What is hypothyroidism?
We recently received an interesting question from one of our members involving hypothyroidism, a condition that affects the thyroid gland and reduces the production of hormones, which impacts the body’s chemical balance. Older adults, typically over 60, and especially women, have the highest incidence of hypothyroidism. It tends to run in families and the symptoms are fatigue (sleepiness), constipation, dry skin, brittle nails, and other aches and pains. Left untreated, hypothyroidism can be dangerous, however, treatment is easy and the condition can be completely managed by medications. Below is summary of the issues our member experienced leading to a question for Dr. Dengler:
- Problems with reflux disease over the last several years
- Decades of taking medications to treat hypothyroidism
- A recent change in medications led to swelling in the throat resulting in a choking feeling
- In addition, there is overall tiredness and a feeling as if something is stuck in the throat
- Internet research suggested that this could be “low stomach acid” leading to the use of apple cider vinegar – a tablespoon in the morning and one at night as a sleep aid. This helped, but there is still a lump in the throat and only high alkaline foods are necessary to manage gastric issues.
Learn more: Is this “stuck in the throat” feeling normal?
Dr. Dengler’s Response
Here is what Dr. Dengler said about this condition and its role with GERD:
You are on medications to treat hypothyroidism. Hypothyroidism can cause the lower esophageal sphincter (LES) to relax and create a situation where acid reflux can occur. Also, the stomach may not empty properly in hypothyroidism and that can further aggravate reflux. Also, it is thought that some patients with hypothyroidism have gluten intolerance, as well. For the hypothyroidism patient, undiagnosed gluten intolerance can be a determining factor in heartburn. Those with gluten intolerance (Celiac disease) have a higher incidence of GERD, according to several research studies.
Therefore, there are three factors that could be at play here: GERD, hypothyroidism and celiac disease. Treating the hypothyroidism can restore the tone of the LES and aid in stomach emptying. The appropriate gluten-free diet is the treatment of celiac disease and improves GERD symptoms as well.
As part of a reflux evaluation for a hypothyroid patient, celiac disease should at least be considered. It is thought that trrating both the hypothyroidism and celiac disease will improve the associated reflux without requiring acid suppressing medications. This is particularly true if added to lifestyle changes, such as losing weight, eating at least three hours before reclining, and avoiding any trigger foods that seem to aggravate reflux. Apple cider vinegar can certainly be used if you find it helpful.
If reflux does not improve after the above considerations, an evaluation to confirm reflux may be indicated, particularly if you cannot sleep lying down. A physician who understands the relationship between thyroid disease and GERD, as you seem to understand, should manage all of this.