Dr. Weyrich's Naturopathic Functional Medicine Notebook is a collection of information on topics of interest to Dr. Weyrich that may be of interest to the world wide audience. Due to limitations of time, not all information that Dr. Weyrich knows or would like to further research is published here. Dr. Weyrich welcomes financial contributions to support specific research topics, as well as copies of non-free access journal articles for him to review on a topic. Constructive criticism is also welcome.


Overview of Hashimoto's Thyroiditis

Hashimoto's thyroiditis is an autoimmune condition in which the cells of the thyroid are destroyed. Initially the destruction of the thyroid cells causes a release of larger than normal amounts of thyroid hormone, resulting in transient acute hyperthyroidism. As destruction of the thyroid cells continues, eventually too few cells will remain to produce normal amounts of thyroid hormone and the patient will develop a hypothyroid state.

Hashimoto's thyroiditis is associated with other autoimmune conditions, such as:

  • Adrenal insufficiency (Schmidt's syndrome)
  • Inflammatory bowel disease
  • Celiac disease
  • Pernicious anemia
  • Diabetes Mellitus type I
  • Graves disease

Complimentary and alternative treatments for Hashimoto's thyroiditis that are considered below include:

  • Immune System Balancing
  • Low Dose Naltrexone

Signs and Symptoms of Hashimoto's Thyroiditis

  • Chronic hypothyroid signs/symptoms: fatigue, weakness, cold intolerance, decreased memory, constipation, muscle and joint pain, hoarseness, weight gain, dry skin and sparse hair, depression, carpal tunnel syndrome, decreased sweating, swollen tongue, eyes, hands and feet, burning, prickling, itching, or tingling sensations, and hearing impairment. Slow heart rate, decreased pulse pressure, low body temperature, delayed relaxation of deep tendon reflexes.
  • Acute hyperthyroid signs/symptoms: Nervousness and emotional distress, shortness of breath, increased sweating and heat intolerance, night sweats, rapid heart rate, heart palpitations, fatigue, weakness, weight loss despite increased appetite, tremors or inward trembling [Kharrazian2010], atrial fibrillation, loss of bone density, bulging eyes (exophthalmos).
  • Physical Exam: Thyroid gland is usually non-tender, diffusely enlarged with fine nodularity, possibly asymmetrically.

Etiology of Hashimoto's Thyroiditis

The exact cause of the autoimmune condition is unknown, but leaky gut syndrome, dysbiosis, and food allergies are thought to play an important role both in initiating and maintaining the autoimmune process.

Diagnosis of Hashimoto's Thyroiditis

  • Hashimoto's thyroiditis may present as either an acute hyperthyroid or chronic hypothyroid condition in the standard thyroid screening panel (TSH, free T4).
  • Elevated antithyroperoxidase levels (95%).
  • Elevated antithyroglobulin antibodies (60%).
  • Thyroid gland nodularities upon palpation merit further evaluation (to rule out concomitant cancer) with ultrasound or fine needle biopsy, especially if isolated or unilateral, or patient has history of head/neck radiation exposure.
  • Follow-up labs for associated conditions:
    • CBC (anemia).
    • Lipid panel (elevated cholesterol).
    • Chem Panel (elevated CPK, LDH, AST, Hyponatremia).
    • IgA antiendomysial antibodies and IgA tissue transglutaminase (Celiac).
    • Adrenal Stress Index (adrenal insufficiency).
    • Intestinal Permeability Test (leaky gut).
    • Food Allergy Test (autoimmune triggers).

Differential Diagnosis of Hashimoto's Thyroiditis

  • With hyperthyroid symptoms:
    • Graves disease: Depressed TSH and elevated T4.
    • Pituitary tumor: Elevated TSH and elevated T4.
    • Pheochromocytoma: Elevated 24-hour urine VMA, catecholamines, and metanephrine.
    • Toxic multi-nodular goiter: (Iodine deprivation followed by repletion).
  • With hypothyroid symptoms:
    • Iodine-deficient goiter.
    • Drug-induced: Lithium, amiodarone, propylthiouracil, methimazole, phenylbutazone, sulfonamides, interfereon-alpha, iodine, aminosalicylic acid, aminoglutethimide.
    • Genetic.
    • Ablation of thyroid gland.
    • Subacute thyroiditis: Elevated Erythrocyte Sedimentation Rate (ESR) and low antithyroid antibody titer.
    • Pregnancy or post-partum.

Treatment of Hashimoto's Thyroiditis

Please see conventional, complimentary and alternative medical treatments for important background information regarding the different types of medical treatments discussed below.

Naturopathic, Complimentary and Alternative Treatments

  • Treat adrenal insufficiency first, if present (supplementing T4 or T3 in the presence of adrenal insufficiency is contraindicated).
  • Hormone replacement therapy: Start with 1.6 mcg/kg/d levothyroxine (T4, Synthroid, Levothyroid) and titrate up 25 mcg/d every 4-6 weeks until TSH is normalized. Some patients get better results with a T4/T3 blend from a compounding pharmacy). Drug interactions with thyroid HRT requiring dosage adjustments: oral anticoagulants, insulin, oral hypoglycemics, estrogens and OCP, cholestyramine, iron and calcium supplements. Start with 33% lower doses in the elderly.
  • Gluten-free diet if Celiac is a comorbidity [Kharrazian2010].
  • Treat dyslipidemia (cholesterol imbalance) if present; however Dr. Weyrich notes that correcting T4 levels will often correct dyslipidemia without further intervention.
  • Treat dysbiosis if present.
  • Heal the leaky gut if present.
  • Identify and avoid problem foods.

Immune System Balancing

[McCulley2018, pp 28, 35, 61, 89] reports that Hashimoto's thyroiditis is a TH1-dominant, localized, autoimmune disorder, and proposes an approach to treating this disease, which should be supervised by a properly trained medical professional. Dr. Weyrich has considerable interest in this topic, and has treated several cases of Hashimoto's thyroiditis with Immune System Balancing.

Please see What is Immune System Balancing? for more information.

Low Dose Naltrexone (LDN)

According to the Low Dose Naltrexone home page [LDN], LDN has been seen to benefit Hashimoto's thyroiditis, which is considered to be an autoimmune disease.

Dr. Weyrich has been trained in the use of Low Dose Naltrexone (LDN) and offers these protocols as a complement to other therapies; however at this time Dr. Weyrich has only treated one confirmed case of Hashimoto's thyroiditis using LDN (in addition to thyroid hormone replacement therapy). The patient reported significant improvement in symptoms, and auto-antibody markers were seen to be substatially reduced.

Please see What is Low Dose Naltrexone? for more information.


ICD-9 Codes related to Hashimoto's Thyroiditis

ICD9-CodeDescriptionComments
245.0Acute thyroiditis 
245.1Subacute thyroiditis 
245.2Chronic thyroiditis 

References for Hashimoto's Thyroiditis