Can You Reverse An Autoimmune Thyroid Condition?

This is one of the most common questions that I ask in my practice. But to properly address it, first, let’s back up to better understand the variety of different thyroid conditions, what causes them, the typical diagnostic testing that is done (and not done), and then explore possible treatment options. For the purposes of this conversations, we will be mostly concerned with the  most common thyroid conditions: autoimmune thyroiditis, also called Hashimoto’s, and low functioning thyroid due to conversion issues.

Autoimmune conditions like Hashimoto's Thyroiditis pose a complex challenge for patients seeking to improve their health. At the forefront of many conversations that I have with patients is the question: ‘can autoimmunity be reversed?’. To address it, it's crucial to understand the physiologic processes that cause autoimmune diseases and the potential for management and improvement.

Screening Tests Versus Comprehensive Testing for the Thyroid:

TSH, A Full Thyroid Panel with Antibodies, & Ultrasounds

In mainstream conventional medicine, a screening test, called Thyroid Stimulating Hormone (TSH) is typically the first and often, the only test run to assess the thyroid. The TSH test, which looks at the basic function of the thyroid, has a very wide acceptable ‘normal’ reference range in conventional medicine. It’s an area where your conventional provider may tell you your levels came back ‘normal’, but they may be far from ‘optimal’ even if not flagged on your lab results report.

Comprehensive testing that looks at the full function of your thyroid gland should include TSH as well as free T3, free T4, and thyroglobulin (TGB) and thyroperoxidase (TPO) antibodies.  This important workup for symptoms of unexplained fatigue, sluggish digestion/constipation, weight gain, dry skin and hair, cold body temperature, and low mood. The diagnosis of the autoimmune condition Hashimoto's thyroiditis relies on the presence of elevated antibodies, but often, it can take a long time before the initial TSH screening test is elevated enough to prompt further testing.  This often delays diagnosis.

To further complicate it, although elevated thyroperoxidase (TPO) and thyroglobulin (TGB) antibodies are commonly associated with Hashimoto's, studies reveal that a significant percentage of individuals with the condition may not test positive for these antibodies. This suggests that using antibodies alone as diagnostic markers could result in missed diagnoses in a minority of instances. Combining antibody testing with a thyroid ultrasound in some patients can offer a more comprehensive assessment, but it's essential to recognize the limitations of these diagnostic methods.

Reversing Autoimmunity: Conventional Perspectives versus Alternative Perspectives

The conventional view maintains that once an autoimmune process begins, it is considered a complete diagnosis and irreversible. Conventional medicine may label a diagnosis that no longer produces symptoms ‘in remission’. There is some veracity to this approach as once triggered, an autoimmune process always has the potential to flare again.

However, emerging perspectives suggest that addressing factors like improving gut health, reducing inflammation, and changing diet, may halt or even reverse autoimmune responses. This should be taken on a case-by-case basis and depends on how far the destruction of the thyroid tissue has progressed.

The current research evidence we have available does not definitively support the idea of successfully reversing autoimmunity once it is established.

In addition, the dietary and lifestyle changes that are necessary to pursue autoimmune reduction or reversal may not be accessible or appealing to everyone; however clinically, we do see that holistic approaches such as identifying and mitigating autoimmune triggers, decreasing inflammation, improving gut health, and re-regulating the immune system can significantly improve quality of life for individuals with autoimmune conditions. We do have small studies suggesting that reducing the amount of antigen-antibody reactions taking place is correlated with reduced symptoms, and that’s very important.

Other Low Thyroid Issues: Understanding T4 to T3 Conversion Issues

Many individuals with low functioning thyroid may not have an autoimmune condition, but instead, may be having other difficulties in converting inactive thyroxine (T4) into active triiodothyronine (T3). Contrary to popular belief, these conversion problems are not necessarily indicative of thyroid gland dysfunction, but typically arise from peripheral issues in the body. The three main reasons a person may have adequate T4 but low or suboptimal T3 include the following:

• Inflammation: The signaling molecules, called cytokines, that are associated with inflammatory states can suppress T4 to T3 conversion directly. They can also interfere with the cellular communication between the brain and the thyroid and from the thyroid to the rest of the body. Specifically, inflammation reduces the pituitary output of TSH, and it also reduces the cellular sensitivity to thyroid hormones. So even if you have enough T3 floating around in your system, your cells are unable to receive it. And without T3 activating cellular receptors, you end up with symptoms of hypothyroidism, even if your labs are normal.

• Poor Gut Health: 20% of the conversion of T4 to T3 occurs in the gut. If you have poor gut health such as a disrupted gut microbiome, small intestinal bacterial overgrowth (SIBO), gut permeability issues (leaky gut), parasites, then it’s entirely possible that a significant portion of T4-to-T3 conversion is not happening appropriately.

• Under Nourishment: Chronic under-eating, poor nutrient assimilation, or a lack of healthy carbohydrates can suppress thyroid function. The body’s way of protecting itself from expending energy in resource-scarce conditions. If you may have one of these habits or issues, you may be unintentionally suppressing your own metabolism and sabotaging thyroid health.

• Endocrine Disrupting Chemical Exposures: Compounds found in pesticides, unfiltered water, synthetic fabrics, and chemicals found in personal care products have been shown to cause thyroid conversion issues in addition to increasing susceptibility to autoimmunity.

Addressing these underlying causes, rather than solely relying on thyroid medication, is getting to most important layer of healing for T4 to T3 thyroid conversion issues.

Monitoring Thyroid Medication Dosages

The appropriate level of thyroid hormone is important for many vital areas of health. Allowing a thyroid condition to go unmanaged—either with excessive or insufficinet levels of thyroid hormone—is dangerous to the cardiovascular system, nervous system, metabolism, and the body as a whole. If you’ve been prescribed thyroid medication, it’s important to take the prescribed amount and continue the recommended monitoring to keep your levels within range.

This is particularly important to self-advocate for during certain periods in which the chance of increased autoimmunity goes up, such as in the post-partum period, menopause/hormonal transition, and after exposure to strong virus such as COVID.

What About the Possibility of Getting off Thyroid Medication?

Another common question. For individuals who are exploring the possibility of discontinuing thyroid medication, the path forward is one of careful patience, monitoring medication levels, and highly dependent on motivation, willingness to change dietary and lifestyle factors, healing potential underlying causes, and of course, monitoring with the appropriate lab testing along the way to ensure safety. That’s correct: safety. It may be unsafe and unhealthy to discontinue your thyroid medication if your body needs you to be on it.

Addressing underlying causes, such as gut health, inflammation, or nutrient deficiencies, may offer opportunities for improvement and, in some cases, medication reductions. A systematic review study found that discontinuation of gluten or other inflammatory dietary components was associated with improved antibody levels against peroxidase (TPO), TSH, and free thyroxine (free T4) .

However, for those with advanced thyroid gland damage due to conditions like Hashimoto's, long-term thyroid hormone replacement therapy may be necessary for optimal health as basic safety.

Navigating Hashimoto's Thyroiditis and similar autoimmune conditions requires a multifaceted approach. While complete reversal of autoimmunity may not always be achievable, proactive management strategies focusing on root causes and symptom alleviation can significantly enhance quality of life. Working closely with healthcare providers and adopting a holistic approach to wellness can empower individuals in their journey towards optimizing the thyroid health.

REFERENCES

• Osowiecka K, Myszkowska-Ryciak J. The Influence of Nutritional Intervention in the Treatment of Hashimoto's Thyroiditis-A Systematic Review. Nutrients. 2023 Feb 20;15(4):1041. doi: 10.3390/nu15041041. PMID: 36839399; PMCID: PMC9962371.