Also in this article:

Hair loss in Hashimoto’s patients – What you need to know

Recent published study – Hashimoto’s reduces brain function


Top 10 reasons Hashimoto’s patients don’t get better

Hashimoto's disease chalkboard imageThere is not one easy fix to successfully managing Hashimoto’s hypothyroidism, an autoimmune thyroid disease. As many people have learned the hard way, using thyroid hormones to get TSH within lab ranges certainly doesn’t guarantee a fix for most people, although it can help.
For Hashimotos patients to truly manage their autoimmune Hashimoto’s hypothyroidism, it’s important to understand the factors that contribute to it.

10. Immune Reacting Fillers in Thyroid Hormone Replacement

Many thyroid supplements use corn starch or modified food starch that contains gluten. You need to make sure your thyroid hormones are gluten-free and free of corn starch if you react to corn. If your medication is in capsules make sure the capsules are gluten-free. Otherwise you could be taking hormones every day with dietary proteins that stimulate your autoimmunity.

9. Taking Immune Enhancing Supplements

Nutritional supplements can either help or flare up your autoimmunity based on an individual’s T-helper dominance (whether you have a TH-1 or TH-2 dominance). Supplements such as echinacea, green tea, acai, astragalus, licorice, and a variety others. can either help or aggravate autoimmunity depending on your dominance. If you are unaware of this you may be taking supplements that promote an autoimmune response. Please refer to Chapter Three of my thyroid book, Why Do I Still Have Thyroid Symptoms? for more information and lists of supplements and herbs to be aware of.

8. Fixating their focus on thyroid hormone replacement only

Many thyroid patients believe that if they could only figure out the perfect version of thyroid hormones (natural versus bio-identical or T3 versus T4) they can correct all of their symptoms. Unfortunately, Hashimoto’s hypothyroidism is a complex autoimmune disorder and thyroid hormone replacement is only one part of a large puzzle. However, if you need help learning more about thyroid hormone variations please refer to a previous newsletter article titled, Which thyroid hormone is right for you?

7. Increasing Stress

Emotional stress activates pathways involving the inflammatory immune messengers IL-6 and TH-17. This activity creates an autoimmune flare-up. Unhealthy relationships with your spouse, co-workers, or friends can promote autoimmune flare-ups, as can a bad work environment, or other significant and chronic lifestyle stressors. If you have Hashimoto’s you need to create a healthy emotional environment for yourself. Bad personal relationships or poor work environments can be detrimental to Hashimoto’s patients.

6. Not Strictly Gluten-Free

You are either 100 percent gluten-free or you’re not gluten-free. Choosing to eat gluten-free only when it is convenient is not a gluten-free diet. If you are not strict about your food being 100 percent gluten-free when you eat out and you continue to consume condiments that have gluten, regular beer, and foods fried in fryers that use the same oil for breaded foods, then you are still being exposed to gluten. Gluten is a major trigger for most Hashimoto’s patients and many cannot improve until they are 100 percent gluten-free.

5. Not avoiding gluten cross-reactive foods

Although a strict gluten-free diet is a great place to start, if you are still eating foods that cross-react with gluten you may not recover well. Cross-reactive foods have proteins similar in structure to gluten and can trigger the same immune response as if you were eating gluten. The most commonly ignored cross-reactive food is milk (casein), followed by rice, corn, sesame, and gluten-free oats. In fact, it is best to avoid all grains and adopt a diet such as a Paleo diet when you have Hashimoto’s.

4. Ignoring their brain health

The most common form of collateral damage in chronic Hashimoto’s patients is accelerated brain degeneration. Brain degeneration leads to identical symptoms of hypothyroidism, including fatigue and depression. I strongly suggest all thyroid patients become experts in identifying and supporting their brain health by referring to my second book, Why Isn’t My Brain Working?

3. Ignoring insulin sugar spikes

Surges of insulin that follow eating or drinking something sugary or starchy (sweet coffee drinks, desserts, bowls of pasta or rice, bread, etc.) trigger the inflammatory TH-17 activity, which promotes autoimmune flare-ups. Eating sweets throughout the day or overeating promotes insulin surges, which can be identified by symptoms of fatigue or sugar cravings immediately after eating. If you have those symptoms after eating it means you are not managing your insulin levels and your Hashimoto’s autoimmune response will be hard to tame.

2. Missing meals

When blood sugar gets too low it raises the inflammatory messenger IL-6 and promotes autoimmune flare-ups. Symptoms of low blood sugar are most noticeable between meals or if you skip meals and include shakiness, blurred vision, crankiness and irritability, and loss of function. If you feel a jump in your function and energy after eating it confirms your blood sugar was low—when your blood sugar is stable the only thing you should feel after eating is not hungry. Constantly skipping breakfast and missing meals will aggravate your autoimmune response and promote autoimmune flare-ups.

1. Passive attitude

The passive patient does not question or challenge her doctor. If you are a passive Hashimoto’s patient and you do not take your health into your own hands you may not fare as well as the person who educates herself. The conventional model is based only on lowering your TSH with whatever thyroid medication your insurance plan or doctor prefers. Once TSH is within lab ranges, this model has nothing more to offer except to check your TSH once a year. It takes time and effort, but the thyroid patient who wants to feel better needs to roll up her sleeves and master the various mechanisms of Hashimoto’s. The more you understand Hashimoto’s the more likely you are successfully manage your health.

Hair loss in Hashimoto’s patients –- What you need to know

thinning hair imageThyroid hormones are important for the health of hair follicles and many thyroid patients struggle with thinning hair and hair loss. Although many thyroid patients resolve their hair loss issues with thyroid hormone medication, many others don’t. It’s important to understand factors beyond thyroid medication that affect hair loss.

Inflammation can impair hair follicle cell function

First, the autoimmune response impairs how thyroid hormones act on cellular receptors, including the cells in hair follicles. When inflammation is high, inflammatory immune cells called cytokines can interfere with the action of thyroid hormones on these cellular receptors. This is one reason why, in addition to making sure your thyroid hormone levels are sufficient, it’s important you manage inflammation. Many times hair loss will not resolve until the patient learns how to manage their autoimmunity.

Elevated testosterone in women main cause of hair loss

However, the most common reason female Hashimoto’s patients suffer from hair loss is due to elevated testosterone. Symptoms of elevated testosterone include thinning hair, hair loss, an inability to lose weight, and in more extreme cases, excess facial hair. For most women, high insulin levels brought on by an unhealthy diet and lifestyle cause excess testosterone. This is because insulin stimulates an enzyme in the ovaries called 17,20 lyase, which promotes the synthesis of testosterone. This increased testosterone then leads to thinning hair and hair loss. Factors that promote insulin surges and hence elevated testosterone are a diet high in starches, refined carbohydrates, and sugars, and a sedentary lifestyle.

Poor blood flow to scalp causes hair loss

Another common cause of continued hair loss in Hashimoto’s patients is poor circulation. The hair follicles need a constant supply of nutrient-rich blood. If circulation to the scalp is compromised, hair loss is inevitable. Clinically, the signs that signify poor circulation include cold hands, cold feet, cold tip of your nose, and poor nail health (nails also require good circulation to be healthy). Thinning hair is not the only consequence—poor circulation can have devastating impacts on your brain health. I discuss this concept in detail and offer strategies in my new brain book, Why Isn’t My Brain Working?

Recent published study –- Hashimoto’s reduces brain function

brain scans 1A recently published case study showed that neurological symptoms can occur in Hashimoto’s patients. SPECT brain scan imaging showed reduced brain activity (hypoperfusion) both in patches and throughout the entire brain. The brain scan images completely changed after subjects were given corticosteroids to suppress the autoimmunity, showing improvements in many areas. However, patchy areas of impairment persisted despite autoimmune suppression.

brain scans 2This study illustrated two key concepts. First, Hashimoto’s impairs brain function and dampening autoimmunity can improve function. Second, areas of continued brain degeneration persist despite treatment that dampens autoimmunity.

I cannot stress enough how important it is to improve your brain health when you have Hashimoto’s. This is exactly why I wrote my second book on brain health—it is so critical for my Hashimoto’s readers. In in my practice I have found the most important second step Hashimoto’s patients must take after reducing their autoimmune expression is to optimize their brain function.

To read the study, click here.



  • shirley June 8, 2014 at 2:00 pm

    After 20 years of brain fog and fatigue to the point I could not work, I am now on a grain free diet. I have more energy and not as much brain fog but I still do not think or remember many simple things like simple words. What do you suggest to optimize the brain?

    • Thyroid Book June 10, 2014 at 5:53 am

      Have you seen his new brain book? He has lots to say about this. As with everything, it’s all about finding finding the root cause. It can be a neuro inflammation issue, a food that is cross reacting with gluten, a neurotransmitter issue, a hormone issue, etc. The brain book will give you more ideas:

  • INDIANA CERTA June 17, 2014 at 1:38 pm




  • Marge Cantu July 3, 2014 at 10:54 pm

    The “Why do I Still Have Thyroid Symptoms? and “Why isn’t my Brain Working?” books are life changing. I read both books and realized the seriousness of Hashimoto’s and what to do about it. Thank you Dr. Kharrazian for all your research & work!

    • Thyroid Book July 15, 2014 at 6:59 am

      Thank you! If you have the time, reviews on amazon always help spread the word!

  • patty July 10, 2014 at 2:59 am

    hola…tengo hashimoto y tengo la testosterona baja…(yo había leído que en el hipotiroidismo los niveles de testosterona bajaban).. reflejándose en problemas con la líbido, piel seca, debilidad muscular, etc etc…Por lo leído en el párrafo anterior…no siempre bajaría la testosterona?….y en mi caso, sería recomendable utilizar geles de tedtosterona ?….gracias por su valiosa respuesta…saludos.

    • Thyroid Book July 15, 2014 at 6:58 am

      El Dr. Kharrazian siempre aconseja para hacer frente a la causa del desequilibrio hormonal funcionalmente primero si es posible. De lo contrario, lo mejor es consultar con un profesional con experiencia de trabajo con las hormonas bioidénticas y poner a prueba con regularidad.

    • amelia rodriguez February 24, 2015 at 5:18 am

      ojala llegues a ver esta respuesta. Si tus hormonas estan desequilabradas, segun el doctor kharrazian, se debe ver si hay un problema mas central que pueda ser la tiroides.

      Por ende, yo no empezaria con el balanseo de las hormonas si no con la determinacion si hay defecto en la function de la tiroides. Si es asi, leeria su libro Why Do I Still Have Thyroid Symptoms en espanol para que hagas cambios de inmediato y trates tu tema de la salud de forma integral, inclusive tu salud intestinal.
      Buena suerte

  • Marilyn July 13, 2014 at 7:14 pm

    Does Dr. Kharrazin have any doctors he trained in Canada?

    • Thyroid Book July 15, 2014 at 6:55 am

      Only US practitioners receive training at this time I believe.

  • Elizabeth Marriott July 14, 2014 at 4:30 pm

    Dr K – Do you know of any doctors in Scotland who work with these issues along your lines? Had a good one but he died and the NHS has turned its back on treating for symptoms when tests are ‘normal” Need help!

    • Thyroid Book July 15, 2014 at 6:54 am

      At this time only practitioners in the US receive training, however some work long distance. You can inquire through the Find a Practitioner page.

  • Angela July 17, 2014 at 6:00 am

    I was diagnosed with cholestatic liver disease/questionable autoimmune Hepatitis. I have this diagnosis because I have every symptom for autoimmune hepatitis but all my blood markers and two liver Bx came back normal. I was prescribed URSO which makes my liver enzymes normal but my symptoms are still there. I have been trying to change my diet but my symptoms keep coming back. Everytime they come back its worse everytime. Every DR I see says my labs are normal and dismiss me.They say I am a rare case. Does Hashimoto disease act similar to autoimmune liver disease as explained in this blog?

    • Thyroid Book July 27, 2014 at 6:22 pm

      The basic mechanisms behind autoimmune disease are similar regardless the tissue being attacked. You might want to check out his brain book for newer info on working with autoimmune reactions.

  • sue August 6, 2014 at 4:57 am

    Please, I need a recommendation for a dr trained under dr k. In Orange California. I have hashimotos and now gaining a lot of weight walking heating healthy food choices plus gluten an dairy free. I hope u can advise

  • Lynda Beaudoin August 14, 2014 at 10:53 am

    J’aimerais communiquer avec un praticien au Quebec ou au Canada. I would like to communicate with a Quebec or a Canadian practicionner. Please help Thank you

  • Jamyla November 4, 2014 at 9:59 am

    I am looking for a doctor in Lebanon or in a European country if possible.
    I have Hashimoto.

    Thank you

  • Cheryl Dieffenderfer November 18, 2014 at 7:10 pm

    Is there a doctor in the Atlanta, Ga area trained by Doctor K? Two of my children as well as me have Hashimoto’s and adding the thyroid is now failing for one of them. She is already gluten free but had rice and egg allergies as a baby although seems to tolerate them now. I am wondering how to find the cross reactive foods as well as help her as the first step her doctor wants to take is an iodine supplement which I understand can lead to more problems. Thank you

  • Amanda November 22, 2014 at 8:28 pm

    Your list of local practitioners is quite short. Is there a more extended list that can be accessed? I began the protocol with a practitioner that moved out of state. Without the practitioner, getting the recommended supplements from Apex Energetics has been quite challenging.

  • Elsie December 10, 2014 at 2:49 am

    I was diagnosed with underactive thyroid 5 years ago and have been taking medication daily since then (25 mcg). Is it possible for me to go off medication thru diet? Have recently started a gluten free diet as well as dairy free. And is it possible to be dairy free when eating kefir every day? Is kefir classed as dairy free? Please reply.

  • Bonnie February 19, 2015 at 2:06 am

    Is there a doctor in the Phoenix, Arizona area that has been trained by Dr.Kharrazian to treat my Hashimot’s? I have been on a strict diet, grain and dairy free along with multiple food allergies for 18 months with no improvement of my symptoms. I can’t even tolerate Armor or Synthroid.

  • Rebecca February 19, 2015 at 8:06 pm


    I am reaching out because I’m really overwhelmed and can’t find clear answers online.
    I recently found out through an ultrasound that the right side of my thyroid shows signs of disease but all of my blood tests (including antibodies) are normal. They said it could be the very beginning of Hashimoto’s.
    I have decided to try going gluten free, however I am terrified by everything I’m reading and I’m not sure just how careful I have to be. I also have OCD so that is making me completely paranoid about cross-contamination but I’m not sure to what level I need to be. For example, if I go to chipotle do I need to tell them to put on new gloves before they touch my to-go bowl? Should I avoid eating out at restaurants altogether? I am terrified of the idea that microscopic particles of gluten are damaging my thyroid and I don’t even know it because I don’t have overly obvious symptoms.
    Any help and advice would be greatly appreciated.



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