Group of Papers on Hashimoto's thyroiditis

[diogenes]

This open source collection may be of interest to Hashimoto's sufferers - in Thyroid

Found at [e-mail]

Special Collection: Hashimoto’s Thyroiditis

[humanbean]

home.liebertpub.com/lpages/...

One of the articles in the collection is entitled :

Thyroidectomy Improves Quality of Life and Fatigue in Patients with Hashimoto’s Disease and Persistent Symptoms Compared to Adequate Thyroid Hormone Replacement

My jaw dropped when I read the title. It suggests to me that the author has never spoken to a patient who has done poorly following thyroidectomy and as far as I'm aware there are many of them. Having one's thyroid removed should be a last resort, in my opinion, apart from in cases where the patient has thyroid cancer. Having no thyroid does not improve quality of life for a lot of people.

...

Influence of Dietary Habits on Oxidative Stress Markers in Hashimoto's Thyroiditis

Background [from the article]: There is a growing awareness that nutritional habits may influence risk of several inflammatory and immune-mediated disorders, including autoimmune diseases, through various mechanisms. The aim of the present study was to investigate dietary habits and their relationship with redox homeostasis in the setting of thyroid autoimmunity.

I won't disagree with the above comment. I have found that my symptoms improved and my TFT results improved when I gave up gluten and improved some of my nutrient levels. But telling a doctor this just got me a condescending and patronising response.

However, I fear that if patients are treated by doctors and told that nutrients and giving up gluten are solutions to hypothyroidism that getting treatment with thyroid hormones will become harder than ever. I am already aware that persistent symptoms in hypothyroidism are considered (in some quarters) to be caused by mental health problems that could be solved with CBT and exercise.

Oh, and the reference to the Mediterranean Diet (Med Diet) suggests that it is a low meat diet. I'm pretty sure that many people living around the Med love their meat. As I understand it one source of information about the Med Diet came from Ancel Keys who collected his data during Lent when many people gave up meat for religious reasons. And also, the idea that all the different societies living on the coast of the Med share a similar diet is laughable.

Another point - none of the people used as subjects were being treated with thyroid hormones. An odd choice of subjects in my view.

Also, from the description of the subjects they recruited :

Exclusion criteria were obesity (body mass index [BMI] >30 kg/m2); diabetes mellitus; kidney failure; history of neoplastic disease; existence of any comorbid cardiovascular, autoimmune, infectious, or inflammatory disease; current or past smoking history; and current or former alcohol abuse. Patients who had already been diagnosed with thyroid disorders or who had already been treated for thyroid dysfunction were also excluded.

So, they excluded people with any known autoimmune disease and yet claim the article is about Hashimoto's Thyroiditis.

Oh, and by the way, can you remember how often you ate meat 5 years ago? What about fish? Vegetables? Grains? Sugar? Using food frequency questionnaires as a way of getting an accurate idea of historical diet is hugely inaccurate.

.

[tattybogle in reply to humanbean]

Totally agree with you about the rather horrifying suggestion of thyroidectomy as a treatment for hashimoto's ..it's not the first time i've seen reference to this as a potential treatment, and i wondered where the idea was coming from... i will have a read of that one in a bit. But until they can sort out proper treatment that restores health to ALL the people who did have a clear clinical need to remove thyroid, it seems dangerously cavalier to go whipping them out in Hashi's patients (unless they had a massive goitre or something) .

The other study you mention ... the study group did have hashimoto' s (either TPOab positive or ultrasound evidence ) they just excluded other (comorbid) autoimmune conditions.

The controls didn't have TPOab .. both study group and control group had Euthyroid TFT's.

lol ..i certainly cant remember what i was eating in years past , so my responses to a survey wouldn't be worth a damn for accurate research ..... and i 'm pretty sure most mediterranean's do like to eat quite a lot of sheep ... which might arguably be easier to digest than beef ? , but it's definitely still 'meat'

[Charlie-Farley in reply to tattybogle]

Hi tatty these papers seem just a bit crazy! Haven’t got time to keep up at the mo. Into the season and things happening 🤫. Tell you more when we can.

humanbean you are sport on re the second paper you quote. For me, the exclusion caveats are so many in number they seem to be missing the point.

Had a similar argument with one of my supervisors when I was conducting an experiment of digestion of radio-labelled hydrocarbons in soil.

He wanted me to blend up the soil I was using in a mixer, to homogenise the material. 😱 soil is naturally heterogeneous.

In his quest for strong statistically significant results he completely missed the fact that he was changing the system (i.e. the soil) so completely that the results would not be representative of real life. Thankfully there was an Oxford researcher up at the time doing some collaborative work who agreed with me and it was the way they did it in their research group. 😅

The more you muck about with the experimental design, the less real-life it becomes. Hell that’s what multi-variate analysis is for but the experimental design has so much sway over what gets spat out the other end.

Cherry picking can get great results but out of poor experimental design.

Who really wants to Title a scientific paper ‘The digestion hydrocarbons in soil I mushed up in a blender’ 🤪😟 and bad science to pass it off as being representative- but it happens ALL THE TIME in all fields to a greater and lesser extent.

I wonder how many subjects they rejected before they got their ideal and TOTALLY unrepresentative sample group. 🤣

[jimh111 in reply to humanbean]

A quick glance at the thyroidectomy study suggests it is perfectly valid. The patients had very high TPO antibody levels that dropped dramatically after thyroidectomy. This was accompanied by a clear reduction in symptoms. Ideally each person in the control group would have had sham thyroidectomy but I don’t see this happening. The study provides the useful confirmation that elevated TPO antibodies are likely to cause symptoms independently of thyroid status. Research into means of reducing TPO antibodies without the need for thyroidectomy would be welcomed.

[tattybogle in reply to jimh111]

i was just checking it out too... can't get to the full results , but i do wonder from one or two comments that the symptoms which qualified people for inclusion in the trial, and one of the outcomes looked at for 'symptoms which improved' might have been symptoms directly to do with having a goitre compressing structures / voice etc . which would obviously improve with thyroid removal regardless of antibody action.

unfortunately they say they didn't have good detail on the 'adequate' thyroid hormone replacement any of them got before or afterwards.. so all the usual questions remain about adequate vs optimal treatment with Levo / TSH 'in range' .

The improved scores do look impressive ,, but i'd really want to see what the questions were , what the original and improved symptoms mostly were, and how well anybody's thyroid hormone treatment was optimised , before accepting that it really was the lowering of antibodies that improved the symptoms ( and i agree with you ...even if it was the lowering of antibodies that improved an array of symptoms .,and not just thyroidectomy improving constriction .... i think it would be better to look for less invasive methods to reduce the antibodies first )

Speaking as somebody who initially had unusually high TPOab of 2499 [<50] followed by > 3000 (but no goitre) , and 15 yrs later on levo had 'only' 195 .. (so a similar starting point and 'improvement' to this study group ) .... i can attest that i honestly don't think my symptom burden was any less when my antibodies were lower.

[humanbean in reply to jimh111]

The patients had very high TPO antibody levels that dropped dramatically after thyroidectomy.

I obviously missed that. I know that quite a few members of this forum benefit hugely by going gluten-free, and/or improving nutrient levels. Also, isn't keeping TSH low ( and hence thyroid hormones quite high) supposed to reduce the problems of the immune system attacking the thyroid?

I would guess that few sufferers from high TPO antibodies are told that certain courses of action may reduce their TPOAb levels and hence reduce ongoing damage to their thyroids.

Doctors appear to love reducing patients' options in order to steer them into a course of action that is to the doctor's benefit.

[helvella Administrator Thyroid UK in reply to humanbean]

I'm not convinced!

TPOab reducing after thyroidectomy makes sense - there will be less, or no, TPO being produced and getting into the bloodstream. Hence, no (or, at least, less) need for TPOab to help clearing up.

But reducing TPOab doesn't, so far as I understand, reduce thyroid damage.

If - even without having a thyroidectomy - someone reduced the rate of damage to their thyroid, then I'd expect to see TPOab drop as well.

[tattybogle in reply to helvella]

my TPOab dropped from >3000 to 195 , 15 yrs later ..... all by themselves (no idea when they dropped so much lower) ... my assumption is that this reduction is simply because i have less healthy thyroid tissue to attack now than i did when they were >3000 .. so there's less thyroid peroxidase floating about the place for them to label for 'clean up' . I never did a thing to help lower them .. arguably i did many things opposite of what is usually suggested to lower antibodies .

i eat shed loads of things with gluten in , i smoke tobacco. i use far too much sugar.... apart from that (!) my diet is pretty healthy/ wholefoods etc but it's a hell of a long way from 'AIP'

unfortunately i've never had an ultrasound ,so no idea what's been going on in there to confirm my theory .all i know is i've never been able to feel/ find my thyroid at all . or had any pain / discomfort / swelling where it is ( or isn't !)

But i had just as many problems with 195 as i did with >3000.... so i just don't believe it was the lowering of their antibodies that made them feel better.

[jimh111 in reply to helvella]

I think the issue is TPO antibodies affecting tissues other than the thyroid and so causing symptoms.

The full paper is here liebertpub.com/doi/10.1089/... or rather reference 6 is the original paper, see doi.org/10.7326/M18-0284 . It’s behind a paywall but the questions are documented here clinmedjournals.org/article... .

[helvella Administrator Thyroid UK in reply to jimh111]

Simply having an immune system that is being continuously stimulated (to produce TPOab) could have a significant effect. But I am still questioning exactly why they feel better after a thyroidectomy. And whether there is any real difference between end-stage total atrophy of thyroid and surgical removal.

[tattybogle in reply to helvella]

But I am still questioning exactly why they feel better after a thyroidectomy.

There' s zero information about their 'treated' thyroid hormone levels . other than TSH in range ...... my initial thought was , i wonder if Doctors were more prepared to give higher doses of Levo , or allow T3 use etc in people who had full thyroidectomy ?

.... Perhaps i'm just trying too hard to disprove it cos i don't like the idea.

[jimh111 in reply to helvella]

They suggest the improvement is a result of the thyroidectomy giving a rapid and very substantial reduction in TPO antibodies. Slow atrophy might have the same effect and it would be interesting to see some data on this.

[tattybogle in reply to jimh111]

if the NHS had been doing anything other than just testing TSH (and fT4 if you're lucky) for the last 20 years , there would be loads of real life data. Every one of us with autoimmune hypothyroidism should ideally have had an ultrasound and a full antibody panel including TRab at diagnosis ..in the name of collecting data for research ... for such a common disease that they don't know how it works ... it s bit rubbish that they don't bother showing any interest in these easily available bits of information.

if anybody lends me 150 quid i'll go do an ultrasound , see if my thyroid's gone down yet. cos my antibodies definitely have .

But my condition is worse and more unstable now than it was when TPOab were extremely high .

[Charlie-Farley in reply to humanbean]

On point! We said humanbean