Good Hormone Health: Hashimoto’s Disease Specialist

The best doctor for Hashimoto’s disease is a specialist such as Dr. Friedman, who sees hundreds of patients with Hashimoto’s disease, which is also called Hashimoto’s thyroiditis.  It is an autoimmune disease where antibodies attack the thyroid gland.  It requires optimal thyroid hormone replacement that an endocrinologist can offer.  Most primary doctors cannot offer that.  End-stage Hashimoto’s refers to a condition where the thyroid is completely destroyed by an autoimmune process. Rarely, severe Hashimoto’s can affect the brain.

What Is the Life Expectancy of Someone With Hashimoto’s Thyroiditis?

Most people with Hashimoto’s thyroiditis live a normal life and, with proper treatment, feel well and have a good quality of life.  However, other patients have poor quality of life because they are not on proper hormone replacement.

What Is Hashimoto’s Thyroid Disease?

Hashimoto’s thyroiditis is an autoimmune condition affecting the thyroid gland and leads to hypothyroidism.  Some patients can have antibodies present that are attacking the gland but do not get hypothyroid, while other people do not have the antibodies and do not have Hashimoto’s but have other qualities of hypothyroidism.  Dr. Friedman is a specialist in treating Hashimoto’s and hypothyroidism, and a specialist is helpful in treating the condition. 

The thyroid gland is one of the body’s master glands that control multiple functions, including energy, temperature regulation, hair growth, gastrointestinal motility, thinking processes, reaction time, and cardiac function.  If the thyroid gland is not properly treated, patients will often have multiple symptoms, including feeling tired, cold, sluggish, with slow reflexes, hair loss, brittle nails, and swelling.  With severe conditions, they may even get heart failure.

What Are the Risk Factors for Hashimoto’s?

Hashimoto’s is mostly in women.  About 80% of Dr. Friedman’s patients are women.  It can occur at any age.  It usually occurs between 20 and 50.  Patients with Hashimoto’s often have another family member who did have Hashimoto’s or some other type of autoimmune condition.  They may have family members who have Addison’s disease, celiac disease, or Graves’ disease. 

Common Symptoms 

Some of the common symptoms of hypothyroidism include fatigue, weight gain, cold sensitivity, dry skin, hair loss, muscle weakness, and depression.  The symptoms may develop gradually or may be quite severe, or they may be mild.

Diagnosing Hashimoto’s Disease 

It is very important to diagnose the disease early before the thyroid gland is completely destroyed and the patient is suffering.  The most common diagnostic test is the TSH test.  A high TSH indicates hypothyroidism.  The range usually goes up to about 4.5 or 5.  Values above 5 are hypothyroid.  Those with a value in the upper range of normal may be hypothyroid, depending on other tests.  Dr. Friedman also gets a free T4 and free T3 level to measure the actual hormones.  Some of them may be affected by more severe hypothyroidism.  Dr. Friedman also gets a thyroid peroxidase (TPO) antibody test, which is the specific test for Hashimoto’s.  The thyroglobulin antibody test, which is an older test, is not helpful for Hashimoto’s.  The TPO antibody test is quite specific for Hashimoto’s, and if it is positive, it indicates that the patient has Hashimoto’s.  Dr. Friedman will also get a thyroid ultrasound to look for characteristic findings of Hashimoto’s thyroiditis to help confirm the diagnosis. 

Dr. Friedman is very careful with diagnosing people with Hashimoto’s and putting the right people on thyroid medicine.  He sees many people who were put on thyroid medicine who do not have Hashimoto’s and do not need thyroid medicine and are probably doing worse on it because it suppresses their own glands.  At your virtual appointment, Dr. Friedman will visually inspect your thyroid gland and watch you swallow.  Dr. Friedman will take your careful medical history, including some signs and symptoms related to Hashimoto’s.

Treatment Options

The main treatment option is to replace thyroid hormones and also decrease the thyroid peroxidase antibody level.  The standard approach for treating hypothyroidism is levothyroxine, of which there are several brands, including Synthroid, Levoxyl, and Unithroid.  However, studies have shown that at least 15% of people taking levothyroxine still have symptoms of hypothyroidism, even though their TSH is normalized.  This led Dr. Friedman and other specialists to realize that they needed other hormones in thyroid medicine in addition to levothyroxine.  Dr. Friedman also gives liothyronine, which is T3, or Cytomel, in addition to levothyroxine, but he has found that even better than that is to give desiccated thyroid.  Desiccated thyroid comes from pig thyroid and has T4 and T3, as well as other ingredients in the thyroid gland, such as T1 and T2, that may be helpful.  Dr. Friedman has reviewed the literature, and there are at least 7 papers showing that patients do better on desiccated thyroid than on levothyroxine, while there are no papers showing that patients do better on levothyroxine than desiccated thyroid.  Dr. Friedman will also recommend supplements, such as selenium and myoinositol, to reduce antibody levels.  Lifestyle changes are often helpful, and having a clean diet can be quite beneficial.  Dr. Friedman will carefully monitor your thyroid levels, including the free T4, free T3, and reverse T3, to make sure your treatment is optimized.  

Many conventional endocrinologists do not care about or do not understand the role of reverse T3.  Dr. Friedman has summarized the data in a paper submitted to Clinical Endocrinology on reverse T3 and has found that it is quite helpful in determining the proper thyroid treatment for patients with hypothyroidism.  The thyroid hormone levels do change with time, and therefore, it is very important to have frequent follow-ups with Dr. Friedman, who will carefully measure your thyroid hormones and adjust your thyroid medicine.

Living with Hashimoto’s

Most people with Hashimoto’s disease who are on proper treatment do quite well.  However, they do need to have regular blood tests and regular follow-ups.  There are various support groups online for patients with Hashimoto’s and hypothyroidism.  Dr. Friedman has a Facebook group and is also on Instagram and TikTok. He has several articles on his websites and social media about the treatment of hypothyroidism.

Hashimoto’s versus Hypothyroidism 

Hypothyroidism is usually diagnosed with an elevated TSH and often with a low free T4.  The symptoms of hypothyroidism include fatigue, hair loss, sluggishness, constipation, brittle nails, slow reflexes, and weight gain.  There are different causes of hypothyroidism.  The most common is called Hashimoto’s hypothyroidism.  

In Hashimoto’s hypothyroidism, the thyroid gland is attacked by antibodies.  The main antibody is called the anti-thyroid peroxidase, or TPO, antibody.  This leads to hypothyroidism in some but not all cases.  Thus, you can have hypothyroidism without Hashimoto’s and Hashimoto’s without hypothyroidism. 

Dr. Friedman uses the TPO antibody to determine who should get thyroid medicine if they have a TSH in the upper normal range.  If the antibody is positive, he is more likely to give a patient thyroid medicine.  Patients with Hashimoto’s hypothyroidism are also at risk for other autoimmune diseases, such as Addison’s disease, celiac disease, or pernicious anemia.

How Can Hashimoto’s Disease Lead to Hypothyroidism?

In Hashimoto’s, the thyroid gland is being attacked by thyroid antibodies.  This can cause the thyroid gland to not work.  The first response is for the TSH to go up.  Eventually, the free T4 and free T3 can also decline.

What Causes Hypothyroidism and Hashimoto’s?

The most common cause of hypothyroidism is when the thyroid antibodies attack the thyroid gland.  Other causes could be radioactive iodine treatment, surgery for thyroid disease, and congenital problems.  Patients can also have central hypothyroidism, where the pituitary is not sending the message to the thyroid to cause the thyroid hormones to be released.  In central hypothyroidism, the free T4 and free T3 are often low.  Rarely patients have hypothyroidism from iodine deficiency or other unknown causes.

Are Treatments for Hashimoto’s and Hypothyroidism the Same?

The treatments are similar.  However, patients with Hashimoto’s can often benefit from agents such as selenium and myoinositol that lower their TPO antibody, while patients with hypothyroidism not due to Hashimoto’s do not need these supplements.  In addition, patients with Hashimoto’s should be screened for other autoimmune diseases, including pernicious anemia that manifests as a low B12 level, celiac disease, where patients have sensitivity to gluten, and, in some cases, Addison’s disease, where patients have a high ACTH and renin level and a low cortisol and aldosterone.  Dr. Friedman will determine whether you need to be evaluated for these other conditions as part of your appointment. 

Choosing a Hashimoto’s Disease Specialist for Thyroid Concerns

If you’re looking for a specialist, you’ll want to look for someone who is well-versed in Hashimoto’s and especially well-versed in different treatments for it, including desiccated thyroid.  While most endocrinologists only give levothyroxine and do not bother to test other hormones besides a TSH, your treatment options with a conventional endocrinologist may be limited.  Dr. Friedman will give you comprehensive care to optimize your thyroid hormones.  He will help you with medication management and lifestyle advice and will carefully monitor your disease.

FAQs

1. Do people with Hashimoto’s have to be gluten-free?  

The answer is no.  It is relatively rare for people with Hashimoto’s to have celiac disease, and only patients with celiac disease need to be gluten-free.  Most patients with Hashimoto’s can consume gluten.  However, if you are sensitive to gluten, you should avoid it.  Dr. Friedman will test you for celiac disease. 

1. Can a patient with Hashimoto’s only be treated with supplements?  

It is possible a patient with mild Hashimoto’s can be treated only with supplements.  This happens when a patient has a TSH in the upper range of normal or only slightly elevated.  If a patient has pretty severe hypothyroidism with Hashimoto’s with a TSH that is significantly higher, they will need thyroid hormone medications.

Contact and Consultation 

To summarize, Dr. Friedman specializes in Hashimoto’s disease and will give you optimal treatment. You can schedule an appointment at goodhormonehealth.com.

Dr. Friedman’s web site does not offer medical advice. These materials are offered for information purposes only. Do not act or rely upon information from goodhormonehealth.com without seeking professional medical advice. Additionally, the transmission of information from the website, goodhormonehealth.com to you, is not intended to create nor does create a physician-patient relationship between you and Dr. Friedman.