Dr. Jennifer Luis ND

What is Hashimoto’s disease?

Hashimoto’s thyroiditis is the most common cause of hypothyroidism. Symptoms can present as fatigue, low mood, weight gain, hair loss, difficulties with temperature regulation, dry skin, brain fog, irregular periods and constipation.

In these situations, hypothyroidism may be confirmed by blood test, but additional testing is required to confirm if Hashimoto’s is present and it isn’t always considered. Sometimes in the early stages, Hashimoto’s patients can experience hyperthyroid symptoms such as insomnia, headaches, heart palpitations, heat, weight loss and shaking or nervousness.

The auto-immune disease Hashimoto’s can be found amongst family members because of genetic tendencies but it can also be found with no family history. Auto-immune diseases are categorized together because an “error” in the immune system enables an immune response to human tissues. In the case of Hashimoto’s, antibodies are created against particular proteins found in the thyroid gland and when these auto-antibodies reach a threshold, thyroid inflammation occurs. This can make it difficult for the thyroid to make enough thyroid hormones (or in some cases, cause the thyroid to make elevated levels of thyroid hormones) and symptoms of hypothyroidism begin. The thyroid itself may feel enlarged, either with a visible lump in the neck or cause the sensation of something stuck in the throat with swallowing. Hashimoto’s can be present without thyroid enlargement however blood work and a thyroid ultrasound can be ordered to identify the condition.

What does Hashimoto’s feel like?

General inflammation such as joint pain, mild fever, headaches and fatigue can occur when an auto-immune disease is present. These symptoms may be present along with hypothyroid or hyperthyroid symptoms.

Hypothyroidism is when the thyroid and cells are not making or converting enough thyroid hormones for the metabolic rate of the body to keep up to normal. Running at an overall slower rate can result in fatigue, depression, weight gain, headaches, bloating and constipation, loss of hair, eyebrows, lashes, brittle nails, acne, dry skin, changes to menstrual cycles, and infertility. This usually indicates that thyroid medication is required to replace the suboptimal levels of thyroid hormone.

Hyperthyroidism is much less common, but some people can have their first flare as hyperthyroid or swing between hypothyroid and hyperthyroid. Overproduction of thyroid hormones result in an up-regulated metabolic rate. This can cause heat, insomnia, sweating, headaches, weight loss, heart palpitations, tremors, excess thirst and hunger. Similar symptoms to hypothyroidism such as fatigue, hair loss and swelling may also be noted.

It is possible to have Hashimoto’s thyroiditis and not feel hyperthyroid or hypothyroid symptoms. In these cases, usually the thyroid inflammation is not causing hormone levels to be abnormal. Other general symptoms such as feeling puffy or bloated, joint or muscle pain, infertility and fatigue could be present.

What is the main cause of Hashimoto’s disease?

Auto-immune diseases can initiate from a variety of causes. Hashimoto’s thyroiditis is grouped into the auto-immune disease category and one contributing factor is genetics. A family history can lead to a higher risk of developing most auto-immune diseases. It usually also takes an environmental trigger for the onset to begin.


Stress, whether it is mental, emotional, traumatic stress or physiological stress, is often a precursor to Hashimoto’s thyroiditis development. Many women with the condition were diagnosed after a pregnancy which causes a lot of change and “stress” on the body. Perhaps the degree of hormonal changes, the birthing process or the lack of sleep and difficulty recovering from child bearing are the stressful contributors.


Auto-immune disease and its origins are currently being studied in research. Chronic viral or other infections such as the EB virus seem to create a higher risk of development when a family history is present. Other factors such as long-term digestive inflammation such as IBS, chronic high stress environments and presence of other auto-immune diseases may also increase risk for Hashimoto’s. For more information on auto-immune connections, click HERE

How serious is Hashimoto’s disease?

Hashimoto’s thyroiditis can be managed and not impact lifespan averages. If a person has severe hypothyroidism or hyperthyroidism, medication must be used to manage and alleviate serious complications. In general, Hashimoto’s is controlled with medication, supplementation, diet and a healthy lifestyle.

How do you confirm Hashimoto’s?

Blood tests and a thyroid ultrasound can diagnose Hashimoto’s thyroiditis. Serum levels of anti-thyroglobulin and anti-thyroperoxidase antibodies can be measured and when above the reference range will indicate the condition. Thyroid ultrasounds show changes to the size, blood supply and texture of the thyroid gland and can show characteristics associated with Hashimoto’s. It is not required to confirm with ultrasounds, however establishing a baseline image of thyroid helps to understand the severity and progression of the condition.

Testing the basic blood test, thyroid-stimulating hormone or TSH, does not confirm Hashimoto’s. Many people with hypothyroidism also have Hashimoto’s but are undiagnosed because thyroid antibody testing and/or ultrasounds have not been ordered. It is important to understand the whole thyroid health picture so that appropriate treatment can be prescribed and the progression of the disease limited. 

Can you make Hashimoto’s go away?

Auto-immune diseases can be put into remission, and thus so can Hashimoto’s. Remission implies that the disease is not active but the body still has the tendency for re-activation. When auto-thyroid antibodies drop below the reference range, the condition is said to be in remission. However if high stress environments or other chronic inflammatory conditions arise, antibodies may be elevated and the disease can become active again. It is not uncommon to have auto-immune flares over a lifetime once diagnosed with an auto-immune disease. These flares and their severity can be minimized with healthy lifestyles and a  proactive health plan.

What is the treatment for Hashimoto’s?

Conventionally, Hashimoto’s patients are prescribed the pharmaceutical drug Synthroid to take daily, usually long term. This medication may be enough to take over for the loss of thyroid production to help alleviate hypothyroid symptoms. It can cause a slight reduction of auto-thyroid antibody production which leads to less thyroid inflammation.

However, there is a lot more to consider for optimal wellness. Synthroid must be converted in the body to its active form by enzymes called deiodinase type 1 and 2 and co-factors of vitamins such as selenium and zinc. There are many reasons as to why this conversion isn’t optimal including vitamin deficiencies, malabsorption of nutrients due to poor digestion, and high stress or cortisol. In these cases, hypothyroid patients may benefit from the use of a different medication that includes the active thyroid hormone. This could be Cytomel or desiccated thyroid and a good treatment plan usually accounts for the ability to convert and includes active thyroid hormone when required.

The inflammatory aspect of Hashimoto’s is not addressed with thyroid hormone medication alone. Removing sources of chronic inflammation in the whole body will lower the immune system’s activation of auto-immune patterns. Treating IBS by re-balancing the bacteria and flora, lowering blood sugar and insulin, addressing cortisol dysregulation and sex hormone imbalances can all work to improve thyroid health.

Nutrients both through diet and through supplementation can be consumed that will help lower thyroid antibodies. Selenium helps both with conversion to the active hormone and to lower auto-antibodies. Inositol and certain prescriptive pharmaceuticals such as LDN have been shown to lower antibodies and inflammation in general. Eating a whole food diet and avoiding gluten can cause significant changes to inflammatory symptoms and antibody levels.

What vitamins should I avoid with Hashimoto’s?

All nutrients are healthy in moderation and in a well-balanced diet. Iodine supplementation is not generally recommended with Hashimoto’s thyroiditis. Iodine is an important mineral for the thyroid, thyroid hormones cannot be made without a regular source of naturally-occuring iodine. However, too much iodine can cause worsening of auto-immune thyroid symptoms and may lead to serious complications. Using sea salt (contains iodine from the sea and consuming seafood and sea vegetables will provide healthy levels. When iodine is suggested as a supplement, it should be carefully evaluated by a physician and treatment monitored.

What foods to avoid with Hashimoto’s?

There is a lot of information available regarding auto-immune nutrition. Sometimes, when experiencing a strong flare of Hashimoto’s, a strict diet can reduce symptoms and improve overall health. When using protocols such as the popular AIP (auto-immune paleo) diet, it should generally be a short-term solution while the offending causes of a flare or onset of disease are revealed and treated. Using strict diets as a lifestyle can lead to nutrient deficiencies in the long term and may not be  a fun way to enjoy nutrition and food.


There was a research study published linking gluten to an increase in auto-immune thyroid antibodies. This likely is related to the high correlation between Hashimoto’s and Celiac diseases. One of the first ways to lower inflammatory symptoms can be to remove gluten from the diet. This is the only long term diet restriction that is generally recommended. Measuring antibody levels before and after removing gluten has clinically shown a reduction within 3 months for a number of my patients.

Refined sugars

White sugar is inflammatory. Period. Processed foods, especially with added sugar have a multitude of negative effects and can contribute to general inflammation. Spiking and lowering of blood sugar and feeding imbalanced gut bacteria and yeast are just a few effects of sugar that can be avoided. A general reduction in all sugar types – whether it is honey, maple syrup or fruit can be of benefit for all people – thyroid condition or not.

High iodine diet

As noted, iodine can trigger flares and worsen symptoms in some people with auto-immune thyroid conditions. Using sea salt instead of table salt while cooking may lower consumption but be careful not to remove iodine-rich foods entirely as the thyroid still requires a constant food source.

How do naturopaths treat Hashimoto’s?

Hashimoto’s thyroiditis is a complicated condition. All body systems are regulated by thyroid hormone levels and thus many seemingly unrelated symptoms can be traced back to inflammation of the thyroid and thyroid hormone levels. Simply taking a prescription to replace thyroid levels is usually not enough to feel back to normal or to prevent the disease from progressing. For more information on the root causes of Hashimoto’s, click HERE

Once the right combination of thyroid hormones have been prescribed, starting with digestive health should be the next step. Chronic inflammation from IBS, yeast overgrowth, SIBO or food sensitivities can contribute to inflammation elsewhere such as the thyroid. Testing for these conditions is possible and a preferred way to develop a specialized treatment plan. Cortisol and adrenal health is also important to address in the beginning steps of treatment. Either too low or too high cortisol may create difficulties with successful treatment in other areas. Similarly to thyroid hormones, cortisol is connected to all systems and can impede thyroid hormone conversion. Using herbs, vitamins, lifestyle and dietary changes, cortisol can be balanced in unison with the thyroid.

Sex hormone imbalances can sometimes correct themselves with healthy thyroid and cortisol levels, however some gynecological conditions such as PCOS are tightly linked with Hashimoto’s. Treating concurrent conditions along with the thyroid will help restore hormonal balance.

What is the best food for Hashimoto’s?

Eating healthy in general is a great place to start. Make an effort to fill half of the lunch or dinner plate with non-starchy vegetables. 2 tablespoons of healthy fats such as nuts, seeds, avocado, olive oil should be present at all meals and about 25% of your plate protein-rich foods. Whole grain, non-gluten carbohydrates can consist of up to 25% (or ½ cup) of the meal. Avoid white, refined flours and sugars when possible and limit fruit to a maximum of 2 servings of 1 cup daily. Lower glycemic fruits such as berries and tart apples are preferred over sweet, tropical fruit which can be consumed on special occasions.


Experiment with gluten-free grains such as brown or wild rice, quinoa, teff, amaranth, oats, sorghum and millet. Cassava root is a healthy non-grain starch that can be used in baking and a replacement for flour or corn based foods. 

Fish and seafood contain natural iodine and anti-inflammatory omega 3s. Servings can be enjoyed multiple times per week and qualifies as both the healthy fat and protein components of a meal. Brazil nuts contain good fats and are a fantastic source of selenium while pumpkin seeds are high in zinc.

Remember, the AIP diet can work for those people in an auto-immune flare but it is very strict. Often working with a Naturopathic Physician will widen food choices by treating digestive inflammation which alleviates the reason for the dietary restrictions in the first place.