When it comes to trying to find out the cause of one’s thyroid or autoimmune thyroid condition, testing can play a very important role. This is why I recommend testing to just about all of my patients with Graves’ Disease and Hashimoto’s Thyroiditis. However, one shouldn’t underestimate the importance of a comprehensive health history. While many times doing a thorough health history alone won’t identify the autoimmune trigger, it can still provide some important clues.
What I plan on doing in this blog post is to discuss some of the more important components of a health history. While I hope that most people reading this are working with a natural healthcare professional who will conduct a thorough health history, if this isn’t the case I would go through each of these components on your own. In fact, regardless of whether or not you are working with an expert I think it’s a good idea to read through this information, as doing so might help to identify certain triggers. Another benefit of a thorough health history is that it can help determine which tests are required to find certain imbalances which are either directly or indirectly responsible for your condition.
It’s also important to understand that completing a thorough health history might require you to fill out multiple forms. It depends on the healthcare professional you’re working with, as some doctors will have all of the information on a single form, while others will require multiple forms to be completed. Some offices will allow you to fill out all of the patient information electronically, while this won’t be the case for others.
Components of A Comprehensive Health History
Lifestyle factors. This is one of the main reasons that more and more people are developing autoimmune thyroid conditions. Some of the more common lifestyle factors which can either directly trigger autoimmunity, or make someone more susceptible to autoimmunity, include the following:
- High stress levels
- Low stress handling skills
- Drinking alcohol on a regular basis
- Consuming a lot of sugar
- Overtraining
- Excess caffeine consumption
- Insufficient sleep
Medications and supplements. Certain medications such as antibiotics, NSAIDs, and acid-blockers can make someone more susceptible to developing an autoimmune condition by having a negative effect on the health of the gut. While most nutritional supplements and herbs won’t trigger or exacerbate an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, there are possible exceptions. For example, some natural healthcare professionals recommend for people with Hashimoto’s to avoid Echinacea and chlorella out of fear that these will further enhance the immune system response, thus exacerbating, or possibly even causing an autoimmune condition. However, this is controversial, and I spoke about this more in past blog post entitled “Echinacea: Harmful for Hashimoto’s, Beneficial For Graves’ Disease? [1]”
Past procedures and surgeries. While most medical procedures and surgeries won’t trigger thyroid autoimmunity, certain procedures may make someone more susceptible to developing autoimmunity. For example, while there is a concern over estrogen dominance, estrogen also has a protective effect with regards to immune system health. And while I didn’t find any evidence of a correlation between getting a hysterectomy and developing Graves’ Disease or Hashimoto’s Thyroiditis, there is evidence that a hysterectomy can be a factor in other autoimmune conditions, such as systemic lupus erythematosus (1) [2]. Other surgical procedures might also increase the risk of autoimmunity, such as bariatric surgery (2) [3]. Keep in mind that I’m not suggesting that women should never get a hysterectomy, as there definitely is a time and place for these and other surgical procedures. And I think it’s safe to say that most of the time these and other medical procedures won’t trigger thyroid autoimmunity, but it’s still a factor we need to consider when gathering information.
Infections (current and past). Certain infections can play a role in the development of autoimmune thyroid conditions. As a result, it’s good to know if someone with Graves’ Disease or Hashimoto’s Thyroiditis had a previous infection. Of course just because someone had a previous infection prior to developing an autoimmune thyroid condition doesn’t mean that the infection was the trigger. But it still can be beneficial to know if someone had an infection.
For example, there is a correlation between H. Pylori and thyroid autoimmunity, especially with regards to Graves’ Disease. As a result, if someone with Graves’ Disease tested positive for H. Pylori a few months or years prior to being diagnosed with Graves’ Disease, this doesn’t confirm that this was the trigger. However, it is possible that this infection was a trigger, and even if the person had received treatment to eradicate this infection, it probably would be a good idea to do an updated test for H. Pylori.
Family history. Although genetics isn’t the most important factor in the development of an autoimmune thyroid condition, it is a factor. And while you can’t change your genes, I still think it is beneficial to find out if there is a family history of a thyroid or autoimmune thyroid condition in someone who has Graves’ Disease or Hashimoto’s Thyroiditis. Although the natural treatment approach might not differ much for someone who does have a strong family history of thyroid autoimmunity, if a person with Graves’ Disease or Hashimoto’s Thyroiditis has multiple family members with an autoimmune thyroid condition then they might want to be a little more strict with the diet and other lifestyle factors not only while restoring their health, but while trying to maintain a state of wellness.
Symptoms. While you usually can’t rely on symptoms for detecting the autoimmune trigger, this doesn’t mean that one’s symptoms should be ignored. For example, many people with Hashimoto’s Thyroiditis are overweight, but some people with Hashimoto’s Thyroiditis have the opposite problem. In other words, some people with Hashimoto’s have difficulty gaining weight. And if this is the case then one possible cause is a malabsorption problem, which in turn can be due to a pathogenic infection, or a condition such as small intestinal bacterial overgrowth. Speaking of infections, if someone has extreme fatigue, along with migrating muscle and joint pain, then Lyme disease might be the culprit.
Of course certain symptoms can have multiple causes. For example, if someone with Hashimoto’s Thyroiditis has extreme fatigue, then this can be due to low thyroid hormone levels, adrenal fatigue, one or more nutrient deficiencies, a pathogenic infection, or even blood sugar imbalances. And while testing might be necessary to determine the cause of the fatigue, asking the right questions can also help. Below are some of the signs and symptoms people with Hashimoto’s Thyroiditis commonly have:
- Trouble concentrating/memory difficulties/brain fog
- Fatigue
- Cold hands and feet
- Weight gain
- Bloating/belching/gas
- Constipation
- Hair loss
- Lowered libido
- Hot flashes and/or night sweats
And these are some of the signs and symptoms people with hyperthyroidism and Graves’ Disease commonly have:
- Increased resting heart rate
- Heart palpitations
- Weight loss
- Increased appetite
- Tremors
- Loose stools or diarrhea
- Hair loss
These are other signs and symptoms some people with both hypothyroid and hyperthyroid conditions can experience:
- Sweet cravings
- Caffeine cravings
- Headaches/migraines
- Muscle pain/joint aches
- Bloating/belching/gas
- Stomach burning
- Dry eyes and/or dry skin
- Increased frequency to food reactions
- Intolerance to smells
- Multiple smell and chemical sensitivities
- Indigestion and fullness last 2-4 hours after eating
- Sense of fullness during and after meals
- Coated tongue
- Dizziness when standing up quickly
Exposure to Environmental Toxins. We live in a toxic world, and most people are exposed to hundreds, if not thousands of different chemicals on a regular basis. Because of this, if an environmental toxin is the trigger, then many times it can be challenging to find out what the triggering chemical is. While you can spend money to test for certain environmental toxins, including heavy metals, as well as other chemicals, you can’t test for all of the chemicals you’re exposed to. And so rather than spend a lot of money testing for environmental toxins, sometimes the best approach is to 1) minimize your exposure to environmental toxins, and 2) do things to eliminate chemicals from your body.
With that being said, sometimes you can find out some valuable information about environmental toxins during a thorough health history. For example, mercury is a potential trigger of thyroid autoimmunity. As a result, a natural healthcare professional who conducts a health history should find out if their patients with autoimmune thyroid conditions has mercury amalgams. The presence of these amalgams doesn’t mean that this is the autoimmune trigger, although there of course is a possibility that this is the case.
Recently I had a patient who had very high cadmium levels on a hair mineral analysis. Upon further investigation the patient told me that his work environment involves exposure to certain chemicals, and cadmium was one of them. And while there isn’t a correlation in the literature between cadmium and thyroid autoimmunity, this doesn’t mean that high cadmium levels can’t be a factor. For example, even if a certain environmental toxin isn’t a direct trigger of thyroid autoimmunity, this doesn’t mean that it can’t indirectly cause autoimmunity by compromising the immune system.
The truth is that we don’t know everything about environmental toxins and autoimmunity. As a result, when conducting a health history, it’s foolish to just focus on the environmental toxins that have been proven to trigger autoimmune thyroid conditions. Keep in mind that being exposed to one or more environmental toxins can result in a loss of self tolerance, which in turn can make someone more susceptible to developing an autoimmune thyroid condition. I spoke about this in an article I wrote entitled “Thyroid Autoimmunity and Loss of Self Tolerance [4]”.
When conducting a health history I recommend asking the patient (or you can ask yourself if you are conducting your own health history) the following questions with regards to environmental toxins:
- Do you consume conventionally grown fruits and vegetables on a regular basis?
- Do you consume conventionally raised animal products on a regular basis?
- Do you consume fish or seafood on a frequent basis?
- Do you consume foods with artificial colors, flavors, and/or preservatives on a regular basis?
- Do you frequently use conventional cleaning chemicals, hand sanitizers, air fresheners, and other scented products?
- Do you smoke or are you often exposed to second-hand smoke?
- Do you have mercury amalgams, root canals, crowns, dental implants, etc.?
- Do you have a history of heavy alcohol use?
- Do you have a history of heavy use of recreational or prescription drugs?
- Have you been exposed to new construction materials or furniture?
- Are you frequently exposed to adhesives, paints, solvents, and other air-borne chemicals?
- Do you live near a cell phone tower or high-voltage power lines?
- Have you been frequently exposed to herbicides, pesticides, and/or fungicides?
- Do you jog or ride your bike along busy streets?
Sex hormones/Reproductive health history. Sex hormone imbalances can be a factor in thyroid and autoimmune thyroid conditions, and here is some of the information I ask for on my health history forms:
- Do you currently take, or have you taken oral contraceptives or bioidentical hormones?
- Do you currently take, or have you had an intrauterine device (IUD)? If yes, was it a copper or hormonal IUD?
- How many live births have you had?
- Were they natural births or Cesarean sections?
- Is there a history of ovarian cysts?
- Is there a history of uterine fibroids?
- Is there a history of endometriosis?
- Is there a history of fibrocystic breasts?
Estrogen dominance can be an autoimmune trigger, and estrogen dominance is also a common factor with ovarian cysts, uterine fibroids, endometriosis, and fibrocystic breasts. As a result, if someone checks off one of these then I will suspect problems with estrogen metabolism. This is also one way to determine if testing of the sex hormones is necessary. For example, if a cycling woman has irregular menstrual cycles, moderate to severe cramping, and a history of ovarian cysts, uterine fibroids, and/or endometriosis, then one can argue that testing the sex hormones might be necessary in this situation.
Completing A Food Diary Can Be Very Valuable
In addition to completing a health history, I find that having the patient put together a food diary can be valuable. After all, certain foods can act as triggers, or can make someone more susceptible to autoimmunity by increasing the permeability of the gut. I would recommend putting together at least a one-week food diary. And the reason for this is because a person’s eating habits can vary depending on the day of the week.
So hopefully you understand the importance of conducting a thorough health history. While doing tests can help to detect the underlying cause of your condition, doing a comprehensive health history can provide a lot of value as well. First of all, a good health history can help to determine what tests are necessary to obtain, as well as what diet the person should follow, supplements they should take, etc. And there are times when a thorough health history can help to detect the thyroid or autoimmune thyroid trigger. If you choose not to work with a healthcare professional I would recommend to conduct your own health history.