Close to one in eight women will experience a thyroid issue in her lifetime, and one problem that is showing up more than others is Hashimoto’s disease.

   Hypothyroidism is a condition where your thyroid doesn’t produce enough thyroid hormones. Hashimoto’s thyroiditis is an autoimmune condition where your immune system attacks healthy thyroid cells.

   Autoimmune diseases, like Hashimoto’s, can be tricky to diagnose and treat for a few reasons. First, symptoms of Hashimoto’s are nonspecific and can seem unrelated. Second, if hypothyroidism is suspected, generally a TSH is the only lab that is drawn. This approach has significant limitations and may exclude a large subset of patients, resulting in the potential misdiagnosis of hypothyroidism. Third, basic lab work doesn’t test for autoimmune conditions like Hashimoto’s. You need advanced lab panels.

   Flare ups can look different for every person and each flare up that you have can look different than the last with different symptoms. In general, symptoms can be similar to hypothyroidism and include: Constipation, fatigue, weight gain, brain fog, poor concentration, brittle hair and nails, cold sensitivity, muscle aches and pains, anxiety or depression, pale and dry skin, hair loss, heavy periods and enlarged thyroid gland (goiter).

   Since everyone’s biochemistry is different, triggers are going to be unique to you with some people having a higher threshold to certain triggers. Some triggers include the following.

   Nutrient deficiencies: Your body relies on a certain amount of specific nutrients for your immune system to function optimally. Deficiencies in selenium, vitamin D and iron have been linked to poor immune function in people with autoimmune thyroid conditions. Iodine is another nutrient that is important as it is used for the production of thyroid hormones.

   Stress: Your main stress hormone, cortisol, can block conversion of T4 to the active T3 and can also increase the unusable reverse T3, further confusing the delicate balance of thyroid hormones that are essential for good health.

   Diet: Just like you might not get enough of the right nutrients, you may be eating too much of certain irritation foods. Many with Hashimoto’s find that even a small amount of gluten can flare up symptoms. Pay attention to any possible food intolerances you may have.

   Toxin exposure: Studies have shown that chemicals and heavy metals can cause an autoimmune response against the thyroid.

   Infections: Virals or bacterial infections such as Helicobacter Pylori and Yersinia enterocolitica can contribute to molecular mimicry where the immune system mistakenly identifies its own tissues as foreign invaders and attacks.

   Genetics: It’s known that genetics play a role. However, there is a saying in epigenetics: “Genes load the gun, environment pulls the trigger.”

   Gut health: Genetics and environment have been the main two recognized causes of autoimmunity, but researchers are finding there is more, including intestinal permeability or leaky gut. When intestinal barrier function is compromised, the body’s ability to regulate the immune response is out of balance and autoimmunity ensues. In order to successfully treat Hashimoto’s and see a decrease in antibodies over time, we have to address an individual’s environmental triggers and gut infections.

   Pregnancy: During or following pregnancy, some women begin to produce very high levels of thyroid hormones, followed by a very rapid decline.

   Interactions of certain medications: The most common medications that seem to lead to the development of underactive thyroid are drugs to treat cancer, heart problems and certain psychiatric conditions.

   Inactivity and lack of exercise: Research shows that people who regularly exercise usually get better sleep, deal with stress better and more often maintain a healthier weight, all of which reduce some of the biggest risk factors and symptoms associated with hypothyroidism.

   The focus in functional medicine is on treating autoimmune thyroid problems more naturally. The following are some ways.

   Alleviate stress: Stress is such a big trigger that alleviating it as much as possible is important. You can add mindfulness practices like meditation and deep breathing exercises to actively lower your cortisol levels.

   Switch to non-toxic products; Changing beauty and personal care products will help lower your toxin load, as these are absorbed directly into your skin.

   Add in supplements: This can be helpful when dealing with any deficiencies. Some to think about are: Selenium (this is necessary for the production of the T3 thyroid hormone and can reduce autoimmune effects); L-tyrosine (this plays a role in the production of melatonin, dopamine and/or norepinephrine, which are all natural “feel good” hormones); fish oil (critical for brain and thyroid function and is associated with a lower risk for anxiety, depression, high cholesterol, inflammatory bowel disease, arthritis and diabetes); vitamin B-complex (important for neurologic function and hormonal balance); and ashwagandha (a herb that helps the body respond to stress, keeping hormone levels better in balance).

   Try an elimination diet: Figuring out what food or foods trigger you is critical.

   Avoid added iodine: Avoid products fortified with iodine like table salt and opt for Himalayan pink sea salt.

   Rebalance the microbiome: Maintaining diverse and balanced gut bacteria helps tame autoimmunity. Eating various whole foods and incorporating probiotic-rich foods like kimchi and sauerkraut and prebiotic-rich foods like artichokes, garlic and beans will nourish healthy bacteria.

   Some other dietary suggestions include: Cutting back or eliminating refined carbs, gluten, conventional dairy, refined sugar and artificial sweeteners. Upping your intake of nutrient-dense foods, especially foods high in selenium, zinc, iron, B vitamins and vitamin A. Increase the consumption of healthy fats such as olive oil, avocado oil, olives, nuts, seeds and omega-3 fats from wild-caught fish like salmon and sardines. Eliminate food sources with heavy metals. You should limit alcohol. Drink clean water as it helps with hydration and digestive function.

   Try to implement these lifestyle suggestions: Remove heavy metals from your life, practice restorative exercise vs. intense exercise, quality sleep, meditate, spend time in nature, get off birth control pills if it’s an option, and use professional counseling and therapy.