You just got diagnosed with Hashimotos Thyroiditis. It sounds scary. But what is it? First off some basics. It is a thyroid disorder. It is more difficult to treat than most thyroid disorders for several reasons.
1. It is characterized by both highs and lows in the thyroid hormone levels at varying times.
2. It is a chronic condition without a known cure.
3. Up until this day the standard of care is considered to wait and watch until the thyroid levels are “low enough” and then start the patient on low dose thyroid replacement once the person has consistently low thyroid levels. If the persons levels spike then take them off and give them a medication to block the effects of thyroid hormone called a beta blocker (usually propranolol). Another option is to consider removing the thyroid and replacing the hormones entirely with medication. Standard of care is defined as what the majority of medical providers define as the main approach to treatment.
Why is the thyroid so important? It only controls nearly every metabolic function in the body. A person rarely will feel good until their thyroid is regulated.
It still sounds scary but wait…There is hope.
One of the main difficulties with diagnosis has always been that the patients labs seem to be “all over the place”. As seen in this graph:
Hashimotos Labs Values Over Time
A person with Hashimotos Thyroiditis will get periodic surges in their thyroid hormones. They will get classic symptoms of thyroid excess (detailed right) and then after a period of a few days or weeks they level out and the thyroid hormones go back to normal range. After a few days or weeks these hormones then dip into the low range only to repeat the cycle at a later time when the thyroid hormones start to surge again. It puts the patient on perpetual thyroid roller coaster which is frustrating for both the patient and the those attempting to manage or diagnosis them. Often patients who have been off and on thyroid medications because they have been high and low at multiple times in their life and nobody thought to look into whether they have Hashimotos. These “flare ups” can be caused by multiple triggers including viruses, inflammation in other parts of the body or by autoimmune processes.
The standard of care is to let the persons thyroid “burn out” until the person consistently needs treatment with synthroid which is one of the two thyroid hormones. Is there another option?
Yes. The first thing you need to know is that the way that you may may be treated by a Jasmer Health Provider might not be considered “standard of care”. Why? The standard of care is to let the damaged thyroid continue to wax and wane until it reaches a point where the it is chronically on the lower end of the spectrum. If the person is frequently getting thyroid storms or times when they are getting high thyroid output then sometimes they will be a good candidate for surgery. This is not something Dustin Jasmer FNP is trained to do but can make appropriate referrals to good surgeons. This can be a good option for some people. Propranolol is another medication that can be used during these surges of thyroid hormone. Some people may need to take an antithyroid hormone called tapazole if their symptoms become too severe. This is a medication that can block some of the effects of the thyroid output on the body. This might need to be prescribed by an endocrinologist and sometimes is prescribed in conjunction with thyroid medicine while awaiting thyroidectomy. Propranolol is a medication that should be prescribed regardless of whether you are treated by Dustin Jasmer or by another medical provider. Also, regardless of who treats the condition the patient should have certain tests to determine if there is a known cause of their thyroiditis.
So how can Hashimotos be treated differently?
1. A patient should have have an ultrasound. This can rule out other potential causes of thyroiditis and also show severity of the disease. If this is positive for nodules then the person may need further workup to determine if the thyroid needs to be removed or if these are benign. The person may need to be referred to a specialist to determine the next step. The nodule may be benign (incidental) or it could be problematical.
2. A patient should have the option of being on a medication that has the potential to decrease the potential for both the periods of hypo (low) and hyper (high) thyroidism. This medication is called Low Dose Naltrexone (LDN). This medication does not take the place of thyroid medication most of the time. Many times times the damage to the thyroid is already done and person will likely need thyroid medication on top of this medication. This medication will be described below but one thing to know is that it is prescribed “off-label” and most medical providers will not realize the reason why you are on it. We will provide you with research that you can give these medical providers. You should read it yourself before going on it. It is a safe medicine but every medicine can have side effects. Common side effects include nightmares, nausea and has a terrible taste. The other problem is that insurance won't cover it and it must be sent to a compounding pharmacy. We can refer you to one of the pharmacies that we work with who are familiar with dosing it.
3. There are two different thyroid hormones. T4 (synthroid) and cytomel (T3). Research and my experience has shown that many patients do better with both of these hormones. We have rarely seen patients treated with synthroid mono-therapy who feel better. There is also significant research that shows that adding cytomel (t3) can help with depression, lipid profiles, metabolism, hair loss, mood and their other hypothyroid complaints. During periods of high thyroid (storms, the person should stop taking their T3 and continue their T4 to prepare for when the thyroid stops putting out high levels again and then restart it.) Some patients can do well with Armour thyroid (dessicated pig thyroid) but this is harder to adjust the dose so I prefer commercially available products and despite popular belief these are biologically equivalent to human hormone.
4. I believe that a patient should have propranolol available to be taken on an as needed or even in some cases a consistent basis for times of thyroid storms (hyperthyroid). The hope is that as the person increases their LDN dose that these storms will be less and less over time.
5. Selenium- Selenium is a trace element that the person can consider taking. It has been shown in some clinical trials to help regulate thyroid function in hashimotos among other functions. The typical dose is 400 mcg.
6. A person with hashimotos should have the following labs:
They should have a celiac workup because celiacs is highly associated with hashimoto’s. They likely were already worked up for graves disease but if they came in with a hashimotos diagnosis this should be worked up as well as this can occur simultaneously. The person should have a basic rheumatology profile, b12, complete blood counts and iron studies done as well as these can be abnormal with people who have celiacs or thyroid abnormalities. They will need to have their thyroid labs followed frequently if they are placed on thyroid medications. These labs are after diagnosis has been completed and they have already gotten frequent thyroid studies and their antibodies completed.
So the end of the story: There is a hope. Look at the research for low dose naltrexone and make sure you know the symptoms of both high and low thyroid because it is important to distinguish what is causing your symptoms at the moment.