Last week’s topic (insulin resistance – a popular one) got me thinking about the thyroid because women often come to see me because they are struggling with an inability to lose weight or progressive weight gain. One of the first things they usually want to know is if it has to do with their thyroid.

Understandably, we want something ‘easy’ to point to. An answer that we can fix. 

(side note: approximately 90% of adult hypothyroidism has an autoimmune cause, mostly due to Hashimoto’s thyroiditis, and popping a pill – thyroid replacement therapy – does not fix everything.)

Hypothyroidism, namely Hashimoto’s thyroiditis, is incredibly common, affecting 10-12% of the general population, making it the most common autoimmune disease. 

Women are between 4-7x more likely than men to develop the disease and although the disease may occur in teens or young women, it more often develops (at least full-fledged) in women ages 30 to 50. Part of this may have to do with the fact that autoimmune diseases are more likely to be triggered by pregnancy and postpartum (due to changes in hormone and immune function). 

Symptoms of Hashimoto’s can be mild at first and take years to develop. Research has found antibodies may be present in the blood for 7 years before the thyroid actually begins to underperform. 

Translation: you can feel crummy for a long time before your thyroid lab markers actually meet a diagnosis of hypothyroidism. And, even after you get medication to correct the low thyroid function, symptoms can persist despite some of your thyroid labs normalizing.

This is why only testing TSH (and fT4) to screen for thyroid disease isn’t optimal, whatsoever. 

Where appropriate, we should be screening for thyroid antibodies (blood markers showing your immune system attacking your own thyroid). I’ve treated patients where their Mom or older sister got a diagnosis of Hashimoto’s, which prompted them to test their own antibodies. When we get a positive result, we get to intervene early before the thyroid fails, and remission is possible (yay for preventative testing and treatment!).

Just to complicate matters further, there’s also something called ‘seronegative’ Hashimoto’s. This means no autoimmune blood markers are found. This type of Hashimoto’s is difficult to have officially diagnosed – I’ve only witnessed it in practice once before in a patient who had been to the Mayo Clinic and had her thyroid biopsied. But don’t panic, in these cases (found to be ~5%) invasive procedures aren’t usually necessary (in fact, they won’t do a biopsy if all they are looking for is Hashimoto’s, there has to be some other reason, e.g. suspicious-looking nodules). Based on the symptoms, we can begin to treat with the lens of Hashimoto’s and see how things improve. 

(PS – I’ve read studies looking at diagnosing Hashimoto’s based on symptoms + “ultrasound appearance” but I have yet to have a patient diagnosed this way – besides the one who had been to the Mayo Clinic.)

Fun fact: I was diagnosed with seronegative postpartum autoimmune thyroiditis by a super fab Endocrinologist. I think in SK, part of the issue is the lack of Endocrinologists 💔. They are the experts on this, not family doctors, which could play a role in why autoimmune screening tests aren’t being run very often. I’ve had patients with life-threatening hormone disease, such as Addison’s disease, have a hard time getting into their Endocrinologists in this province. The system is taxed. This is why you may have to pay privately for this lab work.

Hashimoto’s thyroiditis tends to run in families, but the issue is most women have never been diagnosed with anything other than hypothyroidism. I see patients all the time, diagnosed and medicated for 20 years, only to find out that it was Hashimoto’s the entire time. It reminds me of Celiac disease: unless it runs in the family, people aren’t as likely to get tested for it.

So, what do we do when the typical lab tests are normal (TSH, fT4)?

We test the whole panel: TSH, fT4, fT3, anti TPO antibody, anti thyroglobulin antibody.

Keep in mind, conventional providers may not want to check your thyroid antibodies. Although this can feel frustrating it may be because the results wouldn’t change their treatment plan. When we run labs, it should be to inform our course of treatment for you. For them, it may not matter, they will either suggest monitoring your thyroid over time, “until it burns out” or if it has already burnt out, the only option they can provide is thyroid replacement therapy (which for most all cases is required, potentially lifelong, depending on how long the autoimmune attack of your thyroid has been going on). This doesn’t mean that thyroid hormone replacement is all you need to actually recover and feel good with Hashimoto’s. You also have to treat the underlying causes.

As you can probably tell, this is a huge topic & in the future, I want to dig into this more with you!

If you’re wondering, some early symptoms of Hashimoto’s include weight gain, fatigue, and constipation. When it comes to treatment, in addition to thyroid replacement therapy, we need to address gut health, regulate the overactive immune response, and ensure your stress is being addressed.

Despite all this, I still see insulin resistance as the #1 reason for weight gain and difficulty losing weight.

But, we should still check for hypothyroidism and Hashimoto’s where it makes sense. You can have both going on. In fact, blood sugar regulation and insulin resistance are one of the very first things to address for women with Hashimoto’s.

Want to learn more about this topic with a group of supportive like-minded women & me as your guide? Join me this Fall for the Wild Collective, module 4 is all about optimizing your thyroid health. Click here to learn more.