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Have you ever wondered if hypothyroidism could be the cause of your acid reflux? This question often goes unexplored despite the known connection between thyroid function and digestive health.

Hypothyroidism, characterized by an underactive thyroid gland, impacts bodily functions beyond its primary role in metabolism. In particular, the thyroid regulates the digestive process, including food movement through the digestive tract. So, while acid reflux involves stomach acid backing up into the esophagus, hypothyroidism may worsen this condition.

In this article, we’ll explore the topic of acid reflux and its potential link with hypothyroidism.

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Acid reflux is a common health condition that most people experience at some time in their lifetime. It’s a common condition that occurs when stomach acid flows back up into the esophagus. Those with heartburn experience a burning sensation primarily in the lower chest area. Besides this burning sensation, other symptoms of acid reflux include:

• Nausea
• Heartburn: a burning sensation in the chest that may worsen after eating or lying down
• Chest pain: a feeling of pressure or discomfort in the chest that may mimic a heart attack.
• Indigestion
• Regurgitation: a sour or bitter taste in the back of the throat due to stomach acid rising up
• Trouble swallowing, the sensation of food getting stuck in the throat
• Bad breath
• Chronic cough or hoarseness

Some people may experience acid reflux now and then, with symptoms ranging from mild to moderate. An occasional episode of acid reflux isn’t usually harmful, but constant acid reflux, as seen in GERD, can be.

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GERD

GERD, gastroesophageal reflux disease, is a medical condition that affects around 20% of Americans. People often use the term acid reflux interchangeably with GERD, but they are not the same. GERD is a long-term problem with more severe symptoms that often need medical attention. On the other hand, acid reflux is just one of the symptoms of GERD.

If left untreated, GERD can cause inflammation of the esophagus (acid reflux esophagitis) and a medical condition called Barrett’s esophagus. It is essential to let your healthcare provider know if you have symptoms of GERD or acid reflux. They can determine if further follow-up is needed and develop a treatment plan.

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At the bottom of your esophagus (the tube that connects your mouth to your stomach) sits a muscle called the lower esophageal sphincter (LES). This muscle acts as a valve by opening and closing to let food enter.

When you swallow, the LES relaxes, allowing food to move from your esophagus into your stomach. The LES usually stays closed when you aren’t eating to help keep stomach contents inside your stomach.

Sometimes, the LES relaxes when it shouldn’t, or the strength of the LES weakens. When this occurs, food and stomach acid flow back into your esophagus, causing a burning sensation.

Premature relaxation or weakness of the LES can occur for the following reasons:

• Being overweight or obese
• Taking certain medications, such as NSAIDs, muscle relaxants, blood pressure medications, antihistamines, antidepressants, or sedatives
• Having previous stomach or esophageal surgeries
• Smoking or exposure to secondhand smoke
• Eating large meals or lying down immediately after eating
• Eating spicy or fatty foods
• Pregnancy
• Hiatal hernia

In addition, low thyroid hormone levels can also affect how your LES works.

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Low thyroid hormone levels can prevent the LES from doing its job correctly. 

Your muscles, including the LES, rely on appropriate thyroid hormone levels to relax and contract. Thus, when the thyroid gland is underactive, low levels of thyroid hormone may weaken muscle contractions. As mentioned, a weakened LES contraction may allow stomach contents to pass upwards into the esophagus.

Furthermore, the esophagus also relies on muscle contractions to move food down. Low thyroid hormone levels may slow down esophageal motility, meaning it takes food longer to move into your stomach and digestive tract. This can lead to trouble swallowing, a possible sign of acid reflux. Those with higher thyroid-stimulating hormone (TSH) levels had longer esophageal transit times than those with a normal TSH level, according to a 2017 study.

Along the same lines, stomach contents may sit in the stomach longer. This is because hypothyroidism decreases gastroesophageal motility. The longer your stomach contents stay in your stomach, the greater your chance of experiencing acid reflux symptoms.

Another possible link between hypothyroidism and acid reflux is the use of certain medications to treat thyroid disorders. Some medications, such as levothyroxine, can alter stomach acid levels and contribute to acid reflux symptoms.

Additionally, individuals with hypothyroidism may experience stress and anxiety related to their condition, which can also exacerbate acid reflux.

There is also evidence to suggest that there may be a connection between acid reflux and hypothyroidism when it’s caused by Hashimoto’s thyroiditis, the autoimmune disease that causes hypothyroidism. One theory is that the inflammation caused by Hashimoto’s disease can impact the function of the esophagus and stomach, leading to acid reflux. 

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It may, especially if the underlying cause of your acid reflux is solely low thyroid hormone levels. Often, there may be other factors, such as being overweight, contributing to acid reflux.

One study found that those with low levels of thyroid hormone who took thyroxine, a synthetic T4 medication, saw a reduction in TSH levels and improvements in esophageal transit time, helping to reduce acid reflux symptoms.

THYROID GUIDE

Your Guide To Thyroid Medication

Optimizing your thyroid levels with thyroid hormone replacement medication is usually the first step in minimizing symptoms.

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Several over-the-counter (OTC) options can provide relief from acid reflux:

• Antacids: Antacids are a standard first-line treatment for acid reflux. They work by neutralizing stomach acid to quickly relieve heartburn and indigestion. Some popular antacid brands include Tums, Rolaids, and Maalox.
• H2 blockers: H2 blockers, such as Pepcid AC and Zantac, work by reducing the production of stomach acid. They effectively provide longer-lasting relief from acid reflux symptoms compared to antacids.
• Proton pump inhibitors (PPIs): PPIs, such as Prilosec OTC and Nexium, are the strongest over-the-counter medications for acid reflux. They work by blocking the production of stomach acid and can relieve persistent heartburn and other acid reflux symptoms.
• Alginate medications: Alginate medications, such as Gaviscon, create a protective barrier in the stomach to prevent acid from refluxing back into the esophagus. They help control acid reflux symptoms, especially when taken after meals or before bedtime.
• Bismuth subsalicylate: Bismuth subsalicylate, found in medications like Pepto-Bismol, can help relieve symptoms of acid reflux, such as indigestion and nausea. It works by coating the stomach lining and reducing inflammation.

Remember that some antacids and PPIs can interfere with the absorption of thyroid medications. (Liquid forms of levothyroxine, like Tirosint, are generally recommended for patients who regularly take these medications.) Generally, OTC medications are taken just as needed for heartburn symptoms. They are not recommended for daily use without your healthcare provider’s supervision. Make sure to check with your healthcare provider before starting any OTC antacid.

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Lifestyle and diet changes are also Here are several ways to help minimize acid reflux symptoms at home:

1. Eat smaller meals more frequently

A full stomach may increase the likelihood of acid reflux. Try eating smaller meals throughout the day instead of three big ones. This helps prevent your stomach from getting too full.

2. Remove foods that trigger symptoms

You may find certain foods often cause you to experience acid reflux. Try to identify your food sensitivities, triggers, and patterns of food intolerance -- and avoid those foods! Some common triggers of acid reflux include:

• Caffeine
• Alcohol
• High-fat foods
• Acidic-based foods like tomato sauces
• Spicy foods

3. Avoid eating within 2-3 hours before bedtime

Give yourself and your stomach enough time between your last meal of the day and bedtime. This break will allow your stomach to empty and help decrease the likelihood of acid reflux when you lie down.

Some also find elevating their head by adding extra pillows or a wedge helps reduce acid reflux symptoms when sleeping.

4. Stop smoking

Smoking is a known risk factor for acid reflux. Talk with your healthcare provider about ways to quit. Some find nicotine patches, gums, or other medications helpful.

5. Lose weight

A common symptom in those with hypothyroidism is weight gain. And many find it hard to lose weight even after starting on thyroid hormone replacement medications. Weight loss reduces acid reflux symptoms by decreasing the pressure on the LES, allowing it to open and close properly. Consider consulting with a Paloma Health nutritionist or a local trainer to help you with your weight loss journey.

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Acid reflux is a lesser-known symptom of hypothyroidism but one that shouldn’t be dismissed. If you have any of these symptoms, it might be a perfect time to take proactive steps towards better thyroid health.

Getting your thyroid tested is the first step in determining if hypothyroidism is the underlying cause of your acid reflux symptoms. Paloma’s convenient, at-home testing kit allows you to test for the three most common thyroid biomarkers to diagnose a thyroid disorder. Once you get your results, our providers can discuss your next steps.
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Key points

• Hypothyroidism, an underactive thyroid condition, can contribute to acid reflux by weakening the lower esophageal sphincter (LES) and slowing esophageal motility.
• Acid reflux occurs when stomach acid backs up into the esophagus, causing symptoms like heartburn, chest discomfort, regurgitation, and difficulty swallowing.
• Factors such as obesity, smoking, certain medications, and dietary choices can exacerbate acid reflux, alongside low thyroid hormone levels.
• Thyroid medications, like levothyroxine, may sometimes alter stomach acid levels, potentially worsening acid reflux symptoms.
• Hashimoto's thyroiditis, a common cause of hypothyroidism, may link inflammation to digestive dysfunction, increasing acid reflux risk.
• Lifestyle changes, such as eating smaller meals, avoiding trigger foods, losing weight, and not eating before bedtime, can reduce acid reflux symptoms.
• Thyroid hormone replacement therapy can help alleviate acid reflux caused by hypothyroidism by improving esophageal motility and digestive function.