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Crohn’s disease and Hashimoto’s thyroiditis are complex conditions that have garnered significant attention from researchers. While they are two distinct conditions, they both affect the immune system, and the interplay between them presents an intriguing area of interest for patients and researchers. If you live with Crohn’s or Hashimoto’s, or you have both, you may wonder if there is a connection between them. Ahead, we’ll explore the relationship between Crohn’s disease and Hashimoto’s. 

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Hashimoto’s is an autoimmune thyroid disease. With autoimmune diseases, the immune system mistakenly attacks a gland, tissue, organ, or cells. In Hashimoto’s, the target is the thyroid gland; over time, the attack leads to chronic inflammation and damage to the gland. This damage usually results in an underactive thyroid, also known as hypothyroidism.

Symptoms of Hashimoto’s can be different for everyone, but the common ones include:

• Fatigue
• Weight gain
• Cold intolerance
• Depression
• Hair loss
• Dry skin
• Constipation

To diagnose Hashimoto’s, your healthcare provider will order lab tests. Those with Hashimoto’s will almost always have elevated thyroid antibodies evident on blood tests. If Hashimoto’s has caused hypothyroidism, then thyroid function biomarkers such as thyroid stimulating hormone (TSH), free thyroxine (Free T4), and free triiodothyronine (Free T3) will also be abnormal. Some healthcare providers may also order an ultrasound of your thyroid to detect changes in the cells.

Treatment focuses on increasing thyroid hormone levels. Generally, this involves taking a thyroid hormone replacement medication like levothyroxine.

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Crohn’s disease is one of two disorders known as inflammatory bowel disease (IBD); the other is ulcerative colitis. Crohn’s disease causes severe inflammation of the lining of the gastrointestinal (GI) tract. This inflammation can occur anywhere along the digestive tract. However, the small intestine and the beginning of the large intestine (colon) are the most commonly affected sites.

Crohn’s disease causes a variety of symptoms including:

Abdominal pain and cramping

One of the hallmark symptoms of Crohn’s disease is frequent and intense abdominal pain and cramping. This pain is often caused by inflammation in the digestive tract, ranging from mild to severe. It may also occur in different areas of the abdomen, depending on the location of the inflammation. Managing this pain involves medications prescribed by a healthcare professional and adopting lifestyle changes, such as stress reduction and dietary modifications.

Diarrhea

Chronic diarrhea is another common symptom of Crohn’s disease. This occurs when the inflammation disrupts the normal functioning of the intestines, leading to loose and frequent bowel movements. In some cases, blood or mucus may also be present in the stool, or rectal bleeding may be seen. 

Fatigue and weakness

Crohn’s disease can cause extreme fatigue and a general feeling of weakness. The inflammation and malabsorption of nutrients in the digestive tract can contribute to this persistent fatigue. Adequate rest, regular exercise, and a balanced diet can help combat these symptoms. 

Unintentional weight loss

Many individuals with Crohn’s disease experience significant weight loss without intentional dieting or exercise. This weight loss can result from a reduced appetite, malabsorption, increased nutrient loss, or metabolic changes associated with chronic inflammation. 

Joint pain and inflammation

Crohn’s disease is not limited to the digestive system, as it can affect other body parts, including joints. Joint pain, stiffness, and swelling, similar to arthritis symptoms, are common in some individuals with this condition. Exercise, physical therapy, and medications can help alleviate joint discomfort and improve mobility.

Skin problems

Individuals with Crohn’s disease may experience various skin complications, including ulcers, rashes, and painful sores. These skin manifestations are often a result of inflammation and are typically found near the affected digestive tract. Regular monitoring and consultation with a dermatologist can help manage these symptoms effectively.

It’s crucial to note that the severity and combination of symptoms can vary greatly among individuals with Crohn’s disease. Additionally, some individuals may experience periods of remission where symptoms improve or disappear temporarily.

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When you visit a healthcare provider, they will begin by taking your medical history and asking questions about your symptoms. It is essential to provide accurate information about the duration and severity of your symptoms and any previous medical conditions or family history of digestive disorders. Following this, a physical examination will assess your overall health and check for any visible signs of inflammation in the abdominal area.

To confirm a diagnosis of Crohn’s disease, your healthcare provider will likely recommend specific diagnostic tests. These tests can help identify the presence of inflammation, evaluate the extent and severity of the disease, and rule out other possible conditions. Some standard tests include:

• Blood tests: Blood tests can help determine inflammation markers, check for anemia, assess liver function, and measure nutrient deficiencies.
• Stool tests: Stool samples may be analyzed to check for infection or blood in the stool, which can indicate Crohn’s disease.
• Imaging tests: X-rays, ultrasounds, CT scans, or MRIs may be used to visualize the digestive tract and identify abnormalities or inflammation.
• Endoscopy and biopsy: A flexible tube with a camera called an endoscope may be inserted into the digestive tract to visualize and assess the affected areas directly. Biopsy samples may also be taken during this procedure to examine under a microscope for specific signs of Crohn’s disease.

Crohn’s disease can be challenging to diagnose as its symptoms can resemble other digestive disorders, such as ulcerative colitis or irritable bowel syndrome (IBS). Therefore, your healthcare provider may need to rule out other conditions through additional tests, allowing for a more accurate diagnosis.

In complex cases or for further evaluation, your healthcare provider may refer you to a gastroenterologist—a specialist in digestive disorders. A gastroenterologist will review your medical history, perform a physical examination, and possibly order additional tests to confirm the diagnosis and develop an appropriate treatment plan.

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While there is currently no cure for Crohn’s disease, various treatment options can help manage the symptoms and improve overall well-being. Let’s delve into the different approaches to treating this chronic condition.

Medications

The primary course of action for managing Crohn’s disease involves medication. The prescribed medicine depends on the disease’s severity, the inflammation’s location within the digestive tract, and the individual’s response to previous treatments. Anti-inflammatory drugs, such as corticosteroids and aminosalicylates, may be prescribed to reduce inflammation and alleviate symptoms. Immunosuppressant drugs, such as azathioprine and methotrexate, can help to suppress the immune system and prevent further inflammation. Biologic therapies, such as infliximab and adalimumab, target specific proteins in the immune system to reduce inflammation. These medications can have potential side effects, so working closely with a healthcare professional to monitor their effectiveness and address any concerns is essential.

Dietary changes

While no specific diet can cure Crohn’s disease, certain dietary modifications can help manage symptoms and reduce inflammation. Working with a registered dietitian or nutritionist specializing in gastrointestinal disorders is crucial to developing an individualized plan. Some individuals may find relief by avoiding trigger foods like dairy, high-fiber foods, and spicy foods. Others may benefit from a low-residue diet, which limits foods that are harder to digest. In severe cases, a liquid or elemental diet, which provides essential nutrients in pre-digested forms, may be recommended to rest the intestines and promote healing.

Lifestyle changes

Alongside medical treatment and dietary changes, certain lifestyle modifications can positively impact the management of Crohn’s disease. Stress management techniques, such as meditation, yoga, or counseling, can help reduce stress levels, which have been known to trigger flare-ups. Regular exercise is also essential, as it can improve digestion, reduce inflammation, and boost overall well-being. It’s crucial to consult your healthcare provider before starting any exercise regimen to ensure it’s appropriate for your condition.

Surgery

In some cases, medication and lifestyle modifications may not provide sufficient relief, and surgical intervention may be necessary. Surgery can involve removing the affected portion of the digestive tract, repairing damaged areas, or correcting complications such as strictures or fistulas. It’s important to note that surgery does not cure Crohn’s disease, but it can provide symptom relief and improve overall quality of life.

Alternative therapies

In addition to conventional medical treatments, some individuals explore alternative therapies to complement their Crohn’s disease management. These therapies can include acupuncture, herbal remedies, probiotics, and mind-body techniques like hypnotherapy. While some individuals report finding relief from these treatments, it’s essential to approach them cautiously and consult a healthcare provider before incorporating them into your treatment plan.

Living with Crohn’s disease can be challenging, but with the right treatment plan, you can effectively manage symptoms and enjoy a good quality of life. By working closely with healthcare professionals, making necessary lifestyle changes, and exploring all available treatment options, people with Crohn’s disease can find relief and achieve long-term well-being. Remember, everyone’s journey with Crohn’s disease is unique, so it’s crucial to have a personalized approach that addresses your specific needs.

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Research suggests there is a higher prevalence of thyroid disorders among individuals with Crohn’s disease compared to the general population. But, not all evidence supports this.

An older study included in a 2016 literature review found that 0.5% of people with Crohn’s disease had hypothyroidism. Yet, the prevalence of hypothyroidism among those without Crohn’s disease was higher at 0.7%. A more recent study from 2013, also part of the literature review, showed a much higher prevalence, 2.3%, of hypothyroidism in those with Crohn’s disease compared to previous studies.

Interestingly, a recent study involving pediatric participants with Crohn’s disease found that the medication infliximab (Remicade), commonly used for treating Crohn’s disease, may protect against the development of Hashimoto’s. This finding supports the role of gut inflammation in Crohn’s disease in developing Hashimoto’s.

Researchers also found that in more than 70% of cases, Crohn’s disease was diagnosed before Hashimoto’s. The time between the diagnoses ranged from no time gap to 27 years. And the general age range for being diagnosed with both was 10 to 55 years.

While the relationship between Hashimoto’s and Crohn’s disease remains unclear, they do share factors that influence their development. Let’s take a look at three of these factors.

Shared genetic risk factor

As mentioned, both Hashimoto’s and Crohn’s disease involve an overactive immune response. But why this occurs remains a mystery. In both medical conditions, genes appear to play a role.

Generally, those with an autoimmune disorder often have a first-degree family member who also has an autoimmune condition. For instance, in the case of Crohn’s disease, 1 in 5 individuals with the condition also have a family member affected by it.

And research has told us that having one autoimmune disorder puts you at risk for developing others. For example, individuals with Hashimoto’s are likely also to have rheumatoid arthritis.

Gut health

In the gut, a collection of good and bad bacteria is known as your gut microbiota. Your gut microbiota helps with digestive processes and even affects your immune system. When the balance of good and bad bacteria is thrown off, your body function may be negatively impacted.

In Crohn’s disease, the gut microbiota influences the degree of inflammation seen in the GI tract. If left unchecked, inflammation can lead to irreversible tissue damage and may contribute to a syndrome known as leaky gut.

A leaky gut is when toxins leak through the lining of the GI tract and enter the body. Experts hypothesize these toxins contribute to inflammation and damage throughout the body. This widespread inflammation can impact various organs and glands. As a result, those with a leaky gut are at a higher risk of developing autoimmune disorders, including Hashimoto’s.

You don’t have to have Crohn’s disease to have a leaky gut. Other causes of leaky gut include environmental contaminants, unhealthy food choices, and medications.

Absorption concerns

Chronic intestinal inflammation alters nutrient absorption. Because of this, those with Crohn’s disease are often deficient in specific vitamins and minerals, like iodine and selenium. Some of these nutrients are essential for thyroid hormone production.

For instance, iodine is essential for producing thyroid hormones thyroxine (T4) and triiodothyronine (T3). An iodine deficiency can lead to thyroid dysfunction by lowering the amount of thyroid hormone available to the cells.

Oxidative stress

Experts believe that oxidative stress can influence the development of autoimmune disorders like Hashimoto’s and Crohn’s disease.

Oxidative stress is an imbalance between harmful free radicals and antioxidants, which help neutralize free radical’s harmful effects. As a result, tissue damage occurs, causing further inflammation. Inflammation increases the production of free radicals, contributing to ongoing oxidative stress. Damage from oxidative stress isn’t limited to one area of the body. So, over time, oxidative stress can harm different areas.

Selenium is a powerful antioxidant essential for converting thyroid hormone from the inactive form (T4) to its active form (T3). Unfortunately, those with Crohn’s disease are often deficient in it, usually due to absorption issues. So, not only does a selenium deficiency influence oxidative stress, but it also can contribute to thyroid hormone deficiency.

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Thyroid cancer appears to be more prevalent in those with IBD, according to a 2016 study. Individuals with Crohn’s disease are 2.3 times more likely to develop thyroid cancer compared to individuals with diverticulitis or ulcerative colitis. Diverticulitis is not an IBD, even though it causes inflammation in the GI tract. The GI tract has small pouches called diverticula, and when they become inflamed, one develops diverticulitis.

Researchers aren’t entirely clear why those with Crohn’s disease have a greater chance of developing thyroid cancer. The inflammatory response observed in Crohn’s disease may play a role in the development of thyroid cancer through various factors, including:

• Genetic alterations
• High multivitamin intake
• Radiation exposure, especially at a young age
• Taking certain immunosuppressant medications, such as azathioprine and 6-mercaptopurine

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While the connection between Hashimoto’s and Crohn’s disease is still under debate, research suggests there may be a higher prevalence of thyroid disorders in those with Crohn’s disease. Both health conditions involve an overactive immune response and chronic inflammation.

If you live with one of these medical conditions or both, there are ways to manage them effectively. Besides medications, which differ for each condition, here are other ways to manage your health conditions:

• Check thyroid hormone levels to ensure they are within an optimal range.
• Take medications as prescribed by your healthcare provider.
• Follow an autoimmune-friendly diet, such as the autoimmune protocol.
• Manage stress to limit flare-ups.

The management of both Crohn’s disease and Hashimoto’s often involves working with different specialists. But did you know that teaming up with a registered nutritionist can also be beneficial? A registered nutritionist can provide valuable insight into the dietary needs of those with an autoimmune disorder. They can help you pinpoint food triggers while ensuring you get the optimal nutrients to support your health. Set up a free consultation with one of Paloma Health’s nutritionists today.

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