How Do Naturopathic Doctors Treat Hypothyroidism?

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 diabetesceliac 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 inflammationvitamin 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.

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.