Part 1 of 2 (Part 2)
by Mary J. Shomon
Drs. Richard and Karilee Shames, Authors of the new book Thyroid Power, Look at the Mind-Body Aspect of Autoimmune Hypothyroidism
I reviewed the new book Thyroid Power, and believe that one of the strongest chapters is Richard and Karilee Shames' discussion of mind-body aspects of autoimmune hypothyroidism. Their interesting theories about autoimmune hypothyroidism offer some interesting ideas that may resonate with some thyroid patients. Mary also wrote an excellent review of their book.
Mary Shomon: Most people have a vague sense that the immune system is involved with thyroid illness. Some even know that the brain is involved with immune function. Can you explain briefly that important connection?
Drs. Shames: It turns out that the cause of virtually all cases of low thyroid is not so much a faulty thyroid gland, as it is an over-zealous immune system. As strange as it might seem, common low thyroid is a mild immune system illness in which the immune system wrongly attacks the innocent thyroid gland.
The illness is called Hashimoto's Thyroiditis in honor of the Japanese doctor who first identified it.
Of course, there are other kinds of thyroid problems: infections, injuries, benign nodules, and cancer, for instance. But, most simple low thyroid disease is immune-caused.
Normally, the immune system is poised and waiting to defend the body against foreign invaders such as virus or bacteria. Part of this job involves constant search-and-destroy missions by certain white blood cells. These neutrophils and monocytes are always in motion, hunting down a hiding germ or cleaning up cellular debris. On a good day, they can even direct a killer lymphocyte into eliminating a previously normal body cell that has recently turned cancerous.
All this normal immune function is, of course, to our benefit. We live in a veritable sea of bacteria and other creepy-crawlies that are nicely held at bay by this relentless vigilant system. However, some of us pay a price for this pervasive vigilance.
Without warning and for no good reason, our immune system can sometimes start attacking our normal cells and tissues.
It is clearly a mistake for the body to be attacking itself, but it does happen. The name for this seemingly bizarre event is autoimmune illness. Once thought to be rare, it is now known to be surprisingly common.
For the moment, let us say that recent research is suggesting runaway environmental pollutants, among others, as likely culprits.
These deleterious influences appear to be assaulting our sensitive and delicately balanced immune systems, causing mixed messages within the body. Some of the new chemicals our immune system tries to fend off are hormone mimics. Others are hormone blockers. Still others are immune disrupters. Many of the thousands of these new chemicals dumped into the environment are simply low-level poisons.
In a desperate attempt to ward off an apparent assault from all sides, our confused antibodies are increasingly attacking our own glands and hormones. No one knows the exact mechanism, but the results are becoming obvious.
Mary Shomon: There is compelling recent information that bacterial infection might be involved in the underlying cause of triggering the autoimmune effect. What are your thoughts about this?
Drs. Shames: Yes, in fact you reported in your newsletter that there has been an interesting research study in Greece regarding the bacteria Yersinia Enterocolitica. The researchers in the Journal of Clinical Microbiology and Infection reported that the prevalance of antibodies to this bacteria was fourteen times higher in people with Hashimoto's Thyroiditis than in the control groups.
They concluded that there is strong evidence for an immunopathic causative relationship between this bacteria and Hashimoto's.
This is just one further example of what we are calling the multifactorial theory of Hashimoto's Thyroiditis etiology. In other words, various non-chemical factors might be combining with the chemical siege to cause our immune systems to make antibodies against our own thyroid glands.
If you have a family history of low thyroid, diabetes, or other rheumatic/autoimmune illness, then almost any serious physical or mental stress might trigger the primed immune system into mischievous action against the thyroid, one of its favorite body targets.
Thus, the cause of low thyroid disease may be viewed as multi-factorial, just as heart disease is multi-factorial. A person may have multiple risk factors, each of which can add to that individual's likelihood of acquiring the syndrome. Most people know that the risk factors combining to yield heart disease include family history, smoking, high blood pressure, high blood fats, stress, lack of exercise, and high levels of homocysteine.
Other than genetics and chemicals, are there other risk factors that could account for the energy epidemic that grips us? Could radiation, for example, be another cause? We know how deleterious this can be on sensitive immune balance. With the depletion of the ozone layer, our exposure to the sun's ultraviolet radiation is increasing.
Not only is the neck a likely place to receive much of this added new radiation, but the thyroid gland is particularly sensitive to it. Even more directly sensitizing to the delicate thyroid is the increased irrigation of food crops with brackish water containing significant amounts of radioactive iodine 131. This potentially toxic isotope is known to head straight for the thyroid gland and become concentrated there.
One non-chemical immune irritant on the increase is intestinal parasites. Once thought to be a problem confined to third world populations, a wide variety of mild parasitic conditions now affect the average city dweller in the United States.
Sometimes, without causing any particular distress, their presence is like a thorn in the side of the immune system, which makes increased levels of antibody against them. Increased antibody production against the parasites has a subtle way of spilling over into increased antibody production against the thyroid.
Still another possibly suspicious trend on the increase is the widespread fluoridation of municipal water supplies. This well-intended activity has been so widely accepted in today's society that it is shocking to read the mounting research casting doubt on its safety.
The short-range goal of reducing tooth decay seems to have blinded many to the long-range risks to sensitive immune balance posed by fluoridation. We discuss this in Thyroid Power.
The high stress of daily life may be as big a factor in thyroid disease as it is in heart disease. Anxiety and depression are known to have deleterious effects on immune balance. Also, the increasingly rapid pace of life may leave little time for immune-restoring activities like aerobic exercise, muscle building, or slow stretching. Keep in mind that what is disruptive to the immune system now, may be disruptive to a thyroid gland later.
Mary Shomon: How are these causative factors related to the mind-body connection?
Drs. Shames: Although it was once thought that the immune system functioned fairly autonomously, it is now known that this body system is in constant two-way dialogue with the brain. The control centers in the brain are continually feeding information to the immune system, and the immune system is continuously feeding information back to the brain. Our emotions, our stress level, and the very fabric of our inner life are directly related to the quality of this brain-immune conversation.
Current medical science does not provide easy solutions for people with autoimmune low energy. It is not simply that the underlying reason for the low energy is missed, though this is often the case.
Even when the problem is diagnosed properly, the treatment frequently falls short.
In autoimmune conditions, the whole body is involved, rather than just the organ that has been attacked. The damaged organ, in this case the thyroid, is referred to as the "target-organ." This is medical lingo for the part that displays the symptoms of the total body autoimmune situation. Interventions are generally directed only at the target-organ, and not the source of the problem, which is the entire immune system.
People need to know that taking hormones and vitamins for autoimmune low thyroid is similar to taking nose drops or eye drops for hay fever. The drops can help the symptoms, but can never fully address the root cause of the problem.
Thyroid doctors do not generally address the immune system problem because almost every standard medicine in the conventional medical arsenal is ineffective for autoimmunity. Recently developed immune-boosting medicines are not appropriate when the immune system is already in autoimmune overdrive.
Even the new immune-modulator drugs like Paxone and Avonex are not used for thyroiditis. Unfortunately, doctors simply do not have a pill to prescribe that will directly reduce the autoimmune component of low thyroid.
However, many non-drug approaches offer substantial promise. Before using them, you first need a clear sense of what is causing your particular version of the illness.
Mary Shomon: Do you feel then, that stress and emotions might be an autoimmune trigger in the same way that chemical pollution and/or Yersinia bacteria are autoimmune triggers?
Drs. Shames: Yes. The triggering of the autoimmune phenomenon resulting in common low thyroid (Hashimoto's Autoimmune Thyroiditis) is indeed possible from stress alone.
The tendency for the autoimmune reaction is in part genetic. There is presently no way to do much about that, except to choose your ancestors more carefully! We can, however, learn ways to reduce the factors that trigger the autoimmune tendency into a full-blown autoimmune attack.
One trigger is age. Some people's internal time clock goes off, and their autoimmune thyroiditis gets triggered. This can occur at any age, for no apparent reason, without another precipitating event. On the other hand, some women's thyroiditis is triggered by fluctuations in their female hormone levels, specifically at the unsettled times of puberty or menopause.
Other women find that the end of pregnancy is a trigger. This response is named post-partum thyroiditis. Many women who are diagnosed with postpartum depression, or postpartum low energy, actually have autoimmune inflammation of the thyroid gland.
Other triggers that have been described range from accidents, operations, and severe infections, to bulimia, crash dieting, and major changes in lifestyle. A few of our patients suffered from specific trauma to the neck (especially whiplash), which apparently triggered their long-term thyroid inflammation.
Scientists believe that the antibody inflammation gets started secondary to cell destruction from some other mechanism. This other mechanism can cause irritation and damage to the thyroid cells through the effects of outside chemicals, free radicals, food allergy, and perhaps other irritants.
It is even possible for severe stress alone to be a trigger. This should not be totally surprising, when considering the number of documented incidents in which stress has been shown to affect immune function. It may be part of the genetic makeup of certain individuals to be anxious and worried, which in itself predisposes them to this kind of triggering effect.
Fortunately, this is one genetic tendency where intervention has been successful. You might not be able to change your genetic makeup, but you can learn to be less stressed by life events, reducing the likelihood of triggering further autoimmune difficulty.
In fact, keeping your mental state in optimal health will reduce the likelihood that Yersinia, chemical pollution, and perhaps a host of other external factors will be able to trigger you into thyroiditis.
Stress does affect your immune function. It is certainly known and accepted in medical circles that severe stress can trigger hyperthyroidism, and perhaps Hashimoto's thyroiditis. The exact causal mechanism for this is not clear, but it is tempting to speculate.
Mary Shomon: So what does it mean to handle extra stress properly?
Drs. Shames: We've all heard about stress-reduction activities. When you are going through difficult situations, this is definitely the time to utilize any stress-reduction training you've had. You could choose meditation, self-hypnosis, or specific relaxation exercises from biofeedback or yoga. It is certainly the time to begin getting some exercise or to increase your exercise program, if you already have one. Ideally, you would initiate such a stress-reduction program before you were in the midst of big changes.
This could also be a good time for increased interactions with friends, or a time for some counseling sessions with a professional. Many people have found that biofeedback sessions can be very useful during stressful times. The act of quieting the mind using meditation techniques helps relieve the biochemical difficulties caused by the stress.
A combination of several of these techniques is known as imagery. Imagery involves imagining yourself in a relaxing locale. It's like a mental vacation. In addition, you can "see" a positive outcome to a problematic situation, or can mentally envision your world getting better.
Some call the process "visualization", but we find that people are very diverse in the ways they perceive. Instead we use "imagery", as imagination can take many forms, including sensations, smells, and feelings.
Mary Shomon: What practical things would you suggest someone with autoimmune hypothyroidism can start doing right now in their path toward better wellness?
Drs. Shames: For sufferers of autoimmune thyroiditis, why not visualize your immune system getting smarter, and leaving your thyroid alone? Just imagine it getting the point that its best job will be to protect you from outside invaders, like bacteria and viruses. Picture it leaving your glandular system, especially your thyroid, completely free to do its job, unencumbered.
The medical field specializing in the mind's effect on immunity is called psycho neuroimmunology. Its practitioners and researchers tell us that the brain is constantly talking to the immune system, and that the immune system constantly provides vital information to the brain.
Knowing this, you might therefore want to employ the above, or similar, imagery exercises on a regular basis. You might also want to consider more advanced forms of self-hypnosis and enhanced affirmation strategies. Our own books on this topic are Healing With Mind Power and Creative Imagery in Nursing.
Mary Shomon: I find it interesting to consider how being more mentally in control of the immune system might enable patients to better cope with their autoimmune thyroid problems. But are there specific practical things to focus on?
Drs. Shames: That is certainly a fair question. Here are some of our best tips for doing exactly that, based upon over 20 years of clinical experience each, both with thyroid individuals and thyroid recovery groups.