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Hashimoto’s thyroiditis, an autoimmune condition, is the primary cause of hypothyroidism. This disease causes your immune system to attack your thyroid, causing gradual damage and often resulting in hypothyroidism, with low thyroid hormone production. Hypothyroidism, in turn, impacts various systems in the body, including your gastrointestinal (GI) tract. Patients with Hashimoto’s and hypothyroidism frequently experience GI symptoms, ranging from mild discomfort to severe digestive issues that interfere with daily life. This article explores the complex relationship between Hashimoto’s, hypothyroidism, and GI health, covering common symptoms, underlying mechanisms, overlapping conditions, and effective ways to manage these GI symptoms.
Hashimoto’s thyroiditis is an autoimmune disease in which your immune system mistakenly attacks your thyroid gland. This chronic inflammation gradually impairs the thyroid’s ability to produce hormones, often progressing to hypothyroidism. In Hashimoto’s, the immune system targets thyroid cells, leading to the formation of thyroid antibodies that destroy thyroid tissue over time. As this damage continues, thyroid hormone levels decrease, leading to various metabolic and physical symptoms.
Your thyroid gland produces hormones, primarily thyroxine (T4) and triiodothyronine (T3), crucial metabolism regulators. These hormones control numerous bodily functions, from heart rate and temperature regulation to digestive processes and GI motility. Low thyroid hormone levels disrupt the thyroid-gut axis and normal functioning of the GI system, leading to symptoms like slowed digestion and altered nutrient absorption. Understanding the role of thyroid hormones is vital to recognizing how their deficiency can influence your digestive health and symptoms.
Hashimoto’s disease and the condition it usually causes – hypothyroidism -- can lead to a variety of gastrointestinal issues. The reduced production of thyroid hormones affects the motility and function of the digestive tract, resulting in several characteristic symptoms. Understanding these gastrointestinal symptoms is crucial for proper management of Hashimoto’s disease and hypothyroidism. It’s important to note that while these symptoms are common, they can also indicate other gastrointestinal disorders. Therefore, a comprehensive evaluation by a healthcare provider is always essential for accurate diagnosis and appropriate treatment.
Constipation
Constipation is one of the most common gastrointestinal symptoms of hypothyroidism. The slowed metabolism and reduced gut motility can lead to infrequent bowel movements, hard stools, and difficulty passing them. Research has found that around 15% of hypothyroid patients have fewer than three bowel movements weekly, and various studies show that constipation affects up to 30 to 40% of patients with hypothyroidism.
Bloating
Patients with Hashimoto’s and hypothyroidism often experience stomach bloating. They frequently report feeling full or swollen in the abdominal area, even without consuming large meals. This occurs because thyroid hormones regulate digestion, and gastric emptying and intestinal motility are reduced when thyroid levels are low. As a result, food lingers in the digestive tract longer, which can lead to the overgrowth of intestinal bacteria and the accumulation of gas. This leads to abdominal distension and bloating. Additionally, thyroid hormones affect stomach acid production and digestive enzymes. Insufficient levels of these substances may result in incomplete digestion, also leading to gas and bloating.
Acid reflux
Acid reflux, also known as gastroesophageal reflux disease (GERD), is frequently reported by people with Hashimoto’s and hypothyroidism. The lower esophageal sphincter may not function properly due to hormonal imbalances, allowing stomach acid to flow back into the esophagus. This can cause heartburn, chest pain, and difficulty swallowing.
Abdominal pain
Stomach pain is a less specific but still common symptom in Hashimoto’s and hypothyroidism. It’s typically related to the slowed digestive process, increased bacterial growth in the gut, or associated conditions like constipation, celiac disease, or gastritis. The pain can range from mild discomfort to more severe cramping, depending on the underlying cause and the severity of the thyroid dysfunction.
Diarrhea
While constipation is more common, some patients with Hashimoto’s and hypothyroidism experience diarrhea. This is mainly the result of increased bacterial growth secondary to bowel hypomotility. In some cases, it may also be related to associated autoimmune conditions or malabsorption issues in the gastrointestinal tract. It’s important to note that while diarrhea is more commonly associated with hyperthyroidism, it can occur in hypothyroid states as well.
Nausea
Nausea in Hashimoto’s and hypothyroidism can be attributed to the overall slowing of the digestive process. Delays in gastric emptying and reduced intestinal motility can lead to feelings of fullness and discomfort in the stomach, resulting in nausea. This symptom may be particularly noticeable after eating.
Dysphagia (difficulty swallowing)
Dysphagia, or difficulty swallowing, can be an uncommon but significant symptom of Hashimoto’s thyroiditis and hypothyroidism. In these conditions, dysphagia may occur due to several mechanisms. The thyroid gland can enlarge (goiter), directly compressing the esophagus and causing an obstruction. Additionally, hypothyroidism can lead to an enlarged tongue, known as macroglossia, and swelling of the larynx, further contributing to swallowing difficulties. In some cases, the myopathy associated with thyroid dysfunction can affect the muscles involved in swallowing.
Reduced appetite
Hypothyroidism and Hashimoto’s thyroiditis patients may experience a reduced appetite. This can be due to the slowing of metabolic processes, including digestion. However, weight gain may still occur – despite reduced appetite – due to fluid retention and slowed metabolism.
Malabsorption
Hypothyroidism can lead to malabsorption of certain nutrients. While the total quantity of nutrients absorbed may be normal or even increased due to extended bowel transit time, the absorption of specific substances may be decreased. This can lead to deficiencies in vitamins and minerals if not adequately addressed.
The presence of other gastrointestinal disorders can complicate the picture. The following conditions are more common in people with Hashimoto’s and hypothyroidism and can exacerbate GI symptoms or make them more resistant to treatment.
Autoimmune gastritis
Autoimmune gastritis is a chronic inflammatory condition that primarily affects the stomach. It is characterized by antibodies that target parietal cells and intrinsic factor. As these cells are destroyed, gastric acid and intrinsic factor production drops. Studies show that up to 40% of patients with autoimmune gastritis also have Hashimoto’s thyroiditis. The destruction of parietal cells results in low levels of stomach acid, which can interfere with the absorption of nutrients and medications, including thyroid hormone replacement, potentially worsening hypothyroidism.
The signs of autoimmune gastritis in patients with Hashimoto’s and hypothyroidism can be subtle at first but may progress to more severe complications. Initially, patients may experience non-specific symptoms such as upper abdominal discomfort. As the condition advances, it can lead to vitamin B12 deficiency, resulting in pernicious anemia and neurological symptoms.
Celiac disease and gluten sensitivity
Celiac disease is an autoimmune disorder triggered by ingesting gluten, primarily affecting the small intestine. Celiac disease damages the intestinal lining, leading to a wide range of gastrointestinal symptoms, including abdominal pain, bloating, diarrhea, constipation, and malabsorption. Compared to the general population, patients with autoimmune Hashimoto’s thyroiditis have an almost 5-fold increased risk of developing celiac disease.
Non-celiac gluten sensitivity, while not an autoimmune condition, also occurs more frequently in patients with Hashimoto’s thyroiditis. This condition is characterized by symptoms similar to celiac disease but without the same level of intestinal damage or autoimmune-specific antibodies.
Additionally, celiac disease and gluten sensitivity can cause other symptoms such as fatigue, joint pain, and skin rashes, which can overlap with or worsen symptoms of hypothyroidism.
Proper diagnosis and management of these gluten-related disorders are essential for optimizing overall health and thyroid function in patients with Hashimoto’s and hypothyroidism. It’s also important to note that the malabsorption that results from celiac disease or gluten sensitivity can complicate the management of hypothyroidism by reducing the effectiveness of thyroid hormone replacement medication, potentially requiring adjustments in thyroid hormone replacement therapy.
Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by recurrent abdominal pain associated with changes in bowel habits. While not precisely an autoimmune condition, IBS has been observed to have a higher prevalence among patients with elevated thyroid antibodies -- Hashimoto’s thyroiditis -- and hypothyroidism. The exact mechanism linking these conditions is not fully understood. Still, it may involve alterations in gut motility, visceral hypersensitivity, and changes in the gut microbiome, which can be influenced by thyroid dysfunction. Additionally, the chronic stress and inflammation associated with autoimmune thyroid disease may contribute to the development or exacerbation of IBS symptoms.
Patients with Hashimoto’s thyroiditis and hypothyroidism who also have IBS may experience a variety of symptoms, including abdominal pain, bloating, and alternating patterns of diarrhea and constipation. These gastrointestinal symptoms can overlap with and potentially be exacerbated by hypothyroidism, which itself can cause constipation, bloating, and digestive discomfort. The presence of IBS can also complicate the absorption and effectiveness of thyroid hormone replacement treatment, particularly in patients with diarrhea-predominant IBS. Management of IBS in the context of thyroid disease requires a comprehensive approach, addressing both conditions simultaneously to improve overall quality of life and ensure optimal thyroid hormone replacement.
How To Maintain A Healthy Gut
Digestive issues like bloating, constipation, or gas can be resolved or improved with simple lifestyle changes
Small intestinal bacterial overgrowth (SIBO)
Small intestinal bacterial overgrowth (SIBO) is found in over half of all hypothyroidism patients. It occurs when there’s an overgrowth or imbalance of intestinal bacteria in the digestive system due to reduced gut motility. SIBO can lead to symptoms such as bloating, abdominal pain, diarrhea, and nutrient malabsorption. The condition can exacerbate other gastrointestinal symptoms and contribute to the overall digestive discomfort experienced by many Hashimoto’s and hypothyroidism patients.
There are a variety of factors that result in GI symptoms in Hashimoto’s and hypothyroidism patients.
Slowed GI motility and constipation
Reduced thyroid hormone levels directly impact gut motility, causing slowed digestion. This leads to constipation, a common complaint among hypothyroid patients. Sluggish gut motility can result in the buildup of waste in the intestines, causing bloating, discomfort, and straining during bowel movements. With impaired motility, the absorption of essential nutrients may also be affected, impacting overall health and energy levels.
Impact on gastric acid production
Low thyroid levels can lead to decreased stomach acid production, a condition known as hypochlorhydria. Stomach acid is essential for breaking down food and absorbing nutrients, so its deficiency can disrupt digestion, leading to symptoms like acid reflux, bloating, and indigestion. Low thyroid function may also weaken the lower esophageal sphincter, making acid reflux more likely.
Dysbiosis and altered gut microbiome
Hypothyroidism may disrupt the gut microbiome, the community of bacteria, and other microorganisms residing in the digestive tract. This imbalance, called dysbiosis, can lead to symptoms like bloating, gas, and abdominal discomfort. Since the microbiome plays a vital role in immunity, digestion, and the presence of beneficial bacteria, its disruption can worsen GI symptoms and negatively impact overall health.
Malabsorption and nutrient deficiencies
Due to slowed gut motility and hypochlorhydria, individuals with hypothyroidism may experience malabsorption of essential nutrients. Common deficiencies include iron, vitamin B12, and magnesium, all vital for maintaining energy levels and supporting cellular function. Malabsorption can contribute to fatigue, anemia, and other health complications.
The frequency of these symptoms in patients with Hashimoto’s and hypothyroidism is significant. Studies have shown that up to 50 to 60% of patients experience some form of gastrointestinal symptoms. However, it’s important to note that not all patients will experience all symptoms, and the severity can vary widely.
The gastrointestinal symptoms associated with Hashimoto’s disease and hypothyroidism can vary greatly in both severity and duration among individuals. This variability can be attributed to several factors discussed here.
Disease progression
The severity of symptoms often correlates with the degree of thyroid dysfunction. As Hashimoto’s disease progresses and thyroid function declines, GI symptoms may become more pronounced. However, this is not always a linear relationship, and some patients may experience severe symptoms even with mild thyroid dysfunction.
Treatment status
The management of hypothyroidism with thyroid hormone replacement therapy can significantly impact GI symptoms. Many patients report improving their digestive issues once their thyroid hormone levels are optimized. However, the response to treatment can vary, and some individuals may continue to experience GI symptoms even with adequate hormone replacement.
Individual factors
Factors such as diet, stress levels, and overall health can influence the severity and frequency of GI symptoms. Some patients may find that certain foods trigger or worsen their symptoms, while others may notice a correlation with stress levels.
Fluctuations in thyroid function
Hashimoto’s disease can sometimes cause fluctuations in thyroid function, with periods of normal function, hypothyroidism, or even transient hyperthyroidism. These fluctuations can lead to changes in GI symptoms over time.
The impact of these GI symptoms on quality of life can be significant. Chronic constipation, bloating, and abdominal discomfort can affect daily activities, social interactions, and overall well-being. Additionally, the unpredictable nature of these symptoms can lead to anxiety and frustration for many patients.
Gastrointestinal (GI) problems are common in people with autoimmune thyroiditis and hypothyroidism, often presenting significant challenges in diagnosis and management.
Diagnosing GI issues in individuals with Hashimoto’s and hypothyroidism requires a thorough evaluation. Thyroid function tests, such as thyroid stimulating hormone (TSH), free triiodothyronine (free T3), free thyroxine (free T4), and thyroid peroxidase antibody levels (TPOAb), are essential to understanding the extent of thyroid dysfunction. GI-specific tests like the hydrogen breath test for SIBO and endoscopy for celiac disease can help identify concurrent conditions.
The overlap of GI symptoms between Hashimoto’s/hypothyroidism and other digestive disorders can present a diagnostic challenge. Symptoms such as bloating, constipation, and acid reflux are common in various GI disorders, making it difficult to pinpoint their cause. In some cases, a multidisciplinary approach involving multiple specialists may be necessary to ensure accurate diagnosis and effective treatment.
Thyroid hormone replacement
The mainstay treatment for hypothyroidism is thyroid hormone replacement therapy. By restoring hormone levels, this therapy can alleviate many GI symptoms. Monitoring symptoms during treatment is essential for identifying the need for dosage changes or alternative therapies.
Dietary adjustments
Diet plays a crucial role in managing GI symptoms in hypothyroid patients. Increasing fiber intake helps alleviate constipation, while gluten-free diets may benefit those with celiac disease or gluten sensitivity. Low-FODMAP, anti-inflammatory diets, and programs that avoid food sensitivities can also help reduce bloating, gas, and discomfort by minimizing foods that are hard to digest or may trigger immune responses.
Probiotics and gut health support
Probiotics, beneficial bacteria that support gut health, can help manage dysbiosis and relieve GI discomfort. A diet that includes fermented foods and specific probiotic strains, such as Lactobacillus and Bifidobacterium, have been shown to improve digestion and gut function, making them beneficial for hypothyroid patients struggling with bloating and gas.
Lifestyle changes and stress management
Stress is a known factor in both GI function and autoimmune disease. Techniques like mindfulness, meditation, and regular exercise can reduce stress, improve digestion, and support immune function in Hashimoto’s and hypothyroid patients. Additionally, maintaining a regular sleep schedule and practicing stress-relief exercises can be instrumental in managing GI symptoms and promoting overall wellness.
Managing Hashimoto’s thyroiditis and hypothyroidism requires a holistic approach that addresses both thyroid function and gastrointestinal health. While thyroid hormone replacement is often the cornerstone of treatment, addressing GI symptoms is crucial for improving overall quality of life.
Integrative and functional medicine approaches offer valuable insights by considering the interconnectedness of the thyroid and digestive systems. These methods emphasize lifestyle modifications, dietary interventions, and holistic treatments alongside conventional therapies to address root causes and provide whole-body care.
For patients experiencing persistent or severe digestive issues, consultation with a gastroenterologist may be a necessary extra step. These specialists can provide advanced testing and tailored treatments for complex cases, particularly when symptoms like severe weight loss or nutrient deficiencies are present.
Dr Goggin has been excellent. After one visit, she put me on a blended dosage or Armour Thyroid and Levothyroxine and by the next checkup, all of my levels were finally normal. I wish I had done this years ago!
Jeremy D
Verified Review
Paloma Health specializes in comprehensive care for Hashimoto’s and hypothyroid patients, recognizing the intricate relationship between thyroid function and digestive health. Paloma’s approach encompasses personalized treatment plans that address your thyroid and GI symptoms and offer sound guidance on dietary adjustments to support your thyroid and gut health.
By focusing on your unique needs, Paloma Health helps you achieve optimal thyroid function while alleviating associated digestive symptoms and achieving immune regulation. Paloma’s patient-centered care model ensures that, as a Hashimoto’s or hypothyroidism patient, you will receive comprehensive support for improved overall well-being.
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