Acid Reflux and Hashimoto’s

Thyroid disease doesn’t solely affect the endocrine gland. Other organs that may be stricken by thyroid disease include the heart, liver, and stomach. Your digestion and thyroid function are closely connected, so if one isn't functioning properly, the opposite might not either.

The connection between hypothyroidism or Hashimoto's, acid reflux, or gastroparesis is commonly overlooked.

However, studies have shown that the connection between the two isn’t unusual.

Acid reflux, also known as heartburn, is a common condition where people feel a burning sensation from stomach acid rising into the gullet (esophagus), especially in the lower chest area.

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Gastroparesis is a more serious condition that affects the normal muscle function of the stomach. This usually causes symptoms such as nausea, vomiting, and feeling full immediately after eating. The term gastro paresis means “paralysis of the stomach” because the stomach cannot contract normally, so it cannot properly break down food as it enters the small intestine. 

Weight loss is also common in people with gastroparesis because nutrients and calories are not being absorbed from food. Obviously, hypothyroidism reduces gastrointestinal motility, leading to symptoms of acid reflux.

Most interestingly, studies have shown that people with Hashimoto’s autoimmune gastritis may need high doses of levothyroxine (a thyroid hormone replacement drug) to balance thyroid-stimulating hormone (TSH).

80% of levothyroxine is absorbed in the small intestine, called the jejunum. Therefore, if someone with hypothyroidism has digestive problems, such as acid reflux, they should discuss medication dosage with their doctor. 

acid reflux

If you are experiencing symptoms of acid reflux or gastroparesis, it is important to report these symptoms to your trusted doctor or physician to better understand the cause.

There is a less obvious but more common direct link between thyroid imbalance and digestive disorders such as acid reflux and GERD. If you have Hashimoto’s disease and suffer from reflux regularly, you may wonder if it’s related. The short answer is yes.

The good news, however, is that when you work to improve one problem, you may find that the other will resolve itself as well. First, it’s important to understand the terms that are often used interchangeably (e.g., GERD and acid reflux) and what exactly happens when you experience these terms. And of course how it relates to your thyroid.

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During a meal, food passes through the esophagus into the stomach. To prevent reflux, there is a closing sphincter called the lower esophageal sphincter (LES) at the junction of the esophagus and stomach. 

The LES is closed by the release of stomach acid from food. When stomach acid fails to do this, some of the stomach acids can back up into the esophagus and cause a burning sensation. 

Acid reflux is the experience of stomach acid coming up through the LES. 

However, this does not explain the situation. It’s completely different because it can happen once or chronically.


GERD, or gastroesophageal reflux disease, is a chronic condition that sometimes occurs frequently and over a long period of time. 

Some doctors go to the doctor at least twice a week before diagnosing GERD. In addition to the discomfort it can cause, long-term effects of GERD can include esophageal cancer.

Experiences can vary from person to person; people have different ways of describing the sensation of acid reflux. As you know, heartburn has nothing to do with the heart. Although it is actually acid reflux, the sensation occurs at the base of the esophagus in a common area around the heart.

It can range from mild heat to a burning sensation and may progress to eating. However, some people have had GERD for years without heartburn, making it difficult to diagnose.

Besides heartburn, other symptoms of acid reflux and GERD include

  • Sore throat
  • Hoarse voice or laryngitis
  • Chest pain
  • Chronic cough
  • Difficulty swallowing
  • Regurgitation of food or sour liquid in your mouth

Many people have their symptoms come up often at nighttime or soon after eating.


There are several causes and risk factors for reflux esophagitis and GERD, some of which can be controlled while some cannot. The LES naturally weakens, especially as we age, making acid reflux much more common. 

Lying down too soon after a meal can make this worse. Obesity and pregnancy increase your risk because they push on your organs. 

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Smoking is also a risk factor. 

Perhaps the most common cause of GERD is often misunderstood as being different from what people expect.  Because reflux esophagitis is caused by stomach acid, people often think that excess stomach acid is the cause, but the opposite is actually the cause. If we have too little stomach acid and the sphincter doesn’t close, acid reflux will eventually lead to GERD. 

So the question we keep asking ourselves is, what is the connection between GERD and Hashimoto’s disease? The answer depends on the relationship between low stomach acid and the thyroid gland. Hypochlorous acidosis, which refers to low stomach acidity, can be due to a number of causes, including natural aging and certain medications.

Malnutrition is also an important factor.  However, among the many roles of the thyroid gland, there is one that may surprise you. It is the production of stomach acid. This is because the thyroid regulates your metabolism, and a slow metabolism means less stomach acid. 

However, digestion can depend on the activity of the thyroid gland and vice versa. Like many organs, systems, and glands in the body, the gut and thyroid gland work very synergistically. The thyroid gland produces an inactive form of thyroid hormone called thyroxine (T4), which must be transformed into the active form, triiodothyronine(T3).


The intestine plays an active role in this process, providing the necessary nutrients for conversion. Other chemicals found in the gut can inhibit thyroid-stimulating hormone (TSH), which plays an important role in stimulating thyroid hormone production. This means that balancing your gut flora can help regulate your thyroid hormone levels. 

Thyroid hormones (both T4 and T3) have been found to help prevent stress ulcers. Anyone with Hashimoto's disease is at increased risk of secondary autoimmune diseases such as celiac disease or rheumatoid arthritis. The immune system attacks the parietal cells of the stomach wall, reducing the production of stomach acid.

Pylori and Hashimoto’s disease pylori, bacteria normally found in the gut are easily ingested and are a common cause of low stomach acid. Hashimoto’s is triggered by an overabundance of H. pylori and people with Hashimoto’s disease are more likely to test for the bacterium. 

Medicines can make GERD  worse Unfortunately, there are still many cases where doctors and patients who do not understand the cause of GERD end up being put on proton pump inhibitors (PPIs). The most common of these are Prilosec, Nexium, and Prevacid. Their job is to reduce stomach acid, which they do very well.

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In the short term, this will stop the reflux and provide some relief. But if the real problem is low stomach acidity, the result is that the patient will need more and more doses to prevent SLE activation. Even if you don’t take  PPIs, medications can affect GERD, or  GERD  can affect medications. Levothyroxine is a commonly prescribed thyroid replacement drug. However, BRGE has been found to inhibit the absorption of levothyroxine, requiring higher doses. Some women may experience GERD during periods of peak progesterone such as pregnancy, PMS, and menopause.

While this can vary from person to person, some foods that may cause acid reflux include:

  • Tomatoes
  • Coffee and black tea
  • Dairy (a common food intolerance)
  • Soda
  • Citrus
  • Alcohol
  • Raw onion or garlic
  • Chocolate
  • Gluten

You may have heard about taking apple cider vinegar for acid reflux.

This is an excellent food that is fermented and naturally triggers the stomach to produce acid for food breakdown.

A little goes a long way but even just a teaspoon at the start of a meal can offer relief. (Some people experience an increase in burning sensation with apple cider vinegar, so ease into this if you’d like to try it.)


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Nutrients for GERD (thyroid support)

  1. The mineral magnesium has several roles in the body, but the most important is muscle contraction and relaxation. Not surprisingly, magnesium deficiency is associated with a  condition caused by an empty sphincter. Many antacids contain magnesium.

However, a good source is a stable magnesium supplement, which is closer to the cause of the problem.  A simple supplement of 200 to 400 mg twice daily should be sufficient. Magnesium is also an energy source for Hashimoto. 

  1. Probiotics for thyroid and gut support have a strong connection between the thyroid gland and the gut. One of the best ways to support this bond is with probiotics.  

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Traditionally, many cultures have included fermented foods in their diet. However, American society consumes a lot of fermented foods, and as we phase out fermented foods, our gut flora has paid the price. Naturally, fermented foods such as kimchi, sauerkraut (which must be frozen, not all fermented), natto, kefir, and kombucha are good ways to get probiotics.

  1. Another nutrient deficiency associated with GERD is vitamin B12. Studies have found that people who take PPIs long-term are more prone to B12 deficiency.

B12 is also necessary for the conversion of T4 to T3, so it’s a strong thyroid supporter in cases of Hashimoto’s. While we get some of our B12 from our food is actually made in our gut.

But this can only happen when the gut is in balance with good bacteria.

Hence, there is a connection between Hypothyroidism or Hashimoto’s and Acid Reflux. If you are suffering from any of its symptoms, consult your doctor so that the exact root cause can be addressed and medication can be assigned accordingly.


Suffering from a chronic disease like thyroid, gut problem, weight issues, autoimmune issues, etc... is not easy. Dr. Gupta is a certified Functional Medicine Physician and his personalized plans have helped thousands of people to reclaim their health back.

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