Gluten Free and Thyroid Disease Free: An Update on Lilly
The last time we met, Dear Reader, before I high-tailed it on out of the blogosphere for the summer, I introduced you to Lilly and her thyroid woes. Below are her original thyroid studies that she obtained from her primary care doctor and brought to our first meeting. Lilly did not want her endgame to be levothyroxine for life. She sought a second opinion.
June, 2013. Lilly’s baseline thyroid laboratory results demonstrated autoimmune hypothyroidism (also called Hashimoto thyroiditis).
What do these results mean?
As I said in my original post, Lilly’s elevated TSH (thyroid stimulating hormone) demonstrated that her body was working awfully hard trying to get her thyroid to do its job. And the thyroid peroxidase antibody elevation –albeit mild—revealed that Lilly’s own immune system was attacking her thyroid gland. Certainly these results were a big piece of the fatigue puzzle.
Why was Lilly’s immune system attacking her thyroid gland? I must admit, I was pretty certain gluten was involved. I wrote in my post:
It is well-documented that autoimmune hypothyroidism is associated with gluten intolerance. Indeed, celiac disease is associated with myriad autoimmune conditions, including type 1 diabetes, lupus, pernicious anemia, autoimmune hepatitis, Sjogren’s syndrome, Raynaud’s syndrome, myasthenia gravis, and autoimmune hypothyroidism.
Also recall, Dear Reader, that Lilly was entirely loath to remove gluten—her nightly crusty bread with olive oil– from her diet. Lilly thought the whole gluten-free epidemic was another overhyped phase. (Who can blame her?) She said: “I was tested for celiac disease eight years ago and I am negative. I don’t have a gluten issue.”
I didn’t debate. But I knew that my laboratory investigations with her would include looking for gluten reactivity in its many forms. Here is what I found:
June, 2013. This lab result demonstrates that Lilly’s immune system was reacting to gluten. She didn’t have celiac — those tests were negative — but she was definitely sensitive to gluten.
So what did we do?
The lab result was enough to convince Lilly to stop gluten for a while. We negotiated an eight week trial. She understood that it was possible that gluten could be impacting her thyroid. She was 100% motivated to abstain from it entirely for the agreed upon time.
Not surprisingly, Lilly had micronutrient deficiencies as well, including B12 and magnesium. Again, even though she didn’t have celiac disease, it looked like her body was having a hard time absorbing the nutrients it needed. While this is extremely common and well-documented in celiac, it’s less-recognized in gluten sensitivity.
Our treatment plan was straightforward: Avoid gluten, take B12 and minerals. I also ordered a thyroid-centric supplement (containing the nutrients selenium, zinc and tyrosine, designed to support thyroid function) that Lilly took for a little while but stopped when she ran out.
When I chatted with Lilly in July, she told me her gut was better. Gut? Lilly didn’t report any gut issues at our first meeting. It’s interesting how we can identify issues we have tolerated – sometimes for years –only after they’re no longer there! She also said her energy was much, much better. We both knew she was on the right track.
In August, 2013, eight weeks after she started the supplements, Lilly had follow-up testing:
August, 2013. Just eight weeks after the start of going gluten free, Lilly’s thyroid function tests were normal. Her TSH and her antibodies were no longer elevated. Good job, Lilly — No medication needed!
In functional medicine, we like to see TSH less than 2.00. Lilly’s is almost, but not quite, there. I suggested to Lilly that she restart the thyroid supplement I originally prescribed to see if we can get her into optimal range. I also suggested we continue with the gluten free plan, seeing that she’s doing so well.
Lilly responded immediately, agreeing to take the thyroid support, and proclaiming:
“No gluten since we started and no desire to have any ever again :-)”