Written by: Leah Bedrosian, MPH
Published on: November 27, 2019
Updated on: September 1, 2020
Reviewed by: Gerda Endemann, PhD
Our science and research team launched goop PhD to compile the most significant studies and information on an array of health topics, conditions, and diseases. If there is something you’d like them to cover, please email us at [email protected].
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in developed countries. It is ten times more common in women than in men and is especially common in women who are between forty-five and fifty-five years old (McLeod & Cooper, 2012). Hashimoto’s is an autoimmune disorder, which essentially means that the body starts attacking its own cells instead of foreign “invader” cells. Hashimoto’s manifests when the immune system begins targeting the thyroid, causing chronic inflammation. Over time, these repeated attacks on the thyroid decrease its ability to produce hormones and can lead to an underactive thyroid.
The Thyroid and Its Hormones
The thyroid is a butterfly-shaped gland in the front of the neck. You may not think twice about your thyroid, but it’s responsible for releasing hormones that regulate metabolism and affect hunger, sleep, and body temperature. Thyroid disorders can increase or decrease the thyroid’s production of these hormones. This creates metabolism issues that can throw our whole body out of whack and can cause weight and mood changes.
When the thyroid is working properly, the brain produces thyroid stimulating hormone (TSH), which signals to the thyroid that it should begin releasing hormones. Within the thyroid gland, the enzyme thyroid peroxidase (TPO) then synthesizes the two most important thyroid hormones: triiodothyronine (T3) and thyroxine (T4). T3 is the active hormone, and T4 is converted in various tissues to T3 as needed. If the immune system attacks the thyroid, as it does in Hashimoto’s, then anti-TPO antibodies and other antithyroid antibodies will interfere with thyroid hormone creation and disrupt the delicate feedback system between the brain and the thyroid.
Primary Symptoms of Hashimoto’s
Hashimoto’s develops slowly and can go unnoticed for several months or even years. Symptoms include fatigue, sensitivity to cold, constipation, pale skin, brittle nails, hair loss, swollen tongue, muscle aches, depression, and memory issues (NIH, 2017). Since symptoms such as fatigue, weight gain, or depression are not necessarily unique to the disorder, many people may not seek treatment. Others may have no recognizable symptoms. If the thyroid gland eventually becomes severely swollen, a visible lump called a goiter develops.
What’s the Difference between Hypothyroidism and Hyperthyroidism?
Hypothyroidism with an o refers to a decrease in thyroid hormones and thyroid functionality. Hyperthyroidism with an er refers to an increase in thyroid hormone production and an overactive thyroid. Symptoms of hypothyroidism include fatigue, constipation, sensitivity to cold, and/or a puffy face. Symptoms of hyperthyroidism include appetite changes, rapid weight loss, difficulty sleeping, heart palpitations, increased sweating, and/or irritability. The most common cause of hypothyroidism in developed countries is Hashimoto’s thyroiditis; in underdeveloped countries, the most common cause is iodine deficiency. The most common cause of hyperthyroidism is the autoimmune disorder Graves’ disease.
Potential Causes and Related Health Concerns
Hashimoto’s is likely caused by an interplay of genetics and environmental factors. While the specifics are not entirely known, some researchers believe Hashimoto’s may be largely caused by infections, while others think the issue is exposure to endocrine disruptors.
People with Hashimoto’s are at risk of having high cholesterol and other co-occurring autoimmune disorders.
Genetics seem to be the biggest player when it comes to a person’s risk of developing Hashimoto’s. Scientists are working to explain how environmental factors may interact with our genes to trigger autoimmune disorders. More than a million gene variants have been identified, thanks to ongoing efforts from several large studies, such as the 1000 Genomes Project, which analyzed thousands of people’s genomes from around the world. Scientists have found that several immune-regulating genes are associated with Hashimoto’s (Lee, Li, Hammerstad, Stefan, & Tomer, 2015; Tomer, 2014). And new therapeutic drugs to target these genes can be designed to treat Hashimoto’s and other autoimmune diseases.
More research is also starting to focus on epigenetics, which is an exciting, growing field of science. Epigenetics is the study of biological changes (caused by either innate or environmental factors, like smoking) that alter gene expression: essentially switching genes “on” or “off” but not changing the DNA itself. This combination of genetic makeup and gene expression makes each of us unique. Studies in cells and tissues of autoimmune thyroid disease patients have shown several epigenetic markers of the disease, but data is limited and clinical research is needed (B. Wang, Shao, Song, Xu, & Zhang, 2017).
The Hygiene Hypothesis
Several autoimmune diseases have been shown to be associated with the number of infections a person had as a child (Bloomfield, Stanwell-Smith, Crevel, & Pickup, 2006). This phenomenon is called the hygiene hypothesis: The more germs you are exposed to early in life can increase your body’s ability to protect you against certain allergies and immune conditions as an adult. But if you were more of a germ-free kid, you may be at higher risk for certain diseases as an adult. There isn’t consistent evidence that this is the case for Hashimoto’s.
The reverse may also be true—that the presence of certain infections may trigger thyroid inflammation, causing Hashimoto’s to develop (Bloomfield et al., 2006; Mori & Yoshida, 2010): Research suggests that certain infections, such as hepatitis C or Epstein-Barr virus, may trigger individuals to develop autoimmune disorders, especially if they have an underlying genetic susceptibility (Janegova, Janega, Rychly, Kuracinova, & Babal, 2015; Kivity, Agmon-Levin, Blank, & Shoenfeld, 2009; Shukla, Singh, Ahmad, & Pant, 2018).
So it seems that some infections as a child might protect you from autoimmune disease by bolstering your immune system (the hygiene hypothesis), while other, specific types of infections (such as hepatitis C or Epstein-Barr) could create autoimmunity.
More and more evidence is piling up against phthalates, BPA, and parabens, showing that these chemicals are able to disrupt our body’s hormone system. This can create a wide array of issues related to reproduction, development, and thyroid function. These chemicals are used in many different products, from cosmetics to canned food, plastic bottles, and children’s toys.
Several studies by John Meeker, ScD, CIH, and his colleagues at the University of Michigan have linked phthalates, BPA, and parabens to altered TSH and thyroid hormones in pregnant women (Aker et al., 2016; Aung et al., 2017; Johns, Ferguson, McElrath, Mukherjee, & Meeker, 2016).
How to Avoid Endocrine Disruptors
1. Buy clean beauty products and household cleaners. Avoid products that list chemicals ending in “phthalate” or “paraben” on the label, and avoid products that contain fragrance. The Environmental Working Group’s Skin Deep database allows you to search for products and see how they meet specific criteria for health and safety. The organization also has a guide to healthy cleaning products.
2. Avoid plastic-containing products, especially ones that will come into contact with your mouth (such as water bottles) or be heated (such as plastic food containers). Since babies often teethe on toys, avoid plastic toys.
3. Buy fewer canned foods. The lining of aluminum cans often contains BPA or BPA replacements, which may not be any safer.
4. Buy organic food as much as you can in order to avoid pesticide exposure.
One related health concern of Hashimoto’s is high cholesterol, which is associated with adverse cardiovascular health and events (NIH, 2017). While most doctors recommend statins for people with high cholesterol, this is not recommended for people with hypothyroidism who are using hormone replacement medications, since these drugs generally already decrease cholesterol levels.
People with other autoimmune disorders, such as celiac disease, lupus, type 1 diabetes, and rheumatoid arthritis, are more likely to develop Hashimoto’s (NIH, 2017).
How Hashimoto’s Is Diagnosed
To diagnosis Hashimoto’s, doctors will want to consider family medical history and symptoms. While the exact cause of Hashimoto’s is not known, it does tend to run in families. Additionally, doctors will want to do a confirmatory blood test to determine levels of TSH, T4, T3, and anti-TPO antibodies. High levels of TSH and anti-TPO antibodies along with low levels of the thyroid hormones T3 and T4 are consistent with Hashimoto’s.
However, individuals who are diagnosed early may only show high antibody levels on their blood tests. If you suspect that you may have Hashimoto’s, ask your doctor for a blood test to see if your thyroid antibodies are high, which is usually the first sign. Some doctors may treat Hashimoto’s if just TSH levels are high, while others may want to also see evidence of antibodies and disrupted thyroid hormone levels, too. It depends on what type of specialist you see and how they approach treatment. Normal TSH levels are typically around 0.4 to 4.9 milliunits per liter, but levels depend on the lab technique used, so be sure to talk to your doctor about your results.
For more information, consult your doctor or an endocrinologist, who specializes in the thyroid. You can also visit the American Thyroid Association’s website.
You may want to avoid gluten and “goitrogenic” foods, which are believed to affect the thyroid. Ketogenic diets may also not be right for people with Hashimoto’s.
Autoimmune Protocol (AIP) Diet
To combat inflammation from autoimmune conditions, a restrictive diet called the Autoimmune Protocol (AIP) diet has more recently been recommended by some functional medicine doctors. This diet eliminates inflammation-causing foods and is similar to a paleo diet. The diet is very restrictive: You do not eat grains, legumes, dairy products, processed foods, refined sugars, industrial seed oils (canola or vegetable oil), eggs, nuts and seeds, nightshade vegetables, gum, alternative sweeteners, emulsifiers, or thickeners.
There have not yet been adequate clinical trials of the effects of this diet on Hashimoto’s (and more research in general is needed on autoimmune diets). A pilot study in 2019 found that sixteen women with Hashimoto’s who followed the AIP diet for ten weeks showed significant improvements in quality of life and symptom burden; However, they did not show improvements in their thyroid function or any reduction in thyroid antibodies (Abbott, Sadowski, & Alt, 2019). If you’re interested in trying the AIP diet, work with a nutritionist to ensure you are getting proper nutrients.
Gluten and Celiac Disease
People with and without celiac disease are turning toward gluten-free diets and foods. Celiac disease is an autoimmune disease, like Hashimoto’s, where the body targets the small intestine after gluten is eaten. (See our review of celiac disease and gluten sensitivity to learn more.) And new research shows that celiac and Hashimoto’s might be related. Celiac patients have highly sensitive immune systems, may not absorb key nutrients (like iodine, selenium, and iron), and have lots of antibodies that may affect both the intestine and thyroid (Liontiris & Mazokopakis, 2017; Roy et al., 2016; Sategna-Guidetti et al., 1998). Preliminary research suggests that people with Hashimoto’s should be screened for celiac and that a gluten-free diet may be helpful in managing symptoms (Krysiak, Szkróbka, & Okopień, 2018; Lundin & Wijmenga, 2015).
Ketogenic diets have become popular for weight loss. But they aren’t great for everyone, and research suggests that they probably are not good for people with Hashimoto’s. Ketogenic diets are low-carb, high-fat diets. The goal is for your body to switch out of sugar-burning mode and into fat-burning mode. This is called ketosis. Since ketogenic diets essentially mimic starvation, they may not be desirable for people whose thyroids are already functioning suboptimally, because the diet could further disrupt their metabolism. Several small studies have suggested that when carbohydrate intake is reduced, T3 levels decrease (Bisschop, Sauerwein, Endert, & Romijn, 2001; Hendler & Bonde III, 1988; Spaulding, Chopra, Sherwin, & Lyall, 1976). These were short-term studies of individuals without hypothyroidism, so the results may not be applicable, but they suggest that carbs may be an important food group for people with Hashimoto’s.
Goitrogens are foods that are believed to cause “goiter”—swelling of the thyroid gland—and affect thyroid hormone production. Some goitrogenic foods are soy milk, green tea, cassava, rutabaga, some forms of millet, and green leafy vegetables (Bajaj, Salwan, & Salwan, 2016; Chandra & De, 2013; Fort, Moses, Fasano, Goldberg, & Lifshitz, 1990; Paśko et al., 2018). These foods may cause problems for people who are deficient in thyroid-specific nutrients (read the following section), but little is known about how they interact with the thyroid or whether eliminating them has any effect on Hashimoto’s.
Nutrients and Supplements for Hashimoto’s
When it comes to a sensitive thyroid, what we’re eating becomes especially important. The right amounts of iodine, selenium, iron, and vitamin D can help support a healthy thyroid. In excess, though, iodine may be problematic.
Iodine is a trace element found in foods such as seafood, dairy, produce, and enriched grains (NIH, 2019a). It is a vital component of the thyroid hormones and is absolutely essential for a healthy thyroid. Iodine deficiency used to be an epidemic in the United States before iodized salt and fortification programs were introduced, and iodine deficiency is still a public health issue in other countries. Iodine deficiency can create serious problems, such as hypothyroidism, and during pregnancy it’s the number one preventable cause of mental retardation worldwide (NIH, 2019a). The Recommended Dietary Allowance (RDA) for adults is 150 micrograms, and for pregnant and lactating women it is 220 and 290 micrograms (NIH, 2019a).
While iodine deficiency has historically been an issue, too much iodine has been associated with thyroid dysfunction. It seems counterintuitive, but studies have suggested that autoimmune hypothyroidism and thyroid antibodies may be more common in areas with higher iodine intake (Laurberg et al., 1998). In Japan, for example, where iodine intake from seaweed is very high, numerous studies have shown a high prevalence of thyroid dysfunction (Konno, Makita, Yuri, Iizuka, & Kawasaki, 1994; Michikawa et al., 2012). Also, kelp is high in iodine and consumption of kelp or kelp supplements have been shown to result in cases of hyperthyroidism, hypothyroidism, or iodine-induced thyroid toxicity (Di Matola, Zeppa, Gasperi, & Vitale, 2014; Eliason, 1998; Miyai, Tokushige, & Kondo, 2008; NIH, 2019a).
How Much Iodine Is Too Much?
Although the US Food & Nutrition Board determined that it’s safe to consume up to 1,100 micrograms of iodine (NIH, 2019a), some studies have shown that even small increases in iodine intake, even if consumption is well below the 1,100-microgram threshold, are associated with hypothyroidism (Bjergved et al., 2012; NIH, 2019a; Pedersen et al., 2011; Zhao et al., 2014). One suggested mechanism behind these findings is that excess iodine may promote apoptosis (cell death) of thyroid cells (Xu et al., 2016). While average levels may be okay for most people, there may be some people who are more sensitive to iodine.
In general, nutrition tends to be about balance; too much or too little of a nutrient may cause issues. You may want to consult a doctor to determine if your iodine levels are optimal and if your diet needs any changes to increase or reduce your iodine intake. The safest way to go with supplements is to be moderate. Look at the label and stay close to around 100 percent DV instead of 1,000 percent DV. You may also want to avoid kelp snacks and supplements if you have Hashimoto’s.
Selenium is also a major player in thyroid function. It is an antioxidant and anti-inflammatory nutrient that is needed to remove iodine from thyroid hormones in order to activate and deactivate the hormones (Liontiris & Mazokopakis, 2017; St. Germain, Galton, & Hernandez, 2009).
Sources of Selenium
Selenium is naturally present in many different foods—good sources of selenium include Brazil nuts, yellowfin tuna, halibut, shrimp, chicken, cottage cheese, brown rice, and eggs (NIH, 2019b). The Recommended Dietary Allowance (RDA) for adults is 55 micrograms and 60 micrograms for pregnant women (NIH, 2019b).
Two large cross-sectional studies in France and Germany showed that higher selenium was associated with less goiter and less tissue damage, but only among women; men did not see these benefits in the study (Derumeaux et al., 2003; Rasmussen et al., 2011). Selenium supplementation may help combat the inflammatory and immune responses characteristic of Hashimoto’s. Several studies have shown that selenium can decrease anti-TPO antibodies (Fan et al., 2014; Reid, Middleton, Cossich, Crowther, & Bain, 2013; Toulis, Anastasilakis, Tzellos, Goulis, & Kouvelas, 2010; van Zuuren, Albusta, Fedorowicz, Carter, & Pijl, 2014; W. Wang et al., 2018). And a study published in 2019 found that four months of selenium supplementation (with eighty-three micrograms of selenomethionine daily) normalized TSH levels in a group of twenty-five men and women with Hashimoto’s (Pirola et al., 2020). A clinical study in Denmark is currently recruiting patients to investigate whether selenium supplementation can improve the quality of life for people with Hashimoto’s; for more information, see the clinical trials section.
As always, consult your doctor about your diet and any supplements you may be taking if you have Hashimoto’s.
Studies have shown that iron deficiency and thyroid problems sometimes occur together (Erdal et al., 2008; M’Rabet‐Bensalah et al., 2016). Remember our thyroid enzyme TPO? TPO needs adequate iron in order to synthesize thyroid hormones. And in one small study, improving iron levels helped with thyroid symptoms (Rayman, 2018). However, it is not clear whether iron deficiency causes thyroid dysfunction or thyroid dysfunction causes iron deficiency (Szczepanek-Parulska, Hernik, & Ruchała, 2017). Researchers hypothesize that people with Hashimoto’s may be more prone to iron deficiency due to a higher occurrence of other autoimmune disorders, such as celiac disease, which results in poor absorption of nutrients (Rayman, 2018; Roy et al., 2016; Sategna-Guidetti et al., 1998). Studies also have shown that pregnant women who are iron-deficient (not an uncommon scenario since growing a baby uses up lots of iron) may be at higher risk for hypothyroidism (Zimmermann, Burgi, & Hurrell, 2007).
In any case, iron is an important nutrient we shouldn’t overlook. And women tend to be more deficient than men (Miller, 2014). According to the CDC, 14 percent of American women are low in iron levels (CDC, 2012).
Sources of Iron
Foods that are high in iron include oysters, white beans, and dark chocolate while good sources or iron—meaning they contain between 10 to 19 percent of your daily value—include lentils, spinach, tofu, chickpeas, tomatoes, beef, cashew nuts, and potatoes. The Recommended Dietary Allowance for iron is 18 milligrams for women and 8 milligrams for men, while pregnant women’s RDA is 27 milligrams. Since many people are low in iron, especially women, you may want to supplement.
Attention vegetarians: Since iron from plant-based foods is less bioavailable, people who do not eat meat are advised to eat almost twice as much iron (NIH, 2018).
While you may know that vitamin D is good for your bones, you may not know that it also regulates our immune system. And recent research suggests that it may play a role in the development of several autoimmune disorders (Yang, Leung, Adamopoulos, & Gershwin, 2013).
A study in Europe showed that vitamin D deficiency was more common in individuals with autoimmune thyroid diseases, and low vitamin D was associated with more antibodies and abnormal thyroid function tests (Kivity et al., 2011). Among children, higher vitamin D levels were associated with fewer thyroid antibodies (Camurdan, Döğer, Bideci, Celik, & Cinaz, 2012). However, other studies have shown inconsistent results (Effraimidis, Badenhoop, Tijssen, & Wiersinga, 2012; Goswami et al., 2009). A small study published in 2019 suggested that selenium intake may enhance the effect of vitamin D on thyroid antibodies, so selenium levels may need to be taken into account along with vitamin D levels (Krysiak, Kowalcze, & Okopien, 2019). For now, the jury is still out on whether vitamin D supplementation is useful for those with autoimmune disorders such as Hashimoto’s (Antico, Tampoia, Tozzoli, & Bizzaro, 2012; Talaei, Ghorbani, & Asemi, 2018). But in the meantime, it’s a fact that vitamin D is important healthwise, so you want to be sure your levels are optimal.
Sources of Vitamin D
You can get some of your daily vitamin D from a limited number of foods, such as seafood, eggs, and dairy products. But it’s generally not realistic to get enough vitamin D from foods alone. The recommended daily value is 800 international units (IU), which is twenty micrograms. A three-ounce serving of fatty fish provides around 500 IU of vitamin D. And you’d have to eat almost a whole carton of eggs or drink an entire quart of milk to get your daily requirement from non-fish sources (NIH, 2019c).
Our bodies can also produce vitamin D after exposure to the sun’s rays, so getting a daily dose of sunshine, without a layer of sunscreen, helps. This is about moderation; it’s never a good idea to get a sunburn. And note that if you have darker skin, it’s harder to get all the vitamin D you need from the sun.
Many of us may not be getting enough; to learn more about testing your vitamin D levels and supplementing, see this Ask Gerda piece on vitamin D written by our in-house PhD.
Other Supplements for Specific Symptoms
Since there are many side effects of Hashimoto’s, vitamins and supplements to help with specific symptoms may be recommended.
Hair loss is a common issue for people with thyroid dysfunction. Zinc and iron supplements have been shown to help alleviate hair loss among people who are deficient (Karashima et al., 2012; Park, Kim, Kim, & Park, 2009; Trost, Bergfeld, & Calogeras, 2006).
Individuals with hypothyroidism may be low in vitamin B12: One study found that 40 percent of hypothyroid patients were deficient, so you may want to consider incorporating B12 supplements if your levels are determined to be low (Jabbar et al., 2008).
Lifestyle Changes for Hashimoto’s
As with most diseases, managing stress, exercising regularly, and getting enough sleep are important.
Many people with Hashimoto’s may experience muscle aches and tightness. Additionally, those with hypothyroidism are at a higher risk of cardiovascular diseases. So regular exercise is essential: It keeps your heart healthy and your muscles in motion in order to reduce pain and your chance of developing other health problems. You may want to try incorporating yoga and stretching at first, before moving to aerobic exercises—talk to your doctor about this. While moderate exercise may support healthy thyroid hormones, be careful not to overdo it and overwhelm your thyroid with high-intensity workouts (Ciloglu et al., 2005; Lankhaar, de Vries, Jansen, Zelissen, & Backx, 2014; Lesmana et al., 2016).
You may have heard (a lot) about adrenal fatigue. Researchers and most conventional medical doctors aren’t sold on the concept. The theory behind adrenal fatigue is that when our body is super stressed out, our adrenal glands are pushed to the limit, producing massive amounts of cortisol, which leads them to burn out. The result? A wide variety of symptoms, such as depression, fatigue, and inability to handle stress.
While adrenal fatigue may not be recognized as a disorder by most doctors, the symptoms are very real for many people. And it’s possible that hypothyroidism or other conditions, such as fibromyalgia, may be at play.
Preclinical studies have shown that stress may affect thyroid hormones, even hours after a stressful event (D. L. Helmreich & Tylee, 2011; Servatius et al., 2000). What’s interesting is that psychologically coping with stress could protect our thyroid hormones. In one study where researchers exposed rats to both escapable and inescapable foot shocks (which is sad), they found that thyroid hormones decreased only among rats who couldn’t stop the shocks and control their stress (D. Helmreich, Crouch, Dorr, & Parfitt, 2006).
This research emphasizes how important it is for us to feel in control of our daily stress in order to maintain a healthy body and mind. Try going offline for a bit, taking a self-care day, or starting a mindfulness practice.
Hypothyroidism can cause excessive sleepiness as your metabolism slows down. People with Hashimoto’s may also be more likely to suffer from sleep disorders, such as sleep apnea (Bozkurt et al., 2012). Sleep apnea can be improved by weight loss if you are overweight. Continuous positive airway pressure (CPAP) can also be helpful. CPAP is a mask that fits over your face, delivering oxygen while you sleep to keep your airways open.
Conventional Treatment Options for Hashimoto’s
The most common treatment option for Hashimoto’s is hormone replacement. Thyroidectomy has also been shown to be effective for some people.
If you are diagnosed with Hashimoto’s, your doctor may recommend T4 and/or T3 thyroid hormone medications. Your doctor will recommend routine follow-up blood tests in order to determine the best doses and formulations, which may take some time to find.
The most commonly used medication is synthetic levothyroxine, which is bioidentical to the T4 that your body makes. Some people benefit from the addition of liothyronine, which is bioidentical synthetic T3. The people who benefit the most from T3 may be those who do not efficiently convert T4 to T3, possibly due to a genetic polymorphism in the enzyme that carries out this conversion.
It has also been reported that some people prefer what has been referred to as bioidentical natural thyroid replacement, which consists of desiccated animal thyroid glands. These provide a combination of T3, T4, and other components. For example, Armour Thyroid is derived from pig thyroid glands.
For many years, the maker of the branded levothyroxine, Synthroid, claimed that it was superior to other branded and generic levothyroxine products. The company suppressed the publication of research disproving this claim. In 1997, research was finally published showing that several branded and generic forms were equivalent, and lawsuits forced the company to pay restitution to consumers who had unnecessarily paid for the more expensive Synthroid. A clinically significant advantage to using Synthroid has not been demonstrated (Alexander, 2019, Dong et al, 1997, Garber et al., 2012, Santoro et al., 2016).
In certain cases, your doctor may advise you to have your thyroid removed. This is typically prescribed when someone does not respond to other treatment options or when the thyroid looks like it may be cancerous (Caturegli, De Remigis, & Rose, 2014). Thyroidectomy is generally a low-risk procedure and has been shown to significantly reduce patient symptoms (McManus, Luo, Sippel, & Chen, 2011). If you have a total thyroidectomy, meaning your entire thyroid is removed, you will need to take synthetic thyroid hormone medications since your body will no longer be able to produce thyroid hormones on its own.
In one study, Hashimoto’s patients who were managing their thyroid with hormone medication but still had significant symptoms were randomly chosen to undergo a thyroidectomy or continue treatment as usual. The patients who underwent surgery had improved general health, reduced fatigue, and lower levels of anti-TPO antibodies post-treatment, compared to the patients who did not have a thyroidectomy (Guldvog et al., 2019). It may be that the presence of the thyroid itself and the inflammation from anti-thyroid antibodies continues to cause systemic problems even if thyroid function is being properly managed with medication.
Alternate Treatment Options for Hashimoto’s
Working with a holistic practitioner may be helpful for managing the myriad symptoms of Hashimoto’s. Herbal supplements such as adaptogens and guggul may be helpful. You may want to avoid lemon balm and holy basil, which may negatively affect the thyroid gland.
Holistic approaches often require dedication as you work closely with an experienced practitioner. There are several certifications that designate an herbalist. The American Herbalists Guild provides a listing of registered herbalists, whose certification is designated RH(AHG). Traditional Chinese medicine degrees include LAc (licensed acupuncturist), OMD (doctor of Oriental medicine), or DipCH (NCCA) (diplomate of Chinese herbology from the National Commission for the Certification of Acupuncturists). Traditional Ayurvedic medicine from India is accredited in the US by the American Association of Ayurvedic Professionals of North America (AAPNA) and the National Ayurvedic Medical Association (NAMA). There are also functional, holistic-minded practitioners (MDs, DOs, NDs, and DCs) who may use herbal protocols.
While we don’t recommend self-treating Hashimoto’s, there are some interesting preliminary studies about various herbs that may either help support a healthy thyroid and immune system or may be harmful. Always discuss herbal supplements with your doctor first.
This class of Ayurvedic herbs is celebrated for its ability to help your body manage stress and regulate itself. Ashwagandha root extract has been reported to increase levels of thyroid hormones and to normalize TSH levels in two studies (Gannon, Forrest, & Roy Chengappa, 2014; Sharma, Basu, & Singh, 2018). In a well-controlled clinical study, 600 milligrams of ashwagandha extract daily for eight weeks helped to normalize thyroid hormones (Sharma et al., 2018). This is not enough research to conclude that ashwagandha is definitely helpful for Hashimoto’s, but it does suggest that it could be. Several herbal supplements on the market that are designed for thyroid support contain ashwagandha at levels far below 600 milligrams, so check the dose on the label of any supplement.
Another herb used in Ayurvedic tradition for the thyroid is guggul. And some preclinical evidence (animal research) has shown that guggul may increase thyroid activity (Panda & Kar, 2005; Tripathi, Malhotra, & Tripathi, 1984). In the research literature, human evidence is limited, and thyroid benefits have not been demonstrated for guggul (Antonio et al., 1999).
Herbs to Potentially Avoid If You Have Hashimoto’s
Lemon balm is a member of the mint family whose leaves have been used traditionally to address bloating, menstrual cramps, toothaches, and cold sores because of its sedative, calming effect. A few studies have suggested that lemon balm may disrupt the thyroid by inhibiting TSH—so consider avoiding this herb (Auf’Mkolk, Ingbar, Kubota, Amir, & Ingbar, 1985; Santini et al., 2003). Other preclinical studies have shown that holy basil may decrease T4 levels, so you may want to avoid this popular adaptogen as well if you have hypothyroidism (Panda & Kar, 1998).
New and Promising Research on Hashimoto’s
Certain chemicals, such as fluoride and bromide, may disrupt thyroid function, while laser therapy and stem cells have been proposed as potential new treatment options.
Fluoride and Bromide
There is evidence that fluoride and bromide, which are chemically similar to iodide, interfere with iodine metabolism in the body. Exposure to bromides can come from pesticides, swimming pool cleaning treatments, and fire retardants commonly used in fabrics and mattresses (CDC, 2018). Bromides appear to displace iodine, and it has been proposed (although not confirmed) that they should be considered goitrogens. However, it seems that a very large amount of bromide would be required to affect iodine metabolism (Buchberger, Holler, & Winsauer, 1990; Pavelka, 2004
New research is also pointing to fluoride as a potential issue for individuals with hypothyroidism. A recent systematic review concluded that excessive fluoridation of water may be associated with high levels of hypothyroidism (Chaitanya et al., 2018). An individual’s iodine status may be an important factor when considering if fluoride is causing any issues. One study found that adults with moderate to severe iodine deficiency and high fluoride intake had increased TSH levels (Malin, Riddell, McCague, & Till, 2018). However, an observational study published in 2019 of 293 children between the ages of nine and thirteen found that long-term intake of fluorinated water did not affect their thyroid function (Shaik, Shanbhog, Nadlal, & Tippeswamy, 2019). If you are interested in reducing excess fluoride intake, a quality water filter may be useful.
In São Paulo, Brazil, researchers are studying low-level laser therapy (LLLT) as a cost-effective intervention for patients with Hashimoto’s. Other studies have shown that LLLT can assist with autoimmune diseases, regenerate tissues, and increase thyroid hormone levels by stimulating cell function with lasers that are applied to the surface of the body. A team of researchers in Brazil recently found that LLLT improved thyroid gland vascularization among forty-three people with Hashimoto’s who underwent levothyroxine replacement; however, more research is needed to determine the duration of the effect (Höfling et al., 2012).
A 2020 study randomized 350 patients with Hashimoto’s to either six sessions of photobiomodulation to the neck near the thyroid gland plus vitamin D, iron, and selenium supplements or just the supplements. Photobiomodulation is a type of light therapy using nonionizing light, such as a laser, that is designed to trigger cellular changes in the tissues it is applied to. Patients who received both the vitamin regimen and photobiomodulation had significantly increased T3 levels and significantly lower TPO antibodies than those who just took the supplements (Ercetin, Sahbaz, Acar, Tutal, & Erbil, 2020). The authors suggested this could be due to the lasers decreasing inflammation in the thyroid; however, further research is needed on this sort of therapy to determine exactly what’s at work and if it’s truly effective for people with Hashimoto’s.
The thyroid therapy of the future could be stem cells: immature cells that can develop into various cell types. Darrel Kotton, MD, a stem cell researcher at Boston University School of Medicine, and Anthony Hollenberg, MD, a Harvard endocrinologist, have collaborated on groundbreaking research that may open the door for thyroid regeneration. Using stem cells, they were able to create follicular cells—thyroid cells that make the thyroid hormones T3 and T4. When they implanted these new follicular cells into mice that had no thyroid glands, the cells were able to grow normally and start making thyroid hormones within two weeks (Kurmann et al., 2015). Incredible.
Clinical Trials for Hashimoto’s
Clinical trials are research studies intended to evaluate a medical, surgical, or behavioral intervention. They are done so that researchers can study a particular treatment that may not have a lot of data on its safety or effectiveness yet. If you’re considering signing up for a clinical trial, it’s important to note that if you’re placed in the placebo group, you won’t get access to the treatment being studied. It’s also good to understand the phases of clinical trials: Phase 1 is the first time most drugs will be used in humans, so it’s about finding a safe dose. If the drug passes the initial trial, it can be used in a larger, phase 2 trial to see whether it works well. Then it may be compared to a known effective treatment in a phase 3 trial. If the drug is approved, it will go on to a phase 4 trial. Phase 3 and phase 4 trials are the most likely to involve the most effective and safest up-and-coming treatments.
In general, clinical trials may yield valuable information, may provide benefits for some subjects, and may have undesirable outcomes for others. Speak with your doctor about any clinical trial you are considering.
Where Do You Find Studies That Are Recruiting Subjects?
You can find clinical studies that are recruiting subjects on clinicaltrials.gov, which is a website run by the US National Library of Medicine. The database consists of all privately and publicly funded studies that are happening around the globe. You can search disease or a specific drug or treatment you’re interested in, and you can filter by country where the study is taking place.
The CATALYST trial is a large clinical study in Denmark studying selenium supplementation. Scientists are recruiting patients who have autoimmune thyroiditis and take the synthetic thyroid hormone levothyroxine (LT4). The study will last a year, and participants will be blindly assigned to either take 200 micrograms of selenium daily along with their normal LT4 or take a placebo pill with their LT4. This study is important because it could help us better understand selenium’s role in Hashimoto’s and determine whether it is a useful supplement to add to your routine; stay posted or learn about enrolling here.
In China, researchers at the First Affiliated Hospital of Harbin Medical University are investigating the gut and oral microbiomes of patients with Hashimoto’s. Using gene sequencing, they aim to compare the bacterial diversity of patients with autoimmune diseases to healthy controls. Previous research has shown that alterations in gut microbiota are important factors in the development of inflammatory and autoimmune diseases. The two studies are currently recruiting; for more information, check out the oral and gut microbiome studies.
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This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information and advice in this article is based on research published in peer-reviewed journals, on practices of traditional medicine, and on recommendations made by health practitioners, the National Institutes of Health, the Centers for Disease Control, and other established medical science organizations; this does not necessarily represent the views of goop.