Hashimoto’s Thyroiditis

Author: Cory Lenherr, MD
Cornelia Lenherr, MD, practices Functional Medicine in Chatham, NY where she specializes in Mood, Mind and Autoimmune disorders. She can be reached at drcory@healthymd.org or 585-880-5856.

The thyroid, one of the most under-appreciated endocrine glands in the body, can make or break your health. It is highly sensitive to the slightest alterations and sets the body’s speed limit. If you’re cold, it steps on the gas to create more heat. Catch a virus, and it revs up the engine of the immune system. Overly stressed, it hits the brakes to keep from blowing a gasket.

How the Body Makes Thyroid Hormones

Located in front of the neck, the thyroid gland controls metabolic function in every cell of the body via the thyroid hormones thyroxine (T4), which makes up the vast majority at 93%, and triiodothyronine (T3). To understand the full story, we’ll start with how thyroid hormones are made.

Through a series of biochemical steps, tyrosine, an amino acid derived from protein, is eventually converted into T4 and T3. The active form of thyroid hormone, T3, turns on or slows down metabolic function, and is therefore responsible for much of our thyroid’s healthy functioning. However, most doctors focus attention almost exclusively on T4, the inactive form of thyroid hormone. The liver, gastrointestinal tract, heart, muscle, and nerves all play a role in converting most of the T4 in our bodies into T3, and our body relies on certain vitamins, nutrients, and other hormones to make this process work. The remaining T4 is converted into reverse T3 (RT3), which plays a role in suppressing T3 activity at the cellular level.

Thyroid and Brain Function

T3 is integral to hundreds of physiological functions including bone metabolism, gastrointestinal function and acid production, regulation of growth hormone, insulin and glucose metabolism, protein synthesis and regulation of brain chemistry. The brain is saturated with thyroid receptors, and healthy thyroid function is integral to healthy brain function. Conversely, a healthy brain and adequate production of neurotransmitters serotonin and dopamine are necessary for healthy thyroid function. The most common symptoms of hypothyroidism, or an underactive thyroid gland, are also very common in dementia and depression, and can be seen in the box below:

Symptoms of Hypothyroidism


  • Brain fog
  • Cold body, hands and feet
  • Constipation
  • Depression
  • Dementia
  • Dry skin
  • Hair loss
  • Low body temperature
  • Low energy, fatigue
  • Puffiness

  • Diminished libido
  • Feeling nervous and emotional
  • Heavy, irregular periods
  • Hoarseness
  • Insomnia (or requiring excessive amounts of sleep)
  • Joint and muscle pain, stiffness, swelling
  • Muscle weakness
  • Slow digestion
  • Slowed heart rate
  • Stubborn weight gain

If you are experiencing any of these symptoms, or a combination of them, think THYROID. As you can see, the brain can become impaired (sometimes severely so), if the body is not making enough of the active form of thyroid hormone (T3). Untreated hypothyroidism can lead to a host of other diagnoses including depression and dementia.

How Hashimoto’s Thyroiditis Develops

Twenty-seven million Americans are affected by thyroid malfunction, the most common form being Hashimoto’s thyroiditis. In Hashimoto’s, the body makes antibodies in response to inflammatory trigger-foods (sugar, wheat, dairy), infections, and/or toxins, which can permeate the lining of the intestines. Some antibodies mistake thyroid tissue for a foreign invader and attack it. Initially, Hashimoto’s remains silent and the thyroid functions normally. As thyroid damage continues, hormone release is inconsistent, and individuals may experience the effects of having too much or too little hormone in circulation. Eventually, thyroid function will stop completely and classic hypothyroidism occurs.

Diagnosing Thyroid Problems

A blood test will identify thyroid peroxidase (anti-TPO) and/or thyroglobulin (anti-Tgb) antibodies, signs of Hashimoto’s. If found early, it’s possible to reverse this autoimmune disease by removing problematic foods, infections and toxins, and healing the gut. Individuals with Hashimoto’s are at an increased risk for developing other autoimmune conditions; therefore, addressing the root cause(s) of the immune response is particularly important. Unfortunately, Hashimoto’s often progresses unrecognized, leading to irreversible damage to the thyroid. At that point, thyroid hormone replacement is usually necessary.

One way to determine whether you have an underactive thyroid is to take your temperature upon waking, and one or two other times throughout the day. A temperature below 98 degrees suggests low thyroid function.

Tests to Request from your Doctor

If you have symptoms of hypothyroidism or an underactive metabolism, ask your doctor to check for thyroid peroxidase and thyroglobulin antibodies, free and total T4 (thyroxine), free and total T3 (triiodothyronine), reverse T3 (rT3) and thyroid stimulating hormone (TSH).

Healing Your Thyroid

If your tests show evidence of autoimmune thyroiditis or your hormone levels are low, following the steps below (with the help of an integrative/functional medicine practitioner) can restore thyroid balance:

  1. Improve your nutrition by getting amino acids from proteins, essential vitamins (including B Vitamins, C & D) and minerals (such as selenium, iron, iodine, and zinc). Avoid inflammatory foods, especially gluten and dairy. Grains and legumes may also need to be eliminated.
  2. Build a healthy gut: remove infections, parasites, food allergens, and acid-blocking medications.
  3. Make sure the adrenals are functioning well. Your doctor will work to optimize cortisol levels by suggesting many of the steps mentioned here such as lowering stress and the amount of sugar in the diet.
  4. Reduce your body’s toxic burden: avoid exposure to toxins and support your body’s detoxification mechanisms.
  5. Heal any lingering infections. If you feel inflammation or pain in the body, and the cause has not been identified, seek help to find out the cause so it can be addressed. Common infections that may go undetected are in the mouth and other areas of the body which have experienced invasive procedures, insect and tick bites, mold exposure, etc..
  6. Relieve stress through regular activities such as yoga, meditation, prayer, and paced breathing.
  7. Make rest a priority by getting 7-8 hours of solid sleep nightly.
  8. Move your body every day by doing some form of exercise.

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