Can Hashimoto's correct itself?

Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disease where the immune system attacks and destroys the thyroid gland. This results in hypothyroidism, or an underactive thyroid. Hashimoto’s is the most common cause of hypothyroidism in the United States. It typically develops slowly over years and is usually permanent once diagnosed. However, some people wonder if Hashimoto’s can correct itself or go into remission over time. Here is an overview of the key points:

Hashimoto’s is caused by autoantibodies attacking the thyroid. Autoantibodies are proteins made by the immune system that mistakenly target the body’s own healthy cells. In Hashimoto’s, three autoantibodies often found are thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), and TSH receptor antibodies (TRAb).
These autoantibodies lead to inflammation and damage of the thyroid gland. Over time, the thyroid is not able to produce enough thyroid hormone for the body’s needs.

Hashimoto’s usually continues to progress over many years. The thyroid damage from the autoimmune attack is generally permanent.
However, some people may experience temporary remissions where symptoms improve and thyroid hormone levels normalize for a period of time.
Achieving lasting remission of Hashimoto’s without treatment is very rare. But lifestyle changes and medications may help prolong periods of remission.

The key takeaway is that while complete reversal of Hashimoto’s is unlikely, temporary remissions are possible in some cases with proper management. Read on for more details.

What Causes Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis develops due to a combination of genetic and environmental factors leading to loss of tolerance of the thyroid by the immune system. This results in chronic inflammation and destruction of the thyroid gland.

Some of the main drivers of Hashimoto’s include:

Genetics: Hashimoto’s often runs in families. Certain genes are associated with increased risk.
Sex: Hashimoto’s is 5-10 times more common in women than men.
Age: Onset is typically between ages 30-50 but can occur at any age.

Pregnancy: The hormonal and immune changes of pregnancy can trigger or worsen Hashimoto’s.
Radiation exposure: Prior radiation treatment to the head, neck or chest area increases risk.
Viral infections: Viruses may spark the initial autoimmune reaction against the thyroid.

Other autoimmune diseases: People with type 1 diabetes, rheumatoid arthritis, celiac disease and other autoimmunes are at higher risk for Hashimoto’s.
Iodine deficiency/excess: Too much or too little iodine may promote Hashimoto’s in those already at risk.
Medications: Certain medications like lithium, interferon-alpha, and interleukin-2 may induce Hashimoto’s.

Toxins: High exposure to environmental toxins may be a potential trigger.

In those with a genetic predisposition, a combination of these environmental factors is thought to spark the malfunction in immune tolerance that underlies Hashimoto’s. This leads to chronic inflammation and damage of the thyroid gland.

The Autoimmune Process in Hashimoto’s Thyroiditis

Here is an overview of how the autoimmune attack unfolds in Hashimoto’s:

Genetic susceptibility and environmental triggers cause a malfunction in immune tolerance.
Inflammatory T-cells and B-cells infiltrate the thyroid gland and activate.
Activated B-cells produce thyroid autoantibodies like TPOAb, TgAb, and in some cases TRAb.

These autoantibodies bind to and mark thyroid proteins for attack.
The thyroid gland becomes inflamed and thyroid follicles are progressively damaged and destroyed.
This impairs the thyroid’s ability to produce hormones T3 and T4 which are needed to regulate metabolism.

The resulting hypothyroidism causes symptoms like fatigue, weight gain, hair loss and sensitivities to cold.
As thyroid function declines, TSH levels rise to compensate, eventually leading to goiter and thyroid enlargement.
Over time, thyroid hormone production continually decreases as more of the gland is damaged.

This chronic autoimmune attack on the thyroid occurs slowly, often over many years or even decades. The thyroid tries to regenerate itself, but eventually the damage outpaces repair and thyroid hormone levels drop below normal.

Are Remissions Possible in Hashimoto’s?

For most people, Hashimoto’s thyroiditis is a permanent condition. The immune system continues to attack the thyroid, which makes complete reversal of the disease very rare.

However, some people may experience periods of remission where symptoms improve, thyroid hormone levels normalize, and antibody levels decline. During remissions, thyroid function can sometimes return to normal for months or even years before Hashimoto’s flare ups again.

According to studies, remission rates for Hashimoto’s vary widely:

About 5-15% of people with Hashimoto’s go into remission at some point.
Remissions tend to be more common in children and adolescents than adults.

Partial remissions are more common than complete remissions.
Spontaneous remissions without treatment are rare at less than 5%.
With optimal treatment, remission may occur in 20-30% of patients.

Remissions typically last about 1 to 5 years on average.
Only 5-10% of patients experience sustained long-term remission.

Research shows that a number of factors can influence chances of remission in Hashimoto’s:

Age – Younger people are more likely to experience remission.
Antibody levels – Lower antibody levels indicate higher remission rates.
Thyroid hormone levels – People with mild thyroid dysfunction are more likely to improve than those with severe low thyroid.

Treatment – Certain medications and supplements may prolong remissions.
Triggers – Avoiding triggers like pregnancy and medications can help maintain remission.
Lifestyle factors – A healthy diet, stress reduction, exercise, and good sleep hygiene make remission more likely.

So while achieving complete reversal of Hashimoto’s without treatment is unlikely, temporary remissions are possible, especially with the right interventions.

Can Lifestyle Changes Improve Hashimoto’s?

Making positive lifestyle modifications can help some people with Hashimoto’s prolong remissions and minimize thyroid antibody flares:

Follow a Hashimoto’s diet: An anti-inflammatory diet high in nutrient-dense whole foods may help lower antibodies. Key diet tips include:

Choose high fiber fruits, vegetables, legumes, nuts and seeds.
Eat quality proteins like fatty fish, eggs, bone broth.
Avoid processed foods, sugars, unhealthy fats.

Eliminate Hashimoto’s food triggers like gluten, dairy and soy if needed.
Optimize vitamin D, omega-3s, selenium and zinc.
Stay hydrated with clean filtered water.

Reduce stress: Chronic stress raises inflammation and autoimmunity. Consider daily meditation, yoga, breathing exercises, nature time and other stress-busters.

Exercise regularly: Daily low-intensity workouts like walking, swimming, tai chi and Pilates can lower antibody levels. Avoid overtraining.

Improve sleep habits: Getting 7-9 hours nightly, sticking to a schedule, limiting blue light exposure at night, and creating a relaxing bedtime routine enhances thyroid health.

Avoid triggers: Steer clear of potential triggers like smoking, infections, toxins, high iodine intake, immune-altering drugs, pregnancy and stress when possible.

While lifestyle strategies alone are unlikely to send Hashimoto’s into complete remission, they can be helpful complementary therapies to prolong symptom-free periods.

Can Hashimoto’s Be Reversed with Medication?

Standard medical treatment for Hashimoto’s focuses on hormone replacement with levothyroxine (Synthroid, Levoxyl). This helps relieve hypothyroid symptoms but does not stop the immune attack on the thyroid.

However, some emerging medical therapies show promise for better controlling autoimmunity and helping induce remission in Hashimoto’s:

Thyroid hormone optimization: Carefully adjusting levo dose based on symptoms and labs may help some patients achieve remission. Combination T4/T3 therapy is also emerging.

Low dose naltrexone (LDN): This off-label drug boosts endorphins and may regulate the immune system. Small trials on LDN are promising for Hashimoto’s remission.

Selenium: This essential mineral is important for thyroid hormone synthesis and immune regulation. Selenium supplementation may help lower antibodies.

Vitamin D: Optimizing vitamin D levels to between 60-80 ng/mL may enhance immune tolerance and induce remission in some cases.

Immunosuppressants: Medications like low-dose methotrexate, cyclosporine, and biological agents may induce remission in treatment-refractory cases, but with significant side effects.

Intravenous immunoglobulin (IVIG): This therapy uses antibodies from healthy donors to modulate the immune system and has shown promise in small Hashimoto’s studies.

Plasmapheresis: This blood filtration technique removes antibodies and may temporarily lower antibody levels, but benefits are often not sustained long-term.

Thymectomy: Removing the thymus gland has been shown to induce remission in about one-third of people with Graves’ disease (hyperthyroid autoimmune disorder). It has not been studied extensively in Hashimoto’s yet.

Research into reversing Hashimoto’s clinically is an emerging area. While current conventional treatments only replace hormones, future therapies hold hope for definitively halting the autoimmune attack on the thyroid.

Should Thyroid Antibodies Be Monitored in Hashimoto’s?

While some degree of thyroid autoimmunity likely remains even in remission, checking TPOAb and TgAb levels can be useful for assessing disease activity and response to treatment in Hashimoto’s:

Diagnosis: High TPOAb or TgAb confirms a diagnosis of Hashimoto’s. Levels over 100 IU/ml are considered positive.

Disease monitoring: Declining antibody levels are a sign that inflammation is decreasing and remission may occur. Rising levels indicate a flare up.

Predicting hypothyroidism: High and rising antibodies signal future risk of progressing from subclinical to overt hypothyroidism.

Treatment outcomes: Lowering antibodies, especially to the normal range, is an indicator that lifestyle interventions or medications are working.

Remission tracking: Very low/undetectable antibodies increase likelihood remission will be sustained long-term.

Recurrence monitoring: Rising antibodies after a period of remission indicate the disease is flaring up again.

Here are some general guidelines for optimal TPOAb and TgAb levels to aim for in Hashimoto’s:

Normal: Under 20-40 IU/ml
Mild: 40-100 IU/ml
Moderate: 100-200 IU/ml

High: Over 200 IU/ml

Regularly testing antibodies in Hashimoto’s provides key data to guide prognosis and determine whether lifestyle and medical management is working to calm the autoimmune attack on the thyroid.

What is the Prognosis for Hashimoto’s Thyroiditis?

The prognosis for Hashimoto’s depends on individual factors, but some generalizations can be made:

Most patients eventually develop permanent hypothyroidism requiring lifelong thyroid hormone replacement.
The rate of thyroid function decline varies widely – for some it happens quickly while others maintain normal thyroid levels for decades.
Symptoms also vary – some patients have mild issues while others have more severe quality of life impairment.

Around 5-15% of patients go into remission at some point, but it is rarely permanent without ongoing management.
Thyroid enlargement with goiter affects about 40% of people with Hashimoto’s.
There is an increased risk of developing other autoimmune diseases where the body attacks itself.

Subclinical hypothyroidism increases the risk of developing heart disease, depression, and cholesterol abnormalities if not treated.
Overt hypothyroidism can lead to heart failure, peripheral neuropathy, infertility, and joint pain if not controlled with thyroid hormone replacement.
Extended untreated hypothyroidism can lead to myxedema coma, a rare but life-threatening condition.

With early detection and proper treatment, most patients with Hashimoto’s live normal healthy lives.

The overall outlook for Hashimoto’s is good with proper management. Achieving remission can be challenging but is possible in some cases with a multifaceted approach and close monitoring.

The Takeaway

Hashimoto’s thyroiditis is an autoimmune condition that often continues to progress over the long-term. The immune-mediated destruction of the thyroid causes inflammation, hypothyroidism, and eventual thyroid gland failure.

Complete reversal of Hashimoto’s without treatment is very rare. However, temporary remissions are possible where thyroid function and symptoms can improve or normalize for months or even years.

Lifestyle factors like diet, stress reduction, exercise, sleep and trigger avoidance can help prolong periods of remission. Certain emerging medical therapies also show promise for suppressing autoimmunity and restoring thyroid function in some patients.

While remission provides a respite from symptoms and offers hope, most patients require lifelong thyroid hormone replacement therapy. Close monitoring and individualized treatment is key to optimizing outcomes and quality of life.

In summary, remission provides a glimpse of how positive it would be to definitively correct Hashimoto’s disease. Until regenerative therapies can repair and regrow a damaged thyroid, the next best approach is early diagnosis, lifestyle optimization, supported medical management and vigilance for sustained wellness and remission.