7 Gut Health Questions to Ask your Practitioner if you have Hashimoto’s

We’re looking at the often overlooked connection—the relationship between your gut health and Hashimoto’s thyroiditis. If you’ve been diagnosed with Hashimoto’s or suspect you may have thyroid issues, we are looking at 7 questions you should ask your practitioner.

If you want tips on how to work on these areas then jump into the podcast episode on this topic where we look in more detail at these questions! Click the image below to jump to the episode.

Question 1: Thyroid and Gut Motility

Question for Providers:

‘Is my thyroid function contributing to my slow digestion or gut issues?’”

Why:

Let’s start with gut motility. If you’ve been experiencing constipation or sluggish digestion, your thyroid could be to blame. Hypothyroidism, which is common in Hashimoto’s, slows down gut motility. Essentially, it’s like your digestive system is running in slow motion. This can lead to a build-up of bacteria in the small intestine, causing something called SIBO, or Small Intestinal Bacterial Overgrowth.

Clinical Insight:

When gut motility slows, it doesn’t just lead to discomfort; it can increase systemic inflammation, worsening autoimmune conditions like Hashimoto’s. This is a classic domino effect: a sluggish gut leads to bacterial imbalances, which, in turn, exacerbate thyroid dysfunction.

Question 2: Thyroid Hormones and Digestive Enzymes

Question for Providers:

‘Could low thyroid hormones be reducing my digestive enzyme production, and how can we address this?’

Why:

Digestive enzymes are crucial for breaking down the food we eat into nutrients our bodies can absorb. Thyroid hormones play a direct role in the production of these enzymes. When thyroid function is low, your body may produce fewer enzymes, leading to symptoms like bloating, food intolerances, or undigested food in your stool.

Clinical Insight:

When you don’t have enough digestive enzymes, it places extra stress on your digestive system. This can trigger inflammation, which not only worsens gut health, but can also make autoimmune symptoms, like those in Hashimoto’s, more severe.

Question 3: The Gut Microbiome’s Role in Thyroid Health

Question for Providers:

‘Is my gut microbiome contributing to my thyroid issues, and should I consider a microbiome test?’

Why:

The gut microbiome is a game-changer when it comes to thyroid health. Your gut bacteria help regulate your immune system, which is crucial for anyone with an autoimmune condition like Hashimoto’s. An imbalanced microbiome can increase gut permeability—commonly referred to as ‘leaky gut’—and trigger systemic inflammation, worsening your thyroid symptoms.

Clinical Insight:

Certain strains of bacteria, like Lactobacillus reuteri and Bifidobacterium bifidum, have been shown to support thyroid function and reduce inflammation. Research also suggests that a diverse microbiome is associated with better thyroid outcomes.

Question 4: The Enzyme Connection: T4 to T3 Conversion

Question for Providers:

‘Could an imbalance in my gut microbiome be reducing my active thyroid hormone levels?’

Why:

Now, here’s a fascinating connection: your gut plays a role in converting T4, the inactive form of thyroid hormone, into T3, its active form. This conversion is facilitated by an enzyme called deiodinase, which is influenced by gut health. If your microbiome is imbalanced or you have chronic gut inflammation, this conversion process can be impaired.

Clinical Insight:

Without enough T3, your cells can’t properly use thyroid hormones, leading to fatigue, brain fog, and other symptoms commonly associated with Hashimoto’s.

Question 5: Gut Permeability and Autoimmune Flare-Ups

Question for Providers:

Should I be tested for leaky gut and what steps can I take to heal it if it’s contributing to my Hashimoto’s symptoms?

Why:

Gut permeability, often called ‘leaky gut,’ is when the gut lining becomes damaged and allows larger particles, like undigested food or toxins, to pass into the bloodstream. This triggers an immune response that can worsen autoimmune conditions like Hashimoto’s.

Clinical Insight:

Leaky gut has been closely linked to autoimmune diseases. When the immune system is constantly reacting to particles that shouldn’t be in the bloodstream, it can go into overdrive, attacking the thyroid in the process.

Question 6: Gut Infections, Parasites, and Yeast Overgrowths

Question for Providers:

Should I be tested for gut infections, parasites, or yeast overgrowth, and could these be contributing to my Hashimoto’s symptoms?

Why:

Gut infections, including parasites and yeast overgrowths like Candida, can significantly impact your thyroid health. These infections disrupt the delicate balance of your gut microbiome, increasing inflammation and triggering immune system dysregulation. For someone with Hashimoto’s, this can exacerbate thyroid dysfunction and autoimmune activity.

Clinical Insight:

When the gut is compromised by an infection or overgrowth, the immune system often goes into overdrive to fight off these invaders. This heightened immune activity can lead to increased production of thyroid antibodies, accelerating damage to the thyroid gland. Additionally, yeast overgrowths, like Candida, produce byproducts that can further disrupt thyroid hormone balance and increase symptoms like fatigue, brain fog, and digestive discomfort.

Question 7: Gut Inflammation and Its Impact on Thyroid Antibodies and Reverse T3

Question for Providers:

Could inflammation in my gut be increasing my thyroid antibodies or affecting my Reverse T3 levels?

Why:

Gut inflammation is a major factor in autoimmune diseases like Hashimoto’s. When your gut is inflamed, it can lead to a condition known as leaky gut, or increased intestinal permeability. This allows toxins, undigested food particles, and microbes to escape into your bloodstream, triggering an immune response. For someone with Hashimoto’s, this heightened immune activity often leads to an increase in thyroid antibodies, which can accelerate damage to the thyroid gland.

Clinical Insight:

Chronic gut inflammation doesn’t just affect your antibodies; it can also influence your thyroid hormone balance. Inflammation can interfere with the conversion of T4, the inactive thyroid hormone, into T3, the active form your body uses. Instead of converting to T3, more T4 may be converted into Reverse T3, an inactive form that can block thyroid hormone receptors. This creates a double hit: not only are your antibodies attacking your thyroid, but your body’s ability to utilise thyroid hormones is also impaired.

What Next?

• If you want tips to work on these steps and get more advice around what can be done then head to the podcast episode now for more information.

• Your gut health and thyroid health are deeply interconnected. Slow gut motility, low digestive enzymes, an imbalanced microbiome, and impaired T4-to-T3 conversion can all play a role in Hashimoto’s symptoms. The key is to ask the right questions and work with your healthcare provider to address these root causes.

• We also have some free resources under the podcast episode.

  • Be sure to download the ‘Top 5 Nutrients for Gut and Thyroid Health’ PDF.
    This guide breaks down the essential nutrients that support both systems, why they matter, and the best food and supplement sources to incorporate them into your routine.

  • Next, check out the Checklist: ‘Questions to Ask Your Doctor About Gut and Thyroid Health.’
    It’s packed with the key questions we covered today to help you get the most out of your next appointment with your healthcare provider.

  • And for those of you who love interactive tools, don’t miss our MitoImmune Assessment Quiz.
    This quick and easy quiz will give you a personalised thyroid and gut health score, helping you understand where you stand and what areas might need extra attention.

  • You can also access our comprehensive stool testing kit —an invaluable tool for identifying gut issues like infections, imbalances, or inflammation.

  • You can find all these resources linked in the show notes below the podcast episode jump to this page to find them all.

    Taking these extra steps can make all the difference in optimising your gut and thyroid health.

  • And don’t forget to grab a copy of my book Optimal You where we look at the thyroid connections around the whole body not just the gut and there is a nutrition blueprint you can personalise to your own health needs.

    
    So go ahead, download those handouts, take the quiz, and start asking the right questions to take charge of your health.