I was sorry to read over at Megan McArdle's blog over at the Atlantic yesterday that she has Hashimoto's thyroiditis and as a consequence has to give up being a vegan. (Her diet was high in soy for protein, and there is some evidence that soy interferes with thyroid function. More on this in a bit.) Anyway, I noticed in the comments that there are lots of people that hadn't ever heard of Hashimoto's (and my Mom actually had it too), so I would say a couple of things to clarify.
Hashimoto's thyroiditis is the most common kind of thyroid failure in areas of the world where people get enough iodine in their diet. It is a chronic autoimmune disease caused by the progressive destruction of the thyroid gland by antibodies and immune cells. Thyroid hormone -- for those who don't know -- is important for regulating your metabolism. If you don't have enough of it (hypothyroidism), you feel really dreary, gain weight, and feel cold all the time. If you have too much (hyperthyroidism), you eat gobs and gobs and you feel like you are having hot-flashes.
When it comes to prevalence, the core demographic is mostly older women. (It has about a 7:1 female gender bias, and your risk of hypothyroidism increases with age.) It almost certainly has genetic risk factors. We know this because people with this tend to have other autoimmune diseases such as type I diabetes or celiac disease. It also tends to run in families.
The trouble with Hashimoto's is that while as an endpoint you end up with less thyroid function (the thyroid eventually dies), it can be a bit of a rollercoaster getting there. This is because thyroid hormone precursors are stored in the thyroid gland in what are called follicles (some nice pictures here). As the thyroid gland becomes inflamed, these follicles dissolve and are released into the blood at levels much higher than physiological. These high levels of thyroid hormone can cause what is called a thyroid storm -- where you have heart palpitations and feel really feverish. Eventually as the follicles become depleted, you will (usually) go back to hypothyroid hormone levels. This up and down makes patients absolutely miserable. Fortunately, it is usually time limited.
With respect to treatment, when hypothyroidism is the problem, we usually use thyroid hormone replacement therapy. I'm sad to say that most of the time when you start this hormone replacement, it is life long. There are some examples where individuals with Hashimoto's have recovered thyroid function, but they are in the minority. In most cases, the end result of Hashimoto's is that you have to take thyroid hormone in pill form for the rest of your life. Fortunately, after a period of tapering, you can usually get by on the same dose, and thyroid hormone formulations are available as generics.
As an aside, I am ignoring here the details of thyroid regulation and metabolism. Thyroid hormone comes in two forms: a less active form called T4 and an active form called T3. T4 is converted to T3 in peripheral tissues by an enzyme called 5'-iodinase. Thyroid hormone release is triggered by another hormone released by the brain called Thyroid Stimulating Hormone or TSH. There is a feedback between T4 and T3 and TSH release -- T4/T3 go up, TSH goes down and vice versa. Thus, the clinical picture in terms of blood tests for hypothyroid is low T4/T3, high TSH.
So, what is this deal with soy?
Well, we know that in animal models soy diet can produce a goiter. A goiter happens when you have too much TSH. TSH stimulates both T4/T3 release and growth of the thyroid gland cells. Thus, a goiter is a large growth of thyroid cells caused by the TSH being ineffective at raising T4/T3 -- which would then lower the TSH. (You can also get a goiter from insufficient iodine in your diet. Iodine is necessary for thyroid hormone synthesis.) This is evidence in animals that suggests that individuals who consume large amounts of soy also need to consume extra iodine.
Likewise, there is some in vitro evidence that compounds found in soy called isoflavones can inhibit an enzyme called thyroid peroxidase -- the enzyme that liberates T3 and T4 from the follicles. Thus, there is some convergence of evidence in vitro and in vivo that soy can inhibit proper thyroid function.
What is the clinical evidence for this effect though? Well, studies have looked at this issue are pretty spare, but actually very few of them show any effect of soy in people who do not have some underlying thyroid problem already. (The subject is reviewed here.) However, there is some evidence that in individuals who require thyroid supplementation, soy can interfere with the drug. This is probably because the soy is binding up the artificial thyroid hormone in the intestines and preventing its absorption. This is particularly true in hypothyroid infants who are giving soy milk. Thus, in people who have to take thyroid hormone (the most common types are Cytomel and Synthroid) it is probably not advisable to eat a lot of soy. (It may be possible to still include it in your diet, however. You would need to increase your dose and/or vary the time in the day that you take the drug. But this is something that you would definitely want to discuss with your endocrinologist.)
Anyway, that is all I have on Hashimoto's and soy. I am sorry to hear about Megan's condition, particularly as it is interfering with what is a very healthy life choice (ethical issues aside). My suspicion is that many of you know someone with Hashimoto's, or you will at some time in your life. Now you can show off your knowledge. If you have questions, put them in the comments and I will try and look them up.
Thank you a hundred times for your well-researched, rational article about soy and thyroid. You probably know how hard it is for the intelligent layman to get good information on this subject. An article like this is a real prize.
I just failed my endocrine physiology final. I wish you were my professor instead.
Holy crap. My sister was recently diagnosed with this. My aunt had her thyroid removed completely years ago.
I could never understand why I have horrible hot flashes (with palpitations), but otherwise, I get freezing cold (layers of clothes don't help), my skin is drying out and no matter how much sleep I get, it's not quite enough... I'm also a vegetarian, and consume mass quantities of soy...
Guess I should be calling an endocrinologist!
Thanks so much for the informative post!
I'm a layman, but while high TSH and low T3/T4 may be indicative of hypothyroidism, is it the additional ANA test which is considered diagnostic of Hashimoto's thyroiditis?
ANA is sometimes high in Hashimoto's but it is not a very specific test. There are more specific antibodies that they check for that are targeted to thyroid speicific proteins -- stuff like TSH receptor -- that they tend to test for more.
Usually to diagnose Hashimoto's they would run your thyroid panel, and then they would also check for the antibodies. Although the diagnosis doesn't really (in itself) change how you would treat it -- you still do supplemenetation -- it can change your perception of the likely clinical course.
Que soyra, soyra....
This is a wonderful article. I have Hashimoto's plus lack of TSH due to a pituitary tumor and surgery to remove it. I have a wonderful endocrinologist who wrote a great book on this, so was already informed, but find this so refreshing to read. It's hard to find anything online that spells it out so well, yet is so readable. I know a lot of folks who are going to want to read this.
10 years ago I was diagnosed with Hashimoto's. I was placed on synthroid and told I would be on it for the rest of my life.
After moving to a new state I found a doctor. Prior to providing a new prescription the doctor ran his own blood work. He told me my thyroid was fine and I no longer had Hashimoto's. That like other diseases my body has cleared this one and I no longer had to be on the medication.
Wow!!! boy was I happy. no longer would I have to take a pill for the rest of my life.
Over the next two years I became depressed, tired and GAINED weight. I associated the depression with the death of my mother and the loss of my job. I associated the weight gain to the lack of nicotine, as I had quit smoking.
After having to move for employment I started to see a new doctor. After reviewing new blood work, he informed me that my last doctor should never have taken me off of the synthroid and that I do indeed have Hashimoto's .
I no longer will trust the judgment of one medical professional when being given a lifelong diagnosis like this type.
ALWAYS SEEK A SECOND OPINION. It might cost more up front but it sure can save you a lot more then money.
I do have a question on Iodine and how it relates to thyroid function. Has there been any study on people with Iodine allergy and how it correlates to their thyroid status/function? I ask because I once was given an IVP contrast and I ended up going into anaphylactic shock.
Being that it seems I am allergic to the Iodine contrast dye, would that be a reason why a person could have thyroid problems?
Thanks for publishing your article. Great info.
I find it very interesting all of the comments because I too had Iodine contrast dye reaction. About 3 years ago. Now I have been recently told that I have Hasimoto's and that despite the pain in my throat, the painful swallowing, and the gaging when sleep, sudden grasp for air, and other symptoms. My physican states there is nothing they can do for the discomfort. I seems to me that they are just waiting for the symptoms to get grave. I have a difficult time understanding because of the mood swings, memory loss why they can't do anything, Should I be seeing another physician?
I was diagnosed in 1981 with underactive thyroid after a pregnancy. I asked the endocrinologist if my tuna craving could be associated with my thyroid problem and he said no.
I ate tuna salad every day for lunch for over ten years!
By 11:30 a.m. I would be a little shaky until I ate my tuna "fix". Once I was diagnosed and on Synthroid, I did not crave the tuna anymore. My older son also had tuna cravings.
I have six grown children (28 to 42) and five of them are on medication for underactive thyroid! I am on Levoxyl plus a compounded drug. In my opinion, my body was craving the iodine in the tuna and kept me at a level that made my thyroid condition undiagnosable. What do you think of that? Lou
Thank you for sharing this valuable information on the effects of soy on autoimmune thyroid. It's information that's not widely enough disseminated. I'm a holistic nutrition consultant and health writer, as well as a Hashimoto's sufferer, and thyroid is my specialty in my practice, so while there's much to add to this, I'd like to focus on one issue.
While it's true that most people are treated with Synthroid (or it's generic cousins), which is synthetic T4, and Cytomel, which is synthetic T3, it is inaccurate and possibly dangerous to say that these are the only 2 thyroid-derived hormones. Just as the biologically active T3 is converted from the storage hormone, T4, further conversions occur, creating T2 and then T1. (Thyroid hormone consists of the amino acid, tyrosine [the 'T'], and iodine. The numbers reflect how many iodines are attached to the tyrosine. So as the hormone continues on its path, it is progressively deiodinated). Until recently, researchers were only aware of the T4 and T3 activity. They assumed the other 2 had no activity. Oops. Turns out T2 may be quite actively involved in keeping our metabolisms fired up. T1 they're still not sure about, but a good guess is that it's not just sitting there looking pretty.
Because of this, synthetic T4, especially, is often ineffective for hypothyroid patients, because everybody has differing abilities to effectively make the conversions. About half of all patients feel much, much better when they take dessicated porcine thyroid, such as is found in Armour Thyroid, and the more natural Westhroid and Nature-throid. You probably have no idea how frustrating and crazy-making it is for someone who's on T4 replacement, with 'normal' labs but lots of hypo symptoms, to be told it's all in her head, that there's nothing wrong. Happens all the time, so the more people who know about this and demand further action from their docs, maybe the sooner we can get the medical profession to wake up and recognize bio-chemical individuality.
As someone who suffers from Hashimoto's hypothoridism I found this interesting. After being diagnosed I stopped all soy and tea (for the fluoride which can also inhibit thyroid function). I definitely experienced the thyroid storm you mentioned, it lasted quite a while - around 2 years off and on.
I had been eating a lot of soy before being diagnosed and thought this would help. After a couple years and reaching a more or less stable dose of Levoxyl, I decided to try a little soy again in the fermented form of tofu or tempeh which is though to have less effect on thyroid function. To my surprise I noticed no difference in my thyroid function and how I felt. I even had before and after starting soy TSH, T3 and T4 labs done and they were almost identical. I then started to drink tea again and the same thing - all thyroid levels were the same. I think it is easy to get hyped up about say and tea and all the other foods that supposedly hurt thyroid function and overly restrict your diet. A small amount of soy, like tea, is good for you. I now eat a little soy everyday (supposedly good for the prostate) with no ill-effect and drink a couple cups of tea a day too. I would urge everyone to scientifically (before and after lab tests) assess the effects of soy before giving it up completely.
Thank you Jodi. I take armour thyroid and boy is it hard to find a doctor to get a prescription. I tried the synthroid and it almost put me in a coma. All I did was eat-very little and sleep--could not stay awake. I got back on the armour thyroid and am now fine. In my research I found out that 5% of the population can be allergic to one or the other. Only wish the doctors and pill companies could understand that but then they get money kickbacks for selling synthroid. Pill companies only care about $$$$$'s in their pocket not the health of the people. Alternative medicine is the way to go. They care about the people not the $$$$$$$$$$$'s.
Before I was diagnosed with hypothyroidism (Hashitmoto's), my cholesterol was good (177). Since the diagnosis and treatment with Synthroid, I can't get my cholesterol below 254. No one in my family can take statin drugs; they cause muscle pain. Any suggestions?
For Lou-- I would most definitely see another doctor. I have had hashimotos since the early 80s when I was in my late 20s( I probably had had it for years before I was diagnosed when my thyroid failed completely). There is LOTS a good doctor can do to alleviate your symptoms , starting with thyroid medication( synthroid, ArMOUR, cytomel, etc), diet, exercise....I have seen a great endocrinologist( Dr. Nathan Becker in San Francisco)for the past 24 years, and his care has made a huge difference in my life--I lead a healthy, normal life, feel well. My son has hashis , too( he was diagnosed at age 11 with TSH levels off the charts) and he too feels great, as he also receives a great medical care for his hashis.
Sorry--I meant in my comment above to say "for Bernadette".
I really appreciate this post and have questions that I hope aren't too far off topic. I have lump in my throat a small goiter, I guess. I had an ultrasound and bloodwork done before consulting the endo doc yesterday. He said blood was normal, but I've gained like seven pounds in a week, which is out of ordinary even at holidays. He gave me Synthroid to test whether it would decrease the size of nodules, and ordered a needle biopsy. When I asked about side effects he was dismissive, but I'm wondering if other folks might have more info, more insight. Are there questions I should be asking? Are there people who don't present with all the typical symptoms? Any insight is much appreciated, as well as homeopathic, diet suggestions. Thanks very much.
People with thyroid diseases don't necessarily present with all the typical symptoms and some doctors can be dismissive of symptoms. Many doctors also don't know which thyroid tests to run and how to read them and end up telling their patients that they don't have thyroid disease/their blood tests are normal when they do have thyroid disease and their tests are not normal. I have been very fortunate in that I was diagnosed with hashimotos as soon as I felt really sick and have had wonderful care and a doctor who understands the complexities of reading the lab results and how this needs to be coupled with my symptoms in evaluating my thyroid medication dose. However, I have met many people who have been less fortunate and have dragged around sick from doctor to doctor until they get to the right doctor ,diagnosis and treatment. A good place to start learning about symptoms, lab tests, how to evaluate the results of thyroid lab tests, medications, etc. is the newsletter that Mary Shomon disseminates and her website, which is very informative- see http://thyroid.about.com/ I don't know where you live, but she also has a place on her website where people have written feedback on good thyroid doctors across the US.
I have been struggling with Hashis for years. thanks to Marys newsletter I was encouraged to seek out a new doctor and am going to the Cleveland Clinic in a few days. After YEARS of not feeling right, gaining weight dispite the fact that I was always on a diet and working out like a maniac. I began having heart palipataions and hot flashes. I went from doctor to doctor to doctor to doctor searching for some one who could help me feel right, I am currently on Prozac, I have been off and on antidepressants for years, I am now wondering how much of my depression is caused by either my thyroid or my frustration with my weight gain. After years of not feeling well I ended up at an endo who found nodules, I had a needle biopsy which resulted in atypical cells which resulted in a partial thyroidectomy. so now i have 1/2 a thyroid and have gained 30 pounds in 18 months I am on.75 levothyroxine and still feel like crap always tired and fat. I have a huge goiter and more nodules. I need help and encouragement, My life is a struggle everyday. I just want energy and to feel normal.
I have Hashimoto's, diagnosed long after I knew something was wrong, concurrently with premature ovarian failure. This sequence of events followed the diagnosis of Familial Hyperchoesteolemia, which put me on statins. Needless to say, there were a lot of changes occurring at this time!
Armour was the only drug that really helped me and I have been on it for 10 years or so. Having to change doctors, I could not find one who would prescribe it, and was changed to Levoxyl. The reasons stated for the change were, my TSH was suppressed, and this was considered dangerous for my heart and bones. (Even though I have a low resting pulse, normal/low B/P, and good BMD.)
My question is this: Have you any feelings about the recent study pointing towards pseudo-hyperthyroidism caused by statin use? I take 80 mg of Lipitor, and since the Levoxyl, my cholesterol is back up to 275, and I feel basically semi-comatose emotionally.
Have you any opinion on the theory that some people do not convert T4 very well, and actually do need T3?
Thank you for your very thoughtful comments on Hashimoto's.
For Nancy: It is common for people with hypothyroidism to have high cholesterol levels. My doctor (alternative medicine) is against statin drugs. Based on what I've read, I am also against statin drugs. I would recommend a high-quality fish oil formulation such as Phytomega, which has plant sterols that help prevent absorption of cholesterol. I always try natural alternatives before any prescription medications.
For Shawne: Find an alternative medicine doctor who might try you on different thyroid meds, Armour being one, that might give you relief. I take a combination of Synthroid and Armour. Thyroid balance is an ongoing challenge, and sometimes adjustments have to be made. I have found that if blood tests did not reveal malfuction of the thyroid before medication was started, they often won't reveal the best dosage after medication is begun. More simply put, don't always trust lab results. My doctor does muscle testing, and we have gotten better results from that than from lab tests.
As for soy, I was drinking soy protein shakes on a regular basis for quite some time. I then started feeling very tired and had pain in my neck in the area of the thyroid. Had I not read that soy can suppress thyroid function, those dots may have never been connected so that I would know to remove soy from my diet. I actually developed a sensitivity to it that caused an upset of my digestive system.
For everyone who is facing thyroid problems: Keep reading and studying in order to fine-tune your own treatment. You know better than anyone what your habits are, what your diet is, what your history is, etc., etc. Doctors don't always ask the right questions, and it seems that many of them can't seem to think outside the envelope. I know this because I went from doctor to doctor before I finally found one who looked at the whole clinical picture, rather than lab results alone, and put me on medication.
One more thing, thyroid meds usually will not be effective if the adrenals are weak. In my case, I initially felt better and more like myself again after taking Armour Thyroid, but after a couple of weeks the benefits subsided. The doctor then started me on a low dose of Cortef to supplement my adrenal glands, and I began to improve again. Since then, we've had to occasionally adjust my meds; e.g., combining Synthroid with the Armour I had been taking. Those who are on medication and are still having a lot of symptoms may need to try different thyroid meds to see what works best for them. Good luck to all!
As someone who has been diagnosed as hypo and used to eat soy regularly you should all read information on soy at the Weston A Price foundation. Mary Enig is one of several who spell out the reasons why soy is an ANTI-nutrient unless it is naturally fermented. Don't take my word for it though, please read for yourself. I didn't realize how much soy is in everything until I made the decision to cut it out. Most soy is also genetically modified which solidified my decision and I'll never go back.
I think due to halogen overload in the body (too much fluoride, chlorine, and bromine) that all of us need iodine, either in the form of iodine or potassium iodide. Read Dr. Abraham's research at http://optimox.com for more information on how important iodine is to one's health.
Stop eating soy and filter your water with a reverse osmosis filter as a minimum for thyroid health.
I understand so many entries it is not funny. The mood swings, the weight gain, the exercising, the dieting,the palipatations, the tiredness, SSRI's etc.
Shawne and whomever else may benefit, I am not a doctor but I have Hashimotos. I am pasting an entry concerning my personal struggle with Hashimoto's, which I didn't know I had until last year. You are not alone. I hope this will help anyone who may try but understand, as I do, we are all genetically different and it may not work. I can only give you what is working for me. Here it is:
I will apologize in advance for being so long winded here, but Ive recently been diagnosed with Hashimotos disease. The endocrinologist has told me that I have had it for ten plus years.Somewhere, in the course of six months,I came across a book Eat Right for Your Blood Type.It intriqued me specifically because my blood type was targeted for Hashimotos.In addition, DAdamo listed foods that inhibit thyroid function and promote it.Although it did not specifically state that peanuts cause low thyroid function,it did state that my type should avoid peanuts.
One thing is certain in my mind,I do not believe that every human being is the same genetically.You should experiment with different foods to determine what ails you and what doesnt.
As an example,I have discovered that foods with wheat gluten are not for me and have caused me to be very sluggish and tired. So, I avoid it altogether and eat rice based products in small weekly doses.
I have found, for myself, the foods (good/bad) listed in the aforementioned book I am studying, has worked in my favor. I have lost nearly 30 pounds in 4 months.That is something that I have not been able to accomplish in over a decade. Even when I ran 3 miles a day five times a week.
Finally,and not least, my medication was changed from levothyroxine ,which I took for 3 years and it did little to help me, to Levoxyl. It has been discovered that the levothyroxine dosages were inconsistant with each dose. In other words, somewhere during the manufacturing process, some dosages of the medication had the correct amount for my thyroid,some had too much and some didnt have anything present at all.
I have suffered for over a deacade thinking that I wasnt doing enough. I am glad to finally know it wasnt due to my lack of trying my best. Instead, I had an actual viable problem.
Too bad the US Navy wouldnt listen to my pleas concerning my ailments.Instead all I got was a cat scan,a visit to a psychologist, who said I had an anxiety disorder, and an honorable disharge for weight control failure. I would have been retired in another 2 years.Oh well, such is life.
My doctor ran the usual TSH, etc. tests and said I didn't have a thyroid problem. Odd, I had symptoms of a problem. I insisted that she run some other test she knew of. (how do you not end a sentence in a preposition) She ran a thyroid peroxidase test, I think that's what it was. She then diagnosed me with Hashimoto's thyroiditis.
Can someone recommend a good doctor in the NYC area. I'm afraid I may have Hashimoto's :(
Thanx in advance!
I was wondering if you could tell me if there is a possible connection with Hashimoto and burning tongue. I have been dx for 1 yr and have had a burning tongie for more than 5yrs. thanks for your time. debbie
I have low Thyroid,Dr. say's its fine at the level it should be. But I have the tiredness,weight gain,dry skin,my hair breaks off,I just dont feel like I should. I take Synthroid,one a day.I also have stomach trouble. I do know I'm alot older now, well just had a birthday,60years!!! What would you suggest.Thanks Linda
My 8 yr old daughter has been diagnosed w/Hashimoto's. Her medication has been adjusted once (she was just diagnosed in March) but the last 3 days she has been out of control. I am starting to wonder if her levels are off again or if her problems are diet related. Any help you might provide would be greatly appreciated. Getting her blood drawn is a very traumatic experience for her & I don't want to do it each & everytime we see behavior issues but she can't verbalize details to us.
My daughter passed away on december 29th 2010. We just found out today that the medical examiner's office declared her death as "Sudden death associated with HASHIMOTO'S THYROIDITIS." My wife and I had never heard of this before and started doing research on Hashimoto's. I have run across nothing that explains her sudden death. She texted her mother-in-law about 7pm, and when mom arrived, it appeared that she was asleep...she never woke up.
So what is the correlation? I'm at a loss for answers here.
I have Hashimoto's thryroiditis and have had issues with what seems like thrush. I have only seen fungal infections of the mouth associated with this disease in one article. What do you know about this? Thanks so much for your input.
I got recently diagnosed with Hashimoto's after 4 years of "postpartum depression". As both my doctor and myself prefer the natural way she told me to go onto a gluten free and dairy free diet. Although being a personal chef and health coach makes it easier for me to cook for myself it does not mean its easier in general. But 5 months later I can honestly say that I feel better, not as tired, my tests are coming back better, although there is room for improvement. I am not there yet but not eating what is for me unhealthy food makes a huge difference. I hope more people will try a change in what they eat, it might reduce or eliminate the need for drugs.
To John Wolfe and family. I'm so sorry for your loss. The correlation sounds like a thyroid induced coma. I'm not a Dr. but a Hashi sufferer since age 13 (I'm now 35). 5 years ago after Dr's wouldn't listen to my plea that something was not right with my thyroid AGAIN, I quit Dr's and went off my meds to try "alternative" treatment on my own. I came very close to a thyroid induced coma and ended up back on meds and seeing a doctor. Also, when they discovered the Hashi's when I was 13 I was sleeping on average 18-20 hours a day.
I have Hashimoto's and a few ignorant months ago I decided to adopt vegetarianism (for religious reasons). The effect was as complete disaster! I started to feel exhausted and put on weight really really fast. It was an unbelieveable reaction! I went to the doctor for help because it was absolutely abnormal, and that's when I found out about the "thiroyd x soy" reaction. I hope this information is spread the best as possible so people with Hashimoto's can avoid what I went through. Unfortunately, vegetarianism is not an option for me anymore.
Got diagnosed in november 2011 after a visit to the emergency room tons of test plus an emergency surgery. Got over medicated the first visit to the dr. Gave me too high of a dose of levothroxine that lead to a 2nd trip back to the ER . Started horrible headaches related to High blood pressure and pre mature ventricular contractions which lead to an echocardiogram and wearing a holter monitor for two days. Finally on the right dose of medications to make me feel normal.