Gluten and hashimotos

[gsilvone7489]

For a while I've been having issues with sometimes having to go to the bathroom multiple times a day (usually twice in the morning, once in the evening) with a feeling of incompleteness in-between (I think it's called incomplete evacuation). No diarrhea involved...stool's pretty solid, but sometimes lacking shape. No pain or blood involved. I had told my doctor about this and he suggested I try a laxative to clear my bowels. That didn't seem to change anything. I checked with another doctor. After a blood test and a quick listen into my gut, instantly the guy told me that I had Hashimoto's disease/hypothyroidism, and specifically it was due to a gluten intolerance (my gut sounded like spastic colon. He wanted me to take thyroid medication (synthroid), cut out wheat, milk, dairy, and soy and take a "gut healer" called "Blue Heron." which would heal the supposed inflamed parts of my gut.

TSH 9.75 (0.45-4.5); TPO-Ab (863mL) (<35)

I didn't get how I could suddenly have a food allergy, especially something like wheat which is in everything. I asked if I could get tested to make certain that I actually have these allergies before I make such a big diet change. He told me it wouldn't matter; I still insisted on doing the test. A few weeks later, the lab results came back. I have yet to actually see the results with my own eyes, but according to my doctor, my food allergy panel was clean, with sensitivities to wheat being very low in fact. (At the same time, he did some blood test for Celiac's and found that to be negative as well.) Despite these results, he still claimed I was gluten intolerant.

Can you still be gluten intolerant despite a clean food allergy panel test? Aside from the existence of a disorder, wouldn't you know if you were gluten intolerant the moment you ingested it? Also, would an underactive thyroid be the cause of why I can't clear my bowels out in just one trip to the bathroom?

[goolarra]

Those are the antibody tests for celiac, and they're negative, which is good.  However, there is no way to positively eliminate celiac without a small intestine biopsy.  That being said, however, "I" certainly wouldn't go there with negative celiac antibody tests.  There's also still the matter of non-celiac gluten intolerance.  Some people just feel better on a g/f diet even without antibodies.  Researching this is very complicated, especially since in the earlier literature on the subject, the terms celiac, gluten sensitivity and gluten intolerance were used interchangeably (non-celiac gluten intolerance hadn't been invented yet).

Believe me, I'm not pushing a g/f diet.  I went g/f a few years ago.  I didn't do it for thyroid reasons, so I expected no thyroid improvement, and that's just what I got!  I was g/f for close to a year, and I ended up with some "new" g/i problems that were really worse than what had brought me to the g/f diet to begin with.  

You have two knowns that need work.  I think if I were you, I'd concentrate on getting those balanced out and see where that leaves your symptoms.

[gsilvone7489]

Got a look at some of my blood tests today...to clarify, the following celiac related tests were done (all negative): Gliadin IgA, Gliadin IgG, and Endomysial.

[gsilvone7489]

Alright, I'll see what happens with the synthroid and vitamin D and post back if there are any changes. Thanks for your help goolarra!

[goolarra]

Yes, you can only treat the symptoms.  

I'm glad to hear he has you on a relatively aggressive dose of vitamin D.

Synthroid is slow acting and has a long half life.  It will take your initial dose 4-6 weeks to reach its full potential in your blood, after which we wouldn't expect any further change until/unless your dose is changed.  50 mcg is a reasonable starting dose, but I suspect that it will not be your ultimate/optimal dose.  With thyroid meds, it's always best to start out low and increase as tolerated.  Otherwise, you can get hyper-like symptoms (which are less fun than hypo symptoms).  

Will you see any benefits in a couple of weeks?  You might.  However, your FT4 is so low right now that you actually might have a period of time where you feel better followed by a "relapse".  This isn't at all unusual as your body has to rebalance after being hypo.  You have to give each dose about 4 weeks to settle, retest, re-evaluate symptoms, adjust dose, repeat until you get it right.

[gsilvone7489]

So, I can only really treat the symptoms?

He did prescribe a supplement 1.25 MG (50,000 unit) once a week, which I've already started taking. I don't know when my Vitamin D will go back into normal ranges, but for the time being should I expect to see any benefit from the synthroid in the next couple of weeks?

[goolarra]

It's not celiac causing elevated TPOab, it's Hashi's.  TPOab is thyroid peroxidase antibodies.  Thyroid peroxidase is the enzyme that catalyzes the addition of iodine, in your thyroid, to thyroglobulin (the protein precursor of the thyroid hormones).  So, these antibodies are very specific.  One antibody attacks one antigen (protein).  Some of us with Hashi's are also TGab (thyroglobulin antibodies) positive.  TPOab can be "somewhat" elevated with other autoimmunes, but it is THE marker for Hashi's.

There is nothing you can do about the antibodies (nothing proven at this time).  There are claims that a number of different things will lower antibodies...gluten free diet, selenium, LDN (low dose naltroxene), barking at the full moon (LOL)...but nothing that has been studied and proven to work.  All you can do is treat the symptoms of the damaged thyroid once the antibodies have done enough damage to make you hypo.  Nor is there anything proven to eliminate antibodies, and the efficacy of just lowering them is questionable.

Your vitamin D is more dismal than yout FT4!  Has your doctor suggested supplementing?  Vitamin D deficiency can have some of the same symptoms as hypo.  If so, how much are you taking?  You need to start working on that right away.  D deficiency can also affect how your body metabolizes thyroid hormones, i.e. if you are deficient in D, your meds might not do you as much good as they should.

[gsilvone7489]

Yeah, that's what I've been reading...that's it's not just about being in the range, but where you are in the range that actually matters.

Well, I have noticed at work that everyone around me will feel hot when I'll feel cold, and I've usually attributed that to just the stuffiness and catching a cold in the morning. But I can still tolerate being cold...

Forgot to mention this too...my Vitamin D-25 levels are also pretty low 21 (30-100).

I was prescribed just 50mcg a day and was told to schedule a lab test in 6 weeks. Haven't started the medication yet because I wasn't sure if my doctor was looking at this all right because of his gluten suspicion. But I suppose, at least the medication makes sense for treating the hypo - I'll give it a go.

But this would just treat the hypo...I still need to be concerned about the high TPO, right? Besides Celiac's, what would cause an elevated TPO?

[goolarra]

Well, your FT4 is pretty dismal, below range.  Most of us find that FT4 has to be close to midrange before symptoms are alleviated.  Your FT3 is at 36% of range, and upper half of range is the rule of thumb for FT3.  However, FT3 relative to FT4 is good (FT3 should be higher in its range than FT4 is in its), which might be why you have relatively few symptoms at the moment.  

Cold intolerance is more feeling cold when everyone else around you is comfortable or hot.  When I was hypo, I also felt that my tolerance of the discomfort of being cold (if that makes sense) was lowered, i.e. when I was cold (which was most of the time), it bothered me much more than it does now when I occassionally get cold.

I would guess that your issue with the A/C might have more to do with the fact that it lowers the humidity.  Post nasal drip can be a symptom, though.

Your bowel issues aren't what I'd call typical.  Most often, constipation is the complaint.  However, once again, symptoms can be very individual and have to be compared to lifelong habits.  Slower digestion might be responsible for having to hit the bathroom several times instead of once.  

I think that if I were you, I'd get my thyroid hormones to better levels and see if that resolves your gut issues before I pursued it as a separate problem.  As I said, 50% of range for FT4 and 50+% for FT3 are target values until you see where you feel best.  Be sure your doctor isn't one of those who gets you into the bottom of the range and thinks his work is done while you still languish with all kinds of symptoms.

Have you already started the Synthroid?  How much are/will you be taking?    

[gsilvone7489]

Thanks for responding to this!

You're right, that was total. The ranges have no decimals because I was reading off of a summary he had given me with his own ranges.

From the actual lab results:
T3 Free 3.0 pg/mL (2.0-4.8) ; T4 Free 0.8 ng/dL (0.9 - 1.7)

I don't know if this is "cold intolerance" but if I leave the AC on while I sleep, I almost always wake up with a sore throat and/or stuffiness.

So, are the bowel issues I described inline with what typically happens under hypo?

[goolarra]

Is that FREE T4 or total T4?  That's an unusual range for FT4.  Also, no decimal places on the FT3 range?

Gluten is being blamed for a multitude of things.  As far as I know, there has been NO scientific study connecting gluten to Hashi's...lots of claims that it is, but I've yet to see the study.  Furthermore, if there is a connection, I believe it would be between Hashi's and celiac, not Hashi's and non-celiac gluten intolerance.  Hashi's and celiac are both autoimmune, and once you have one, you are more likely to have another than the general population is to get its first.  

I think you have to try to separate your "thyroid" symptoms from lifelong "symptoms".  For example, like you, I have always had very dry hands (and feet) all my life, so for me, that's really not a hypo symptom.  Hoarseness and having to clear your throat are symptoms of hypo.  I also had that, and it's vastly improved since treatment.  Hair loss from hypo is usually more overall than male pattern baldness.  Hypo could be exacerbating your hair loss, however.

[gsilvone7489]

Whoops, forgot to post T3/T4...
Free T3 3.0 (2-4); Free T4 4.6 (6-12)

The second doctor was actually naturopathic, which is probably why he blamed gluten.

There are a lot of symptoms which I've had over the years which seem to fit a hypothyroid profile, but they could just as well be symptoms in their own right. For example, I've always seemed to have dry hands and I seem to always need to clear my throat (not sure if that's a hypo symptom actually). I have been balding for the past two years now, which was diagnosed as male-pattern baldness. But it's strange how fast the hair loss progressed in just those two years, so I wonder if the speed of loss could be a symptom.

Listening to gut - he used spastic colon to validate the gluten intolerance. (Irritated gut = food allergy, which would most likely be gluten given its connection to hashimoto's). But again, the guy was a naturopath, so I feel that everything would end up being a food allergy to the guy.

From looking at other posts in this forum, it looks like going to an endocrinologist would be best in order to fully diagnose this.

[goolarra]

First, there is NO way to diagnose Hashi's by listening to your gut.  However, your positive TPOab does indicate that you have Hashi's.  Your TSH is elevated, indicating that you are already hypo, but you should confirm that by having your doctor test the actual thyroid hormones, FREE T3 and FREE T4.

Gluten intolerance and wheat allergy are two different things.  The gluten issue is further complicated because there is both celiac disease (autoimmune gluten intolerance) and and non-celiac gluten intolerance.  With celiac disease, antibodies attack tissue in the gut making it progressively hard to absorb nutrients.  Your doctor probably did an antibody test for celiac,  However, the blood test is not conclusive, only a small intesting biopsy is conclusive.  

Gluten intolerance has become "popular" in our culture and is being blamed for just about everything, including Hashi's (by some).

So, yes, you can be gluten intolerant despite a clear allergy panel.  You would know an allergic reaction most likely immediately, but celiac is slow moving and, like Hashi's, the symptoms are subtle and slow moving.

This is not to say YOU are gluten intolerant or have celiac.  All the tests you've had are negative.  I'm just letting you know what CAN happen.

Thyroid disorders do cause bowel issues.  Constipation is the most frequent complaint with hypo.  Hypo slows the metabolism, which slows the speed with which food passes through the gut.  

Do you have other hypo symptoms?

What type of doctor are you seeing?