Why Many Patients with Hashimoto’s Thyroiditis do not Feel Well Despite their Thyroid Lab Tests Appearing Normal

Despite normal thyroid function lab tests, many individuals with Hashimoto's continue to experience thyroid-related symptoms.

Deficiencies and metabolic dysfunctions, that are not easily detected, can go unnoticed for many years and affect the energy levels, body weight, and mood of patients with Hashimoto's disease.

It is common for patients with Hashimoto's thyroiditis to have normal thyroid function blood tests, yet not feeling well ^[1].

The most common problems affecting patients with Hashimoto's thyroiditis are:

1. Fatigue and Low Energy: This affects daily life and often makes a person feel unable to cope with life's demands. Deficiencies in vitamins (D, B complex, K2), minerals (magnesium, selenium, zinc), and antioxidants, disrupt the hormonal system and thyroid function, slowing metabolism and energy production.
2. Weight Gain: Despite sincere and continuous efforts, significant difficulty in losing weight is common. Insulin resistance and slow metabolism lead to the accumulation of visceral fat and weight gain.
3. Intestinal Function Disorders: Constipation, slow digestion, and bloating are the most common symptoms. These are due to alterations in the intestinal microbiome and disturbances of the intestine and gallbladder motility. In patients with thyroid dysfunction, there are coexisting disorders in the gallbladder's function, which participates in the digestion of fats. Bile is produced in the liver and is essential in activating thyroid hormones..
4. Mood Swings: Patients may experience low mood or sadness, often to a degree that is disproportionate to their life situations. Poor mood can alternate with intense irritability linked to the continuous lack of energy, affecting personal relationships and social interactions. Metabolic disorders and deficiencies common in patients with Hashimoto's disease impact the nervous and hormonal systems, leading to a significant adverse impact on their mood.
5. Mild Memory Difficulties and Reduced Mental Clarity: The thyroid regulates, among other systems, the function of the nervous system. Additionally, disturbances in the microbiome, metabolic disorders, and deficiencies associated with Hashimoto's disease adversely affect mental functions.
6. Diffuse Pain in Muscles and Joints: Hypothyroidism, insulin resistance, and deficiencies in vitamins, minerals, and anti-inflammatory micronutrients impair the body's healing processes in patients with Hashimoto's disease, leading to chronic inflammation.

The above symptoms significantly affect the daily life of a large number of patients with Hashimoto's thyroiditis disease. It is common for patients to gradually "get used" to these symptoms and stop noticing them, considering that this is the "normal" flow of life.

This is because the body's deficiencies and metabolic disorders, such as insulin resistance, remain and disrupt the body's functioning as a whole.

Hashimoto's disease is the most common autoimmune disease. It occurs when the immune system mistakenly attacks the thyroid gland.

The gradual destruction of the gland by the immune system, usually over years, ultimately leads to hypothyroidism.

Four main factors contribute to the onset of Hashimoto’s thyroiditis ^[5-12]:

1. Reduced metabolic rate (slowed metabolism), due to oxidation and deficiencies in vitamins and other elements
2. Insulin resistance
3. Lack of vitamin D3 and micronutrients (vitamins, minerals, trace minerals, amino-acids, antioxidants, fatty acids, probiotics)
4. Mental stress

These four factors negatively affect the function of thyroid cells. Acting for long periods, they alter the composition and morphology of thyroid cells and deregulate the functioning of the immune system.

It's noteworthy that symptoms can remain, to a lesser or greater extent, even after the regulation of hypothyroidism with medication ^[1,2].

An individual can have normal levels of thyroid hormones and TSH, yet still exhibit most of the symptoms mentioned above.

At this point, the external administration of hormones is a vital tool to improve the patient's clinical condition and quality of life. However, the adjustment made in the medication 2-3 times during the year cannot mimic the continuous and precise regulation that the human body does, with responses occurring in seconds.

In our clinical experience, even with up to 80% loss of thyroid function, appropriate hormone replacement restores normal physiology without reducing quality of life. The remaining 20% of endogenous function supports routine metabolic adjustments in daily life, enabling excellent quality of life

Therefore, preserving the thyroid’s remaining function is essential, as it helps the body maintain normal metabolic adaptation

To achieve meaningful health improvement in Hashimoto’s patients, care must extend beyond thyroid hormone regulation to also identify and address underlying deficiencies and metabolic disorders ^[7-12].

Micronutrient deficiencies develop gradually and contribute to disease over time, so correcting them requires patience and consistency.

If these deficiencies and metabolic disorders are left unaddressed, Hashimoto’s typically follows a pattern of gradual decline with alternating periods of flare-ups and remission, placing increasing strain on daily life and overall health

Targeted Testing Guides Hashimoto's Thyroiditis Treatment

Identifying and correcting metabolic dysfunction requires comprehensive lab testing that profiles metabolic status, inflammation, and micronutrient levels. These tests reveal the factors driving the development and expression of Hashimoto’s thyroiditis. An individual’s metabolic state is the leading risk factor for disease onset ^[13–15].

Many of these tests are uncommon in standard healthcare. Advanced panels are needed to accurately detect deficiencies and metabolic disorders in people with chronic conditions like Hashimoto’s.

These panels are not comparable to routine checkups. They are far more comprehensive and are typically available only in select private clinics at a premium price. Kyma is among the few companies nationwide that offers this level of comprehensive, advanced lab testing.

Kyma’s comprehensive lab panel detects metabolic disorders that promote the development of Hashimoto's disease, including ^[16-21]:

• Deficiencies in Micronutrients: Lack of vitamin D, vitamin C, selenium, zinc, antioxidants, and omega-3s are linked to impaired immune system function, inflammation, and the health status of patients with Hashimoto's.
• Difficulty in Metabolising Simple Sugars: Excessive consumption of simple sugars beyond what the body can metabolise triggers inflammation and is a significant indicator of the disease's progression.
• Insulin Resistance: Elevated insulin levels disrupt immune system function, worsen autoimmunity, and accelerate gland destruction.
• Fatty Acid Metabolism: The ratio between omega-3 and omega-6 fatty acids is a crucial indicator of the body's ability to manage inflammation and regulate the immune system's normal response.
• State of the Microbiome: Alteration of the microbiome is linked to impaired immune system function and the ability to distinguish between its own tissues and external elements, such as pathogens and viruses.
• Thyroid Antibodies: Elevated anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies reflect autoimmune activity and correlate with disease severity and progression risk.

Modern management of Hashimoto’s thyroiditis targets the root causes; identifying and correcting nutrient deficiencies and metabolic disorders that led to the onset of the disease, and maintaining an optimal metabolic state.

In our clinical experience, this root-cause approach can lead to several benefits:

• Improved management of the disease, protecting the thyroid gland from further damage.
• Better functioning of the remaining thyroid gland, helping the body adjust its metabolism to daily needs and enhancing life quality.
• A gradual decrease in autoantibody levels.
• Reduction in fatigue and a boost in energy levels.
• Enhanced mood and fewer severe emotional fluctuations due to improved gland function.
• Lowered risk of harm to other organs and less chance of developing additional autoimmune diseases.
• Increase in metabolic rate and maintenance of a healthy body weight.
• Better response to medications.

It usually takes 6–8 months to achieve significant change, one year to stabilise the body at a better functional level, and about two years for optimal results.

As dysfunctions and deficiencies are corrected, the body reactivates regular metabolic processes and develops different needs. As care begins, changes occur in multiple metabolic pathways simultaneously. These changes must be identified and appropriately managed to continue the restoration process. Otherwise, the body’s restoration processes do not progress, significantly delaying health improvement.

Through our clinical experience, we have found that correcting the body’s deficiencies in vitamins and other elements, restoring metabolism, and regulating weight to normal levels can radically change the course of Hashimoto’s disease for the better and improve patients’ quality of life, shifting from steady worsening to steady improvement.

Promptly addressing the above issues is critical to halting the progression of the disease.

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Bibliographic References

_{[1] Is a Normal TSH Synonymous With “Euthyroidism”?Sarah J. Peterson, Elizabeth A. McAninch, Antonio C. Bianco. The Journal of Clinical Endocrinology & Metabolism 2016.}

_{[2] Persisting symptoms in patients with Hashimoto’s disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A systematic review.  Karelina L. Groenewegen et al. J Transl Autoimmun. 2021.}

_{[3] Thyroid hormones, Τ3 and Τ4, in the brain. Amy C. Schroeder and Martin L. Privalsky. Front. Endocrinol., 31 March 2014}

_{[4] Cognitive and Affective Dysfunctions in Autoimmune Thyroiditis Thomas Leyhe, Karsten Müssig. Brain Behav Immun . 2014}

_{[5] Thyroid Hormone Regulation of Metabolism Rashmi Mullur, Yan-Yun Liu, and Gregory A. Brent.}

_{Physiol Rev. 2014 Apr.}

_{[6] Impact of stress on metabolism and energy balance. Cristina Rabasa, Suzanne L Dickson. Current Opinion in Behavioral Sciences. 2016.}

_{[7] Correlation Between Hashimoto's Thyroiditis-Related Thyroid Hormone Levels and 25-Hydroxyvitamin D Guanqun Chao, Yue Zhu, Lizheng Fang. Front Endocrinol (Lausanne). 2020 Feb.  https://pubmed.ncbi.nlm.nih.gov/32117049/}

_{[8] Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis Shiqian Hu, Margaret P Rayman. Thyroid . 2017 May. https://pubmed.ncbi.nlm.nih.gov/28290237/}

_{[9] Improving the Vitamin D Status of Vitamin D Deficient Adults Is Associated With Improved Mitochondrial Oxidative Function in Skeletal Muscle Akash Sinha et. al. J Clin Endocrinol Metab 2013. https://pubmed.ncbi.nlm.nih.gov/23393184/}

_{[10] Enhanced oxidative stress in Hashimoto's thyroiditis: inter-relationships to biomarkers of thyroid function. Rostami R1, Aghasi MR, Mohammadi A, Nourooz-Zadeh J. Clin Biochem. 2013 Mar}

_{[11] Changes in Glucose-Lipid Metabolism, Insulin Resistance, and Inflammatory Factors in Patients With Autoimmune Thyroid Disease Yi Lei et. al. J Clin Lab Anal . 2019https://pubmed.ncbi.nlm.nih.gov/31350776/}

_{[12] Introducing the thyroid gland as another victim of the insulin resistance syndrome. Jorge Rezzonico et al. Thyroid 2008. https://pubmed.ncbi.nlm.nih.gov/18346005/}

_{[13] Micronutrient deficiencies in patients with COVID-19: how metabolomics can contribute to their prevention and replenishment. Dimitris Tsoukalas and Evangelia Sarandi BMJ Nutri Prev Heal. Nov. 2020; bmjnph-2020-000169}

_{[14] Metabolic Characteristics of Hashimoto's Thyroiditis Patients and the Role of Microelements and Diet in the Disease Management-An Overview. Aniceta A Mikulska et al. Int J Mol Sci . 2022 https://pubmed.ncbi.nlm.nih.gov/35743024/}

_{[15] Metabolic pressure and the breach of immunological self-tolerance Veronica De Rosa, Antonio La Cava & Giuseppe Matarese.18 October 2017}

_{[16] Thyroid Hormone Effects on Mitochondrial Energetics Mary-Ellen Harper 1, Erin L Seifert.  https://pubmed.ncbi.nlm.nih.gov/18279015/}

_{[17] Targeted Metabolomic Analysis of Serum Fatty Acids for the Prediction of Autoimmune Diseases. Dimitris Tsoukalas, Vassileios Fragoulakis, Evangelia Sarandi et. al. Frontiers in Molecular Biosciences, Metabolomics (6), 2019, Published 1 November 2019.}

_{[18] Prediction of Autoimmune Diseases by Targeted Metabolomic Assay of Urinary Organic Acids. Dimitris Tsoukalas et. al. Metabolites. 2020 Dec 8.}

_{[19] Metabolic profiling of organic and fatty acids in chronic and autoimmune diseases. Evangelia Sarandi, Dimitris Tsoukalas et al. Advances in Clinical Chemistry. July 15, 2020. Elsevier Inc.}

_{[20] A Clinical Trial for the Identification of Metabolic Biomarkers in Hashimoto’s Thyroiditis and in Psoriasis: Study Protocol by Evangelia Sarandi et al Pathophysiology 2021 https://www.mdpi.com/1873-149X/28/2/19}

_{[21] Non-communicable Diseases in the Era of Precision Medicine: An Overview of the Causing Factors and Prospects. Dimitris Tsoukalas et al. Bio#Futures. Springer, Cham. May 2021.}

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