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I regularly read through recent literature on autoimmune thyroid disease/Hashimoto's. I post about each of these studies on instagram as I review them and put it all together on this blog twice per year.
You can use the categories located to the right of this post and click 'Hashimoto's Research Update' to see all of the updates.
TPO Antibodies and Quality of Life (https://pubmed.ncbi.nlm.nih.gov/21186954/) (2011)
This study included 426 females who planned to undergo thyroid surgery. They only included participants whose TSH, FT3 and FT4 were in the normal range. TPO antibodies were tested prior to surgery and they examined the thyroid tissue that was removed. These women also took symptom and health questionnaires prior to surgery.
The researchers found that the level of TPO antibodies correlated with the grade of thyroid inflammation. This makes a lot of common sense, higher antibodies = more thyroid destruction. The following symptoms were found to be higher in the patients with elevated TPO antibodies: chronic fatigue, dry hair, chronic irritability, chronic nervousness, dysphagia, and easily fatigued. Remember, the study participants all have normal thyroid hormone levels. The researchers also found that higher TPO levels were associated with an overall decreased quality of life.
A patient recently told me that her endocrinologist lamented that Hashimoto’s is so ‘overblown’. This paper was published in 2011. It’s time we start listening to patients AND keeping up with the research. There is nothing overblown about Hashimoto’s and just treating thyroid hormones (TSH, FT3, FT4) isn’t enough for Hashimoto’s patients. We can do better.
Epstein-Barr virus association with Hashimotos (https://pubmed.ncbi.nlm.nih.gov/32215255/) (2020)
Epstein Barr virus, one of the viruses that cause mononucleosis or ‘mono’, is considered a possible trigger of Hashimoto’s disease. This study investigated the prevalence of different types of antibodies to Epstein Barr virus (EBV) in people with Hashimoto’s thyroiditis (HT) and healthy controls. Approximately 95% of the adult population is infected during their life so not surprisingly, all participants tested positive for the antibody that measures if someone has been infected. What’s interesting is that the amount of antibodies present was significantly higher in the HT patients than in healthy controls. In addition, one of the antibodies, the early antigen IgG which is considered a marker of reactivation of the virus, was positive in HT patients at a significantly higher rate than controls.
Review of Nutrients Needs In Hashimoto’s (https://doi.org/10.1967/s002449910507) (2017)
This review article published in 2017 provides an update from the literature regarding several key factors impacting Hashimoto’s. I will summarize their findings for each below.
Iodine: Hashimoto’s is more common in areas that have plenty of iodine in the food supply/soil. Even small increases in iodine intake increase the risk of Hashimoto’s. The authors recommend discouraging excess iodine intake but caution that iodine levels of 250mcg daily are still required for pregnancy. Note from Dr. Barrett: this is a ‘goldilocks’ situation- you still need adequate iodine, just not too much. For non-pregnant patients I recommend limiting total iodine intake daily to 150mcg.
Selenium: The thyroid tissue contains the highest concentration of the trace mineral selenium in our bodies. This mineral acts as an antioxidant and has anti-inflammatory properties. The exact mechanism of benefit to the thyroid has not been determined but we do know that it seems to modify the immune and inflammatory response. Three meta analyses have confirmed that selenium reduced TPO and TG antibodies. Selenomethionine is superior to sodium selenite because selenomethionine is absorbed more easily. The authors concluded that supplementing with selenomethionine is beneficial for Hashimoto’s patients.
Vitamin D: This one is pretty straightforward. Vitamin D supplementation improves Hashimoto’s disease. The authors explain that the low cost and low side effect profile of 2,000- 4,000IU of vitamin D daily make it another good candidate to improve Hashimoto’s disease.
Gluten: The authors argue that according to a recent meta analysis all patients with Hashimoto’s should be screened for celiac disease because of the high association between these two autoimmune conditions. “ In summary, whereas it is not yet clear whether a gluten- free diet can prevent autoimmune diseases, it is worth mentioning that HT [Hashimoto’s Thyroiditis] patients with or without CD [Celiac Disease] benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned”. Note from Dr. Barrett: I think it’s warranted to try the gluten free diet in Hashimoto’s after screening for celiac disease.
Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis (https://doi.org/10.1007/s00296-015-3278-1) (2015)
Hashimoto’s is an autoimmune condition that destroys the thyroid tissue and may lead to hypothyroidism. These two conditions are often lumped together but it’s possible to have Hashimoto’s and not develop hypothyroidism. This study investigated the presence of autoimmune thyroid disease in patients already diagnosed with rheumatoid arthritis (RA). Their aim was to determine if there is an association with chronic widespread pain (CWP) and/or fibromyalgia and autoimmune thyroid disease. Their findings are quite interesting. There is a strong association with the presence of one of the thyroid antibodies and CWP and fibromyalgia but not the other! Only TPO antibodies were associated with the increase in chronic pain in this population. Another interesting finding is that the association of TPO antibodies with fibromyalgia was independent of hypothyroidism. This is important because hypothyroidism can cause widespread pain so the assumption could be made that the association with this antibody and pain could be due to the low thyroid function. That isn’t the case. There is something about the presence of the TPO antibody that is the association with pain. I find these results important because patients are often told once their hypothyroidism is treated, their autoimmune thyroid symptoms should be resolved. This study supports the fact that many patients are still symptomatic even when their thyroid hormones have normalized. The authors conclude that testing for TPO antibody should be standard of care in RA patients to help determine risk of CWP and fibromyalgia.
The association of other autoimmune diseases in patients with autoimmune thyroiditis (https://doi.org/10.1016/j.autrev.2016.09.009 ) (2016)
The association of other autoimmune diseases in patients with autoimmune thyroiditis: Review of the literature and report of a large series of patients.
This literature review found an increased prevalence of several autoimmune disorders when someone has autoimmune thyroid disease. The most common associations were Autoimmune thyroid disease + chronic autoimmune gastritis + vitiligo and Autoimmune thyroid disease + chronic autoimmune gastritis + polymyalgia rheumatica.
Other conditions that were more common alongside autoimmune thyroid disease include: rheumatoid arthritis, celiac disease, diabetes, sjogren disease, multiple sclerosis, systemic lupus erythematosus, sarcoidosis, alopecia, psoriatic arthritis, systemic sclerosis, and HCV-related cryoglobulinemia
Chronic autoimmune gastritis (CAG) was the most commonly associated autoimmune disease with autoimmune thyroid disease. CAG is largely asymptomatic and can remain undiagnosed for a long time. Sometimes laboratory results can clue us in such as low iron and or low B12. Some people can feel generalized digestive upset, reflux and/or feeling full early. CAG is diagnosed with antibody testing (parietal cell and intrinsic factor antibodies) and endoscopy.
Reference:
1. Ott, Johannes & Promberger, Regina & Kober, Friedrich & Neuhold, Nikolaus & Tea, Maria & Johannes, Huber & Hermann, Michael. (2011). Hashimoto's Thyroiditis Affects Symptom Load and Quality of Life Unrelated to Hypothyroidism: A Prospective Case-Control Study in Women Undergoing Thyroidectomy for Benign Goiter. Thyroid : official journal of the American Thyroid Association. 21. 161-7. 10.1089/thy.2010.0191
2. Assaad SN, Meheissen MA, Elsayed ET, Alnakhal SN, Salem TM. Study of Epstein-Barr virus serological profile in Egyptian patients with Hashimoto's thyroiditis: A case-control study [published correction appears in J Clin Transl Endocrinol. 2020 Dec 17;23:100242]. J Clin Transl Endocrinol. 2020;20:100222. Published 2020 Mar 12. doi:10.1016/j.jcte.2020.100222
3. Liontiris, M. I., & Mazokopakis, E. E. (2017). A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation. Hellenic journal of nuclear medicine, 20(1), 51–56. https://doi.org/10.1967/s002449910507
4. Ahmad, J., Blumen, H. & Tagoe, C.E. Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis. Rheumatol Int 35, 1415–1421 (2015). https://doi.org/10.1007/s00296-015-3278-1
5. Poupak Fallahi, Silvia Martina Ferrari, Ilaria Ruffilli, Giusy Elia, Marco Biricotti, Roberto Vita, Salvatore Benvenga, Alessandro Antonelli.The association of other autoimmune diseases in patients with autoimmune thyroiditis: Review of the literature and report of a large series of patients. Autoimmunity Reviews. Volume 15, Issue 12 (2016) Pages 1125-1128. ISSN 1568-9972,
https://doi.org/10.1016/j.autrev.2016.09.009
You can use the categories located to the right of this post and click 'Hashimoto's Research Update' to see all of the updates.
TPO Antibodies and Quality of Life (https://pubmed.ncbi.nlm.nih.gov/21186954/) (2011)
This study included 426 females who planned to undergo thyroid surgery. They only included participants whose TSH, FT3 and FT4 were in the normal range. TPO antibodies were tested prior to surgery and they examined the thyroid tissue that was removed. These women also took symptom and health questionnaires prior to surgery.
The researchers found that the level of TPO antibodies correlated with the grade of thyroid inflammation. This makes a lot of common sense, higher antibodies = more thyroid destruction. The following symptoms were found to be higher in the patients with elevated TPO antibodies: chronic fatigue, dry hair, chronic irritability, chronic nervousness, dysphagia, and easily fatigued. Remember, the study participants all have normal thyroid hormone levels. The researchers also found that higher TPO levels were associated with an overall decreased quality of life.
A patient recently told me that her endocrinologist lamented that Hashimoto’s is so ‘overblown’. This paper was published in 2011. It’s time we start listening to patients AND keeping up with the research. There is nothing overblown about Hashimoto’s and just treating thyroid hormones (TSH, FT3, FT4) isn’t enough for Hashimoto’s patients. We can do better.
Epstein-Barr virus association with Hashimotos (https://pubmed.ncbi.nlm.nih.gov/32215255/) (2020)
Epstein Barr virus, one of the viruses that cause mononucleosis or ‘mono’, is considered a possible trigger of Hashimoto’s disease. This study investigated the prevalence of different types of antibodies to Epstein Barr virus (EBV) in people with Hashimoto’s thyroiditis (HT) and healthy controls. Approximately 95% of the adult population is infected during their life so not surprisingly, all participants tested positive for the antibody that measures if someone has been infected. What’s interesting is that the amount of antibodies present was significantly higher in the HT patients than in healthy controls. In addition, one of the antibodies, the early antigen IgG which is considered a marker of reactivation of the virus, was positive in HT patients at a significantly higher rate than controls.
Review of Nutrients Needs In Hashimoto’s (https://doi.org/10.1967/s002449910507) (2017)
This review article published in 2017 provides an update from the literature regarding several key factors impacting Hashimoto’s. I will summarize their findings for each below.
Iodine: Hashimoto’s is more common in areas that have plenty of iodine in the food supply/soil. Even small increases in iodine intake increase the risk of Hashimoto’s. The authors recommend discouraging excess iodine intake but caution that iodine levels of 250mcg daily are still required for pregnancy. Note from Dr. Barrett: this is a ‘goldilocks’ situation- you still need adequate iodine, just not too much. For non-pregnant patients I recommend limiting total iodine intake daily to 150mcg.
Selenium: The thyroid tissue contains the highest concentration of the trace mineral selenium in our bodies. This mineral acts as an antioxidant and has anti-inflammatory properties. The exact mechanism of benefit to the thyroid has not been determined but we do know that it seems to modify the immune and inflammatory response. Three meta analyses have confirmed that selenium reduced TPO and TG antibodies. Selenomethionine is superior to sodium selenite because selenomethionine is absorbed more easily. The authors concluded that supplementing with selenomethionine is beneficial for Hashimoto’s patients.
Vitamin D: This one is pretty straightforward. Vitamin D supplementation improves Hashimoto’s disease. The authors explain that the low cost and low side effect profile of 2,000- 4,000IU of vitamin D daily make it another good candidate to improve Hashimoto’s disease.
Gluten: The authors argue that according to a recent meta analysis all patients with Hashimoto’s should be screened for celiac disease because of the high association between these two autoimmune conditions. “ In summary, whereas it is not yet clear whether a gluten- free diet can prevent autoimmune diseases, it is worth mentioning that HT [Hashimoto’s Thyroiditis] patients with or without CD [Celiac Disease] benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned”. Note from Dr. Barrett: I think it’s warranted to try the gluten free diet in Hashimoto’s after screening for celiac disease.
Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis (https://doi.org/10.1007/s00296-015-3278-1) (2015)
Hashimoto’s is an autoimmune condition that destroys the thyroid tissue and may lead to hypothyroidism. These two conditions are often lumped together but it’s possible to have Hashimoto’s and not develop hypothyroidism. This study investigated the presence of autoimmune thyroid disease in patients already diagnosed with rheumatoid arthritis (RA). Their aim was to determine if there is an association with chronic widespread pain (CWP) and/or fibromyalgia and autoimmune thyroid disease. Their findings are quite interesting. There is a strong association with the presence of one of the thyroid antibodies and CWP and fibromyalgia but not the other! Only TPO antibodies were associated with the increase in chronic pain in this population. Another interesting finding is that the association of TPO antibodies with fibromyalgia was independent of hypothyroidism. This is important because hypothyroidism can cause widespread pain so the assumption could be made that the association with this antibody and pain could be due to the low thyroid function. That isn’t the case. There is something about the presence of the TPO antibody that is the association with pain. I find these results important because patients are often told once their hypothyroidism is treated, their autoimmune thyroid symptoms should be resolved. This study supports the fact that many patients are still symptomatic even when their thyroid hormones have normalized. The authors conclude that testing for TPO antibody should be standard of care in RA patients to help determine risk of CWP and fibromyalgia.
The association of other autoimmune diseases in patients with autoimmune thyroiditis (https://doi.org/10.1016/j.autrev.2016.09.009 ) (2016)
The association of other autoimmune diseases in patients with autoimmune thyroiditis: Review of the literature and report of a large series of patients.
This literature review found an increased prevalence of several autoimmune disorders when someone has autoimmune thyroid disease. The most common associations were Autoimmune thyroid disease + chronic autoimmune gastritis + vitiligo and Autoimmune thyroid disease + chronic autoimmune gastritis + polymyalgia rheumatica.
Other conditions that were more common alongside autoimmune thyroid disease include: rheumatoid arthritis, celiac disease, diabetes, sjogren disease, multiple sclerosis, systemic lupus erythematosus, sarcoidosis, alopecia, psoriatic arthritis, systemic sclerosis, and HCV-related cryoglobulinemia
Chronic autoimmune gastritis (CAG) was the most commonly associated autoimmune disease with autoimmune thyroid disease. CAG is largely asymptomatic and can remain undiagnosed for a long time. Sometimes laboratory results can clue us in such as low iron and or low B12. Some people can feel generalized digestive upset, reflux and/or feeling full early. CAG is diagnosed with antibody testing (parietal cell and intrinsic factor antibodies) and endoscopy.
Reference:
1. Ott, Johannes & Promberger, Regina & Kober, Friedrich & Neuhold, Nikolaus & Tea, Maria & Johannes, Huber & Hermann, Michael. (2011). Hashimoto's Thyroiditis Affects Symptom Load and Quality of Life Unrelated to Hypothyroidism: A Prospective Case-Control Study in Women Undergoing Thyroidectomy for Benign Goiter. Thyroid : official journal of the American Thyroid Association. 21. 161-7. 10.1089/thy.2010.0191
2. Assaad SN, Meheissen MA, Elsayed ET, Alnakhal SN, Salem TM. Study of Epstein-Barr virus serological profile in Egyptian patients with Hashimoto's thyroiditis: A case-control study [published correction appears in J Clin Transl Endocrinol. 2020 Dec 17;23:100242]. J Clin Transl Endocrinol. 2020;20:100222. Published 2020 Mar 12. doi:10.1016/j.jcte.2020.100222
3. Liontiris, M. I., & Mazokopakis, E. E. (2017). A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation. Hellenic journal of nuclear medicine, 20(1), 51–56. https://doi.org/10.1967/s002449910507
4. Ahmad, J., Blumen, H. & Tagoe, C.E. Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis. Rheumatol Int 35, 1415–1421 (2015). https://doi.org/10.1007/s00296-015-3278-1
5. Poupak Fallahi, Silvia Martina Ferrari, Ilaria Ruffilli, Giusy Elia, Marco Biricotti, Roberto Vita, Salvatore Benvenga, Alessandro Antonelli.The association of other autoimmune diseases in patients with autoimmune thyroiditis: Review of the literature and report of a large series of patients. Autoimmunity Reviews. Volume 15, Issue 12 (2016) Pages 1125-1128. ISSN 1568-9972,
https://doi.org/10.1016/j.autrev.2016.09.009
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