If you have complained of symptoms including fatigue, weight gain, hair loss, cold sensitivity, dry skin, depression, or constipation, there is a good chance someone has mentioned the possibility of a thyroid problem. The thyroid is a small, butterfly-shaped gland in the front of the neck that produces hormones regulating metabolism, energy, heart rate, and body temperature. It releases T3 (triiodothyronine) and T4 (thyroxine) to control how the body uses energy. There are many reasons you might experience thyroid dysfunction, but did you know the most common cause of low thyroid function is autoimmune? That means your thyroid stops working because your immune system mistakenly starts attacking it.
What is Hashimoto’s?
Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis) is the most common autoimmune thyroid disease and the leading cause of hypothyroidism in developed nations, affecting approximately 5 in 100 people in the US. Data suggests that hypothyroidism, largely driven by Hashimoto’s, has more than doubled in the last two decades. This could be partially due to digestive issues and leaky gut, food sensitivities, exposure to toxins and pollutants, nutritional deficiencies, underlying infections,
high levels of stress, and genetic predisposition. In women, it is often triggered by hormone shifts (pregnancy, menopause).
Thyroid antibodies are often present for YEARS before lab markers like TSH (thyroid stimulating hormone) become elevated. However, symptoms may manifest long before regular labs appear abnormal. Typical symptoms include fatigue, weight gain, hair loss, and cold
sensitivity. However, these antibodies can attack other tissues as well, contributing to possible joint pain, brain fog, dry skin or brittle hair, constipation, swelling in the neck (goiter), muscle weakness, slow heart rate,
libido changes, balance issues, carpal tunnel syndrome, an enlarged tongue, puffy eyes/face (especially in the morning), voice changes or hoarseness, brittle nails, or even fertility issues.
Standard care usually centers on monitoring labs (TSH, T4) and prescribing thyroid hormone replacement when levels are out of range. Many people feel better on medication, but a significant number still report fatigue, brain fog, weight gain, and other symptoms despite “normal” labs.
A more holistic approach to Hashimoto’s views it as a systemic immune, gut, and lifestyle disorder that affects the entire body, not just a problem of low thyroid hormone to be fixed with a pill
Why a holistic and individualized approach is important:
Thyroid hormone replacement still may have an important role to play in the management of Hashimoto’s. However, functional medicine shifts the focus to identifying and treating root causes and contributors to the autoimmune process. Practitioners typically do a detailed history, looking at food sensitivities, gut health, diet, toxins, stress, sleep, infections, genetics, and hormones to map out each person’s unique triggers. The goal is to calm the immune attack, support thyroid tissue, and improve overall resilience, not just normalize TSH.
Common areas of focus include:
- Gut integrity and microbiome (SIBO, dysbiosis, candida, leaky gut.
- Food sensitivities (especially gluten and dairy) • Blood sugar imbalance, insulin resistance • Nutrient status (selenium, vitamin D, iron, B12, zinc, iodine balance).
- Chronic stress, sleep quality, and trauma history.
- Estrogen dominance
- Environmental toxins and infections as immune triggers.
Working with a functional medicine practitioner to determine the underlying triggers of your specific condition can help provide the most effective treatment plan.
A note about testing for Hashimoto’s:
The regular thyroid screening tests (TSH and T4) are NOT very sensitive for identifying Hashimoto’s. That’s why it is imperative that you get a full thyroid panel if you are experiencing symptoms. This would include TSH, free T4, free T3, TPO antibodies, anti-thyroglobulin antibodies, and reverse T3. I would also recommend adding vitamin D, iodine, zinc, and inflammation markers. Optimal reference ranges for these labs are also very different than the standard reference ranges. You may still have thyroid dysfunction even if all of your labs are not flagged at being out of range.
Interested in testing for Hashimoto‘s and potential underlying causes?
Schedule an initial appointment with Dr. Goldberg here.
