Did you know that the majority of cases of thyroid disease are autoimmune in nature? Hashimoto’s thyroiditis is an autoimmune condition where the immune system begins to view the thyroid gland as a foreign invader and begins to attack it. Because it is a progressive autoimmune condition, it leads to the destruction of the thyroid gland, causes hypothyroidism, and in some cases, to other types of autoimmune conditions.
Hashimoto’s is not usually discovered until it has reached the advanced stages, with significant damage to the thyroid gland. From the onset of the autoimmune attack on the thyroid gland, till a diagnosis of Hashimoto's is about a 10 yrs. Conventional Western doctors will only test the TSH, which won’t be elevated until Stage 4. There are better tests, TPO, TAA and ultrasounds, which are covered by insurance, that can reveal thyroid disease perhaps a decade before the TSH changes. Still, most doctors won’t run these tests until they see a big enough change in TSH.
Wiersinga and colleagues in a 2014 article identified 5 stages of Hashimoto’s.
Stage 1: Genetic Predisposition
In the initial stage, a person will have the genetic predisposition for Hashimoto’s, but no exposure to the necessary triggers. Their TSH, T4/T3 levels are normal, and no thyroid antibodies are present as yet.
If you have thyroid disease, this may be the stage your relatives and children are currently in. If you have a family member with thyroid disease and you’re reading this, you could be in this stage.
Stage 2: Immune Cell Infiltration of the Thyroid Gland
Hashimoto’s is characterized by an overabundance of lymphocytes (white blood cells) in and around the thyroid gland. In small amounts, these immune cells play an important cleanup role, but when there's too many of them there, over time they begin to attack healthy thyroid tissues as well. We still see normal TSH, Free T3, and Free T4 levels, but patients may be symptomatic, and complain of anxiety, fatigue, miscarriage/infertility, mood swings, excess weight or weight loss. In this phase, there is always impaired gut wall function as well (leaky gut).
In this early stage of Hashimoto’s, up to 80-90% of people will usually have elevated thyroid antibodies. For those that may never have these antibodies present in blood, then performing a thyroid ultrasound or biopsy, and the changes in the thyroid consistent with Hashimoto’s will be apparent. This phase may go on for decades before enough damage is done to detect a change in thyroid hormone levels.
Stage 3: Subclinical Hypothyroidism
The TSH may be slightly elevated, and free T3 and free T4 are normal, but the thyroid antibodies may be higher than in Stage 2. TSH irritates the thyroid, so when levels go up, so does inflammation of the thyroid gland
Stage 4: Overt Hypothyroidism
This person is beginning to have thyroid gland failure, and if enough damage has occurred, then the thyroid will no longer be able to produce thyroid hormone. Their TSH is still elevated, but low levels of Free T3 and Free T4. Thyroid antibodies may be even higher than ever, so this is the most common stage to be diagnosed. The person will now require thyroid medications to prevent serious health consequences.
Stage 5: Progression to Other Autoimmune Disorders
Having Hashimoto’s puts a person at greater risk for developing other health issues. Left unbalanced the immune system may go on to attack different parts of the body, leading to the development of other autoimmune disease such as; celiac disease, psoriasis, Sjogren’s, rheumatoid arthritis, Lupus, multiple sclerosis, and many others.
There are no current treatment recommendations or guidelines in western conventional medicine, to address the immune system attack on the thyroid gland.
Medications are very important, of course, if someone has a low level of thyroid hormones, but they only address the symptoms and not the root causes, and they do nothing for preventing the progression of the autoimmune disease. It's akin to continuing to pour more water into a bucket with a hole in it.
In a broad overview, you need to identify your triggers and strengthen your body by addressing food sensitivities, nutrients, intestinal permeability, toxins, stress, and chronic infections.