Autoimmune Thyroid Disease and Polyautoimmunity 

A primary tenant of Functional Medicine is that all body systems are interconnected.

This concept is always essential to consider but is highlighted in autoimmune disease and the relationship between autoimmune thyroid disease and other autoimmune conditions.  

Conventional medicine addresses autoimmunity by the part of the body that is affected.

You will likely go to an endocrinologist for management of your thyroid health. If you have celiac disease, you might be treated by a gastroenterologist or by a rheumatologist for rheumatoid arthritis.  

Despite the different body parts being affected, all autoimmune diseases are ultimately dysfunction of the immune system that shows differently.

Autoimmune disease arises from a complex interaction between genetics and the environment.   

Functional Medicine is uniquely poised to support autoimmune patients from a root cause and immune system perspective. By addressing the underlying and environmental factors, you may be able to prevent or effectively address polyautoimmunity, the concurrence of multiple autoimmune diseases.   

Keep reading to get answers to these questions and more: 

  • What are autoimmune thyroid diseases? 
  • What is polyautoimmunity? 
  • What is the connection between autoimmune thyroid disease and other autoimmune diseases? 
  • What are some tangible action steps to consider for prevention?  

 Autoimmune Thyroid Disease 

 Autoimmune thyroid diseases include a spectrum of diseases affecting the thyroid, including: 

  • Hashimoto’s thyroiditis 
  • Graves’ disease 
  • Subacute thyroiditis 
  • Primary myxedema 
  • Graves’ orbitopathy 

Autoimmune thyroid diseases affect approximately 5% of the general population and are the most common autoimmune diseases in Western countries.

Hashimoto’s thyroiditis and Graves’ disease are more common than the others listed here, affect more women than men, and have peak rates in adulthood. Hashimoto’s is autoimmune hypothyroidism characterized by low thyroid hormone production.

Since thyroid hormone affects all cells in the body, low thyroid hormone means a slowing down of metabolism.

Symptoms include: 

  • Constipation 
  • Weight gain 
  • Cold hands and feet 
  • Fatigue 
  • Dry skin 
  • Hair loss 
  • Depression 

Graves’ disease is autoimmune hyperthyroidism, characterized by an overactive thyroid and excessive thyroid hormone production.

Symptoms of Graves’ are associated with an acceleration of metabolism and include:  

  • Anxiety and irritability 
  • Weight loss 
  • Rapid heartbeat 
  • Increased appetite 
  • Goiter (enlargement of the thyroid gland) 

While more common in adults, Graves’ disease and Hashimoto’s are the most common thyroid issues observed in kids and may occur in association with genetic syndromes.  

In autoimmune thyroid disease, immune cells, primarily T and B lymphocytes, in the thyroid react against thyroid tissues and produce thyroid autoantibodies. This immune dysfunction damages the thyroid gland and increases inflammation throughout the body.  

Primary thyroid autoantibodies include: 

  • Thyroid peroxidase (TPO) antibodies 
  • Thyroglobulin (TG) antibodies 
  • Thyroid-stimulating hormone receptor antibodies 

We all naturally have low levels of autoantibodies that may play a role in clearing aging cells and in anti-inflammatory processes. In autoimmune disease, autoantibodies attack healthy tissues. 

All autoimmune diseases occur because of an interaction between genetics and the environment, leading to a loss of self-tolerance (increased autoantibodies) and increased inflammation. These are multifactorial diseases and likely have many root causes.  

Environmental factors that play a role in autoimmunity include:  

  • Bacterial infections 
  • Viral infections 
  • Cigarette smoking 
  • Maternal-fetal microchimerism – fetal cells in the mother’s blood 
  • Toxin exposures – including flame retardants and phthalates 
  • Radiation 
  • Medication use 
  • Stress 

Polyautoimmunity and Autoimmune Thyroid Disease 

When you have one autoimmune disease, you have a greater chance of developing a second.

Polyautoimmunity is two or more autoimmune diseases in the same patient.  

Autoimmunity and polyautoimmunity may increase the risk of cardiovascular disease because of increased inflammation. In addition, fertility issues, worsened pregnancy outcomes, and miscarriage risk increase due to autoimmune factors.  

Hashimoto’s thyroiditis and Graves’ disease are the most frequent autoimmune diseases in polyautoimmunity.  

Autoimmune thyroid diseases may concur with the following autoimmune diseases: 

  • Systemic lupus erythematosus 
  • Rheumatoid arthritis
  • Systemic sclerosis
  • Multiple sclerosis 
  • Sjogren’s syndrome 
  • Type 1 diabetes 
  • Autoimmune liver disease 
  • Primary biliary cirrhosis  
  • Myasthenia gravis 
  • Pernicious anemia 
  • Adrenal disease (Addison’s disease and Cushing’s syndrome) 
  • Alopecia areata 
  • Vitiligo 
  • Celiac disease 
  • Connective tissue disease 

Autoimmune Thyroid Disease, Type 1 Diabetes, and Celiac Disease 

Type 1 diabetes is an autoimmune disease affecting the beta cells in the pancreas that produce insulin. With insufficient insulin, patients require exogenous insulin to manage blood sugar.  

The risks of patients with type 1 diabetes also having autoimmune thyroid disease are six times higher in males and four times higher in females. Although women have higher rates of autoimmune disease in general, men may have a higher likelihood of polyautoimmunity.  

Autoimmune thyroid disease and type 1 diabetes are the two most common autoimmune diseases worldwide. Both are endocrine disorders. These diseases can cluster in individuals and families because both share a common genetic predisposition.  

In a study of 500 people with autoimmune thyroid disease (130 with Graves’ and 370 with Hashimoto’s), the frequency of polyautoimmunity was 18.5% in Graves’ patients and 27.8% in those with Hashimoto’s.

The most common concurring autoimmune diseases were Type 1 diabetes and celiac disease.  

Celiac disease is an autoimmune disease that affects the small intestine and nutrient absorption. It is triggered by gluten, the protein component in wheat, spelt, rye, and other gluten-containing grains.  

Autoimmune thyroid disease and celiac share underlying genetic predispositions. Malabsorption due to celiac disease may influence levels of key thyroid nutrients including iodine and selenium. In addition, specific antibodies affect both tissues. 

A gluten-free diet is a critical intervention for people with celiac disease, but it may also be helpful in autoimmune thyroid disease, type 1 diabetes, and other autoimmune diseases.

The scientific literature on gluten-free diets outside of celiac disease suggests that more evidence is needed, but clinically gluten-free diets are very supportive. Some research suggests that a gluten-free diet slows the progression of autoimmune thyroid disease.  

Polyautoimmunity Action Steps  

Because of the multifactorial nature of autoimmune disease, working with a Functional Medicine provider, along with your specialist, is advised. Your Functional Medicine doctor will work with you to understand your unique root causes and triggers and put together a personalized healing protocol.  

Here are some tips and tools to consider: 

Ask for a full thyroid panel. Most doctors will only order TSH (thyroid stimulating hormone) or possibly TSH and T4 (thyroxine). However, just looking at these labs may not provide the whole picture and may miss autoimmunity in its early stages when antibodies begin to become elevated. 

Instead, you want to request a full thyroid panel and work with someone skilled at interpreting the results.

The Every Life Well Thyroid Panel includes: 

  • TSH
  • Free T3 
  • Free T4 
  • TPO antibodies 
  • Thyroglobulin antibodies 

Screen for polyautoimmunity. If you already have an autoimmune disease, ask your provider to screen for autoimmune diseases with similar genetic markers. For example, if you have type 1 diabetes or celiac, ensure regular thyroid screenings. If you have Hashimoto’s thyroiditis, for example, celiac screening is advised.  

Polyautoimmunity needs to be on our radars and screened for frequently.  

Heads up during hormonal transitions. Pay attention to thyroid health during puberty, postpartum, and perimenopause. Since autoimmune diseases and autoimmune thyroid diseases are more common among women, they may be triggered by stress or hormone changes during these times of transition.

Know your family history. Autoimmune diseases run in families because of shared genetics and often shared environmental factors. Know your individual risk and take appropriate measures for prevention. For example, if autoimmune thyroid disease or celiac disease run in your family, adopting a gluten-free diet (or better yet, a Paleo diet) may support prevention.

Avoid environmental triggers. We can’t control everything, but there are some things that we can do to minimize triggers. Examples include avoiding foods you are sensitive to and reducing toxins by simple measures such as filtering your water and eating organic food.  

In addition, reduce stress by balancing blood sugar, prioritizing sleep, and meditation.  

Use Functional Medicine to heal autoimmune thyroid conditions. Address root causes and triggers. This work is highly individual so be sure to work closely with your provider. You can monitor changes in thyroid hormone levels and symptoms as you try different interventions.

Here are some we focus on in our clinic: 

  • Identify food sensitivities. We’ve already discussed how a gluten-free diet can be beneficial, but many people with thyroid conditions will also benefit from going dairy-free and Paleo. In addition, further personalize the diet by avoiding any individual triggers. Corn, nightshade vegetables, and eggs are some we see commonly.
  • Heal the gut. The gut microbiome affects the thyroid and immune system. There are typically imbalances in the gut found in autoimmunity. Through advanced testing, we can identify pathogens and imbalances in the microbiome, along with digestive health, inflammation, and immune function. Diet change, targeted supplements, and lifestyle strategies help to restore balance.
  • Support detoxification. Those with autoimmune thyroid diseases may have certain genetic variations that make detoxification more challenging. In addition to avoiding toxins in the first place, extra support for detoxification pathways may be required for thyroid healing. Again, this is very individual, but you can learn helpful strategies here.  

Autoimmune thyroid disorders are common and increase the risks of developing additional autoimmune conditions.

Polyautoimmunity may be explained by some of the shared genetic and environmental risk factors in autoimmunity.

A root cause, Functional Medicine approach works to uncover contributing factors and provide personalized support and care to prevent, treat, and in some cases, even reverse autoimmune disease.  

 References