Natural Treatments for Hypothyroidism

The thyroid is a butterfly-shaped gland in the lower front of the neck. It produces hormones that are secreted into the blood and carried to every tissue in the body. Hypothyroidism is a condition where the thyroid gland can’t make enough thyroid hormone to keep the body running normally. Of the 20 million Americans who have thyroid disease, most have hypothyroidism.

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

Common Hypothyroidism Symptoms

Thyroid hormones help the body make energy, metabolize food, and regulate temperature, and they keep the brain, heart, muscles, and other organs working as they should. With an underactive thyroid, symptoms can include fatigue, weight gain, thinning hair, dry skin, and depression.

Low thyroid hormone can also cause more serious symptoms like difficulty sleeping, changes in menstruation, or gastrointestinal trouble. Because hypothyroidism symptoms 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 up to 60 percent of people with thyroid disease do not know they have it.

Diagnosing Hypothyroidism

Blood tests are typically used to diagnose hypothyroidism. Three measurements are often considered: free thyroxine (T4) and free triiodothyronine (T3), both produced by the thyroid, and thyroid-stimulating hormone (TSH, also called thyrotropin), produced by the pituitary gland to regulate the thyroid. While many doctors follow current TSH reference ranges for diagnosis (0.4 to 5.0mU/L), there is controversy about what is diagnosable and treatable as hypothyroidism or 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) can confirm or rule out autoimmune thyroid disease that causes hypothyroidism.

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Hypothyroidism: Underlying Causes

Thyroid function regulation can be tricky and requires a whole-person approach. Naturopathic doctors lead with natural therapies that address underlying causes and support the body’s ability to restore healthy function. 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 in men. Elevated levels of anti-TPO antibodies are found in approximately 5 percent of adults and 15 percent of older women. Individuals with other autoimmune diseases such as type 1 diabetes,¹Dosi RV, Tandon N. A study on prevalence of thyroid auto-immunity in type 1 diabetes mellitus. J Indian Med Assoc. 2010;108(6):349-356. celiac disease,²Roy A, Laszkowska M, Sundström J, et al. Prevalence of celiac disease in patients with autoimmune thyroid disease: a meta-analysis. Thyroid. 2016;26(7):880-890. https://doi.org/10.1089/thy.2016.0108 and rheumatoid arthritis³Emamifar A, Hangaard J, Jensen Hansen IM. Thyroid disorders in patients with newly diagnosed rheumatoid arthritis is associated with poor initial treatment response evaluated by disease activity score in 28 joints-C-reactive protein (DAS28-CRP): An observational cohort study. Medicine (Baltimore). 2017;96(43):e8357. https://doi.org/10.1097/MD.0000000000008357 have a higher prevalence of autoimmune thyroid disease.

Central or pituitary hypothyroidism, where the thyroid isn’t making enough hormone, is often influenced by environmental and nutritional factors including gastrointestinal system inflammation,⁴Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/ vitamin and mineral deficiencies⁵Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients. Points that need more investigation. Hell J Nucl Med. 2017;20(1):51-56. https://doi.org/10.1967/s002449910507 or imbalances, high levels of cortisol⁶Benvenga S, Klose M, Vita R, Feldt-Rasmussen U. Less known aspects of central hypothyroidism: part 1 – acquired etiologies. J Clin Transl Endocrinol. 2018;14:25-33. Published 2018 Sep 26. https://doi.org/10.1016/j.jcte.2018.09.003 (due to prolonged stress or oral steroid use), and/or elevated estrogen.⁷Benvenga S, Di Bari F, Granese R, et al. Circulating thyrotropin is upregulated by estradiol. J Clin Transl Endocrinol. 2018;11:11-17. Published 2018 Feb 13. https://doi.org/10.1016/j.jcte.2018.02.002 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.

Natural Remedies for Hypothyroidism

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, taking thyroid hormone alone does not fully address the underlying cause of dysfunction. The medication can create a yo-yo-ing of symptoms while the right dosage is determined. Other individuals don’t tolerate or absorb thyroid hormone well.

Naturopathic doctors are trained on the pharmacological treatments commonly prescribed by conventionally trained MDs, and in some states, may 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 when needed.

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

Diet Modifications

Many nutritional factors play a role in optimizing thyroid function, and the right diet is important to help prevent and manage conditions that accompany thyroid disease. When it comes to Hashimoto’s and other autoimmune conditions, research shows that one important factor in autoimmune response⁸Proal AD, Marshall TG. Re-framing the theory of autoimmunity in the era of the microbiome: persistent pathogens, autoantibodies, and molecular mimicry. Discov Med. 2018;25(140):299-308 is chronic, persistent microbiome imbalance⁹Köhling HL, Plummer SF, Marchesi JR, Davidge KS, Ludgate M. The microbiota and autoimmunity: Their role in thyroid autoimmune diseases. Clin Immunol. 2017;183:63-74. https://doi.org/10.1016/j.clim.2017.07.001 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 decrease inflammation and balance immunity. Food allergy panels or an elimination diet can help identify foods that trigger the autoimmune response¹⁰Coucke F. Food intolerance in patients with manifest autoimmunity. Observational study. Autoimmun Rev. 2018;17(11):1078-1080. https://doi.org/10.1016/j.autrev.2018.05.011 for Hashimoto’s. Those with an autoimmune thyroid disorder should also be tested for celiac disease¹¹Kahaly GJ, Frommer L, Schuppan D. Celiac disease and endocrine autoimmunity – the genetic link. Autoimmun Rev. 2018;17(12):1169-1175. https://doi.org/10.1016/j.autrev.2018.05.013 to determine if gluten elimination is needed.

Supplementation

Naturopathic doctors test for common nutrient deficiencies associated with hypothyroidism and recommend supplements as needed.

• Vitamin B-12¹²Collins AB, Pawlak R. Prevalence of vitamin B-12 deficiency among patients with thyroid dysfunction. Asia Pac J Clin Nutr. 2016;25(2):221-226. https://doi.org/10.6133/apjcn.2016.25.2.22 is essential to thyroid production. B-12 improves cellular response to thyroid hormone and boosts energy production in cells to alleviate fatigue and other hypothyroidism symptoms.
• Selenium¹³Wichman J, Winther KH, Bonnema SJ, Hegedüs L. Selenium supplementation significantly reduces thyroid autoantibody levels in patients with chronic autoimmune thyroiditis: a systematic review and meta-analysis. Thyroid. 2016;26(12):1681-1692. https://doi.org/10.1089/thy.2016.0256 supports efficient thyroid synthesis and metabolism and has been found to reduce thyroid antibody levels in patients with Hashimoto’s.
• Zinc¹⁴Mahmoodianfard S, Vafa M, Golgiri F, et al. Effects of zinc and selenium supplementation on thyroid function in overweight and obese hypothyroid female patients: a randomized double-blind controlled trial. J Am Coll Nutr. 2015;34(5):391-399. https://doi.org/10.1080/07315724.2014.926161 is beneficial for balancing hormone levels and has been shown in studies to positively affect thyroid function in overweight females.

Botanical Herbs

Several herbs may benefit thyroid function, including adaptogens like Ashwagandha,¹⁵Sharma AK, Basu I, Singh S. Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. J Altern Complement Med. 2018;24(3):243-248. https://doi.org/10.1089/acm.2017.0183 which was shown to improve thyroid function for subclinical hypothyroid patients. Adaptogens work on multiple body functions simultaneously to help balance out dysfunction and regulate metabolic processes. They should be used with caution for those who have autoimmune thyroid disease, as some botanicals can stimulate an immune response. Other herbs, such as gum guggal, can treat all forms of hypothyroidism, as they help 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.

The INM and American Association of Naturopathic Physicians (AANP) would like to acknowledge Jennifer Bennett, ND, for her contributions to this article.

Footnotes

• 1
  Dosi RV, Tandon N. A study on prevalence of thyroid auto-immunity in type 1 diabetes mellitus. J Indian Med Assoc. 2010;108(6):349-356.
• 2
  Roy A, Laszkowska M, Sundström J, et al. Prevalence of celiac disease in patients with autoimmune thyroid disease: a meta-analysis. Thyroid. 2016;26(7):880-890. https://doi.org/10.1089/thy.2016.0108
• 3
  Emamifar A, Hangaard J, Jensen Hansen IM. Thyroid disorders in patients with newly diagnosed rheumatoid arthritis is associated with poor initial treatment response evaluated by disease activity score in 28 joints-C-reactive protein (DAS28-CRP): An observational cohort study. Medicine (Baltimore). 2017;96(43):e8357. https://doi.org/10.1097/MD.0000000000008357
• 4
  Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/
• 5
  Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients. Points that need more investigation. Hell J Nucl Med. 2017;20(1):51-56. https://doi.org/10.1967/s002449910507
• 6
  Benvenga S, Klose M, Vita R, Feldt-Rasmussen U. Less known aspects of central hypothyroidism: part 1 – acquired etiologies. J Clin Transl Endocrinol. 2018;14:25-33. Published 2018 Sep 26. https://doi.org/10.1016/j.jcte.2018.09.003
• 7
  Benvenga S, Di Bari F, Granese R, et al. Circulating thyrotropin is upregulated by estradiol. J Clin Transl Endocrinol. 2018;11:11-17. Published 2018 Feb 13. https://doi.org/10.1016/j.jcte.2018.02.002
• 8
  Proal AD, Marshall TG. Re-framing the theory of autoimmunity in the era of the microbiome: persistent pathogens, autoantibodies, and molecular mimicry. Discov Med. 2018;25(140):299-308
• 9
  Köhling HL, Plummer SF, Marchesi JR, Davidge KS, Ludgate M. The microbiota and autoimmunity: Their role in thyroid autoimmune diseases. Clin Immunol. 2017;183:63-74. https://doi.org/10.1016/j.clim.2017.07.001
• 10
  Coucke F. Food intolerance in patients with manifest autoimmunity. Observational study. Autoimmun Rev. 2018;17(11):1078-1080. https://doi.org/10.1016/j.autrev.2018.05.011
• 11
  Kahaly GJ, Frommer L, Schuppan D. Celiac disease and endocrine autoimmunity – the genetic link. Autoimmun Rev. 2018;17(12):1169-1175. https://doi.org/10.1016/j.autrev.2018.05.013
• 12
  Collins AB, Pawlak R. Prevalence of vitamin B-12 deficiency among patients with thyroid dysfunction. Asia Pac J Clin Nutr. 2016;25(2):221-226. https://doi.org/10.6133/apjcn.2016.25.2.22
• 13
  Wichman J, Winther KH, Bonnema SJ, Hegedüs L. Selenium supplementation significantly reduces thyroid autoantibody levels in patients with chronic autoimmune thyroiditis: a systematic review and meta-analysis. Thyroid. 2016;26(12):1681-1692. https://doi.org/10.1089/thy.2016.0256
• 14
  Mahmoodianfard S, Vafa M, Golgiri F, et al. Effects of zinc and selenium supplementation on thyroid function in overweight and obese hypothyroid female patients: a randomized double-blind controlled trial. J Am Coll Nutr. 2015;34(5):391-399. https://doi.org/10.1080/07315724.2014.926161
• 15
  Sharma AK, Basu I, Singh S. Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. J Altern Complement Med. 2018;24(3):243-248. https://doi.org/10.1089/acm.2017.0183