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Below is a summary of the research done to create this Padlet.

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Nigella Sativa treatment and serum concentrations of thyroid hormones, transforming growth factor β (TGF-β) and interleukin 23 (IL-23) in patients with Hashimoto’s Thyroiditis

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Nigella Sativa treatment and serum concentrations of thyroid hormones, transforming growth factor β (TGF-β) and interleukin 23 (IL-23) in patients with Hashimoto’s Thyroiditis

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This article outlines another potential, non-synthetic treatment for Hashimoto's Disease using Nigella Sativa, also known as black cumin. This plant is found throughout parts of Europe and Asia, and has a long history of various health benefits.

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Nigella Sativa treatment and serum concentrations of thyroid

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This review article titled "Occurrence and natural history of chronic lymphocytic thyroiditis in childhood" explains more about how Hashimoto's manifests in children.

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Occurrence and natural history of chronic lymphocytic thyroiditis in childhood

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Levothyroxine Treatment of Euthyroid Children with Autoimmune Hashimoto Thyroiditis: Results of a Multicenter, Randomized, Controlled Trial 

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Levothyroxine Treatment of Euthyroid Children with Autoimmune Hashimoto Thyroiditis: Results of a Multicenter, Randomized, Controlled Trial 

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This article outlines the use of Levothyroxine to treat children with Hashimoto's Disease. The results of this study suggest that children may be treated with Levothyroxine to reduce symptoms, but only after a short time this treatment is less effective. These results highlight the need for alternative treatments for Hashimoto's

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Levothyroxine Treatment of Euthyroid Children

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Anatabine Supplementation Decreases Thyroglobulin Antibodies in Patients With Chronic Lymphocytic Autoimmune (Hashimoto’s) Thyroiditis: A Randomized Controlled Clinical Trial

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Anatabine Supplementation Decreases Thyroglobulin Antibodies in Patients With Chronic Lymphocytic Autoimmune (Hashimoto’s) Thyroiditis: A Randomized Controlled Clinical Trial

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This article outlines a study conducted in 2014 in which Hashimoto's was treated with anatabine, an alkaloid found in tobacco. Subjects showed greater thyroid function after a three month treatment with anatabine. These results show great promise for a new, non-synthetic treatment for Hashimoto's.

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Below is a more in-depth overview of Synthoid. It includes risk factors, efficacy, and more.

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The most popular treatment for Hashimoto's Disease is levothyroxine , a synthetic hormone replacement.  Levothyroxine is available with a prescription from several brand names. The link below focuses on Synthroid, a levothyroxine tablet distributed by Abbot.

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Learn about Synthroid® (levothyroxine sodium tablets,USP), how to take it, support & savings. See Use & Important Safety Information, including BOXED WARNING.

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Alternative Medicine: A pilot study on the effects of gluten on Hashimoto's Disease

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Alternative Medicine: A pilot study on the effects of gluten on Hashimoto's Disease

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This recently published journal article surveyed 37 women with Hashimoto's and monitored the effects of eating gluten on thyroid hormone levels

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national center for biotechnology information

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united states national library of medicine

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The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto's Thyroiditis: A Pilot Study. - PubMed - NCBI

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Exp Clin Endocrinol Diabetes. 2018 Jul 30. doi: 10.1055/a-0653-7108. [Epub ahead of print]

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Some people believe that gluten exhasterbates the symptoms of Hashimoto's Disease. Thought research into this topic is new, early studies indicate there may be a positive correlation between gluten-free diets and reducing Hashimoto's symptoms. This link is from a blog post written by Dr. Izabella Wentz and gives her perspective on the issue.

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As the gluten free diet has gained popularity in recent years, you may hear mixed messages about this... One expert may say that gluten is toxic to humans (and all living things), and many alternative health experts recommend gluten free as a "cure-all" for various diseases. On the other hand, conventional medicine experts will say that the gluten free diet is unnecessary and even harmful, unless you have celiac disease.

So what is a person to do, if they have an autoimmune thyroid condition like Hashimoto's thyroiditis?

My readers often ask me: what about eating gluten free for people who have Hashimoto's, but do not have celiac disease?
(Please note: Hashimoto's thyroiditis is the leading cause of hypothyroidism in the United States. However, most thyroid patients are not properly tested for it.)
In the following article, you'll discover:

The connection between gluten, celiac disease, and thyroid disease

Should you be gluten free if you have Hashimoto's, but not celiac disease?

Is it just American wheat that's bad?

Is gluten the only root cause?

What to do if you're already gluten free and not in remission

Is there harm to eating a gluten free diet?

What to do if you've been "glutened"

Do you have to stay gluten free forever?

My Personal Gluten Free Experience

When I was first diagnosed with Hashimoto's, I was already working as a consultant pharmacist helping people with complicated healthcare needs in getting better health outcomes. I knew that autoimmune conditions tend to co-occur and that having Hashimoto's would put me at a greater risk for other types of autoimmune conditions, including celiac disease. In fact, I came across a study that suggested gluten could be a trigger for both celiac disease and Hashimoto's. (1)

Celiac disease is known for creating gastrointestinal distress... I had numerous gut-related symptoms including bloating, irritable bowel syndrome, acid reflux, and frequent stomach pains, in addition to the "typical" hypothyroid symptoms of brain fog, fatigue, hair loss, weight gain, and cold intolerance! I also had "non-typical" symptoms like anxiety, palpitations, joint pain, carpal tunnel, allergies, and panic attacks that are sometimes associated with celiac disease, so I had my doctor test me for celiac disease.

While I wasn't exactly excited about having a second autoimmune condition, I was hopeful that gluten and celiac disease would be my root cause and that getting the right diagnosis would help me feel human again. But the celiac test came out negative, and my doctor told me I didn't need to bother with the gluten free diet.

As a result, I didn't attempt the gluten free diet. Instead, I started thyroid medications, but continued to deepen my research into my triggers as many of my symptoms continued, despite taking thyroid medications.

The medications helped me feel less tired (my sleep went from 12+ to 11 hours per night), and I was also less cold (I no longer needed two blankets at night!), but the other symptoms remained.

Digging Deeper

About a year into my journey, I decided to dig deeper. I still had an interest in exploring whether diet could play a role in my condition. I learned about three distinct reactions a person could have to foods...

The celiac reaction - This is a reaction specifically to gluten, the protein found in wheat, that is mediated by the IgA branch of the immune system and results in damage to the intestines.

The allergic reaction - This is governed by the IgE branch of the immune system and results in immediate reactions like anaphylaxis, difficulty breathing, rashes, and hives (think hallmark reactions to peanuts or shellfish).

The Type IV delayed hypersensitivity reaction - This is governed by the IgG branch of the immune system. Interestingly, Hashimoto's is also a Type IV delayed hypersensitivity reaction.

Most research has focused on celiac disease and IgE reaction testing, while IgG testing is still considered experimental.

I had already been tested for celiac disease as well as IgE food reactions, but both of those tests came up empty for me- so I decided to try IgG food sensitivity testing.

The tests revealed that I had IgG reactions to gluten, as well as to the dairy proteins, whey and casein.

At that point, my condition was only getting worse, despite taking higher and higher doses of thyroid meds.

With nothing to lose, I decided to give the gluten- and dairy-free diet a try.

To my complete disbelief and amazement, the bloating and stomach pains (a lifelong phenomenon), the irritable bowel syndrome (with me for almost 10 years at that point), and acid reflux (an unwanted guest for more than 3 years) vanished within three days!

I had previously been symptomatic despite taking proton pump inhibitors, Pepcid, Tums, and Pepto Bismol, and yet after three days of this diet, ALL of my symptoms were gone! I made a brave decision to try and stop my acid suppressing medications and guess what! The symptoms never came back.

That is, until a couple of months later when I got hungry at work and decided to try eating something at Panera. I didn't realize the meal I had contained gluten and dairy until I found myself having acid reflux and doubled over in the bathroom with stomach pain (just like I used to have) within hours of my meal. That convinced me to stay away from gluten and dairy for long term.

As time went on, I saw more improvements in my health- the carpal tunnel went away, my panic attacks and anxiety resolved, and my thyroid antibody numbers (a potential marker of how aggressive the attack on the immune system is) were reduced.

I know skeptics will say, "Great, but you're only one person... what about everyone else? What about me?"

While the research for IgE food reactions in Hashimoto's is lacking, I want you to be aware of the important role of the other two types of reactions: celiac disease (IgA) and the Type IV delayed hypersensitivity reaction (IgG) reaction.

Thankfully, there is now a lot of research about celiac disease and how it relates to Hashimoto's and thyroid function.

I've also done some of my own research with over 2000 people with Hashimoto's (with and without celiac disease) and have used IgG testing extensively, which I believe will support the role of Type IV delayed hypersensitivity reaction (IgG) reactions with Hashimoto's.

In this article, I'll touch on the controversial concept known as "non-celiac gluten sensitivity," which I personally believe could be an umbrella term that may one day include the Type IV delayed hypersensitivity reaction (IgG) I've documented.

What is Gluten?

But first, it's important to understand just what gluten is. Gluten is a protein found in barley, rye, and wheat. It's a staple in the Western diet that you'll encounter in most breads, cereals, and pasta. However, it can also be hidden in many other food products. For example, you'll often see wheat flour added to many sauces and even chocolates! Many foods may often be cross-contaminated with gluten as well, including oats. (Did you know? Hidden gluten is everywhere and can actually be found in personal care products such as skin care!)

It's important to know what gluten is, as it can create a toxic response in people with autoimmune disease, including those with Hashimoto's.

The most severe form of gluten response is seen in people with celiac disease.

What is Celiac Disease?

An estimated 1 percent of people (about 3 million worldwide) have celiac disease. Those with celiac disease must stay absolutely 100% gluten free in both their diet and their lifestyle, or else they will have significant life-affecting symptoms.

For those with celiac disease, exposure to gluten triggers the release of zonulin, a chemical that signals the tight junctions of the intestinal wall to open up. This creates intestinal permeability (also known as leaky gut), where toxins, partially-digested food particles, and microbes are allowed to pass into your bloodstream. The body's immune system is then triggered to attack these invaders. Every time you consume the particular food, (gluten, in this case), your immune system is engaged again, resulting in a variety of symptoms. Research has actually shown that gluten triggers this issue in everyone, even those who don't have celiac disease.

But those with celiac disease will also experience an autoimmune attack on the intestines with every bite of gluten. As mentioned above, this reaction is mediated by the IgA branch of the immune system and results in intestinal damage.

This attack destroys the villi, which are delicate, hair-like projections that cover the intestines. The villi are important as they help the body digest and absorb nutrients from food.

This destruction of the villi can result in a malabsorption of nutrients such as selenium, a well-known risk factor for Hashimoto's; as well as lead to issues relating to nutrient deficiencies such as fatigue, failure to thrive, anemia, osteoporosis, digestive issues, and autoimmune diseases.

Celiac disease is often referred to as "the great imitator," as many of the symptoms of the disease mimic those of other diseases. It can go undiagnosed for a long time as it may be misdiagnosed as something else. Symptoms vary widely, with some people experiencing the classical severe diarrhea, nausea, weight loss, vomiting, and acid reflux, while others may not experience any gut issues at all.

Left undetected, people with celiac disease are at greater risk of developing intestinal cancer.

The Celiac and Thyroid Connection

Celiac disease can co-occur with Hashimoto's. In fact, studies have estimated that between 1.2 and 15 percent of Hashimoto's patients also have celiac disease! (2) Furthermore, the antibodies produced in celiac disease can cross-react with thyroid antibodies because they may share similar molecular structures, so molecular mimicry may be one of the reasons for the common co-occurrence of both conditions. (3)

When I first began to research lifestyle interventions that could improve my condition, I came across an Italian study focused on people who had subclinical hypothyroidism, Hashimoto's, and celiac disease, but who had not been following a gluten free diet.

As the gluten free diet is indicated for people with celiac disease, the diet was helpful for the study participants' intestinal symptoms and helped them recover the health of their intestines. There were also improvements in thyroid function! The study found that when most of those with subclinical hypothyroidism were placed on a gluten free diet, their thyroid function normalized! 71 percent of people who had subclinical hypothyroidism (a mildly underactive thyroid) and who had strictly followed a one-year gluten withdrawal (as confirmed by intestinal mucosa recovery) saw a return to normal thyroid function.

Additionally, 19 percent of people who followed the gluten free diet were able to normalize their thyroid antibodies, no longer testing positive for Hashimoto's. The researchers of the study concluded: "In distinct cases, gluten withdrawal may single-handedly reverse the abnormality." (1)

In another study involving patients with Hashimoto's and celiac disease, the average dose of levothyroxine needed (prior to the study) to treat patients with Hashimoto's alone was lower than the average dose required to treat patients with both conditions (that is, Hashimoto's and celiac disease). Furthermore, the study showed that when the Hashimoto's and celiac disease patients went on a gluten free diet, their TSH levels decreased, along with the amount of T4 thyroid medication needed to achieve a targeted lower TSH level!

The study concluded that their TSH likely decreased because of better absorption of thyroid medications. This makes sense as untreated celiac disease can significantly impair medication absorption. However, I've also seen some patients with celiac disease and hypothyroidism wean off thyroid meds completely after going gluten free over the course of 3-12 months, so I suspect that some of the patients in the study also had a recovery of thyroid function that was missed by the researchers because the patients were not followed for a long enough period of time. (4)

In yet another study involving 104 Hashimoto's patients, researchers found that 50 percent of patients with Hashimoto's also had celiac-specific genes, putting them at risk for celiac disease. (However, it's important to remember that though these people had the right genes, genes are not always our destiny- an environmental trigger is often required for the expression of celiac genes and for the condition to manifest.)

Testing for Celiac Disease

The risk for celiac disease increases if you have a family history of the disease, European ancestry, and/or a personal history of other autoimmune disorders.

There are several options to diagnose celiac disease. However, current testing is far from perfect, with blood-screening tests often coming back negative. Additionally, a person must be eating gluten to test positive for celiac disease! These are the current blood-screening tests available:

The Tissue Transglutaminase Antibodies (tTG-IgA) test: This blood test is often used to diagnose celiac disease. If you are currently on a gluten free diet, a gluten challenge (which requires you to have eaten two slices of wheat-based bread over the course of 6 to 8 weeks) is often recommended prior to taking this test, to allow any antibodies to appear in your bloodstream. Unfortunately, this test may results in false negatives and false positives. (5)

IgA Endomysial antibody (EMA) test: This test is not as sensitive as the tTG-IgA test. It's usually used for patients that are difficult to diagnose, but about 5-10 percent of those with celiac disease do not have a positive EMA test.

Total serum IgA test: This test checks for IgA deficiency, which is often associated with celiac disease. IgA deficiency can cause false negatives on tTG-IgA or EMA tests.

Deamidated gliadin peptide (DGP IgA and IgG) test: This test can be used to further screen for celiac disease in those who test negative for both tTg and EMA antibodies, as well as in those with IgA deficiency.

Please note, it's possible for people with celiac disease to have negative test results, especially if they're already following a gluten free diet.

The biopsy of the small intestine is considered the "gold standard" way to confirm a diagnosis and will find more cases of celiac disease than the blood tests. However, again, the person must be eating gluten in order for the biopsy results to be accurate.

A genetic test is a test for celiac disease that can be utilized without a gluten trial. Most people with celiac disease have the HLA-DQ2 and HLA-DQ8 genes, and about 30 percent of all people have these genes. Please note, the genes only predict susceptibility, not whether the celiac disease is expressed. One can do genetic testing through various companies such as 23andMe to help determine if you are genetically at risk for developing celiac disease.

If you're already gluten free and feeling better, I personally believe that your body's own response to gluten is the best test to determine if you should be gluten free, and I am apprehensive about "gluten challenges" just to get a diagnosis. Specifically, this test is not recommended for pregnant women who have been gluten free, as they can precipitate a miscarriage. But even if you're not pregnant, I believe in treating your body well and nourishing it!

I remember one of my readers with multiple autoimmune symptoms had started the gluten free diet. Within weeks, the diet resolved her symptoms, but in order to qualify for specialized health benefits in her country, she had to undertake a trial of gluten and was nearly hospitalized with intestinal bleeding during this trial!

Non-Celiac Gluten Sensitivity

After finding out that I had IgG reactions to gluten, as well as to the dairy proteins, whey and casein, I came across a condition known as non-celiac gluten sensitivity (NCGS).

With non-celiac gluten sensitivity, people have celiac-like reactions to gluten, yet they don't test positive to the typical IgA celiac antibodies nor do they present the characteristic damage to intestinal cells seen in celiac disease.

However, research has shown that there are many correlations between those with thyroid disease and gluten sensitivities. For example, a 2002 study in the European Journal of Endocrinology found that 43 percent of people with Hashimoto's showed activated mucosal T cell immunity, which is usually correlated with gluten sensitivity. (6)

While there is research to support this condition, the condition is considered controversial by conventional medical circles and conventional media. It seems that every other month, I see a headline in the news that supports the condition, followed by another headline that states that the condition does not exist!

The challenge, in my opinion, is that there is not one diagnostic test, nor even one cause, for non celiac-gluten sensitivity.

There could be numerous reasons why a person may react to wheat products.

Some of them include small intestinal bacterial overgrowth (SIBO), which results in an impaired ability to break down various food particles, including fructans. In fact, a recent study found that fructan, a food molecule that may be found in wheat, is to blame for NCGS symptoms, and not gluten. (7)

Histamine intolerance has also been tied to NCGS, (8) as have other types of reactions to food particles, including nickel sensitivity.

A recent review article of the available scientific literature proposed that gluten sensitivity may occur as a result of a specific type of gut imbalance (known as dysbiosis).

Leccioli and colleagues proposed that the root cause of gluten sensitivity may be due to a decrease in the gut bacteria Firmicutes and/or Bifidobacteria, which produce the anti-inflammatory, gut healing short chain fatty acid butyrate. This is a really interesting theory, as I've seen low butyrate levels in many of my Hashimoto's clients who have taken the GI Effects Gut Test. (9)

I personally believe that NCGS is still an emerging concept that should be considered an umbrella term for the various root causes of reasons why a person may react to gluten-containing foods. I also believe that until science has a definitive answer, we should disregard the disempowering headlines that say gluten sensitivity is all in our heads and listen to our own bodies when a food does not agree with us!

I will tell you that my personal and clinical experience has shown that gluten sensitivity is one of the most significant triggers in Hashimoto's. I base this opinion on the severity of symptoms that thousands of people with Hashimoto's have reported, as well as the health improvements they experience once they remove gluten from their diets.

Survey Results Found Significant Improvements on a Gluten Free Diet

I often see articles and comments online ridiculing people without celiac disease for going gluten free to improve their health. I find this to be a very close-minded point of view, and quite frankly, a dangerous one as well.

While I've seen tremendous benefits in my own personal health as well as the health of many of my private clients using unconventional methods, the mainstream research and "evidence base" for eliminating food antigens in Hashimoto's is still lagging... So I decided to create my own evidence base!

I used my outcomes research training to create a little survey that went a bit viral... In the summer of 2015, I developed a survey to assess the impact of various interventions on Hashimoto's. Some 2,232 people with Hashimoto's provided feedback as to the factors that seemed to make their conditions better as well as worse. Many food and non-food triggers were assessed, but I would like to focus in on gluten for this article.

First of all, it is worth noting that out of all who responded, only 3.5 percent had also been diagnosed with celiac disease. (This is consistent with the reported rate of celiac disease of 1-15 percent in people with Hashimoto's.)

Yet, 86 percent of respondents who had gone gluten free reported improvements in digestive symptoms. I believe this re-confirms my earlier points- you do NOT have to have celiac disease to benefit from a gluten free diet!

Most readers said their gluten reactions had included gut issues like constipation, diarrhea, cramping, bloating, gas, nausea, and burning or burping from acid reflux, as well as brain-related symptoms such as headaches, brain fog, anxiety, depression, fatigue, and insomnia. And most felt better going gluten free.
In fact, 88 percent of people with Hashimoto's who became gluten free felt better.
33 percent of respondents had a reduction in their thyroid antibodies on a gluten free diet. (As mentioned above, thyroid antibodies are considered to be a potential marker of how aggressive the attack is against the thyroid gland, and a lower number generally indicates a less aggressive attack.)

Along with feeling better and the reduction in antibodies, the biggest benefits seen in people with Hashimoto's on the gluten free diet were more energy (in 67 percent of people), a better mood (in 60 percent of people), and a healthier weight (in 52 percent of people). As a pharmacist, I was surprised to see that more people reported improvements with the gluten free diets in these domains than they did with using thyroid replacement hormones!

The survey results mirrored the outcomes I had been tracking from my clients as well!

Based on my clinical experience and the results above, I firmly believe that the gluten free diet can be a very effective intervention for most people with Hashimoto's, even in the absence of celiac disease.

Gluten and Intestinal Permeability

Another important point to make about gluten and autoimmune disease is that studies have shown that gluten induces intestinal permeability in all individuals, regardless of whether or not they have celiac disease. (10)

Why is that important?

It's because Fasano and researchers have found that every case of autoimmune disease needs three things present to occur:

A genetic predisposition

An environmental trigger

Intestinal permeability

If one of the three things is missing, the condition will go into remission. (You can read more about this here.)

While we can't change our genes (just yet), and while we don't always have power over our triggers, we can always address the strength of our intestines and work on making them less permeable!

One obvious strategy to make intestines less permeable is to remove the substances that induce their permeability.

I find it is helpful to think of the intestinal permeability (commonly called leaky gut) reaction to gluten in terms of a spectrum.

On one side of the spectrum, some people may only experience momentary discomfort after eating gluten, such as brief bloating. On the other side of the spectrum, you will find people with celiac disease who suffer greatly, and even tiny amounts of gluten can cause significant damage to their intestines and symptoms for many weeks.

Is it Just American Gluten that's Bad?

There are people all over the world who suffer from celiac disease and gluten intolerance.

I often hear people in the US claim that they only have problems with "American gluten," and do not have problems when they travel to Europe and elsewhere- and can eat bread overseas.

However, gluten reactions that occur are seen as specific to local food proteins. Just as we locals react to the wheat here in the US, people in Europe and elsewhere can be sensitive and react to their own local wheat.

Furthermore, the prevalence of celiac disease in a large sample of the European population (Finland, Germany, Italy, and the UK) was found to be about 1 percent. (11)

Having consulted with clients from all over the world, I can attest that most Hashimoto's clients feel better off wheat, no matter where they live! As such, being somewhere on the gluten intolerance spectrum is not just an American phenomenon.

The reason why a person who goes abroad may not react to the gluten there is because the proteins in foods are slightly different depending on where they are grown. Thus, the body may not immediately recognize the foreign proteins as something it should react to. In my experience, people may be non-reactive for up to 2 weeks to the local wheat, but longer term eating of wheat abroad will produce symptoms eventually, as the proteins are similar enough for the immune system to link them up and produce the same reaction.

Can Other Foods - Beyond Gluten - Be Triggers?

Yes they can! Other substantial food triggers seen in my survey include dairy (a large sensitivity for me!), eggs, sugar, soy, grains (corn, in particular), nightshades (tomatoes, potatoes, eggplants and peppers), alcohol, caffeine, nuts, and seeds.

In addition to cutting out gluten, the other most helpful dietary interventions were going on a sugar free diet (87 percent felt better), a grain free or Paleo diet (81 percent felt better), a dairy free diet (79 percent felt better), the Autoimmune Paleo diet (75 percent felt better), and the Low Glycemic Index diet (76 percent felt better). (I discuss much more about these common food sensitivities and dietary interventions, as well as the healing foods you can eat to help you feel better, in my book, .)

It is also worth noting that many dietary interventions received higher percentages of "feeling better" results than actual prescribed thyroid medications. While 43 percent of people reported feeling better on Synthroid, and 58.9 percent felt better on Armour*, 88 percent felt better on the gluten free diet.

As a pharmacist - and someone who advocates for the proper use of thyroid medication - I am obviously a supporter of physician-prescribed thyroid medications to help manage patient symptoms and their condition. But as a "detective" who works diligently to solve my own - and my clients' - health puzzles, I also want to point out the tremendous benefits you can see by trying some of these food elimination strategies.

*Note: While Armour Thyroid does not have any gluten-containing ingredients, it is not tested for gluten content, and cannot be certified as gluten-free. Armour does contain sodium starch glycolate, which can be derived from wheat or corn.

How to Feel Better

So what can you do today to feel better?

I hope I have convinced you (or at least tempted you to do some of your own detective work to learn more :-)) that gluten is a common trigger for those with Hashimoto's.

Based on all of the research and the results from 2,232 of my readers, I firmly believe that every person with an autoimmune thyroid condition should try removing gluten from their diet.

Even in those who do not have celiac disease or diagnosed gluten sensitivity, gluten causes intestinal permeability and can cause significant life-affecting symptoms. You owe it to yourself to at least try eliminating it from your diet... and let subsiding symptoms speak for themselves. You can always add it back if you do not feel any improvements.

IgG Gluten Sensitivity as a Trigger in Hashimoto's

The studies of NCGS have not come up with conclusive opinions, or even diagnostic tests for gluten sensitivity on IgG reactions to gluten. However, I believe that Type IV Hypersensitivity (IgG) reactions are a critical piece of why gluten is a problem for many with Hashimoto's. People with Hashimoto's often present with numerous food sensitivities, and testing may show IgG antibodies to various food proteins. IgG antibodies are thought to be the same types of antibodies that target the thyroid gland in autoimmune disease. Thus, removing IgG reactive foods may attenuate the IgG response to the thyroid gland. These reactions can be tested via lab testing, as well as through an elimination diet.

Food Sensitivity Testing

Some people need to see that they react to a food "on paper" before they commit to making a change. I get it. I was one of them! If you are looking for that proof, I have found that IgG-based food sensitivity tests can be incredibly helpful in recognizing your food reactions and minimizing your symptoms!

Food sensitivities are very individualized, so you might be surprised to find some odd things you are sensitive to!

For me, I wasn't just reactive to the usual suspects of gluten and dairy, but I had a reaction to pineapples and peaches too! They both triggered my acid reflux. It is also worth noting that I tested borderline for gluten intolerance (although I was positive for dairy protein intolerance), but felt much better after removing both from my diet. A follow-up elimination challenge with both foods confirmed my sensitivity to both.

However, not all IgG tests are created equally - there are no defined standards in the IgG food testing industry, and some tests I've seen are highly inaccurate. They may show up with numerous false negatives (meaning you'll still be eating foods that are causing inflammation in your body) and numerous false positives (meaning you'll be left feeling overwhelmed and with nothing you can eat)! The test that I have found to be highly accurate for myself and my clients is the Alletess Lab food sensitivity test. If a food comes up positive on that test, I know that it is a reactive food for that person.

Alletess Lab works primarily through integrative and functional medicine physicians, so if you're working with such a doctor, you can ask him/her to order the test for you. I've also worked with MyMedLab to offer Alletess Lab food sensitivity tests for people to self-order without a doctor's prescription. The test kit comes with a little blood spot collection paper, and can be mailed to just about anywhere in the world! The results are also self-explanatory, so you don't need a highly-skilled healthcare professional to interpret them for you. You either react to a food or you don't!

MyMedLab offers two options to test for the most commonly eaten foods (including gluten):

The 96 food panel is a good one to uncover most food triggers. You'll get a comprehensive report that identifies your sensitivities. I do recommend people repeat sensitivity testing on an annual basis for best results as reactions to foods can change.

I've used this test for hundreds of people with Hashimoto's, and most do come up with an IgG gluten reaction. I hope to have the results published after my team and I have crunched all of the numbers!

Why an Elimination Diet is the Best Gluten Sensitivity Test

If you can't afford food sensitivity testing, I have some good news for you. There is a test you can do that's absolutely free, but it does require more work and paying attention. The elimination diet is still considered the gold standard for food sensitivity testing. Your body will always tell you which foods do not agree with it, but only if you listen to it very carefully.

Why are food sensitivities so difficult to pinpoint? One reason is because we keep eating the foods that our body is sensitive to. For me, I ate dairy and bread every day, never connecting those foods to my long list of symptoms. When you eat a particular food on a daily basis, it is difficult to connect that food to any symptoms you are having.

You might have joint pain, bloating, and acid reflux every day, but how would you ever connect that to the dairy you have always had?

As you continue to consume the food you are sensitive to, your body becomes depleted in its ability to protect itself from the antigenic food. The reactions become less specific and more chronic. Additionally, your body will become sensitive to more and more things.

That is why an elimination diet helps greatly. If you remove a particular sensitizing food for a few weeks, you should feel better and experience less bloating, reflux, and other digestion-related symptoms. And when you are exposed to that food again, your body will be able to produce a stronger, more specific reaction, which will allow you to recognize which particular food is problematic.

I always recommend an elimination diet where you avoid the food in question for 2-3 weeks. See how you feel, and then try it again to see if you react to it. Check out my podcast with Tom Malterre for more info about elimination diets!

What About Non-Food Triggers? (Other Root Causes)

If gluten is the sole root cause of your condition, you will likely see a complete remission of thyroid antibodies after you eliminate it from your diet, and your thyroid function may even return to normal within 3-12 months. If you don't see such improvements, you will need to put your detective hat back on and dig deeper for other contributing root causes.

Along with gluten or other food sensitivities, you may also need to look at infections, environmental toxins, and even how you are managing stress - but getting off reactive foods almost always helps in the healing process.

In my survey of 2,232 people with Hashimoto's, there were 9 great areas of learning beyond the issue of gluten intolerance, including supplements that had proven to be beneficial, the positive results of people using the medication Naltrexone in low doses, and the impact of stress as a trigger. You can read an overview of that here.

Once you find your food triggers, you will still need to help your digestive system heal by adding supportive foods and nutrients. In my survey, I found that incorporating healing foods also made people feel better. Homemade bone broth helped 70 percent of those that tried it, green smoothies helped 69 percent, and fermented foods helped 57 percent.

You may also need to focus on removing toxicity in your environment and supporting your body's detoxification pathways. All of this is part of my 2-week Liver Support Protocol.

You can learn the step-by-step instructions for this highly successful reparative protocol in my book, Hashimoto's Protocol. The book also covers many other important protocols such as gut balancing, adrenal recovery, addressing infections, stress management, and more.

Gluten Free Freedom

Up to 20 percent of people with celiac disease and Hashimoto's can be free of Hashimoto's within a year of going gluten free, and some may go into remission in as little as three months.

Moreover, up to 90 percent can be free of numerous, often lifelong symptoms!

Here are just a few comments from my readers and clients:

"[A] gluten free diet has helped me reduce antibodies almost to a normal range."

"Going gluten free helped me tremendously. It took eight months to feel the difference, and now after two years, most of my symptoms are gone. Nothing to lose by going gluten free."

"Since I went gluten free, my hair started growing back, my bloating and diarrhea [are] gone, [and I have] no more reflux either."

"Going gluten free has helped my hair to start growing back after losing all my hair-even my eyebrows and eyelashes."

"Gluten free and soy free for three months and I was able to lower my meds, and [my] stomach pain, alternating diarrhea and constipation, anxiety, and body aches [are] all gone!!"

"I'm gluten free and have brought my antibodies down to normal range. So thankful!"

Is there Harm to Eating Gluten Free?

Often, people worry about missing out on essential nutrients by removing gluten-containing grains from their diet. Fortunately, in many cases people actually absorb nutrients more effectively from their food when they remove gluten from their diet! In fact, I've seen multiple cases of iron/ferritin deficiency resolve on a gluten free diet. That said, there are some documented deficiencies that are reported on a gluten free diet, but the good news is that you can supplement accordingly.

One of the most common nutrients depleted in gluten free diets is selenium, which also happens to be a common deficiency in Hashimoto's! To counter this, I recommend this selenium supplement.

Grain free diets can also result in a deficiency of thiamine (vitamin B1), another common nutrient deficiency. (Read my full thiamine article for more information.) I recommend supplementing with Benfomax by Pure Encapsulations to ensure you're getting enough of this vitamin.

Other vitamin deficiencies that may occur on the gluten free diet include vitamin A, B2, B3, B5, B6, B7, B9, B12, vitamin D, calcium, copper, iron, magnesium, phosphorus, and zinc. If you're also following the Paleo diet, you may be deficient in vitamin B7 and chromium as well. Again, testing for nutrient deficiencies and boosting your nutrient levels with supplements will help you maintain optimal vitamin levels!

Moving Forward... Gluten Free!

I know giving up gluten may sound daunting! It may take some work and some sacrifices to start cutting out gluten, but you are worth it. You only have your symptoms to lose and you can go back to your previous diet if the gluten free diet doesn't help! I recommend giving it at least a month, though many people see the results in just a week. (I saw life changing results in 3 days!) Having a plan and some good substitutions will help, so I developed a quick start guide with some delicious gluten free recipes to help you ease into the transition. Click here to download my Thyroid Diet Quick Start Guide with Gluten Free Recipes.

Going gluten free is really one of the best things you can try when you have a thyroid condition like Hashimoto's, hypothyroidism, or Graves' disease. Why not try it for a few weeks to see how you feel?

You can also join my community on Facebook, so you will be kept up-to-date on emerging research, new programs, free recipes, and helpful information. We are all in this together!

Do You Have to Stay Gluten Free Forever?

I would say generally with Hashimoto's, most people should remain gluten free for long-term. That said, I have seen some people who have been able to reintroduce foods and seemingly don't have any adverse reactions to gluten. In other cases, some people claim not to react to gluten, but have obvious gluten-related symptoms like joint pain, anxiety and Hashimoto's flare-ups; and are in denial that gluten could be a trigger for them.

If gluten sensitivity is indeed caused by an imbalance of butyrate-producing bacteria, in theory, replenishing the beneficial bacteria could deem gluten sensitivity reversible. Some individuals have reported no longer reacting to gluten after taking the Megaspore probiotic.

I'm still studying the phenomenon of reducing gluten reactions and improving digestion, and I'm hoping to get to the bottom of it.

(This will be the focus of one of my future books- I generally spend about 3 years on research and testing, and one year or so in writing before I publish a book on a topic or give a definitive opinion!) But for now, I would say that long term avoidance of gluten is going to be best for most people. Be sure to subscribe to my newsletter to receive any future updates!

What to do if You've Been Glutened?

Prevention

How many times have you been to a restaurant that was supposed to be safe to eat at, only to discover you've been glutened? Depending on the person, the effects can last from a few hours to a few weeks. One supplement that I've found to be helpful in uncertain situations is Gluten/Dairy Digest. Gluten/Dairy Digest contains enzymes that assist in breaking down gluten and dairy proteins and can help to lessen reactions to them. These enzymes can be very helpful for those with gluten and dairy sensitivity in times where you're concerned about cross-contamination or when you've accidentally consumed something you shouldn't have.

Other digestive enzymes may also offer some protection by helping to break down difficult proteins like gluten. Betaine HCl and pepsin are naturally occurring components of the gastric juices that support our digestion by breaking down protein bonds in our food so their nutrients are easier for our intestines to absorb. They can also help us break down gluten particles. You can learn more about the benefits of betaine with pepsin, and how to find out the appropriate dosage for you, here.

Unfortunately, enzymes only work when you take them with the offending food. Furthermore, while they can minimize the reactions to gluten and dairy, they are not likely to completely eliminate them. So, I don't recommend trying to eat a pound of cheese or a loaf of bread just because you're taking this type of supplement.

After the Exposure

Magnesium citrate - Magnesium is something that I recommend taking daily for most people with Hashimoto's, as getting adequate magnesium from a standard diet can be difficult, and symptoms are often confused with those of other conditions. Taking additional magnesium in cases of accidental exposure to foods that you're sensitive to will ensure that your bowels are moving properly and will support a healthy detoxification process.

Physicians Elemental Diet - After you've been exposed to foods that you are sensitive to, one very important step in recovery is giving your digestive system time to rest. The best way to do this is through a period where you do not consume any solid foods, which will allow the inflammation to die down. The tricky part is, if you're not consuming enough foods, you can wind up feeling tired and drained. One way to prevent this from happening is to use a special formula, like the Physician's Elemental Diet, designed to provide the body with the nutrients it needs while allowing your intestines to repair.

Lemon Water - Drinking this first thing in the morning and throughout the day will help increase and support your stomach acid, as well as your liver detox pathways. It will also assist in the removal of toxins to help your body recover faster from accidental gluten exposure.

Bone broth - While gluten and dairy exposure can lead to a leaky gut by perforating the walls of the intestines, bone broth can help soothe the gut and heal the damage. The gelatin in bone broth helps to seal the junctions in the intestines so they are no longer permeable. That way, gluten and dairy particles, as well as other food particles and toxins you may be sensitive to, can no longer pass through the intestinal wall. (In addition to boosting gut health, bone broth has many other benefits: boosting immunity, relieving joint pain, increasing energy, improving digestion, and giving you a more youthful appearance. You can find how to make my own version of bone broth !)

Epsom Salt Bath - Taking a daily hot Epsom salt bath is not only a wonderful way to relax and de-stress, it's also a great source of magnesium. The magnesium will stimulate the bowels and help your body eliminate toxins. All you need is 1 cup of Epsom salts in a bath of hot water.

Activated charcoal - Activated charcoal is an amazing supplement that binds up toxins and can minimize food reactions. I recommend taking 1-3 capsules at bedtime, at least 4 hours away from other medications or supplements (to avoid impairing their absorption), to help detoxify from food reactions. Additionally, I recommend supplementing with magnesium when taking activated charcoal because it can cause constipation, and it's important to keep the stools and toxins moving out of the body.

References

1. Sategna-Guidetti C, Volta U, Ciacci C et al. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. The American Journal of Gastroenterology. 2001;96(3):751-757. doi:10.1111/j.1572-0241.2001.03617.x.

2. Lerner A, Jeremias P, Matthias T. Gut-thyroid axis and celiac disease. Endocrine Connections. 2017;6(4):R52-R58. doi:10.1530/EC-17-0021.

3. Vojdani A, Tarash I. Cross-Reaction between Gliadin and Different Food and Tissue Antigens. Food and Nutrition Sciences. 2013;4(1):20-32. doi:10.4236/fns.2013.41005.

4. Virili C et al. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. The Journal of Clinical Endocrinology and Metabolism. 2012;97(3):E419-E422. doi:10.1210/jc.2011-1851.

5. Celiac Disease Foundation. Screening. Celiac Disease Foundation. https://celiac.org/celiac-disease/understanding-celiac-disease-2/diagnosing-celiac-disease/screening/#O8ai1iT6IsODzqfu.99. Accessed December 28, 2017.

6. Valentino R, Savastano S, Maglio M et al. Markers of potential coeliac disease in patients with Hashimoto's thyroiditis. European Journal of Endocrinology. 2002;146(4):479-483. doi:10.1530/eje.0.1460479.

7. Skodje G, Sarna V, Minelle I, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-reported Non-celiac Gluten Sensitivity. Gastroenterology. 2017;S0016-5085(17):36302-36303. doi:10.1053/j.gastro.2017.10.040.

8. Schnedi W, Lackner S, Enko D, Schenk M, Mangge H, Holasek S. Non-celiac gluten sensitivity: people without celiac disease avoiding gluten-is it due to histamine intolerance? Inflammation Research. 2017. doi:10.1007/s00011-017-1117-4.

9. Leccioli V, Oliveri M, Romeo M, Berretta M, Rossi P. A New Proposal for the Pathogenic Mechanism of Non-Coeliac/Non-Allergic Gluten/Wheat Sensitivity: Piecing Together the Puzzle of Recent Scientific Evidence. Nutrients. 2017;9(11):1203. doi:10.3390/nu9111203.

10. Hollon J, Puppa EL, Greenwald B, et al. Effect of Gliadin on Permeability of Intestinal Biopsy Explants from Celiac Disease Patients and Patients with Non-Celiac Gluten Sensitivity. Nutrients. 2015;7(3):1565-1576. doi:10.3390/nu7031565.

11. Mustalahti K, Catassi C, Reunanen A, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42(8):587-95. doi: 10.3109/07853890.2010.505931.

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Does Gluten Cause Thyroid Conditions? - Dr. Izabella Wentz

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Even in those who do not have celiac disease or diagnosed gluten sensitivity, gluten causes intestinal permeability and can cause significant life-affecting symptoms. You owe it to yourself to at least try eliminating it from your diet... and let subsiding symptoms speak for themselves.

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Autoimmune disorders impact the lives of all types of people, including celebrities! This article from E! News tells about some famous women who live with Hashimoto's Disease.

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Getty Images for Reebok

Like many celebrities, has often been body shamed online, despite having a figure that got her two Victoria's Secret Fashion Show gigs.

Now, the 21-year-old model is speaking out about dealing with an autoimmune disease that could affect her weight: Hashimoto's disease.

"My metabolism actually changed like crazy this year," she told magazine this week at the Reebok #PerfectNever campaign event. "I have Hashimoto's disease."

"It's a thyroid disease, and it's now been two years since taking the medication for it, so for the VS show I didn't want to lose any more weight, I just want to have muscles in the right place, and if my butt can get a little perkier, then that's good," she said.

Hashimoto's disease, also called Hashimoto's Thyroiditis, causes a person's immune system to attack their own thyroid. If left untreated, it leads to hypothyroidism, which means her thyroid is unable to produce enough hormones to help regulate her metabolism. That condition leads to weight gain, increased sensitivity to cold, a puffy face, hair loss, fatigue, muscle weakness and aches, the development of a goiter and other side effects.

In addition, people who suffer from Hashimoto's disease are also genetically predisposed to developing other autoimmune diseases.

Fortunately, those suffering from either Hashimoto's disease, hypothyroidism or both can be treated for life with daily doses of pills containing synthetic thyroid hormones, or levothyroxine.

But a person's thyroid hormone levels can fluctuate, especially due to life changes such as other illnesses, stress or pregnancy, so regular blood tests are mandatory to determine if medication doses need to be altered. In between those tests, a patient may become hypothyroid if they are not getting enough synthetic hormones, or even hyperthyroid if they are getting too much, and that condition causes a whole new list of health problems, including weight loss.

Several other celebrities have spoken openly after their own battle with Hashimoto's and other thyroid diseases.

Sipa via AP Images

1. Zoe Saldana: The 38-year-old Star Trek actress talked about her ailment in an interview with Net-a-Porter's earlier this year.

"You create antibodies that attack your glands, so you have to eat clean," she said.

Saldana maintains a strict diet, out of choice-both she and husband Marco Perego are gluten and dairy-free.

Tamarra/GC Images

2. Gina Rodriguez: " It's always been a battle for me with weight," the 32-year-old Jane the Virgin star told magazine in August. "Keeping weight off is very difficult because my metabolism is pretty much shot, which to me felt like a curse when I was 19. As an actress, I would say, 'Seriously? In a world that's so vain, I have to deal with the disease that makes you not keep weight off?'"

"But it actually became a blessing because then I got to represent not only women and Latinas but also women who are dealing with this disease," she added.

Rodriguez also told Health she maintains a gluten-free diet and exercises regularly.

"If I can at least walk for 20 minutes a day, it's extremely helpful for my thyroid gland," she said. "Running, boxing, jump rope and hitting the heavy bag are my workout constants."

Ben A. Pruchnie/Getty Images

3. Kim Cattrall: Sex and the City's Samantha Jones was diagnosed with Hashimoto's disease in 1998, the year the HBO show's first season aired.

"I'd always had a lot of energy but it dropped and I knew that something was off and I had some hair loss," the 60-year-old star told the U.K. newspaper The Express in 2012. "If your thyroid is out of whack, you're screwed, as it's your body's thermometer and you can't function. Now I'm on thyroxine and get my blood tested twice a year."

Cattrall also said she diets to maintain a healthy weight.

"My weight is my Stradivarius so I've got to be in tune with it," she added.

Stefanie Keenan

4. Brooke Burke-Charvet: The 45-year-old former Dancing With the Stars host made headlines in 2012 when she revealed she had thyroid cancer. She underwent surgery to remove her thyroid gland, which effectively made her hypothyroid, and is treated with medication.

However, before Burke-Charvet was diagnosed with cancer, she already had Hashimoto's disease.

"Being a woman devoted to living a healthy lifestyle with no health concerns other than chronic fatigue and Hashimoto's, I casually blew off my doctor's recommendation to get a thyroid ultrasound after he felt a lump in my neck during my routine physical," Burke-Charvet wrote on ModernMom.com.

Lisa Lake/Getty Images for Primark

5. Victoria Justice: The 23-year-old Nickelodeon actress was diagnosed with Hashimoto's disease several years ago.

"They had put me on this thyroid medication, and I think the levels were too high for me because it caused my skin to break out," Justice told magazine in 2015. "All my life I've always had great skin, so it was really devastating."

"Also, at first, I was losing a lot of weight, then I went on tour and I started gaining weight, and it was the most I'd ever gained in my life," added the actress, who is 5'5". "I was, like, 115 pounds. Then when I filmed a movie last summer, I actually went under 100 pounds. It was crazy, but things have leveled out, and I'm back to normal."

"I still have Hashimoto's," she added. "But my numbers are back to normal, and I'm not on medication. I feel good."

Steven Lawton/FilmMagic

6. Missy Elliott: The 45-year old famed rapper was in 2008 diagnosed with Graves' disease, an autoimmune disease characterized by hyperthyroidism, or overactivity of the thyroid gland.

The ailment caused her to lose weight and suffer from other side effects.

"It causes hair loss, your eyes bulge," Missy told . "My blood pressure was always up from just overworking."

The rapper takes medication to control the disease.

AKM-GSI

7. Molly Sims: The 43-year-old model's thyroid levels went haywire after she gave birth to her son Brooks in 2012. she suffered from post-partum thyroiditis, characterized by hyperthyroidism followed by hypothyroidism, as well as an enlarged thyroid gland.

Sims wrote on her website that she gained 65 pounds during her pregnant and that after welcoming her child and being given permission from her doctor to begin working out, she was unable to lose weight.

"For over three months I kept trying to lose weight to no avail," she wrote. "People kept telling me that this was normal, that I was overreacting, that this was all part of 'baby weight,' but something just wasn't sitting right with me. My neck was a thick as a football player. There was no way this was all due to pregnancy pounds."

Her doctor ordered an ultrasound, which revealed an enlarged thyroid with irregular growths. She underwent a biopsy, which thankfully came normal, and was put on thyroid medication.

"It worked!!!!!" she wrote. "I started dropping weight and feeling better almost instantly."

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Gigi Hadid Isn't Alone: 7 More Stars Who've Battled Thyroid Disease

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Getty Images for Reebok Like many celebrities, has often been body shamed online, despite having a figure that got her two Victoria's Secret Fashion Show gigs. Now, the 21-year-old model is speaking out about dealing with an autoimmune disease that could affect her weight: Hashimoto's disease.

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This video was created by Access Health as an informative feature story which gives a description of what thyroid diseases there are, how they originate, and how they affect people. It includes a personal perspective, personal testimonies, and intriguing facts about thyroid diseases.

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Where to find more information about Hashimoto's Disease

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Where to find more information about Hashimoto's Disease

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To find more information on Hashimoto's Disease, visit the link below. Womenshealth.gov is a government-run website which specializes in educating women on potential health risks.

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Hashimoto's disease, or Hashimoto's thyroiditis, is an autoimmune disease that damages the thyroid gland.

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This webpage gives a general overview for what Hashimoto's is, signs and symptoms, treatment methods, and potential contacts for patients seeking treatment.  This link is from the Mayo Clinic, a world-renowned research hospital.

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Overview

Hashimoto's disease is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's functions.

Inflammation from Hashimoto's disease, also known as chronic lymphocytic thyroiditis, often leads to an underactive thyroid gland (hypothyroidism). Hashimoto's disease is the most common cause of hypothyroidism. It primarily affects middle-aged women but can also occur in men and women of any age and in children.

Doctors test your thyroid function to help detect Hashimoto's disease. Treatment of Hashimoto's disease with thyroid hormone replacement usually is simple and effective.

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Symptoms

You might not notice signs or symptoms of Hashimoto's disease at first, or you may notice a swelling at the front of your throat (goiter). Hashimoto's disease typically progresses slowly over years and causes chronic thyroid damage, leading to a drop in thyroid hormone levels in your blood. The signs and symptoms are mainly those of an underactive thyroid gland (hypothyroidism).

Signs and symptoms of hypothyroidism include:

Fatigue and sluggishness

Increased sensitivity to cold

Constipation

Pale, dry skin

A puffy face

Brittle nails

Hair loss

Enlargement of the tongue

Unexplained weight gain

Muscle aches, tenderness and stiffness

Joint pain and stiffness

Muscle weakness

Excessive or prolonged menstrual bleeding

Depression

Memory lapses

When to see a doctor

See your doctor if you develop these signs and symptoms:

Tiredness for no apparent reason

Dry skin

Pale, puffy face

Constipation

You'll also need to see your doctor for periodic testing of your thyroid function if:

You've had thyroid surgery

You've had treatment with radioactive iodine or anti-thyroid medications

You've had radiation therapy to your head, neck or upper chest

If you have high blood cholesterol, talk to your doctor about whether hypothyroidism may be a cause.

And if you're receiving hormone therapy for hypothyroidism caused by Hashimoto's disease, schedule follow-up visits as often as your doctor recommends. It's important to make sure you're receiving the correct dose of medicine. Over time, the dose you need to adequately replace your thyroid function may change.

Causes

Hashimoto's disease is an autoimmune disorder in which your immune system creates antibodies that damage your thyroid gland. Doctors don't know what causes your immune system to attack your thyroid gland. Some scientists think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved.

A combination of factors - including heredity, sex and age - may determine your likelihood of developing the disorder.

Risk factors

These factors may contribute to your risk of developing Hashimoto's disease:

Sex. Women are much more likely to get Hashimoto's disease.

Age. Hashimoto's disease can occur at any age but more commonly occurs during middle age.

Heredity. You're at higher risk for Hashimoto's disease if others in your family have thyroid or other autoimmune diseases.

Other autoimmune disease. Having another autoimmune disease - such as rheumatoid arthritis, type 1 diabetes or lupus - increases your risk of developing Hashimoto's disease.

Radiation exposure. People exposed to excessive levels of environmental radiation are more prone to Hashimoto's disease.

Complications

Left untreated, an underactive thyroid gland (hypothyroidism) caused by Hashimoto's disease can lead to a number of health problems:

Goiter. Constant stimulation of your thyroid to release more hormones may cause the gland to become enlarged, a condition known as a goiter. Hypothyroidism is one of the most common causes of goiters. It's generally not uncomfortable, but a large goiter can affect your appearance and may interfere with swallowing or breathing.

Heart problems. Hashimoto's disease may also be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol - the "bad" cholesterol - can occur in people with an underactive thyroid gland (hypothyroidism). If left untreated, hypothyroidism can lead to an enlarged heart and, possibly, heart failure.

Mental health issues. Depression may occur early in Hashimoto's disease and may become more severe over time. Hashimoto's disease can also cause sexual desire (libido) to decrease in both men and women and can lead to slowed mental functioning.

Myxedema (miks-uh-DEE-muh). This rare, life-threatening condition can develop due to long-term severe hypothyroidism as a result of untreated Hashimoto's disease. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness.

A myxedema coma may be triggered by exposure to cold, sedatives, infection or other stress on your body. Myxedema requires immediate emergency medical treatment.

Birth defects. Babies born to women with untreated hypothyroidism due to Hashimoto's disease may have a higher risk of birth defects than do babies born to healthy mothers. Doctors have long known that these children are more prone to intellectual and developmental problems. There may be a link between hypothyroid pregnancies and birth defects, such as a cleft palate.

A connection also exists between hypothyroid pregnancies and heart, brain and kidney problems in infants. If you're planning to get pregnant or if you're in early pregnancy, be sure to have your thyroid level checked.

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Hashimoto's disease - Symptoms and causes

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Hashimoto's disease is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's functions.