The number one cause of hypothyroidism is the thyroid autoimmune disease Hashimoto’s. The majority of my Hypothyroid Mom readers have Hashimoto’s, but most do not know it. The thyroid antibodies for Hashimoto’s (Thyroid Peroxidase Antibodies & Thyroglobulin Antibodies) are often not tested in mainstream medicine. Even when thyroid antibodies are tested and a patient is diagnosed with Hashimoto’s, the only treatment by mainstream medicine is thyroid hormone replacement medication. Hashimoto’s is more than a thyroid condition, it is an autoimmune disease. The underlying cause(s) of Hashimoto’s will vary for each patient and healing happens when the cause of that person’s Hashimoto’s is discovered.
Written by Dr. Nikolas Hedberg
What is Hashimoto’s Disease?
This is your thyroid gland. It is a small butterfly-shaped gland in your neck.
In Hashimoto’s Disease, your body’s immune system is making antibodies against the thyroid gland. The antibodies attack the thyroid gland. They create a lot of inflammation. They destroy the thyroid gland. This results in decreased production of thyroid hormone levels and eventually hypothyroidism.
- Hashimoto’s disease is the most common autoimmune disease in the world.
- Hashimoto’s disease causes approximately 90% of hypothyroidism.
- No treatment is offered by conventional medicine other than thyroid medication.
If you have Hashimoto’s disease there is no conventional treatment for the autoimmune component of Hashimoto’s disease. Conventional medicine doesn’t recognize Hashimoto’s thyroiditis as a major problem. And what I mean by that is that if you have Hashimoto’s thyroiditis, the treatment is going to be the same for you if you just have hypothyroidism and don’t have an autoimmune disease.
So the treatment for hypothyroidism and Hashimoto’s thyroiditis is going to be prescription thyroid hormone but this doesn’t address the autoimmune component.
The Causes of Hashimoto’s Disease
The causes of Hashimoto’s Disease lay the groundwork for your healing process. This is key because one person’s cause of their Hashimoto’s disease may be completely different from another person who has Hashimoto’s.
It’s really important to find out why you have Hashimoto’s and what’s causing it. I put all the research together over my many years of practice and all the research that I’ve done on thyroid disorders, and I put it together into this chart which shows you all the possible causes of Hashimoto’s thyroid disease. Here we see Hashimoto’s thyroiditis in the diagram with all of the different causes surrounding it.
So autoimmune diseases can be caused by a variety of different things. But infections are really a major, major cause and a major overlooked factor in autoimmune disease. So the Epstein-Barr virus is probably the most common infection that causes Hashimoto’s thyroid disease. So Epstein-Barr virus is the virus that causes mononucleosis, also known as the kissing disease. Teenagers get this when they first kiss someone who has this virus and it is transferred by saliva. Genetically, some people just have a really hard time controlling the Epstein-Barr virus throughout their life. So, for example, in Hashimoto’s thyroiditis, the research has shown that if we were to biopsy the thyroid gland and test the tissue for the Epstein-Barr virus, you would find extremely high concentrations of the Epstein-Barr virus in the thyroid gland of individuals who have Hashimoto’s. So if you have Hashimoto’s, the first thing you want to get tested for is Epstein-Barr virus and that’s done with a blood test.
The next factor is iodine, a highly controversial topic, in not so much conventional medicine but in alternative medicine. There are people on two sides of the fence, those who are pro iodine for Hashimoto’s and those who are against iodine. And I land somewhere in the middle. It really depends on the individual and the individual case. But there is some research out there that shows that when iodine is added to the food supply in certain populations, like in Denmark and Turkey as examples, the incidence of Hashimoto’s thyroiditis did increase significantly when iodine was added to the food supply. The other thing we know is that some research out of Japan shows that if you give someone iodine who has Hashimoto’s thyroiditis, you increase what’s called lymphocytic infiltration into the thyroid gland. Basically that means that you create more inflammation into the gland. So iodine can be a potential trigger. Again, it’s highly controversial and a big topic which we won’t cover today. But you do need to be aware of it.
The next thing is going to be bacteria called Yersinia enterocolitica. This is actually in the same family as the bacteria that caused the bubonic plague, also known as the black death, throughout Europe many years ago. That was called Yersinia pestis transmitted by rat fleas. Yersinia enterocolitica you can get just from contaminated food or water and it gets into the gut. And usually your body fights it off. You get some diarrhea, lose stools, maybe feel like you have some food poisoning and your body just gets rid of it. But some individuals, it sets up shop, so to speak, in the gut barrier. And the immune system not only attacks the Yersinia, but it also attacks thyroid tissue, because to your immune system, Yersinia looks just like thyroid tissue and that’s what we call molecular mimicry. Molecular mimicry basically means that your immune system is not only making antibodies against an infection, but it’s also making antibodies against your own tissue that looks just like the infection. So Yersinia, like Epstein Barr virus is tested in the blood. It can also be tested in the stool, but stool analysis is going to miss the vast majority of Yersinia infections. So it really needs to be done in the blood. So by treating the Yersinia, you can remove the reason why the immune system is overactive and attacking the thyroid gland.
Herpes 1, 2, and 6… Herpes 1 and 2 are going to be sort of the classic herpes-type infections that people get where they get either genital or oral outbreaks. Herpes 6, you don’t really see any skin outbreaks. A lot of the symptoms tend to be more fatigue and related to the brain or neurological symptons. But these can be transmitted from person to person pretty easily.
Postpartum, that means after giving birth… many women will develop Hashimoto’s thyroiditis after they give birth. And so you’ll see significant decline in some women’s health after they give birth and that can happen due to Hashimoto’s thyroiditis. Pregnancy creates a big shift in a woman’s immune system because during pregnancy the immune does not want to attack the fetus so there are changes in the immune system to protect the baby. Sometimes then after birth the immune system doesn’t go back to the way it was before.
Lyme disease, Borrelia burgdorferi is the bacteria that causes Lyme. And there is some research that connects Hashimoto’s thyroiditis with Lyme disease. So that’s transmitted by a tick and so that is another thing to be aware of. If you have Lyme disease, you should also be tested for Hashimoto’s and vice versa.
Cytomegalovirus, this is also a herpes virus. I didn’t mention before that the Epstein Barr virus is also in the herpes family. Somewhere around 50 percent of the population has cytomegalovirus. And there are some connections there with Hashimoto’s. Not even close to being as common as the Epstein Barr virus, but again, another infection to be aware of.
Q fever caused by the Coxiella burnetii bacteria, very, very rare. You won’t really see that much. Rubella and rubeola, these are the two different types of measles. Again, an uncommon underlining cause of Hashimoto’s. Most people have had measles but just more infections to be aware of.
Toxic heavy metals, mercury, cadmium, and arsenic. Mercury is really the major player here when it comes to autoimmune thyroid disease. The majority of mercury that we get comes from mercury containing dental amalgams. And then, of course, we also get some from fish and then also from the burning of coal which gets up into the atmosphere and is found in the rain and in the soil in the areas close to coal plants.
Staph and strep infections, rickettsial infections… Rickettsia is transmitted by insects, ticks, and mosquitoes, more of an uncommon cause of Hashimoto’s, but another infection to be aware of. A lot of times we’ll see Rickettsia as a co-infection along with Lyme disease.
And then talking about the gut, some of you are probably aware of what’s known as leaky gut. And gluten, celiac disease, and a lot of food sensitivities can lead to leaky gut syndrome. And since about 70 percent of your immune system is in the gut, whenever someone has Hashimoto’s thyroiditis, we always want to look at the gut and food sensitivities and if there’s a gluten sensitivity, or if the patient has celiac disease, these are all things that we need to be aware of. So if that is a connection, of course, we’ll want to do a gluten-free diet and avoid food sensitivities that we find on blood testing, and then do a leaky gut protocol to try and heal that up so the immune system can become more balanced.
Coxsackie B, again, one of the rare infections. This is a virus that is connected to Hashimoto’s.
Helicobacter pylori, this is, I would put in the top three, along with the Epstein Barr virus and Yersinia as triggers of Hashimoto’s disease. So Helicobacter pylori, everyone has it in the stomach. People who get ulcers… the ulcers are usually caused by H. pylori. When someone is under a lot of stress for a long period of time, the high cortisol levels, they weaken the immune system in the gut, and it allows for bacterial, fungal, and parasitic infections to take hold, and H. pylori is one of those. It’s not only connected with Hashimoto’s but also with Graves disease. So Helicobacter pylori is, again, one of the big three, and we’ll test that in most people with Hashimoto’s. And there are three different ways to test for it, the breath test, which is the most sensitive. It can also be tested in the stool and then also in the blood as well.
Another infection, the parvovirus B19, a very common and more common in children, but parvovirus can be a trigger of Hashimoto’s.
Hepatitis C is pretty interesting, because they found that the thyroid can actually become a reservoir for the Hepatitis C virus. So hep C can be transmitted through drug users who use infected needles and then it can also be sexually transmitted. And normally, the hepatitis C virus just stays in the liver. But there is some research that shows it can travel to the thyroid and be a trigger and a potentiating factor in Hashimoto’s thyroid disease.
HTLV1, this is a tropical virus, extremely rare trigger of Hashimoto’s, but something to be aware of if you’ve spent a lot of time in tropical areas and you developed Hashimoto’s while you were there or after coming back, that could be something to think about.
Cigarette smoke and second-hand cigarette smoke, this is a big one. A lot of patients I see who have had many, many years of second-hand cigarette smoke such as from their parents or if they’re smokers themselves, this can be a potential trigger for Hashimoto’s. Now there is some cadmium in some cigarettes so that could be a potential connection there along with the fact that cigarette smoke is just highly toxic, and the thyroid is very sensitive to environmental toxins.
The flu, sometimes we’ll see someone has a really, really bad flu, and they’ll develop Hashimoto’s.
Excess estrogen, so one of the things we know is that if you have too much estrogen in your body, this can actually inhibit your body’s ability to control the Epstein Barr virus. And so the more body fat you have, usually the more estrogen you’re going to have and that goes for men and women. So with men, too much body fat will create excess conversion of their testosterone into estrogen. And then women, the more body fat they have, the more estrogen they’ll have. And then they’ll get an imbalance in progesterone and estrogen which really, really throws off the immune system. I test sex hormone levels – testosterone, progesterone, estrogens (estrone, estradiol, estriol), and DHT (Dihydrotestosterone).
I also check for adrenal problems.
Enteroviruses, these are fairly uncommon causes of Hashimoto’s but can be a potential trigger.
And then HIV, this can also be a factor in Hashimoto’s thyroiditis.
There are also genetic factors that we may want to look at including MTHFR.
So again, the big three are really the Epstein-Barr virus, Yersinia enterocolitica, and H. pylori. Other big things to look for are the leaky gut, gluten and food sensitivities, too much estrogen, and then a lot of these other infections I talked about are going to be a little bit more rare compared to the big three.
So it’s a matter of figuring out the underlying cause of the Hashimoto’s and why the immune system is out of balance and why your immune system is attacking your own thyroid gland. So we’ll do lab tests based on the person’s particular health history and symptoms. We’ll deal with the infections or any of these other causes, and try and get the immune system balanced. Your body goes through a certain amount of wear and tear every month, and it’s up to your immune system to keep up with that wear and tear. If the immune system can no longer keep up with the daily wear and tear on your body, then autoimmune disease can develop. And so these infections or the leaky gut, as example, they are just too much stress on you immune system. Things go haywire and then the body starts attacking its own tissue.
A Multifactorial Approach to Hashimoto’s
Determining the cause is key because the cause of one person’s Hashimoto’s may be very different than another person’s Hashimoto’s. We will do a very detailed medical history and laboratory testing to determine what is causing the person’s Hashimoto’s. I’ve written in depth above about the various possible causes of Hashimoto’s. The big three are really the Epstein-Barr virus, Yersinia enterocolitica, and H. pylori.
There are a few other factors that are essential to look at from a multifactorial approach to Hashimoto’s.
Sometimes I will see a patient who has experienced a serious psychological or physical trauma that triggered their Hashimoto’s disease. We discuss things like whether physical or verbal abuse may be occurring or if a major physical accident has happened. Pregnancy too can be a trigger for Hashimoto’s disease. I’ve seen many patients who felt great and had great physical health then after getting pregnant and giving birth, that’s when everything went down hill.
Too much exercise can lead to thyroid problems. Excessive exercise can stress the immune system. Too much exercise can raise cortisol and adrenaline which are not good for the thyroid. It is also hard to heal the gut when someone is overexercising. We do discuss the person’s intensity of exercise and help find the right balance.
Sleep is going to be key because that’s when most of the body’s repair happens including the brain and immune system. If someone is not sleeping well it is hard to get the immune system back in balance.
High cortisol and high adrenaline can significantly cause imbalance in the immune system. It can exacerbate Hashimoto’s disease. We try to figure out all the potential causes of stress, whether they include work stress, relationship stress, and things like that. We’ll also discuss stress reduction techniques like meditation, journaling, walking in nature.
There is no single best diet for Hashimoto’s disease. My nutrition programs are tailored to the individual. Most will be gluten-free. There may be other food triggers that may be an issue for that person as well. Depending on someone’s body type will determine the amount of protein, carbohydrates, and fat. We’ll also look at whether someone is insulin resistant.
Body types from my book The Complete Thyroid Health & Diet Guide:
If there is ongoing stress in a relationship such as in a marriage, with children, family, friends, boss or coworkers, that will slow us down and inhibit our progress in getting the antibodies down and getting the Hashimoto’s under control.
It is interesting that studies have shown that if you don’t have a meaningful purpose in life that that can actually affect the physical body. We talk about life purpose, relationships, attitudes towards their health and more.
This gives an overall picture of all the things we look at and you can see it is very individual. One person’s treatment plan could be very different from another person’s.
Addressing the causes of Hashimoto’s disease is KEY to healing.
About Dr. Nikolas R. Hedberg
Dr. Nikolas R. Hedberg is a Board Certified Naturopathic Physician, Chiropractic Physician and a Diplomate of the American Clinical Board of Nutrition. His practice is the Immune Restoration Center in Asheville, NC where he focuses on thyroid disorders and autoimmune diseases. He is the author of the book The Complete Thyroid Health & Diet Guide and he can be reached through his website www.drhedberg.com.
Listen to my interview with Dr. Hedberg on his podcast here.