Of the 20 million Americans who have thyroid disease, most have hypothyroidism, a condition where the thyroid gland can’t make enough thyroid hormone to keep the body running normally.

More common in women than men, hypothyroidism can have a number of genetic, nutritional, and immune-related underlying causes and contributing factors.

Licensed naturopathic doctors (NDs) have effective approaches for the treatment of hypothyroidism based on rigorous training in therapeutic nutrition and botanical medicine, and an emphasis on addressing the underlying causes of disease.

Hypothyroidism: What is it and what are the symptoms?

The thyroid gland is a butterfly-shaped endocrine gland located in the lower front of the neck. The thyroid’s job is to make hormones which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body make energy, metabolize, regulate temperature, and keeps the brain, heart, muscles, and other organs working as they should. When the body isn’t making enough thyroid hormone, symptoms can include fatigue, weight gain, hair thinning, dry skin, and depression.

Experts believe that between 40 and 60 percent of people with thyroid disease do not know they have it.

Low thyroid hormone can also cause more serious symptoms like difficulty sleeping, changes in menstruation, or gastrointestinal symptoms. Because symptoms of hypothyroidism can resemble those of other diseases and vary widely from person to person, patients may not recognize them as a problem warranting exploration or treatment. Experts believe that between 40 and 60 percent of people with thyroid disease do not know they have it.

Hypothyroidism: Diagnosis

Typically, blood tests are used in the diagnosis of hypothyroidism. Three measurements are often considered: free thyroxine (T4) and free triiodothyronine (T3), both produced by the thyroid itself, and thyroid-stimulating hormone (TSH, also called thyrotropin), produced by the pituitary gland to regulate the thyroid. While many doctors follow the current TSH reference ranges for diagnosis (0.4 to 5.0mU/L), there is substantial controversy about what is diagnosable and treatable as hypothyroidism and sub-clinical hypothyroidism (when blood levels of free T3 and free T4 are normal, but the level of thyroid-stimulating hormone is high).

A blood test measuring thyroid antibodies, anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-TG) is used to confirm or rule out autoimmune thyroid disease causing hypothyroidism.

Hypothyroidism: Underlying Causes

Naturopathic doctors treat hypothyroidism from the root of the problem. There are two main types of hypothyroidism, with numerous contributing factors:

Autoimmune thyroid disease (Hashimoto’s) is the most common cause of hypothyroidism. This is a form of thyroid inflammation caused by the patient’s own immune system. Hashimoto’s is five to eight times more common in women than men. Elevated levels of anti-TPO antibodies are found in approximately five percent of adults and 15 percent of older women. Individuals with other autoimmune diseases such as type 1 diabetes, celiac disease, and rheumatoid arthritis have a higher prevalence of autoimmune thyroid disease.

Central or pituitary hypothyroidism, where the thyroid just isn’t making enough hormone, is often influenced by environmental and nutritional factors including gastrointestinal system inflammation, vitamin and mineral deficiencies or imbalances, high levels of cortisol (due to prolonged stress or oral steroid use), and/or elevated estrogen. Surgery on the thyroid gland (to remove a goiter or nodule) and/or radioactive iodine treatment (to treat a thyroid nodule, hyperactive thyroid, throat cancer, and cancer of nearby sites) can also cause hypothyroidism.

Hypothyroidism—Naturopathic Treatments

The current conventional medical treatment for hypothyroidism is daily thyroid hormone supplementation with synthetic levothyroxine (T4), liothyronine (T3), or natural desiccated thyroid (T4 and T3) to correct low levels. While this treatment can be very effective for some patients, for others with Hashimoto’s taking thyroid hormone alone does not fully address the underlying cause of dysfunction. For some, the medication can create a yo-yo-ing of symptoms while trying to find the correct dosage. Other individuals don’t tolerate or absorb thyroid hormone well.

Naturopathic doctors are trained in the pharmacological treatments commonly prescribed by conventionally trained MDs, and in some states, prescribe pharmaceuticals when necessary. However, NDs rarely use medication as a standalone treatment.

NDs individualize hypothyroid treatment, often combining diet, supplementation, botanical medicine, and conventional pharmaceuticals as needed.

If autoimmune disease is the main cause of thyroid dysfunction, NDs work to help control the inflammation and eliminate autoimmune triggers. Working to reduce thyroid antibodies, if possible, is the main goal of treatment. If the thyroid is just not producing enough thyroid hormone, NDs address lifestyle and environmental factors that may be contributing to low production. Although every hypothyroid treatment is carefully individualized, some common natural therapies for hypothyroidism include:

Diet and Microbiome

Many nutritional factors play a role in optimizing thyroid function, and the right diet is important to help prevent and manage conditions that can accompany thyroid disease. When it comes to Hashimoto’s and other autoimmune conditions, research shows that one important factor in autoimmune response is chronic, persistent microbiome imbalance and inflammation in the gut.

Naturopathic doctors address microbiome dysfunction with nutritional therapies such as probiotics, cultured foods, and diets lower in sugar, starch, and carbohydrates, which help to decrease inflammation and balance immunity. Food allergy panels and/or an elimination diet can help identify food triggers to the autoimmune response for Hashimoto’s. Those with an autoimmune thyroid disorder should also be tested for celiac disease to determine if gluten elimination is needed.

Supplementation

Naturopathic doctors test for common nutrient deficiencies associated with hypothyroidism, and supplement as needed.

  • Vitamin B-12 is very important for thyroid production. It helps improve cellular response to thyroid hormone and boosts energy production in cells to help with fatigue and other symptoms associated with hypothyroidism.
  • Selenium supports efficient thyroid synthesis and metabolism and has been found in studies to reduce thyroid antibody levels in patients with Hashimoto’s.
  • Zinc is beneficial in improving thyroid function and hormone levels and has been shown in studies to have a positive effect on thyroid function in overweight females.

Botanical Herbs

There are several herbs that have been shown to benefit thyroid function, including adaptogens like Ashwagandha, which was shown to improve thyroid function for subclinical hypothyroid patients. Adaptogens are herbs that work on several body functions at once to help balance out dysfunction and regulate metabolic processes. They are used with caution, however, in those with autoimmune thyroid disease as some botanicals can stimulate the immune system response. Other herbs such as gum guggal can be used in all forms of hypothyroidism as they help to convert the inactive form of T4 to the more active form of T3. Any herbal treatment should be approved by a professional trained in herbal medicine to reduce side effects, prevent unwanted drug/herb interactions, and maximize treatment efficacy.

Regulation of thyroid function can be tricky and requires a whole-person approach. Naturopathic doctors lead with natural therapies that address underlying causes and support the body to restore healthy function.

A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM).  The INM and AANP would like to acknowledge Jennifer Bennett, ND, for her contributions to the content of this FAQ.