakaru Hashimoto in 1912 and is the most common form of hypothyroidism. However, it was not attributed with the autoimmune aspect until the 1950s, in which the etiology of HT depends on an immune genetic defect paired with environmental factors (Banasik & Copstead, 2019; Pyzik, Grywalska, Matyjaszek-Matuszek, & Roliński, 2015). Although the pathogenesis of HT is not adequately determined, it is characterized by an enlarged thyroid gland triggered by lymphatic cell and antithyroid antibody infiltration initiating the decrease of thyroid hormone production and the increase of thyroid stimulating hormone from the pituitary gland causing the gland to become inflamed and scarred (Banasik & Copstead, 2019; Pyzik, Grywalska, Matyjaszek-Matuszek, & Roliński, 2015). Another indication of HT is iodine deficiency. Iodine is necessary for the production of thyroid hormones, thyroxine (T4) and triiodothyronine (T3), but thyroglobulin concentration continues to increase. Without T4 and T3 thyroid hormones producing naturally, thyroid stimulating hormone is imbalanced and elevated causing excessive thyroglobulin which produces a goiter, an enlarged thyroid gland, a symptom of HT (Banasik & Copstead, 2019).

Many clinical manifestations can exist with HT. More often diagnosed in women than in men, individuals with HT have a decreased basal metabolic rate which is reported as fatigue, weakness, intolerance to cold temperatures, reduced appetite, weight gain, decreased heart rate, depression, and memory loss. Increased risk of atherosclerosis is evident due to elevated cholesterol and triglyceride levels; this should be monitored when the diagnosis is official. Women with HT may experience menstrual difficulties especially during menses, in which increased flow and clotting could be apparent. In prolonged and overlooked HT, myxedema can occur, which is the accumulation of glycosaminoglycans, therefore retaining excess liquid (Banasik & Copstead, 2019).

The idea behind conventional treatment for patients with HT is to balance serum thyroid levels (Banasik & Copstead, 2019). Oral levothyroxine is prescribed in a dose of 1.6 to 1.8 mcg/kg per day and should not exceed the recommended dose or patients can encounter insomnia, anxiety, and mood instability as well as osteoporosis. Essentially, this dosage should replace or supplement thyroid hormone production (Mincer & Jialal, 2018; Banasik & Copstead, 2019). Other forms of medication include high-dose acetylsalicylic acid, corticosteroid, or nonsteroidal anti-inflammatory drugs therapy; however, these can create adverse effects after long-term use (Sweeney, Stewart, & Gaitonde, 2014). Complementary and alternative medicinal protocols are available and useful as treatment and management of HT.

Results/Discussion

Complementary and alternative medicinal protocols have been evaluated as effective treatment as well as help manage the symptoms of Hashimoto’s thyroiditis. Although natural medicine, such as herbal remedies, can regulate thyroid hormones, do not stop taking your medication; when beginning an alternative treatment, monitor thyroid hormone levels and then it is optional to potentially lower the dosage or week off conventional medicine altogether (Sinadinos, N.A.). It is essential to eliminate certain substances that can either suppress thyroid function or block iodine utilization. Avoiding the use of chromium picolinate, calcium supplements, alcohol, drugs, caffeine, and excessive sugar consumption can help the thyroid gland function normally and allow thyroid medication to be absorbed properly. It is also vital to evade consuming raw goitrogen-containing foods which restrain iodine utilization; these foods are cruciferous vegetables, such as broccoli, brussel sprouts, cabbage, cauliflower, kale, mustard greens, radishes, rutabagas, and turnips, as well as mustard, cassava root, soy products, peanuts, pine nuts, and millet. However, when cooked and consumed in moderation, cruciferous vegetables can provide beneficial nutrients (Sinadinos, N.A.; Motohashi, Vadapalli, Vanam, & Gollapudi, 2018). Sinadinos (N.A.) believes that consuming tyrosine and iodine-containing foods help support the thyroid; a diet with iodine includes brown seaweed, bladderwrack, and kelp, which can prevent the enlargement of the thyroid gland, and foods that contain tyrosine include velvet bean seeds, carob, oats, spinach, watercress, sesame seeds, butternut squash, chaya, chives, fava beans, lamb’s quarters, pigweed, pumpkin seeds, and snow peas (Sinadinos, N.A.).

Vitamin deficiencies can also attribute to a poorly functioning thyroid gland. Vitamin D and B12 deficiencies are apparent in patients with HT. Although there is not a direct link to the development of HT, it is critical to check levels and consume foods or supplement that contain both vitamins. Vitamin D-containing foods are fatty fish, milk, dairy, eggs, and mushrooms; however, consume dairy within moderation due to its potential to cause inflammation. Vitamin B12-containing foods are mollusks, sardines, salmon, organ meats, fortified cereals, and nutritional yeast (Motohashi, Vadapalli, Vanam, & Gollapudi, 2018). Beneficial supplements are also essential for normal thyroid hormone manufacture, supporting thyroid function, and reducing inflammation, such as fish oil, cod liver oil, flaxseed oil, vitamins B2, B3, riboflavin, niacin, B6, and selenium (Sinadinos, N.A.; Motohashi, Vadapalli, Vanam, & Gollapudi, 2018).

Medicinal plants and botanicals can be used for the management of the HT. Herbs can be provided as a tincture, extract, powder, or capsule. If consumption of bladderwrack as food is unmanageable, it is available as a tincture; four to eight drops, three times a day can regulate hypothyroidism, work as an anti-inflammatory, and convert T4 into T3 antibacterial. Twenty-five mg, three times a day of gum guggul increases the iodine uptake by the thyroid gland, enhances T3 production, and is a cholesterol-lowering agent. One to two ml, three times a day of blue flag can detoxify the thyroid gland as well as work as an anti-inflammatory (Neupane, Kaur, & Prabhakar, 2017). Other thyroid stimulating adaptogenic herbal supplements that work directly or indirectly with the thyroid gland are ashwagandha, gotu kola, Siberian ginseng, American ginseng, Panax ginseng, licorice, spikenard, devil’s club root-bark, poor man’s ginseng, reishi mushroom, Schisandra, and Chinese foxglove (Sinadinos, N.A.).

Conclusions

Hashimoto’s thyroiditis (HT) is an autoimmune disease affecting the thyroid gland. Its etiology is determined by lymphatic cell and antithyroid antibody infiltration initiating the decrease of thyroid hormone production and the increase of thyroid stimulating hormone from the pituitary gland causing the gland to become inflamed and scarred. HT can create some symptoms ranging from moderate to severe which disrupt the quality of life of a person. Conventional medicinal treatments are typically used; however, they can cause adverse effects if not mediated properly. Avoidance of agents that disrupt the production of thyroid hormones and maintenance of thyroid gland function is beneficial for treatment. Although it is best to monitor thyroid levels, valuable nutrition, proper vitamin levels, and the introduction of herbal supplements can regulate thyroid hormones and increase iodine utilization.

References

Banasik, J. L. & Copstead, L-E. C. (2019). Pathophysiology (6th ed.). St. Louis, MO: Elsevier Inc.

Mincer, D. L., & Jialal, I. (2018, October 27). Hashimoto Thyroiditis. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK459262/

Motohashi, N., Vadapalli, J., Vanam, A., & Gollapudi, R. (2018). The Impact of Nutrition on Hashimoto Thyroiditis Patients: An Overview. Journal of Clinical Nutrition and Metabolism, 2(2). Retrieved from https://www.scitechnol.com/peer-review/the-impact-of-nutrition-on-hashimotos-thyroiditis-patients-an-overview-5i78.php?article_id=7748

Neupane, N., Kaur, M., & Prabhakar, P. K. (2017). Treatment of Hashimoto’s thyroiditis with herbal medication. International Journal of Green Pharmacy, 11(3). DOI: http://dx.doi.org/10.22377/ijgp.v11i03.1140

Pyzik, A., Grywalska, E., Matyjaszek-Matuszek, B., & Roliński, J. (2015). Immune disorders in Hashimoto’s thyroiditis: what do we know so far? Journal of immunology research, 2015, 979167. doi: 10.1155/2015/979167

Sinadinos, C. (N.A.). Herbal Therapeutic Treatments for Hypothyroidism. Retrieved from https://www.americanherbalistsguild.com/sites/default/files/sinadinos_christa_-_herbal_support_for_hypothyroidism.pdf

Sweeney, L. B., Stewart, C., & Gaitonde, D. Y. (2014). Thyroiditis: An Integrated Approach. Am Fam Physician, 90(6), 389-396. Retrieved from https://www.aafp.org/afp/2014/0915/p389.html