Dr. Robert Pastore, PhD, CNS


#068 - On Autoimmune Thyroid Diseases (& the Celiac Connection)

Dr. Pastore covers the thyroid gland, non-autoimmune hypo & hyperthyroidism, the autoimmune thyroid diseases Hashimoto's Thyroiditis and Graves' Disease, how the two are connected to celiac disease, and what tests you should request from your physician to be an advocate for your own health.

2020-06-198 min read

The Pastore Podcast


What is the thyroid? [0:30]

  • Part of endocrine system
  • Endocrine gland located in the neck, two lobes connected (like butterfly wings)
  • Produces key hormones
    • T3 = triiodothyronine
      • Has 3 iodine atoms per molecule
    • T4 = thyroxine
      • Has 4 iodine atoms per molecule
  • T3 & T4 are iodine dependent
  • Iodine deficiency can disrupt thyroid function
    • Iodine is a common nutritional deficiency for celiacs

  • Thyroid hormones are responsible for….
    • Maintaining basal metabolic rate / metabolism
    • Normalizing heart rate, breathing & temperature
    • Critical for growth & development
    • Critical for normal immune system
    • Stimulate other hormones (regulate estrogen, progesterone, neurotransmitters)
    • Help facilitate sleep

What happens when the thyroid gland is not functioning optimally? [3:00]

  • Thyroid deficit / hypothyroidism
    • Lower output of thyroid hormone
  • Feel colder day to day
  • Develop anemia
  • Food digestion affected
  • Metabolic rate slows, weight gain even on calorie-controlled diet
  • Energy levels, sleep, mood can be affected
  • Bowel habits will slow
    • Slow thyroid can lead to constipation

Non-autoimmune thyroid conditions [4:15]

  • Hyperthyroidism & hypothyroidism
  • Hypothyroidism - sluggish thyroid, not producing enough hormones
    • Results in increase in Thyroid Stimulating Hormone (TSH)
    • TSH’s role is to try to stimulate / “wake up” the thyroid gland to producing more T3 & T4
    • TSH rises & T3/T4 are under-produced
  • Hyperthyroidism - low TSH levels, high T3 & T4 levels
    • Over-producing hormones
    • Can be caused by enlargement of thyroid tissue known as a goiter, can be caused by:
      • Iodine deficiency - MAIN cause
      • Genetic predisposition
      • Injury
      • Overeating raw Brassica genus (broccoli, brussel sprouts, cauliflower)
        • Thioglycosides bind to iodine, making it unabsorbable
        • Rare, & cooking vegetables renders the effect
      • Adenomas - cancer of the thyroid known as thyroid adenoma
      • Cancer of the pituitary gland (communicates with thyroid)

2007-2008 study showed iodine deficiency in 27% of the US population [7:30]

  • Started to add iodine to table salt to address the deficiency
  • Added to prenatal vitamins & breast milk substitute, as iodine is a crucial nutrient for infants, can disrupt growth of infant & even lower IQ scores
  • High soy intake can cause goiter (thyroid enlargement) - can increase iodine to help
  • Found naturally in seafood, egg yolks, vegetables from the sea
  • 150mg per day as an adult, 250mg day as a pregnant woman
  • Pregnancy & iodine podcast: https://drrobertpastore.com/podcasts/049-on-pregnancy-nutrition-part-1

How common is non-autoimmune thyroid dysfunction? [10:45]

  • Common, can be genetic
  • Roughly 40% of Dr. Pastore’s patients have had non-autoimmune thyroid dysfunction
    • Typically hypothyroidism (slow)
    • 14% of that group was due to low iodine levels
      • Measures iodine based of 24-hour urine collection & analysis
    • Can be caused by various nutrient deficiencies (not just iodine) such as zinc, B12, essential fatty acids
    • Most deficiencies were due to food-mediated reactions (food allergies/intolerances/sensitivities) causing malabsorption of nutrients
  • After removing the reaction-causing food entirely, health markers and physical changes will improve
    • If you know you have a food-mediated reaction, ask your doctor to test your thyroid function
    • Dr Philip Felig, Endocrinologist in New York
  • Can feel better in as little as 4-8 weeks for classic hypothyroidism
  • Get thyroid levels tested again 2-3 months after nutrition changes

Autoimmune thyroid diseases [19:30]

  • Graves’ disease & Hashimoto's Thyroiditis
  • Graves' disease often causes hyperthyroidism (fast thyroid)
    • Autoimmune disease where antibodies are produced against Thyroid Stimulating Hormone receptors - which can cause goiter
    • Receptors in the thyroid attacked by your own immune system
    • Increased thyroid hormone output to overproduce all thyroid hormones
    • Results in weight loss, diarrhea, heart abnormalities
    • Bulging eyes
    • Small subset of population with Graves’ disease where the antibodies produced block the Thyroid Stimulating Hormone receptor, rather than attacking it
      • Prevents thyroid hormone production
      • Causes hypothyroid symptoms (slow thyroid)
    • Classically it is treated with antithyroid drugs
      • Propylthiouracil (reduces thyroid hormone production/output)
    • Use radioactive isotopes (in a pill, bound to iodine) to destroy the tissue
    • Even surgical removal of the thyroid gland followed by lifelong medication

  • Hashimoto’s thyroiditis [22:50]
    • Autoimmune disease where the thyroid gland itself is attacked & destroyed by your own immune system
    • Enlargement of thyroid
    • Happens slowly over years
      • Blood work shows thyroid keeps getting slower each year
      • Ultrasound of thyroid to look for abnormalities
    • Horse voices, terrible coughs

Diagnosing autoimmune thyroid diseases [25:00]

  • If treating for Hashimoto’s when it’s actually the small subset of Grave’s disease showing with hypothyroidism symptoms, but thyroid is overactive (hyperthyroidism),  the thyroid stimulating drugs will make things much worse
    • Should be on thyroid-suppressing medication to turn off immune system response
  • Proper way to diagnose requires the following (the more tests, the better):
    • Symptoms
    • Examination of the thyroid gland itself (palpation, ultrasound)
    • Blood tests for T3, T4 & TSH
  • Blood test panel of thyroid antibody tests in addition to thyroid function tests:

How can celiac disease result in autoimmune thyroid diseases? [32:15]

  • Celiac disease typically a decade to diagnosis
  • Hashimoto’s is slow-moving, can take years to diagnose, and then years to normalize
  • Several mechanisms of action connecting celiac disease & autoimmune thyroiditis
    • #1 - TTG-2 IgA antibodies
    • #2 - Genetic link or predisposition between the two
      • Gene coding cytotoxic T-lymphocyte associated antigen-4
        • Specific to thyroid autoimmunity and celiac disease
        • T-cells cause destruction of small intestine when gluten is consumed, then travel to other areas of body to attack other areas of the body

How common is it to have both celiac disease and an autoimmune thyroid disease? Could consuming gluten as a celiac trigger autoimmune thyroid disease? [36:15]

  • Began when celiac disease was being identified in patients with Graves’ or Hashimoto’s
  • Thought it was up to 7%of individuals with these thyroid diseases had celiac disease
  • Additional studies identified 26% of celiac disease patients had serological signs of autoimmune thyroid disease
    • 26% of celiacs had abnormal numbers in one of the 4 thyroid antibody blood tests mentioned above, but did not show symptoms of an autoimmune thyroid disease
  • The risk of thyroid disease was estimated as 3x higher in the celiac disease population vs. the general population
  • Having the genes for celiac disease can still lead to developing an autoimmune thyroid disease due to genetic predisposition

If you have an autoimmune thyroid disease and medication is not working, get tested for celiac disease [42:00]

  • The combination of celiac disease, thyroid disease and type 1 diabetes all happening at the same time has been reported in the literature as well.
    • If diagnosed as a type 1 diabetic, get tested for celiac disease AND get tested for autoimmune thyroid disease [44:50]

  • Going gluten-free is not going to cure your autoimmune thyroid disease [46:00]
    • If caught early, can come off medication or mitigate requirement for medication
    • With Hashimoto's - thyroid tissue is destroyed - could need medication for the rest of your life if thyroid is removed
    • Identify common nutritional deficiencies and food reactions that may simply be caused by nutrient deficiencies due to malabsorption caused by celiac disease
      • Iodine, zinc, B12
      • Can also be responsible for thyroid health
    • Normalize nutrient deficiencies & address digestion-friendly diet

Recommendations for general population diagnosed with hypothyroidism [48:00]

  • A lot of doctors just measure TSH levels, diagnose hypothyroidism & prescribe medication
    • Without testing to see if it’s an autoimmune disorder
    • Without identifying if you have nutritional deficiencies related to thyroid function
      • Test for B12, Iron
      • Iodine urine collection test and/or thyroid antibody tests
  • What is the cause of the thyroid dysfunction?
    • Deficiencies are notoriously present
      • Especially in underdiagnosed in celiac disease patients

Recommendations for gluten-sensitive individuals & celiacs wanting to have thyroid function tested? [51:05]

  • First, get a confirmed diagnosis for celiac disease
  • Get thyroid antibody tests & thyroid function tests run by endocrinologist
    • Investigational, should be covered by insurance
  • If you’ve have celiac disease for years, still have your doctor monitor your thyroid health
    • Being exposed to gluten is common in celiacs
    • Important to check thyroid status

Wrap Up [55:00]

Recommended tests & blood work to assess thyroid function

  • Symptoms
  • Examination of the thyroid gland itself (palpation, ultrasound)
  • Blood tests
    • T3, T4 & TSH
    • SED rate
    • Food-mediated reactions - IGE & IgG4
    • Nutrients - zinc, iodine, essential fatty acids, B12

  • Thyroid antibody blood tests (to determine if it is an autoimmune disease)
    • Thyroid peroxidase antibodies (TPO)
    • Thyroglobulin antibodies (Tg)
    • Thyroid-stimulating hormone receptor (TSH receptor)
    • Thyroid stimulating immunoglobulin (TSI)


University of California Davis resource of governing pathways of thyroid testing: https://blog.ucdmc.ucdavis.edu/labbestpractice/wp-content/uploads/2018/03/UCDMC_Thyroid-Testing-Algorithm061116_3_2.pdf

How to get tested for celiac disease: https://drrobertpastore.com/articles/2019-08-26-what-do-you-do-if-you-think-you-may-have-celiac-disease

After celiac diagnosis, follow up with doctor at 3/6/12 months after diagnosis: https://drrobertpastore.com/articles/2020-02-27-what-is-the-proper-medical-follow-up-for-a-celiac-patient