hashimoto’s flare up

Hashimoto's Flare Up

In this post, we discuss how to prevent Hashimoto’s flare up. Looking closer at what Hashimoto’s disease is, what causes Hashimoto’s, and how to manage it.

What Is Hashimoto’s Disease?

Hashimoto’s thyroiditis (HT) is the most frequent cause of hypothyroidism (Source)

Hashimoto’s thyroiditis is the most common autoimmune thyroid disorder and one of the most common autoimmune diseases. It is characterized by infiltration of lymphocytes (a type of white blood cell) damage to thyroid cells, which may result in hypothyroidism. It often requires lifetime treatment with the medication levothyroxine.

Thyroid antibodies serve as a useful marker for the diagnosis of thyroid autoimmunity. In Hashimoto’s, thyroid peroxidase antibodies are present in nearly all ( approximately 90%!) cases, while thyroglobulin antibodies can be detected in approximately 80% of cases (Source).

What Causes Hashimoto’s?

Because it is an autoimmune disease, there is a complex interplay between genetic and environmental factors.  

If trying to prevent or reduce Hashimoto flare up, it’s important to understand what causes the condition in the first place. 

The causes can be broken down into 3 categories:

Genetic factors: There are various genes that may be connected to Hashimoto’s. The ones discussed in the research include: Histocompatibility genes (HLA class I and II), genes involved in immune regulation (including HLA, CTLA-4, PTPN22, CD40), vitamin D (VDR), thyroid-specific genes, and genes involved in inflammation (such as TGF).

Environmental Factors

  • Nutrients: Iodine, Selenium, Iron, Zinc, Vitamin B12, Vitamin D
  • Pollutants: Organochlorines, pesticides
  • Irradiation
  • Drugs: Interferon Alpha, TNF-Alpha
  • Infections: Hepatitis C, Blastocystis, Epstein Barr virus, Yersinia
  • Stress
  • Smoking
  • Obesity
  • Socioeconomics
  • Stress

Existential Factors: Sex, age, Associated diseases (e.g., type 1 diabetes mellitus, pernicious anemia, coeliac disease, myasthenia gravis), Down’s syndrome, pregnancy. (Source)

Preventing Hashimoto’s Flare Up

In Hashimotos, careful supplementation of possible deficiencies is recommended for the dietary management of these patients.

Vitamin D

We have already seen that the vitamin D receptor gene (VDR) has been associated with Hashimoto’s. Vitamin D deficiency has been linked to a higher prevalence of thyroid autoimmunity. Not only that, but vitamin D supplementation has shown promise in reducing thyroid antibody levels, improving thyroid function, and improving inflammation. (Source)

Overall, current evidence supports the potential role of vitamin D in the prevention of Hashimoto’s flare up and management of HT (Source)

Red Light Therapy

Red light therapy, also known as photobiomodulation, has been shown to be helpful in Hashimoto’s. One study found that red light therapy led to weight loss (which can be helpful in autoimmunity) and reduction in thyroid stimulating hormone, TPO antibodies, TG antibodies, and the amount of levothyroxine required. (Source)


Three meta-analyses have confirmed a beneficial effect of Selenium supplementation on TPO and Tg antibodies in Hashimoto patients. The most recent meta-analysis in 2016 also demonstrated that the form of selenium you take may really matter. Those taking selenomethionine had a significant decrease in serum TPO antibodies compared to those taking the same dose of sodium selenite. The difference might lie in the fact that the absorption of selenite is approximately two-thirds of the absorption of selenomethionine (Source)

Try Going gluten-free 

The research clearly shows that autoimmune thyroid disease and celiac disease are associated. There are a couple of potential explanations as to why they are associated:

  • Those with celiac disease have increased immune sensitivity and so may be at risk of developing autoimmune polyglandular syndrome (multiple autoimmune conditions)
  • A deficiency in nutrients such as selenium and iodine – these, in my clinical experience, are quite common. However, those with celiac disease are at greater risk due to malabsorption or antibodies that affect both target tissues. 

According to a most recent meta-analysis, all patients with Hashimoto’s should be screened for coeliac disease, given the increased prevalence of the coexistence of these two disorders. (Source)

Be mindful of iodine

Autoimmune hypothyroidism and thyroid antibodies (TAb) are more common in iodine-replete areas than in iodine-deficient areas. Hypothyroidism induced by iodine in AITD may be due to a persistent inhibitory effect of iodine on thyroid hormone synthesis and secretion, i.e., a pathologically persistent Wol-Chaiko effect. Cases of Hashimoto’s may have inadequate thyroid hormone synthesis, may be unable to escape from the acute Wolf Chaiko effect, and can develop iodine-induced hypothyroidism. 

Several studies have demonstrated that a moderate iodine excess is associated with a more frequent occurrence of hypothyroidism. (Source)

Have Your Iron Checked

Iron deficiency can impact thyroid function. TPO antibodies are an iron-containing enzyme. 

Unfortunately, due to the fact that those with Hashimoto’s have an increased risk of autoimmune gastritis, Hashimoto’s patients are frequently iron deficient. 

Treatment of anemic women with impaired thyroid function with iron improves thyroid hormone concentrations, while thyroxine and iron together are more effective in improving iron status. (Source)

Manage Your Stress

No need to complicate this one! Stress can be a cause of Hashimoto’s flare up. Chronic stress can cause dysregulation in immunity, the microbiome, and nutrient status (among so many other things) – all of which play key roles in autoimmune diseases. (Source)

Support Your Microbiome

Research has shown that Hashimoto’s patients have an altered gut microbiome and that the gut microbiome correlates with clinical parameters. This means that the microbiome could be used for disease diagnosis and treatment.

Ways to support a healthy microbiome:

  • Eating adequate dietary fiber from foods such as whole grains and vegetables.
  • Focus on dietary diversity (fresh fruit, vegetables, herbs, spices, nuts, seeds, legumes, lentils, pulses, beans, legumes), 
  • Eating fermented foods (sauerkraut, kimchi, kefir).
  • Stay physically active.
  • Get outside in nature as much as possible. (Source)


Depletion of myoinositol may contribute to the development of hypothyroidism. One study found that when participants with subclinical hypothyroidism, with or without autoimmune thyroiditis, supplemented with myoinositol and selenium, TSH levels significantly decreased. (Source)

Optimise Your Circadian Rhythm

Research has demonstrated that clock genes are disrupted in autoimmune thyroid disease patients. We also know that chronic circadian disruption may worsen inflammation in Hashimoto’s (and other autoimmune diseases).

Maintaining a regular circadian rhythm is one of the most important things you can do for optimal health. (Source)

Consider A Paleo Ancestral Diet And Lifestyle

Several studies have investigated a paleo/ancestral diet and lifestyle. 

In one study, eight autoimmune thyroid studies focusing on Paleolithic or ancestral interventions were reviewed. The results are fascinating!

All studies showed clinical improvements; one showed significant improvement, and two showed autoimmune thyroid resolution

It’s important to highlight that in these studies, participants often focused on more than just diet – they focused on exercise and mindfulness practices as well! (Source)

Consider The Autoimmune Protocol

One study that investigated the autoimmune diet showed a statistically significant improvement in health-related quality of life. 

The researchers used the medical symptom questionnaire, which is a quick intake form asking patients to rank specific symptoms. The higher the score, essentially, the worse you feel! The clinical symptom burden decreased significantly from an average of 92 prior to the program to 29 after the program. However, no statistically significant changes were noted in any measure of thyroid function. 

However, inflammation, measured by hs-CRP, had significantly decreased by 29%.

This study suggests that an online diet and lifestyle program facilitated by a multi-disciplinary team can significantly improve health-related quality of life and symptom burden in middle-aged female subjects with Hashimoto’s. (Source)

Eat Your Polyphenols To Reduce Oxidative Stress

Polyphenols are the most abundant antioxidants found in food.

Researchers examined a set of plant polyphenols for their effect on the Sirt1catalytic rate. The polyphenols included fisetin, quercetin, and resveratrol. 

Fisetin is commonly found in strawberries and other fruits and vegetables and has been shown to stimulate signaling pathways that enhance long-term memory.

Quercetin is the active component of many medicinal plants. Foods rich in quercetin include capers, lovage, apples, tea, onions, citrus fruits, green vegetables, and most berries. 

Resveratrol was first known for its antioxidant and antifungal properties. It is found in raspberries, blueberries, grape skins, peanuts and some pine trees. 

Why are polyphenols and antioxidants so important in Hashimoto’s?

In Hashimoto’s, oxidative stress interferes with the normal function of thyroid cells. Oxidative stress results from an imbalance between an excessive production of reactive oxygen species and a lowering of antioxidant production. 

Moreover, oxidative stress has been shown to inhibit Sirtuin 1!

So, we need to focus on a good intake of these antioxidants to counter oxidative stress, which will help ensure that Sirtuin 1 isn’t inhibited, helping to manage Hashimoto’s flare up.

Researchers have placed SIRT1 as a key regulator of oxidative, and they, therefore, believe it could be considered a potential therapeutic target for Hashimoto’s. (Source)

Stay active

Research has found that staying physically active is helpful for both immune and thyroid function. Need I say more?

Physical activity modulates not only the levels of circulating TSH and T4, but also the magnitude of TSH response to lower T4 levels. At low levels of T4, physically active adults appear to produce less TSH. Modulation of TSH production implicates the hypothalamic-pituitary axis, underscoring the widespread impacts of physical activity on the brain and suggesting that physical activity may affect metabolic energy expenditure in tissues throughout the body through effects on thyroid hormone signaling.


As you can see, many things can be considered when seeking to prevent or reduce the frequency of a Hashimoto flare up, ranging from circadian rhythm and sleep to specific nutrients, as well as stress and exercise. 

As is always the case, we need to take a truly holistic approach if we wish to improve or stay in robust physical health!

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