Approximately 10% of Americans will develop a thyroid condition in their lifetime. One type of thyroid condition is thyroiditis, which is inflammation of the thyroid gland. This article will discuss what thyroiditis is, including the phases of thyroiditis, and the different types, causes, and symptoms of thyroiditis. We’ll then discuss functional medicine testing for individualized thyroiditis treatment plans, followed by conventional and integrative therapies to help heal thyroiditis.
What is Thyroiditis?
Thyroiditis is a group of conditions that cause inflammation of the thyroid gland, a butterfly-shaped gland in the neck. The thyroid gland produces hormones that every single cell in the body uses. Thus, the effects of these hormones are widespread, affecting metabolism, reproduction, development, cognition, and more. The inflammation in thyroiditis can lead to over or underproduction of these hormones.
What are The Three Phases of Thyroiditis
This phase is characterized by inflammation of the thyroid gland and overproduction of thyroid hormones. The overproduction of thyroid hormones is called thyrotoxicosis, which can be life-threatening. However, thyrotoxicosis in thyroiditis is temporary, lasting anywhere from weeks to a few months.
**A quick note about thyrotoxicosis and hyperthyroidism. Hyperthyroidism is a type of thyrotoxicosis that occurs when the body produces too many hormones. As you’ll see in the “causes” section below, high thyroid hormones and, thus, thyrotoxicosis can be medication-induced and would not be considered hyperthyroidism.
Due to the overproduction of thyroid hormones in the thyrotoxic phase, the thyroid gland begins to slow down thyroid hormone production and, in turn, leads to the underproduction of these hormones. The underproduction of thyroid hormones is referred to as hypothyroidism. This is typically the final and chronic phase for certain types of thyroiditis like Hashimoto’s and radiation-induced thyroiditis. But for others, it will continue to the next phase, the euthyroid phase.
Normal thyroid hormone levels characterize the euthyroid phase. This phase may occur after the thyrotoxic phase and before the hypothyroid phase. It can also occur after both phases when the inflammation of the thyroid gland has resolved.
What Causes Thyroiditis?
There are eight different types of thyroiditis. Let’s look at each type and see what causes them.
Hashimoto’s thyroiditis, sometimes called chronic lymphocytic thyroiditis, is the most common cause of both thyroiditis and hypothyroidism. This condition is due to an autoimmune process in the body, where the body produces antibodies that attack the thyroid gland.
Silent or Painless Thyroiditis
In addition to being caused by an autoimmune condition, this type of thyroiditis results from an immune response to antithyroid antibodies.
Postpartum thyroiditis occurs when an autoimmune process begins within one year of giving birth. The body undergoes hormonal changes during pregnancy, which can alter the thyroid gland and lead to thyroiditis symptoms after pregnancy.
This type of thyroiditis is the result of radiation used to treat different diseases, including cancer and hyperthyroidism.
Subacute Thyroiditis or de Quervain’s Thyroiditis
This type of thyroiditis is thought to be caused by a virus, as it usually begins after an upper respiratory infection and can be painful.
Acute Infectious Thyroiditis
Acute infectious thyroiditis, as its name implies, is thought to be caused by an infection.
Certain drugs, including lithium, amiodarone, interferons, and cytokines, can induce thyroiditis.
In this type of thyroiditis, not only is inflammation seen in the thyroid, but also fibrosis, or thickening and scarring of the thyroid gland.
Symptoms of Thyroiditis
Symptoms of thyroiditis will vary depending on the type. However, most include symptoms of hyperthyroidism when in the thyrotoxicosis phase and hypothyroidism when in the hypothyroid phase.
Hyperthyroidism can manifest with many different symptoms, including:
- Heart palpitations
- Excessive sweating
- Goiter (enlargement of the thyroid gland
- Problems sleeping
- Anxiety, irritability, and nervousness
- Weight loss
- Muscle weakness
- Frequent bowel movements
Hypothyroidism can present with an array of symptoms, including:
Functional Medicine Labs to Test for Thyroiditis
Functional medicine labs for thyroiditis include a full thyroid panel and inflammatory markers.
Comprehensive Thyroid Panel
A comprehensive thyroid panel, such as the Thyroid Panel, Comprehensive by Access Medical Laboratories, includes six markers to evaluate thyroid physiology. This test includes thyroid-stimulating hormone (TSH), which is a hormone released by the pituitary gland. This hormone should control the amount of thyroid hormones released; however, in hypothyroid and hyperthyroid states, the thyroid doesn’t respond properly. Thus, a high TSH would indicate hypothyroidism and a low TSH can indicate hyperthyroidism. This panel also gives the levels of the thyroid hormones T4 and T3 and autoimmune antibodies.
Two reliable indicators of inflammation in the body are c-reactive protein (CRP), as offered in the CRP test by Access Medical Laboratories, and the erythrocyte sedimentation rate (ESR), as offered in the ESR test by Bioreference Laboratories. CRP will be elevated in acute thyroiditis, and ESR will be elevated in subacute (after the acute phase) thyroiditis.
Thyroid ultrasounds are used to visualize the thyroid gland. Ultrasounds can show the density of the thyroid gland, the blood flow to the thyroid gland, and if there are any abnormal growths, called nodules, on the thyroid gland.
Radioactive Iodine Uptake Test
Patients will be given radioactive iodine in order to perform this test. This test can show how much radioactive iodine the thyroid gland absorbs to get to the root cause of symptoms. In the thyrotoxic phase of thyroiditis, uptake will be low.
Functional Medicine Labs That Can Help Individualize Treatment for Thyroiditis
Functional medicine labs that can help to individualize treatment for thyroiditis include a comprehensive stool and micronutrient testing.
Comprehensive Stool Test
The comprehensive stool test GI Effects Comprehensive Profile by Genova Diagnostics would be an excellent option for those with thyroiditis. This test assesses levels of the bacteria H. pylori, a bacteria commonly found in the stomach. However, when this bacteria overpopulates, it can lead to unwanted symptoms, including heartburn. This bacteria has been associated with the development of autoimmune thyroid conditions. Additionally, this test shows markers that can indicate increased intestinal permeability, something commonly referred to as “leaky gut.” These markers are often raised in autoimmune conditions such as Hashimoto's thyroiditis. Lastly, this test gives an in-depth look at the composition of the microbiome: a collection of microbes that live within the large intestine. Certain bacteria that are considered to be good for the microbiome may be reduced in autoimmune conditions.
A micronutrient test, such as the Micronutrient Panel by Vibrant America, assesses levels of many micronutrients that are involved in proper thyroid physiology, including iodine, iron, selenium, zinc, and vitamin D. Deficiencies in these vitamins can exacerbate symptoms of thyroiditis.
Conventional Treatment for Thyroiditis
Conventional treatment of thyroiditis will depend on what type and phase of thyroiditis. Medications are used in both thyrotoxicosis and hypothyroid phases to return thyroid hormones to normal.
Complementary and Integrative Medicine Treatment for Thyroiditis
Complementary and integrative medicine treatment for thyroiditis can including nutrition, supplements, and herbs.
Nutrition for Thyroiditis
Since thyroiditis is a condition of inflammation, nutrition for thyroiditis should focus on lowering inflammation. The Mediterranean diet is a great anti-inflammatory diet choice. This diet consists of fresh fruits, veggies, herbs and spices, healthy fats including olive oil, nuts, and fatty fish, minimally processed whole grains, beans, and legumes. Additionally, if the thyroiditis is due to an autoimmune process, as with postpartum thryoiditis, the patient may benefit from a gluten-free diet. Studies have suggested that the elimination of gluten can help to reduce the autoimmune process and may also lower inflammation. Lastly, incorporating iodine-containing foods such as seaweed can help with thyroid functioning. The thyroid gland is extremely sensitive to iodine, and thus supplementation can be risky; incorporating iodine into the diet is a safer option.
Supplements and Herbs for Thyroiditis
There are many supplements that integrative practitioners use to help heal the mucosal lining and reduce inflammation in patients with leaky gut. Here are the three most common:
Thyroid Cofactors for Thyroiditis
As mentioned previously, selenium, vitamin D, zinc, and iron are required for proper thyroid physiology because in order to make thyroid hormones, vitamin D, zinc, iron, and selenium are required. Activation of thyroid hormones requires selenium and zinc, and zinc also helps with thyroid hormone uptake in the cells of the body. Additionally, supplementation with selenium has been shown to reduce thyroid antibodies.
Probiotics and Prebiotics for Thyroiditis
Depending on the brand and supplement, probiotic supplements contain varying amounts of different microbes that support a healthy microbiome. Prebiotics are like food for the probiotics, and are also metabolically active on their own. Prebiotics are found in foods like honey and tomatoes. Since the microbiome may play a role in autoimmunity, and organisms can help to heal leaky gut, both probiotics and prebiotics can be beneficial for thyroiditis.
L-Carnitine for Thyroiditis
If thyroiditis is in the thyrotoxicosis state, l-carnitine may be beneficial. L-carnitine is an amino acid derivative and plays a role in energy creation in the body. L-carnitine has been shown to be depleted by hyperthyroidism and it has also been shown to reverse symptoms of hyperthyroidism.
Omega 3s for Thyroiditis
Omega 3s are fatty acids that our bodies require in order to make cell membranes and regulate blood clotting and blood vessel dilation and constriction. Omega 3s also can affect and regulate inflammatory mediators in the body. Omega 3s have been shown to reduce inflammation, including lowering levels of CRP.
Thyroiditis is a term encompassing many different types of thyroid conditions that cause inflammation of the thyroid gland. Many types of thyroiditis are autoimmune in origin; however, some are not. Functional medicine testing can help to evaluate the state of thyroiditis, including the inflammatory process, as well as assess gastrointestinal and micronutrient involvement. Conventional and integrative options may be needed for full symptomatic resolution.