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Natural Treatments for Hashimoto’s Thyroiditis

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Hashimoto’s Thyroiditis (also known as Hashimoto’s Disease) is an autoimmune condition affecting the thyroid gland and is the most common cause of hypothyroidism (underactive thyroid) in the U.S. 1Hashimoto thyroiditis: MedlinePlus Genetics. Accessed May 5, 2023. https://medlineplus.gov/genetics/condition/hashimoto-thyroiditis/

Hashimoto’s affects 1 to 2% of people in the U.S.2Hashimoto thyroiditis: MedlinePlus Genetics. Accessed May 5, 2023. https://medlineplus.gov/genetics/condition/hashimoto-thyroiditis/, with more women impacted than men. The female-to-male-ratio is at least 10:1, and women are usually diagnosed between ages 30 and 50. 3Mincer DL, Jialal I. Hashimoto Thyroiditis. In: StatPearls [Internet]. StatPearls Publishing; 2022. Accessed May 5, 2023. https://www.ncbi.nlm.nih.gov/books/NBK459262/

To learn more about the naturopathic approach to Hashimoto’s as addressed through the Therapeutic OrderTM approach, we sat down with Arizona-based thyroid expert Dr. Alan Christianson, NMD, FABNE.

Quality of Life Impacts

Christianson sees a wide range of symptoms in his Hashimoto’s patients that significantly impact their quality of life. “The big ones are weight issues – easy to gain, hard to lose. There are also fatigue issues, physical and mental weakness, and people find it hard to recover from exercise,” he notes. “I see infertility, menstrual changes (which speaks to hormonal impacts), and digestive symptoms are quite common. Connective tissues can be affected, resulting in thinning hair, dry skin, and brittle nails.”

Level 1: Establish the Foundation for Optimal Health

When establishing the foundations for optimal health in Hashimoto’s patients, Christianson points to the importance of the thyroid in the body. “Every one of our cells has receptors for thyroid hormones. And that’s not true for any other hormone,” he explains. “That tells us that anything that can directly cause symptoms can also secondarily interact with other health conditions.” 

He notes that Hashimoto’s has a higher risk for other chronic diseases such as heart disease, cancers, diabetes, fatty liver disease, and thyroid disease. “Things that might be minor by themselves can synergize in a bad way with thyroid disease, like low-level anemias,” Christianson explains. “It can be asymptomatic. But when someone also has changes in their thyroid function, it can be quite pronounced. There’s a lot of interplay.”

Research shows that people with Hashimoto’s may have a significantly increased risk of cancers of the thyroid, breast, lungs, digestive system, urogenital system, and blood when compared to people without Hashimoto’s. 4Mincer DL, Jialal I. Hashimoto Thyroiditis. In: StatPearls [Internet]. StatPearls Publishing; 2022. Accessed May 5, 2023. https://www.ncbi.nlm.nih.gov/books/NBK459262/

Other conditions that people with Hashimoto’s may be more susceptible to other autoimmune disorders, including vitiligo, alopecia areata, and celiac disease. 5Mikosch P, Aistleitner A, Oehrlein M, Trifina-Mikosch E. Hashimoto’s thyroiditis and coexisting disorders in correlation with HLA status-an overview. Wien Med Wochenschr. 2023;173(1-2):41-53. doi:10.1007/s10354-021-00879-x

How does he handle a new patient assessment, given these complex factors? Factors to explore include whether symptoms can be explained by other phenomena, family history of Hashimoto’s, and how closely the patient fits the typical demographic of women in their 40s and 50s or older. “It can happen in younger people as well, especially after pregnancy or hormonal change. The more suspicious it is going into it, the more broadly we assess. And the more you would take data findings into account differently,” he notes. His assessment typically combines physical exams, blood testing, and possibly ultrasound evaluations.”

Christianson clearly differentiates the concepts of cure and trigger. Where the cause is something that makes a condition manifest, a trigger is something that causes it to come on only if it’s primed and ready. In this context, he notes that there is almost no limit to the number of things we could likely call triggers for thyroid disease, commonly including chronic infection, mold exposure, and sometimes gluten.

In terms of causal factors, he first points to genetics. Significantly, he notes that this non-changeable cause also overlaps with age, gender, and how they connect.

The second causal factor that can reverse the condition is related to iodine exposure. The body needs iodine to make thyroid hormones, but only small amounts (mere micrograms) are required. Iodine deficiency has historically been more common in other parts of the world and is now rarely seen in North America. “We’ve had six documented cases of iodine deficiency in the United States since 1980. It’s not impossible, but it’s exceedingly rare,” Christianson notes. 

Here too, genetics play a role. “The genes that give rise to thyroid disease are the same genes that control iodine metabolism,” Christianson explains. “They control how the body takes in, excretes, and modulates iodine in the body. Gene variations make some people less tolerant of extra iodine than others.”

In North America, the issue is that we are taking in so much iodine that we have trouble getting it out of the body. “A massive amount of iodine is harmful for anyone,” he notes. “Data shows that for age, gender, and ethnicity, about 20% to 40% of the North American population is exposed to levels of iodine that can be harmful for people with that genetic expression.”

Research has indeed suggested that excessive iodine may promote the development of Hashimoto’s. 6 Zhang L, Sun X, Liu L, Wang P, Qian L. Excessive iodine induces thyroid follicular epithelial cells apoptosis by activating HIF-1α-mediated hypoxia pathway in Hashimoto thyroiditis. Mol Biol Rep. 2023;50(4):3633-3640. doi:10.1007/s11033-023-08273-z7Cai T, Du P, Suo L, et al. High iodine promotes autoimmune thyroid disease by activating hexokinase 3 and inducing polarization of macrophages towards M1. Front Immunol. 2022;13:1009932. doi:10.3389/fimmu.2022.1009932

But where are North Americans getting all this extra iodine? “There’s a variety of sources. We get a fair amount in supplements. That’s a tricky one because the amount found is often manyfold above the amount labeled,” Christianson explains. 

The second, more significant source is from foods, which Christianson puts into two categories. “First, the static amount of iodine comes from salt, seafood, and egg yolks. We don’t eat more of these foods than we did in the past, and the amount of iodine in them has remained similar over time.” But there are other foods that have seen significant changes in eating patterns and iodine content. “The big ones are processed grain products and dairy foods. Dairy food intake has been rather constant. But the amount of iodine in dairy foods has roughly tripled over the last several decades,” Christianson explains. “Processed grain food intake has gone up, and the amount of iodine in those foods has more than doubled in the last several decades.”

In other words, eating the same amounts of the same foods in the past compared to today could mean radically different iodine intake. And this has significant implications for people with autoimmune thyroid disease, such as Hashimoto’s. “Several large studies have shown that people with autoimmune thyroid disease who go on a low enough level of iodine have about a 78% chance of reversing the disease within a couple of months, just by doing that. This is one causal factor that can still be taken care of after the fact,” he notes. 

Then there is the issue of how the autoimmune aspect of Hashimoto’s factors into the patient assessment. “At the high level, inflammatory reactions disrupt thyroid function. The autoimmune component can coexist with this change in thyroid function. We can say there’s Hashimoto’s, which is the autoimmunity. And then we can say hypothyroidism, which is a common consequence,” Christianson explains. “We know that these things can independently cause problems. But one can have either or both. Either one can independently cause health issues. It’s important to assess thyroid function, but also to know whether there’s an autoimmune component to it.”

Regarding conventional medical assessments for Hashimoto’s, he finds that evaluating the autoimmunity is often missed. Typically, conventional medicine assesses thyroid health based on how much hormone the thyroid makes and excretes, also called ‘thyroid output.’ But that doesn’t tell the whole story. “We now know that the autoimmune side (the body attacking the thyroid) can cause pretty much all the symptoms we’ve talked about, even without any change in thyroid output,” he explains. “The common approach is to only screen thyroid output, and then in some cases to also screen autoimmunity. But the drawback is that many people are fully symptomatic, with no change in thyroid output.”

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Levels 2 & 3: Stimulate Self-Healing and Restore Weakened Systems

After a thorough assessment, Christianson then turns his mind to creating the conditions where iodine can exit the body to stimulate the body’s natural healing abilities.

As he explains, in most versions of chronic thyroid disease, the body makes thyroid hormones by attaching iodine to a specific protein. But if there’s too much iodine in that protein, problems arise. Free radical damage harms thyroid cells and makes the thyroid abnormally secrete hormones. 

Since so many foods commonly eaten in North America contain iodine, this can further complicate the issue. “For most people, if they can get to a low enough threshold where the extra amounts can come out, then that free radical damage stops and the thyroid cells have a chance to repair themselves,” Christianson explains. “We used to think that once autoimmunity got going, the immune system would perpetuate it. We now know that in this case, once you treat this cause, most cases do repair and heal themselves.”

Christianson strongly believes that supporting all facets of health is vital in treating Hashimoto’s. Essentially, any way the body isn’t functioning well can cause more symptoms. 

Low-level anemias are one such issue, but he also points to supporting healthy gut function and enabling proper absorption of nutrients. “30 to 40% of people with autoimmune thyroid disease have a condition called atrophic gastritis, which makes it difficult to assimilate many key minerals,” he explains. “Digestive health is just as important as is the health of the eliminatory organs. That’s just one example of why it’s also critical to understand digestion.”

Research shows significant differences in the gut microbiota composition of Hashimoto’s patients compared to those without Hashimoto’s. 8Cai T, Du P, Suo L, et al. High iodine promotes autoimmune thyroid disease by activating hexokinase 3 and inducing polarization of macrophages towards M1. Front Immunol. 2022;13:1009932. doi:10.3389/fimmu.2022.10099329Gong B, Wang C, Meng F, et al. Association Between Gut Microbiota and Autoimmune Thyroid Disease: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021;12:774362. doi:10.3389/fendo.2021.774362

There is also evidence that Hashimoto’s patients may have higher levels of leaky gut syndrome (when spaces in the gut lining allow substances to escape into the body, potentially triggering autoimmune responses). 10Demir E, Önal B, Özkan H, et al. The relationship between elevated plasma zonulin levels and Hashimoto’s thyroiditis. Turk J Med Sci. 2022;52(3):605-612. doi:10.55730/1300-0144.5352

Level 4: Address Physical Alignment

Regarding structural health, Dr. Christianson does not incorporate musculoskeletal therapies in his treatment of Hashimoto’s. He notes, however, that the thyroid gland often undergoes structural changes during autoimmunity. “There’s a greater long-term risk for thyroid cancer. Thyroid cancer is actually the fastest increasing type of cancer amongst women in North America with thyroid immunity right now,” he notes. “Thyroid cancers start from thyroid nodules, and thyroid nodules are present in between 40% to 60% of people with chronic thyroid disease.” 

Level 5: Natural Symptom Control

Christianson uses several natural substances to support the goals of getting iodine out of the body and provide overall health support.

“Data shows that iodine tolerance is affected by micronutrient status. One of the most common issues is being below optimal in selenium,” he notes. “Data also shows that overall background intake of selenium is important. But independent of that, supplemental selenium has a role in diminishing autoimmunity and improving the body’s capacity to regulate the thyroid hormones.” 

Several studies have shown that selenium supplementation may benefit thyroid function by increasing the antioxidant activity and upregulating the activated Treg cells (known to prevent autoimmunity). 11Hu Y, Feng W, Chen H, et al. Effect of selenium on thyroid autoimmunity and regulatory T cells in patients with Hashimoto’s thyroiditis: A prospective randomized-controlled trial. Clin Transl Sci. 2021;14(4):1390-1402. doi:10.1111/cts.1299312Wang LF, Sun RX, Li CF, Wang XH. The effects of selenium supplementation on antibody titres in patients with Hashimoto’s thyroiditis. Endokrynol Pol. 2021;72(6):666-667. doi:10.5603/EP.a2021.007413Gorini F, Sabatino L, Pingitore A, Vassalle C. Selenium: An Element of Life Essential for Thyroid Function. Molecules. 2021;26(23):7084. doi:10.3390/molecules2623708414Zuo Y, Li Y, Gu X, Lei Z. The correlation between selenium levels and autoimmune thyroid disease: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(4):4398-4408. doi:10.21037/apm-21-449

Similarly, Christianson recommends addressing other mineral and vitamin deficiencies. “Iron, zinc, and vitamin A are all micronutrients where mild deficiencies may not be that relevant alone, but they can accentuate abnormalities of thyroid output.” 14 Research notes that iron deficiency may impair thyroid function. 15Szklarz M, Gontarz-Nowak K, Matuszewski W, Bandurska-Stankiewicz E. Iron: Not Just a Passive Bystander in AITD. Nutrients. 2022;14(21):4682. doi:10.3390/nu14214682

One reason that iron deficiency is common in Hashimoto’s patients is due to other co-existing conditions. Digestive issues limit iron absorption, while celiac disease can lead to iron loss. 16Zuo Y, Li Y, Gu X, Lei Z. The correlation between selenium levels and autoimmune thyroid disease: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(4):4398-4408. doi:10.21037/apm-21-449

Christianson also utilizes herbs and nutrients. “Data shows that the autoimmunity of thyroid disease can markedly improve with the use of the herb nigella sativa (a.k.a. black cumin) and inositol,” he explains. “These compounds used in nutraceutical mixtures have been documented in quality, human-controlled, double-blind, placebo-controlled studies to lower overall autoimmunity.” Inositol (a vitamin-like sugar) also benefits liver function and blood sugar regulation. “There is independent data saying that inositol can diminish the growth of thyroid nodules and, in some cases, even shrink them,” he adds. 

Research shows that Nigella sativa can improve thyroid status and reduce weight in patients with Hashimoto’s thyroiditis.17Farhangi MA, Dehghan P, Tajmiri S, Abbasi MM. The effects of Nigella sativa on thyroid function, serum Vascular Endothelial Growth Factor (VEGF) – 1, Nesfatin-1 and anthropometric features in patients with Hashimoto’s thyroiditis: a randomized controlled trial. BMC Complement Altern Med. 2016;16(1):471. doi:10.1186/s12906-016-1432-2

Level 6: Synthetic Symptom Relief

As far as medications that may be considered for Hashimoto’s, Christianson acknowledges that thyroid medication is the “mainstay treatment” in the conventional world. “The data is so strong that it has a place. For some people, it can be lifesaving,” he explains. “If they lack a thyroid and in the most advanced cases of hypothyroidism, it often does restore quality of life.”

However, Christianson takes issue with which patients are commonly prescribed thyroid medication. He is frustrated that a meaningful message in the medical literature hasn’t yet entered medical practice. “For the level of thyroid function that at least 85% of people are at when they are prescribed medication – medications won’t help. They don’t improve symptoms, lower disease risks, or cut the risk of progression of thyroid disease,” he explains. “They don’t have any benefit upon the autoimmune course of thyroid disease. There’s been many strongly worded papers in the conventional world saying that these medications are being horribly overprescribed. They’re just not effective or safe.” 

The data also points to another drawback of inappropriately prescribed thyroid medication. “We have clear data saying that those on medication have greater risks for various types of cancers,” Christianson notes. “Not just thyroid cancers, there is greater risk for early mortality and other complications. It’s so much more important to support the body to help it work by itself.”

By the time Hashimoto’s patients see Christianson, many are already taking thyroid medication. He sees this as a great example of how we can’t easily replicate what the body does naturally. “We can encourage it, we can help it, but we can’t replicate it. You would think that if someone’s thyroid output number were low, prescribing medication that gets them back to normal levels would reverse associated symptoms. But the data is clear that it doesn’t,” he says. “Taking something in pill form (even if it’s the same compounds the body would make) does not replicate the body’s own functions.”

Level 7: High-Force Interventions

In terms of ways to actively suppress pathology, Christianson notes that sometimes surgery or other medications can be used in conventional medicine. “In evaluating the structure of the thyroid, we may find signs of existing or pending thyroid cancer. The thyroid gland may be partially or completely removed, or nodules are removed,” he explains. “In rare cases, the inflammatory process of Hashimoto’s is so bad that surgery is considered (or synthetic glucocorticoids like prednisone) are given for periods of time to stop the autoimmunity.”

Christianson encourages patients who are told they need thyroid medication to think it through. He suggests exploring the data showing that thyroid medication doesn’t help in cases of subclinical hypothyroidism (when most patients are prescribed thyroid medication). “On the other side, there are those who have already been prescribed thyroid medication when it’s unnecessary. There’s more and more data out about the process of deprescribing. There are ways in which someone can safely take less (and in some cases no medication), even if they were told they needed them long term.”

Ultimately, most people go to a doctor because of a particular symptom or condition instead of a general desire to improve their overall health. But according to Christianson, there are broader healing opportunities. “The ways in which you improve your health for a specific thing often involves many facets that help your overall health. People find themselves functioning and sleeping better with improved cognitive abilities,” he notes. “People that do engage can not only reverse the issues that emerged; they often obtain better health than if the initial reason never showed up.”

About Dr. Alan Christianson 

Dr. Alan Christianson, NMD, FABNE, is a Phoenix, Arizona-based Naturopathic Physician (NMD) who specializes in natural endocrinology with a focus on thyroid disorders. He founded Integrative Health, a group of physicians that reverses complex and chronic diseases. Accolades include Top Doc recipient in Phoenix magazine. Dr. Christianson is a New York Times Bestselling author whose recent titles include the Thyroid Reset Diet and Hormone Healing Cookbook. His numerous media appearances include CNN, The Today Show, The Doctors, Insider, and Shape Magazine.18About — EndoANP. Accessed May 5, 2023. https://www.endoanp.org/about

Footnotes

  • 1
    Hashimoto thyroiditis: MedlinePlus Genetics. Accessed May 5, 2023. https://medlineplus.gov/genetics/condition/hashimoto-thyroiditis/
  • 2
    Hashimoto thyroiditis: MedlinePlus Genetics. Accessed May 5, 2023. https://medlineplus.gov/genetics/condition/hashimoto-thyroiditis/
  • 3
    Mincer DL, Jialal I. Hashimoto Thyroiditis. In: StatPearls [Internet]. StatPearls Publishing; 2022. Accessed May 5, 2023. https://www.ncbi.nlm.nih.gov/books/NBK459262/
  • 4
    Mincer DL, Jialal I. Hashimoto Thyroiditis. In: StatPearls [Internet]. StatPearls Publishing; 2022. Accessed May 5, 2023. https://www.ncbi.nlm.nih.gov/books/NBK459262/
  • 5
    Mikosch P, Aistleitner A, Oehrlein M, Trifina-Mikosch E. Hashimoto’s thyroiditis and coexisting disorders in correlation with HLA status-an overview. Wien Med Wochenschr. 2023;173(1-2):41-53. doi:10.1007/s10354-021-00879-x
  • 6
    Zhang L, Sun X, Liu L, Wang P, Qian L. Excessive iodine induces thyroid follicular epithelial cells apoptosis by activating HIF-1α-mediated hypoxia pathway in Hashimoto thyroiditis. Mol Biol Rep. 2023;50(4):3633-3640. doi:10.1007/s11033-023-08273-z
  • 7
    Cai T, Du P, Suo L, et al. High iodine promotes autoimmune thyroid disease by activating hexokinase 3 and inducing polarization of macrophages towards M1. Front Immunol. 2022;13:1009932. doi:10.3389/fimmu.2022.1009932
  • 8
    Cai T, Du P, Suo L, et al. High iodine promotes autoimmune thyroid disease by activating hexokinase 3 and inducing polarization of macrophages towards M1. Front Immunol. 2022;13:1009932. doi:10.3389/fimmu.2022.1009932
  • 9
    Gong B, Wang C, Meng F, et al. Association Between Gut Microbiota and Autoimmune Thyroid Disease: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021;12:774362. doi:10.3389/fendo.2021.774362
  • 10
    Demir E, Önal B, Özkan H, et al. The relationship between elevated plasma zonulin levels and Hashimoto’s thyroiditis. Turk J Med Sci. 2022;52(3):605-612. doi:10.55730/1300-0144.5352
  • 11
    Hu Y, Feng W, Chen H, et al. Effect of selenium on thyroid autoimmunity and regulatory T cells in patients with Hashimoto’s thyroiditis: A prospective randomized-controlled trial. Clin Transl Sci. 2021;14(4):1390-1402. doi:10.1111/cts.12993
  • 12
    Wang LF, Sun RX, Li CF, Wang XH. The effects of selenium supplementation on antibody titres in patients with Hashimoto’s thyroiditis. Endokrynol Pol. 2021;72(6):666-667. doi:10.5603/EP.a2021.0074
  • 13
    Gorini F, Sabatino L, Pingitore A, Vassalle C. Selenium: An Element of Life Essential for Thyroid Function. Molecules. 2021;26(23):7084. doi:10.3390/molecules26237084
  • 14
    Zuo Y, Li Y, Gu X, Lei Z. The correlation between selenium levels and autoimmune thyroid disease: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(4):4398-4408. doi:10.21037/apm-21-449
  • 15
    Szklarz M, Gontarz-Nowak K, Matuszewski W, Bandurska-Stankiewicz E. Iron: Not Just a Passive Bystander in AITD. Nutrients. 2022;14(21):4682. doi:10.3390/nu14214682
  • 16
    Zuo Y, Li Y, Gu X, Lei Z. The correlation between selenium levels and autoimmune thyroid disease: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(4):4398-4408. doi:10.21037/apm-21-449
  • 17
    Farhangi MA, Dehghan P, Tajmiri S, Abbasi MM. The effects of Nigella sativa on thyroid function, serum Vascular Endothelial Growth Factor (VEGF) – 1, Nesfatin-1 and anthropometric features in patients with Hashimoto’s thyroiditis: a randomized controlled trial. BMC Complement Altern Med. 2016;16(1):471. doi:10.1186/s12906-016-1432-2
  • 18
    About — EndoANP. Accessed May 5, 2023. https://www.endoanp.org/about

This article is provided by

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