Why many Patients with Hashimoto`s Thyroiditis do not Feel Well Despite their Thyroid Function tests Appearing Normal

Individuals with Hashimoto's disease commonly don’t feel well, even when their thyroid blood tests appear normal.

Why many Patients with Hashimoto's Thyroiditis do not Feel Well Despite their Thyroid Function tests Appearing Normal

Despite normal thyroid function tests, many individuals with Hashimoto's continue to experience thyroid-related symptoms.

Deficiencies and metabolic dysfunctions, not easily detected, can go unnoticed for many years and affect the energy levels, body weight, and mood of patients with Hashimoto's disease.

It is common for patients with Hashimoto's thyroiditis to have normal thyroid function blood tests yet not feeling well themselves^[1].

The most common problems affecting patients with Hashimoto's thyroiditis are^[2][3][4]:

1. Fatigue and Low Energy: This affects daily life and often makes a person feel unable to cope with life's demands. Deficiencies in vitamins (D, B complex, K2), minerals (magnesium, selenium, zinc), and antioxidants, disrupt the hormonal system and thyroid function, slowing metabolism and energy production.

2. Weight Gain: Despite sincere and continuous efforts, significant difficulty in losing weight is common. Insulin resistance and slow metabolism lead to the accumulation of visceral fat and weight gain.

3. Intestinal Function Disorders: Constipation, slow digestion, and bloating are the most common symptoms. These are due to alterations in the intestinal microbiome and disturbances of the intestine and gallbladder motility. In patients with thyroid dysfunction, there are often coexisting disorders in the gallbladder's function, which participates in the digestion of fats. Bile is produced in the liver and is essential in activating thyroid hormones.

4. Mood Swings: Patients may experience low mood or sadness, often to a degree that is disproportionate to their life situations. Poor mood can alternate with intense irritability linked to the chronic lack of energy, affecting personal relationships and social interactions. Metabolic disorders and deficiencies common in patients with Hashimoto's disease impact the nervous and hormonal systems, leading to a significant adverse impact on their mood.

5. Mild Memory Difficulties and Reduced Mental Clarity: The thyroid regulates, among other systems, the function of the nervous system. Additionally, disturbances in the microbiome, metabolic disorders, and deficiencies associated with Hashimoto's disease adversely affect mental functions.

6. Diffuse Pain in Muscles and Joints: Hypothyroidism, insulin resistance, and deficiencies in vitamins, minerals, and anti-inflammatory micronutrients impair the body's healing processes in patients with Hashimoto's disease, leading to chronic inflammation.

The above symptoms significantly affect the daily life of a large number of patients with Hashimoto's disease. It is common for patients to gradually "get used" to the symptoms and stop noticing them, considering that this is the "normal" flow of life.

This is because the body's deficiencies and metabolic disorders, such as insulin resistance, remain and disrupt the body's functioning as a whole.

Hashimoto's disease is the most common autoimmune disease. It occurs when the immune system mistakenly attacks the thyroid gland.

The gradual destruction of the gland by the immune system, usually over years, ultimately leads to hypothyroidism.

Four main factors contribute to the onset of Hashimoto’s thyroiditis^[5-12]:

Reduced metabolic rate (slowed metabolism), due to oxidation and deficiencies in vitamins and other elements
Insulin resistance
Lack of vitamin D3 and micronutrients (vitamins, minerals, trace minerals, amino-acids, antioxidants, fatty acids, probiotics)
Mental stress

These four factors negatively affect the function of thyroid cells. Acting for long periods, they alter the composition and morphology of thyroid cells and deregulate the functioning of the immune system.

It's noteworthy that symptoms can remain, to a lesser or greater extent, even after the regulation of hypothyroidism with medication^[1,2].

An individual can have normal levels of thyroid hormones and TSH yet still exhibit most of the above symptoms.

At this point, the external administration of hormones is a vital tool to improve the patient's clinical condition and quality of life. However, the adjustment made in the medication 2-3 times during the year cannot mimic the continuous and precise regulation that the human body does, with responses occurring in seconds.

To our clinical experience, even when the thyroid gland is under-functioning by up to 80%, this can be corrected through hormonal replacement without negatively affecting the patient's quality of life. The remaining 20% of the gland's function can cover a significant percentage of usual adjustments of metabolism to the needs of daily life, allowing an excellent quality of life.

Therefore, it is essential to maintain any remaining gland function, allowing the body to adapt to these changes metabolically.

To significantly improve health in patients with Hashimoto's disease, treatment must go beyond just regulating thyroid hormones. It should also involve identifying and correcting any accompanying deficiencies and metabolic disorders^[7-12].

As marginal deficiencies of the body in micronutrients accumulate gradually over time and lead to disease, correcting them takes time and effort.

If one does not address the deficiencies and metabolic disorders involved in the development of the disease, the disease's course will progress to a steady and gradual deterioration, marked by exacerbations and remissions. This progression burdens the patient's daily life and health condition.

Targeted Testing Guides Hashimoto's Thyroiditis Treatment

Identifying and treating metabolic disorders can only be done with targeted testing that analyzes small molecules in the blood. These tests detect metabolic disorders associated with the development and manifestation of Hashimoto's thyroiditis. An individual's metabolic state is the leading risk factor for the disease's onset^[13-15].

These tests are called metabolomic analyses. They measure tiny molecules involved in the body's chemical reactions, accurately detecting deficiencies and metabolic disorders and effectively addressing and preventing autoimmune and chronic diseases.

Metabolomic analyses are not comparable to ordinary laboratory tests. These tests are highly specialized and are performed in only a select number of laboratories around the world that adhere to very high standards. Our clinic's lab is involved in quality control programs organized by prestigious institutions such as the US National Institute of Standards and Technology (NIST), the Centers for Disease Control and Prevention (CDC), and the European Network of Laboratory Metabolic Diseases (ERNDIM).

Metabolomic analyses detect metabolic disorders that promote the development of Hashimoto's disease, including^[16-21]:

Deficiencies in Micronutrients: Lack of vitamin D, vitamin C, selenium, zinc, antioxidants, and omega-3s are linked to impaired immune system function, inflammation, and the health status of patients with Hashimoto's.
Energy Production in the Mitochondria: Mitochondrial dysfunction is linked to poor thyroid gland function and the development of Hashimoto's. Reduced mitochondrial performance leads to thyroid overactivity, followed by a gradual gland decline.
Difficulty in Metabolizing Simple Sugars: Excessive consumption of simple sugars beyond what the body can metabolize triggers inflammation and is a significant indicator of the disease's progression.
Insulin Resistance: Elevated insulin levels disrupt immune system function, worsen autoimmunity, and accelerate gland destruction.
Neurotransmitter Metabolism: Substances like dopamine, serotonin, and adrenaline regulate the nervous and hormonal systems. Metabolomic analyses provide an accurate picture of the secretion of these neurotransmitters.
Fatty Acid Metabolism: The ratio between omega-3 and omega-6 fatty acids is a crucial indicator of the body's ability to manage inflammation and regulate the immune system's normal response.
State of the Microbiome: alteration of the microbiome is linked to impaired immune system function and the ability to distinguish between its own tissues and external elements, such as pathogens and viruses.

Current management of Hashimoto's disease focuses on identifying and correcting deficiencies and metabolic disorders that led to the onset of the disease and maintaining the body's optimal metabolic state.

Our clinical experience with Hashimoto's disease shows that treatments guided by metabolomic analysis can lead to several benefits:

Improved management of the disease, protecting the thyroid gland from further damage.
Better functioning of the remaining thyroid gland, helping the body adjust its metabolism to daily needs and enhancing life quality.
A gradual decrease in autoantibody levels.
Reduction in fatigue and a boost in energy levels.
Enhanced mood and fewer severe emotional fluctuations due to improved gland function.
Lowered risk of harm to other organs and less chance of developing additional autoimmune diseases.
Increase in metabolic rate and maintenance of a healthy body weight.

Better response to medications.

It usually takes 6-8 months to achieve significant change, a year to stabilize the body at a better functional level, and about two years for optimal results.

As dysfunctions and deficiencies are corrected, the body reactivates regular metabolic processes and displays different needs. As treatment begins, changes occur in multiple metabolic pathways simultaneously. These changes must be identified and appropriately managed to continue the restoration process. Otherwise, the body's restoration processes do not progress, significantly delaying health improvement.

Through our clinical experience, we have found that correcting the body's deficiencies in vitamins and other elements, restoring metabolism, and regulating weight to normal levels radically change the course of Hashimoto's disease for the better and improve the quality of life of patients, from a picture of steady worsening to steady improvement.

Promptly addressing the issues mentioned above is critical to halting the progression of the disease.

Bibliographic References

[1] Is a Normal TSH Synonymous With “Euthyroidism”?
Sarah J. Peterson, Elizabeth A. McAninch, Antonio C. Bianco. The Journal of Clinical Endocrinology & Metabolism 2016.

[2] Persisting symptoms in patients with Hashimoto’s disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A systematic review. Karelina L. Groenewegen et al. J Transl Autoimmun. 2021.

[3] Thyroid hormones, Τ3 and Τ4, in the brain. Amy C. Schroeder and Martin L. Privalsky. Front. Endocrinol., 31 March 2014

[4] Cognitive and Affective Dysfunctions in Autoimmune Thyroiditis Thomas Leyhe, Karsten Müssig. Brain Behav Immun . 2014
⁵ Thyroid Hormone Regulation of Metabolism Rashmi Mullur, Yan-Yun Liu, and Gregory A. Brent. Physiol Rev. 2014 Apr.
⁶ Impact of stress on metabolism and energy balance. Cristina Rabasa, Suzanne L Dickson. Current Opinion in Behavioral Sciences. 2016.
⁷Correlation Between Hashimoto's Thyroiditis-Related Thyroid Hormone Levels and 25-Hydroxyvitamin D Guanqun Chao, Yue Zhu, Lizheng Fang. Front Endocrinol (Lausanne). 2020 Feb. https://pubmed.ncbi.nlm.nih.gov/32117049/
⁸Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis Shiqian Hu, Margaret P Rayman. Thyroid . 2017 May. https://pubmed.ncbi.nlm.nih.gov/28290237/
⁹Improving the Vitamin D Status of Vitamin D Deficient Adults Is Associated With Improved Mitochondrial Oxidative Function in Skeletal Muscle Akash Sinha et. al. J Clin Endocrinol Metab 2013. https://pubmed.ncbi.nlm.nih.gov/23393184/
¹⁰Enhanced oxidative stress in Hashimoto's thyroiditis: inter-relationships to biomarkers of thyroid function.Rostami R1, Aghasi MR, Mohammadi A, Nourooz-Zadeh J. Clin Biochem. 2013 Mar
¹¹Changes in Glucose-Lipid Metabolism, Insulin Resistance, and Inflammatory Factors in Patients With Autoimmune Thyroid Disease Yi Lei et. al. J Clin Lab Anal . 2019https://pubmed.ncbi.nlm.nih.gov/31350776/
¹²Introducing the thyroid gland as another victim of the insulin resistance syndrome. Jorge Rezzonico et al. Thyroid 2008. https://pubmed.ncbi.nlm.nih.gov/18346005/
¹³Micronutrient deficiencies in patients with COVID-19: how metabolomics can contribute to their prevention and replenishment. Dimitris Tsoukalas^1,2and Evangelia Sarandi^2,3BMJ Nutri Prev Heal. Nov. 2020; bmjnph-2020-000169
¹⁴ Metabolic Characteristics of Hashimoto's Thyroiditis Patients and the Role of Microelements and Diet in the Disease Management-An Overview. Aniceta A Mikulska et al. Int J Mol Sci . 2022 https://pubmed.ncbi.nlm.nih.gov/35743024/
¹⁵Metabolic pressure and the breach of immunological self-tolerance Veronica De Rosa, Antonio La Cava & Giuseppe Matarese.18 October 2017
¹⁶Thyroid Hormone Effects on Mitochondrial Energetics Mary-Ellen Harper 1, Erin L Seifert. https://pubmed.ncbi.nlm.nih.gov/18279015/
¹⁷Targeted Metabolomic Analysis of Serum Fatty Acids for the Prediction of Autoimmune Diseases. Dimitris Tsoukalas, Vassileios Fragoulakis, Evangelia Sarandi et. al. Frontiers in Molecular Biosciences, Metabolomics (6), 2019, Published 1 November 2019.
¹⁸Prediction of Autoimmune Diseases by Targeted Metabolomic Assay of Urinary Organic Acids. Dimitris Tsoukalas et. al. Metabolites. 2020 Dec 8.
¹⁹Metabolic profiling of organic and fatty acids in chronic and autoimmune diseases. Evangelia Sarandi, Dimitris Tsoukalas et al. Advances in Clinical Chemistry. July 15, 2020. Elsevier Inc.
²⁰A Clinical Trial for the Identification of Metabolic Biomarkers in Hashimoto’s Thyroiditis and in Psoriasis: Study Protocol by Evangelia Sarandi et al Pathophysiology 2021 https://www.mdpi.com/1873-149X/28/2/19
²¹Non-communicable Diseases in the Era of Precision Medicine: An Overview of the Causing Factors and Prospects. Dimitris Tsoukalas et al. Bio#Futures. Springer, Cham. May 2021.

Cookie Preferences

Customize preferences