Transcription
Hey everyone, Dr. David Clark. Today, I'll be talking about how different infections can trigger Hashimoto's thyroiditis. Okay, so let's get into this.
So Hashimoto's, as I'm sure you probably all know, is an autoimmune condition where your immune system is attacking either or thyroid peroxidase inside the thyroid gland or thyroid globulin. Ultimately, what happens in Hashimoto's is you are unable to make thyroid hormones the way that you should. So your levels drop on blood work, your TSH goes up because it's inverse, and ultimately you get diagnosed hypothyroid.
Now, interestingly, it usually takes about seven to ten years for most people to get finally diagnosed with Hashimoto's. I'm not sure exactly why that is, except to say that usually in the medical endocrinology world, it doesn't really matter if you have Hashimoto's or not. It just matters if you're hypothyroid or not, because they're really only going to give you replacement hormones. They're not really going to do anything for the autoimmune side of things. And so, with that in mind, let's talk about how do we get there in the first place, right?
Well, there are different infections that can trigger Hashimoto's. Now, how does that work? Well, just to start with, what we're talking about is cross-reactions. Let me show you a graphic about what that means. So, how infections can cause Hashimoto's. Let's do this process called cross-reaction. Sometimes people call it molecular mimicry, but I made this little animation here because I think it does a good job of explaining it.
So, in cross-reaction, we've got thing A, and then we've got thing B. Now, in our example here, thing A is going to be one of these infections that we're going to talk about in just a second. And it could be Helicobacter pylori, it could be Toxoplasma gondii, it could be Candida albicans. But the infections are thing A. And thing B is going to be thyroid peroxidase, which is that thing inside the thyroid gland that your thyroid gland uses to make the thyroid hormones. Thyroid peroxidase is the thing that when your immune system makes antibodies to it, your immune system, uh, blows it up, which leads to becoming hypothyroid.
Now, in cross-reaction, the immune system makes antibodies for thing A, right? Now, in our example, one of the infections we're going to talk about. And of course, those antibodies can stick to that thing because that's what they're designed to do. And you can kind of see how they fit. But the problem is, the antibodies for this infection can stick to this thing over here, which is thyroid peroxidase. And that is the real danger of cross-reaction is when there's a molecular similarity between something and another thing. In our case, infections and thyroid peroxidase. When you have the immune system reacting and going after whatever this thing is, the immune system can also go after this other thing because it looks similar enough. And that's what can happen with various infections, as we'll talk about in a second, and developing Hashimoto's. So that's cross-reaction, and that's how different infections can trigger Hashimoto's.
So let's talk about these different infections. If you're a little Googling, and I'm not really recommending you do that, you'll see one that's called Yersinia enterocolitica. That really has more to do with Graves' disease. Now, Graves' disease is an autoimmune thyroid condition as well, but it is non-destructive and it promotes hyperthyroidism, not hypothyroidism. So we're going to kind of skip that one.
The next one you might see is called Toxoplasma gondii. Now, this is a parasitic protozoan. Infects a lot of different warm-blooded animals, including us. Uh, where do you get it from? Well, you'll see that, you know, if you have cats and you have a litter box, you probably have it, which is kind of overstating it. But basically, if you eat undercooked meat, especially pork and lamb, deer, sometimes shellfish, don't wash your hands, that's how you can ingest this stuff. You can accidentally ingest cat feces, I guess, somehow that would happen cleaning a litter box. Uh, most people that become infected with this don't even know they have it because they don't have any symptoms at all. Some people, the minority, will feel like maybe they have the flu and they'll have like some swollen lymph glands, certain aches and pains that may last for a month or more. That is an infection that is known to cross-react with thyroid peroxidase. How common is that as a cause of Hashimoto's? I mean, I guess obviously there's some people probably had it. I don't think it's probably that popular or that, uh, that common.
The second infection on this list that can cause Hashimoto's is an infection with Clostridium botulinum. And really, in Clostridium botulinum, which is botulism, it's this stuff called neurotoxin A that does the cross-reaction. Now, botulism is a very serious illness. Um, and the toxin in botulism attacks the body's nerves, can cause problems with breathing if it affects your diaphragm muscle, paralysis, even death. Where do you get it from? Well, improperly canned, uh, uh, improperly canned foods, improperly preserved foods, improperly fermented foods that can form, that can present the, uh, the right kind of conditions to grow the spores. Again, what are the symptoms? Difficulty swallowing, double vision, drooping eyelids, slurred speech. These are serious things that are probably going to take you, uh, to the ER. Then there's the foodborne botulism, which is a little less serious looking, where you get vomiting and nausea and stomach pain. And in those, in foodborne botulism, the symptoms you'll start about 18 to 36 hours after eating, uh, the contaminated food.
Now, again, do you probably have an ongoing botulism infection, uh, right now? Probably not. And that's something I probably should have mentioned earlier. With each one of these infections, there's only a couple of them that you could probably still have right now. Most of these things are infections that you would have had at one point. Your immune system would have tried to clear it, and as it makes the antibodies, those antibodies cross-react with thyroid peroxidase.
All right, so we talked about Toxoplasma, we talked about, uh, botulism. The third one is Hepatitis C, which I'm sure a lot of you have heard of. That's a viral infection that causes liver inflammation and can cause liver damage and liver fibrosis. And most people that have Hepatitis C don't know that they have it. They don't look or feel sick. They don't know they're infected. But for people who do develop symptoms, they usually get it about one to two, excuse me, two to twelve weeks after infection. And what do they get? When they get those classic kind of yellow skin, yellow eyes, they don't want heat, they can be having vomiting and nausea, stomach pain, fever, a very dark colored urine, sometimes they call it cola-colored urine or light-colored stool, joint pain, and feeling tired.
Now, Hepatitis C, obviously, is something that you can have as a chronic infection, and it is one of these things that we know can cross-react with thyroid peroxidase. So if you have a known Hepatitis C infection in your past and now you're having low thyroid symptoms, which I think we should talk about, then it's probably time to get checked to see if you have thyroid antibodies. I don't know why most, uh, physicians just won't go ahead and check thyroid antibodies just to see if that's what's causing what's happening or not. Uh, you know, I say that, but I really do know the answer. Number one, insurance doesn't like to pay for it because it's not really going to change what they do. Again, they don't really have anything to offer, uh, the, uh, Hashimoto's patient other than just levothyroxine, Synthroid. And it's not that those aren't necessary, but that's not the only thing they need. That is not the only thing that can help. So I digress.
So, in infections, there's Hep C, there's Toxoplasma, there's the botulinum. There's another one called Human Parvovirus B19. Only affects humans. This is not the kind of parvo you can get from a dog or a cat. Um, it can cause what's called erythema infectiosum in infants. They get it's almost kind of like a hand, foot, and mouth looking disease, but it's really called fifth disease. It's a mild rash. Usually affects children. Adults can get parvo B19, and in some people, what that can create is a very acute, what we call polyarthritis, painful and swollen joints. And it looks kind of like rheumatoid arthritis in a lot of people. Now, again, this is not an infection you probably still have. Usually, what happens, you get an infection, your immune system clears it, but as part of clearing it, those antibodies can cross-react with what's going on inside your thyroid gland.
The last couple we'll talk about, um, I think you'll probably have heard of. The next one's called Candida albicans. Now, Candida is a fungus or a yeast, and it's an opportunistic, it's a pathogenic yeast, but it lives in us. Okay? It already is in our gut flora. It's there. So it's not whether you have Candida, it's whether the one, the stuff that you have is kind of in control and being corralled. That one is not corralled. You can get, you know, vaginal yeast infections, but you can also get sort of, uh, systemic GI disseminated, uh, Candida. And if that's a little controversial, I'll just, I'll just tell you, but you can test to see if someone has elevated, uh, Candida albicans antibodies. And above a certain range, the, the interpretation is you probably have an overgrowth. There are some urine tests you can do. There's this stuff that shows up in urine, it's an organic acid called arabinitol. High levels of that can indicate that perhaps you have an overgrowth of Candida. But these overgrowths are, you know, can be a serious thing. They're inflammatory, they cause disruption of the GI tract. But Candida is one of these things that you could still have. And and again, in an ongoing infection where your immune system is making antibodies, those antibodies could be actively cross-reacting with the thyroid, making the whole situation worse. So it makes sense to get tested for that if you have symptoms that kind of resemble that. The problem is, symptoms of Candida overgrowth are about 80, you know, items long. There's not really like a couple one or two symptoms that say, oh, this is for sure indicative of Candida. Uh, so you got to make sure you're working with someone that knows how to look at the whole picture and knows what tests you got to be doing or should do, and what tests probably don't make any sense to do.
Now, the other infection we'll talk about here is COVID or SARS-CoV-2. There's been some pretty good research to show that infection with COVID, or infection with SARS and getting, uh, COVID, whether it's asymptomatic or not, really likes to promote Hashimoto's in women. So if you've had COVID and now you're developing some of these low thyroid symptoms like fatigue, depression, weight gain, sleep disturbance, hair loss, menstrual irregularities, joint muscle pain, sleep problems, it's time to work with someone who knows about post-COVID autoimmune problems or long COVID. And that's a very kind of a complicated thing, but you got to make sure you find someone that knows about that because that could be what's happened. You had COVID, now you've got these kind of low thyroid symptoms, and it's Hashimoto's.
The last infection we'll talk about is Helicobacter pylori. Now, that is a bacterial infection that you could still have right now. Uh, typically speaking, Helicobacter pylori, you find in the stomach, sometimes in the proximal small intestine, and it's extremely inflammatory. And kind of depending on what part of the stomach it infects, it messes with your stomach acid. So for me, in kind of my take on this, what would tell me that someone has an H. pylori problem? Well, if they have kind of reflux symptoms, if they find themselves needing to take Pepcid all the time or something that's over-the-counter antacids, if they've got heartburn all the time, then I'm probably going to check them because it's just not that expensive to do the test. You can do is called a urea breath test, which is very easy. You basically, you know, breathe in a bag, you drink a drink, you breathe in another bag, and it'll tell you if you have H. pylori. Now, you can't do that test if you've been taking antacids. You've got to wait a couple weeks in between, just as a little side note. But you can also do, uh, there's a blood H. pylori antibody test you can do, there's a stool antigen test you can do. But if you have pretty prominent reflux and heartburn symptoms and low thyroid symptoms, and you haven't been diagnosed with Hashimoto's, or even if you have been diagnosed with Hashimoto's, it probably makes good sense to get checked out and see if you have H. pylori. And then then you get to decide if you have H. pylori, what do you want to do about it? Because there's antibiotics you can take, but I've been, uh, treating H. pylori for years without antibiotics and quite successfully.
So that's a whirlwind, uh, tour of H. pylori and Candida and Toxoplasma and parvovirus and those other things. But the point is, is really understanding cross-reaction and understanding that as your body fights off an infection through that process, it can make antibodies to that thing that then attach to thyroid peroxidase, and then now make your immune system go after that. So, uh, this could be a clue about how you developed Hashimoto's. That could be a clue about you are developing Hashimoto's if you get tested correctly. And it could also be clues about, uh, with those couple infections that you can still have, what you need to be looking for to decrease the attack on your thyroid gland to make your Hashimoto's better.
And this is pretty complicated. So if you know me, I'm always going to tell you, don't DIY. I really wanted you guys to, uh, see this so you can understand how complicated it can be, but also get a better understanding of how infections can do it.