This is a really important topic that I am excited to share with you.  It concerns thyrogastric syndrome, and it is important because so many people with thyroid disease have got unresolved symptoms. Also commonly referred to as autoimmune gastritis or atrophic gastritis, thyrogastric syndrome is important to know about for both your health and wellbeing. Often, they have been left to think that feeling better is only a pill away. We know that’s not true — even if their labs are dialed in, they still don’t feel their best. In these cases, we often need to think about a secondary condition. The majority of people with thyroid disease have some additional condition (that commonly pairs with thyroid disease). Thyrogastric syndrome, for instance, is one of the most common.

What Is Thyrogastric Syndrome?

Let’s start by breaking down this condition in depth.

It all begins with the symptoms. Some of the most common when it comes to thyrogastric syndrom include the following:
  • Fatigue
  • Hair loss
  • Gastrointestinal symptoms
  • Low in nutrients
These are just some of the overarching symptoms that may tell us that we’re suffering from thyrogastric syndrom. But, just how likely is it that you have it?

How Common Is Thyrogastric Syndrome?

Most people that have this don’t have many obvious symptoms. The problem with that is that many go undiagnosed (Read More: The Complete Guide to Testing Your Thyroid).

A couple of larger studies who screened adults, found that it can be about 20% of adult populations who suffer from thyrogastric syndrome.

If we talk about those that we know have thyroid disease, then that 20% goes up to 30-40%, which is very common.

Then, we need to think about the flipside of the coin. If we take those that we know have thyrogastric syndrome, around 53% of them have thyroid disease.

Key Insight: There is a huge amount of overlap between thyroid disease and thyrogastric syndrome. That is why this has been called “autoimmune thyrogastric gastritis.”

We see this condition develop especially when thyroid disease occurs postpartum. But, it can be anyone with thyroid disease (regardless of age).

It is even more common in those who are a little younger, women, and especially prevalent in those that have milder levels of the digestive disease.

Bottom Line: The risks are higher with other autoimmune diseases, as well, like type one diabetes, vitiligo, and Addison’s disease. But, none of those have as strong an overlap as thyroid disease.

What Symptoms Would You Have?

This is fascinating stuff. Until I performed a deep dive to put together this article, I was even under the impression that most do not have symptoms.

In fact, you’ll see most reports on it say exactly that. They will say that people who have it don’t really come to the table with any symptoms.

But, many do! I saw a large paper looking at exactly this question. It turns out that, in the case of at least half the people with thyrogastric syndrome, they do have symptoms.

These symptoms in question can be in the upper intestinal tract, or the lower intestinal tract. Depending on its location, let’s break down the symptoms…

In the upper intestinal tract:

  • Heartburn
  • Difficulty swallowing
  • Stomach pain
  • Nausea
  • Vomiting
  • Problems in passing food

In the lower intestinal tract:

  • Abdominal pain or discomfort
  • Bloating
  • Diarrhea
  • Constipation
  • Accidental stool leakage or incontinence

Key Insight: Of cases of thyrogastric syndrome, symptoms are likely to occur in the upper tract 70% of the time, 16% of the time in the lower tract, and around 14% in both.

Those who were the most symptomatic were commonly under the age of 55. Oddly enough, they were more commonly non-smokers, female, and not yet anemic (meaning they were in the earlier stages of the disease).1

What About “Regular” Gastritis?

When we think about gastritis outside the context of autoimmunity, we often attribute its occurrence to H.Pylori.

That said, if you were curious if they happened the exact same way, there are some differences in symptoms:

  • Unusual weight loss
  • Vomiting
  • Lack of appetite
  • Nausea
  • Ulcers
  • Heartburn

This is a slightly more common symptom profile. However, a good, thorough screening for thyrogastric syndrome would include screening for H.Pylori at the same time.

    How Does Thyrogastric Syndrome Affect Health?

    In general, the damage from autoimmunity to the stomach lining makes it to where we are not producing adequate stomach acid.

    That can cause the body to:

    • Not be able to absorb nutrients
    • Change our bowel flora

    Many of the good bacteria that we have, they need that blast of acid from the stomach to make the world safe for them. This is where they are protected and are better able to thrive.

    When stomach acid is lacking, a lot of these things can go wrong.

    Think about it like this: in Hashimoto’s disease, the thyroid is damaged to the point that it cannot put out hormones. With thyrogastric syndrome, that immune response damages the stomach.

    Iron Levels

    So, when things do go wrong, one of the first things that happen is iron levels begin to creep down (Read More: Nutrients and Depression).

    That, by itself, can cause many symptoms such as:

    • Pain in the chest
    • General fatigue
    • Tinnitus (ringing in the ears)
    • Dizziness
    • Lightheadedness
    • Heart palpitations
    • Insomnia
    • Muscle pain
    • Hair loss

    All of these things can be related to your iron levels.


    As the disease progresses, it can also have an adverse effect on B12 absorption. At that point, we can also see:

    • Dramatic brain fog
    • Unsteadiness when walking
    • Tingling or numbness in the arms or legs

    Again, this is really due to the damage caused to the parietal cells. Because there can be a lack of proper acid secretion, we will also see changes in the health of the bowel flora.

    Key Insight: This will also result in the improper absorption of proteins. If you have a hard time digesting proteins, this may be a reason.

    What Causes Thyrogastric Syndrome?

    If we want to get to the bottom of today’s issue, we need to have a pretty nuanced and thorough perspective on why it happens in the first place. There is not a clear answer, we just know that there is so much overlap between autoimmune thyroid disease. What we do know is that people can have similar symptoms with H.Pylori, but that is different. If someone has iron or B12 deficiency, we think about gastritis and we want to screen for markers of thyrogastric syndrome — we also want to screen for H.Pylori, too. When someone does have H.Pylori, by and large that is treated with antibiotics or natural compounds, and when it is gone and successfully eradicated we can expect the stomach to heal. In the case of thyrogastric syndrome, it continues to persist.

      How Do You Diagnose Thyrogastric Syndrome?

      We diagnose that, first, by screening for the antibodies in question.

      Blood Tests

      These are what we know as parietal cell antibodies. If we want to be really precise, we are doing an ELISA test for gastric H/K ATPase (the most meaningful subtype).

      There are also what we call intrinsic factor antibodies that are useful here. Those tests show the whole autoimmune response in the body.

      A good screen will show, through blood markers, if there is significant damage that is occuring to the stomach. That is shown by gastrin and pepsinogen I/II ratio.

      Key Insight: While they are not always commercially available, they can be helpful. They can show both the autoimmunity, and also if there has been significant damage that has taken place.

        If we do see some signs of there being damage present, that is typically appropriate for screening with endoscopy to visually look and sample portions of the stomach.

        A good screen will also try to make sense of some of the nutrients that may be low in the body. This could include:

        • Iron Panel
        • Ferritin
        • TIBC
        • Serum Iron
        • Serum B12

        Bottom Line: These are all helpful markets to have to understand the full scope of any issues at hand when it comes to thyrogastric syndrome.

        Endoscopy and Biopsy

        This method is especially relevant if we see that there is overt iron deficiency anemia, B12 anemia, and high levels of gastrin. Once that has been done, it is smart to re-check on a three-year cycle. That is because there can be progression involved. Here is something that should be mentioned: there is a thing called a “virtual biopsy” or a “serum biopsy.” That is all the tests that I mentioned before, as well as a new one called “Gastrin 17.”

        Key Insight: This is one of the more sensitive indicators of damage to the stomach. While it is not in the United States at this point, but hopefully soon!

          How Does Thyrogastric Syndrome Progress?

          Here is the thing: for one or two decades, there can be measurable antibodies and the disease is actively occurring, but there are no obvious symptoms.

          There is also no overt damage to the stomach. In that sense, you can view the disease as just starting or “waiting in the wings” for an opportunity to arrive.

          We can start seeing some lack of iron, not overt anemia but low/latent iron depletion (where it is continuously creeping down).

          That can happen in the first couple of decades. At that point, we generally do not see gastrin elevated, and there are no progressive signs of stomach damage.

          The next step is gastrin elevating. Often, from that damage, we will begin to see iron deficiency anemia, and B12 levels running low.

          Key Insight: At that level, things can go on for many, many years. Oftentimes, by the time B12 gets low, that is one of the later stages and is coupled with marked damage to the stomach.2

            What Is The Main Risk of Thyrogastric Syndrome?

            Building on all these things, and the timeline we mentioned, the main risk involved has to be esophageal cancer and gastric cancer.

            We manage those risks simply by screening, and ensuring that progression isn’t occurring to where this sort of risk is possible.

              How Is Thyrogastric Syndrome Managed?

              The main thing you can do for thyrogastric syndrome is screening and then watching these “big nutrients” that we mentioned earlier.

              There are some nutrients that, in the case of thyrogastric syndrome, you are not going to be able to reverse the deficiency by taking them orally.

              It simply will not work. However, in many cases once you have replenished your stores, you can maintain these levels with a combination of oral supplementation and diet.

              Key Insight: Iron and B12, especially iron, when you get low, the math simply does not work to get it back to normal with supplements alone.

                What you need are a few doses of intravenous iron. The cool thing is that years’ worth of deficiencies can be reversed in half an hour — it can safely be brought back to normal right away.

                This is also true for B12. Your body can store it, it can be used orally, but often not enough to reverse a bad deficiency (but, generally, enough to maintain it).

                A huge part of wellbeing and improvement for thyrogastric syndrome is keeping an eye on those nutrients. Getting them both corrected and getting them stable.

                Keep in mind, this can be life-changing. That is the biggest source of so many of these symptoms, these critical nutrients that the body needs but is not getting.

                This can also be why protein requirements differ because proteins can take longer to effectively break down. But, by and large, with easy digestible proteins, you can feel well.

                Without knowing, though, there can be risks and there can even be long-term problems that would never be resolved.

                  Thyroid Medications and Thyrogastric Syndrome

                  One of the final things worth noting is that people may have a difficult time absorbing their thyroid medication.

                  This is if their levels fluctuate for no particular reason, or if they are on a dose that is a lot higher than they would need (simply to break even).

                  Thyrogastric syndrome could be the reason why! If any of those things apply to you, the first thing I would recommend is getting screened.

                  In fact, all of the doctors here at Integrative Health can easily make sense of this issue. For most people, it’s as simple as a blood test to get to the heart of the issue.

                  Key Insight: This way, we can stay on top of the issue, work around it, and keep you healthy — while feeling your absolute best.

                  Test Your Thyroid Today

                  It all starts with a simple test.

                  If you haven’t had the chance, I’d love for you to take the Thyroid Quiz today (Click Here: Take The Quiz Right Now). After our discussion today, you may be on the hunt for answers, and I want to help.

                  This simple quiz can be your first step to better health, and to getting to the root cause of any issues you’re currently going through with your health. It’s simple, intuitive, and can even equip you with action steps to get started. Please try it today.


                  1 – 2 –
                  P.S. Whenever you are ready, here is how I can help you now: 1. Schedule a Thyroid Second Opinion with me, Dr. C, Click Here for Details 2. Download and use my Favorite Recipes Cookbook Here 3. Check out my podcast Medical Myths, Legends, and Fairytales Here Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet, The Metabolism Reset Diet and The Thyroid Reset Diet. Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.