Thyroid Health and Workplace Performance: Why Hashimoto's Management Matters
Hashimoto’s disease is common but often undiagnosed.
Hashimoto's disease is one of the most common autoimmune conditions in the United States, affecting around 5% of the population (1). It is diagnosed when elevated thyroid peroxidase (TPO) antibodies are detected in the blood, a marker included in our Root Cause Panel, which screens for this and many other conditions your employees may not yet know they have.
Hashimoto's disease is one of the most common autoimmune conditions in the United States, affecting around 5% of the population (1). It is diagnosed when elevated thyroid peroxidase (TPO) antibodies are detected in the blood, a marker included in our Root Cause Panel, which screens for this and many other conditions your employees may not yet know they have.
These antibodies attack the thyroid gland, eventually damaging its ability to make thyroid hormone over time, resulting in hypothyroidism as a late finding. However, these same antibodies also impact many other systems in the body including the nervous system, reproductive system, skin, gastrointestinal, musculoskeletal, and others. Of these, effects on the nervous system including the brain are prevalent and impact daily functioning, often early on in the autoimmune process, well before low thyroid hormone production develops as a later manifestation of chronic autoimmune attack.
Impacts on workplace productivity
Hashimoto’s disease and its related hypothyroidism significantly reduce workplace productivity due to extreme fatigue (both mental and physical) and cognitive impairment. The collection of brain-related symptoms termed Hashimoto’s encephalopathy (often called “brain fog”) affects memory, mental clarity, ability to focus and make decisions, slowed thinking, word-finding troubles, and mood. It impacts decisiveness and workplace relationships.
Affected individuals face a higher risk of long-term sick leave and disability, with the greatest impact occurring in the first year after diagnosis. Research analyzing Danish registry data shows that thyroid dysfunction can lead to labor market implications including increased absenteeism, disability, difficulty maintaining employment due to both physical and psychological symptoms, and lower income when untreated (2).
The Care Gap
Conventional medicine approaches thyroid disease by detecting overt thyroid dysfunction with abnormalities in thyroid stimulating hormone (TSH). This occurs months to years after TPO antibodies can be detected. Those with TSH abnormalities can be suffering with symptoms for years before a proper diagnosis, at which time thyroid hormone supplementation is initiated.
At Root, a full thyroid panel with TPO antibodies is included upfront in the Root Cause Panel. This is reviewed by a functional medicine physician who is specifically looking for conditions like Hashimoto’s before they have a chance to quietly drain your employees energy, focus and productivity.
Figure 1: Root Cause Panel Labs
Figure 1: Root Cause Panel Labs
Functional Medicine Approach
A functional medicine approach involves looking into root causes for the immune system problem, with the goal to preserve long term thyroid gland function and resolve chronic symptoms. With this approach, functional medicine clinicians often see noticeable early improvements for “brain fog” and fatigue within weeks of treatment.
Common root causes are considered first, followed by further evaluation for less common individual contributors if needed. A hereditary predisposition is often present and by nature is not changeable, but there are other common modifiable root causes for this autoimmune condition that can respond to therapeutic lifestyle interventions.
Gluten
Gluten is associated with TPO antibody primarily through molecular mimicry where the immune system confuses gluten protein structures with thyroid tissue (3, 4). Gluten also is known to open tight junctions between intestinal lining cells which allows the immune cells just under the surface to become activated (5). The gut lining is a delicate structure that is impacted by many other factors including shifts in the microbiome (important GI tract bacteria), inflammatory diet patterns, stress, and circadian rhythm problems to name a few. Working with a dietitian on a personalized dietary and lifestyle approach can help improve gut health by various mechanisms. And since gut health is closely linked to immune system health, we see that improvement in diet impacts whole-body wellness.
Nutrient Deficiencies
Vitamin D and omega 3 fatty acid (fish oil) deficiencies along with other micronutrient changes, are common nutritional issues that impact immune function, contributing to the development of autoimmunity. Correcting micronutrient deficiencies is an important step, and it's something our Root dietitians specialize in through personalized nutrition planning.
Stress
Stress is a well-known contributor to the development and worsening of autoimmune conditions (6), and while we don’t always have control over stressful life events, we can prioritize the inclusion of daily stress-reduction practices and add other supports to lessen the impact of stress on current and long-term health.
Conclusion
Tracking both symptom and lab trends over time is key to making sure the approach is working and evolving with each person. At Root, that ongoing personalization is built into the process. Our Root Cause Screening and Wellness Program gives your employees early answers and a real path forward, with expert functional medicine physicians and dietitians working to address the root causes behind conditions like Hashimoto's before they become costly to your people and your organization.
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References:
- Kotak PS, Kadam A, Acharya S, Kumar S, Varma A. Beyond the thyroid: a narrative review of extra-thyroidal manifestations in Hashimoto's disease. Cureus. 2024;16(10):e71126. PMID: 39525250.
- Thvilum M, Brandt F, Brix TH, Hegedüs L. Hypothyroidism is a predictor of disability pension and loss of labor market income: a Danish register-based study. J Clin Endocrinol Metab. 2014;99(9):3129-3135. PMID: 24915121.
- Esfahani KS, Asri N, Mahmoudi Ghehsareh M, Rezaei-Tavirani M, Jahani-Sherafat S, Rostami-Nejad M. The role of gluten in the development of autoimmune thyroid diseases: a narrative review. Int J Endocrinol Metab. 2024;22(3):e153730. PMID: 40065831.
- Benvenga S, Guarneri F. Molecular mimicry and autoimmune thyroid disease. Rev Endocr Metab Disord. 2016;17(4):485-498. PMID: 27307072.
- Drago S, El Asmar R, Di Pierro M, et al. Gliadin, zonulin and gut permeability: effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006;41(4):408-419. PMID: 16635908.
- van der Kolk BA. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Penguin Publishing Group; 2014.