Hashimoto’s Thyroiditis – an autoimmune disease where the immune system mistakenly attacks the thyroid gland, causing hypothyroidism – affects 1-2% of people in the United States. This adds up to a minimum of 3,558,507 individuals. If you narrow the criteria a bit, 10% of women over age 30 suffer from the condition.
It’s the most common cause of hypothyroidism (underactive thyroid), and it’s 10x more common in women than in men.
Symptoms include:
- Enlargement of thyroid gland
- Fatigue
- Muscle weakness
- Muscle and join pain
- Low body temperature (feel cold all the time)
- Infertility
- Hair loss or thinning
- Dry skin
- Weight gain (slowed metabolism)
- Irregular, heavy, or painful menstrual cycles
- Depression
You would think with Hashimoto’s being such a common condition, the medical field would do an excellent job of screening for and treating it.
Unfortunately, it is criminally under-treated. Modern medicine doesn’t offer any treatment besides hormone replacement, and they completely ignore the elephant in the room – that the immune system is attacking and destroying the thyroid gland.
If you want to get your doctor to order anything other than a TSH test to find out if you have a thyroid condition – good luck.
There’s good news, though. You can get significantly better treatment if you see a naturopathic or functional medicine doctor. There’s also a lot you can do on your own to manage the condition as well.
Finding the Right Practitioner
Functional Medicine Doctors
Functional medicine is focused on getting to the root cause of chronic disease and treating it with complementary and alternative medicine, to improve health.
Typically, functional medicine doctors order a comprehensive set of labs and get a thorough health history for each of their new patients. Then, they treat the newly uncovered root cause of that patient’s illness with complementary and alternative therapies. This can include diet changes, nutritional supplements, herbal medicine, detoxification support, and body work – like massage, chiropractic, and acupuncture.
Medical doctors (MDs), osteopathic doctors (DOs), nurse practitioners (NPs), physician assistants (PA-Cs), naturopathic doctors (NDs), and chiropractic doctors (DCs), can all choose to undergo additional training and become board certified in functional medicine.
The two most common functional medicine board certification options include The Institute for Functional Medicine (IFM) and Functional Medicine University (FMU).
Each type of functional medicine doctor has their own set of benefits.
- DC functional medicine doctors can offer chiropractic care in addition to other types of functional medicine treatment, without having to refer patients to a separate practitioner.
- DO functional medicine doctors can offer osteopathic manipulation, prescribe drugs if necessary, and bill insurance for their services.
- MD, NP, and PA-C functional medicine doctors can prescribe drugs if necessary and bill insurance for their services.
- Of the four types, ND functional medicine doctors have the most extensive education and training in the field of alternative and complementary health and treatment methods. Licensed N.D.s can prescribe drugs if necessary, too.
To search for a functional medicine doctor near you, take a look at these directories.
- IFMCP network (Institute for Functional Medicine)
- CFMP network (Functional Medicine University)
Naturopathic Doctors
Naturopathic medicine is focused on working with evidence-based natural, non-invasive types of treatment first. This can include healing diets, nutritional supplements, botanical medicine, detoxification support, bodywork, and more. Naturopathic philosophy believes in turning to drugs and surgery only if alternative and complementary interventions fail.
Naturopathic doctors treat complex chronic illness and autoimmune disease cases through the complementary and alternative methods above, often with incredible success.
In addition, N.D.s have the most extensive training in alternative and complementary medicine a person can get.
All licensed N.D.s in the United States have completed a bachelor’s degree in a science related field, completed their doctorate degree in naturopathic medicine from one of five AANMC accredited universities, and passed the NPLEX exam to earn their title and licensure. They are not the same thing as a traditional naturopath, who may have a diploma or two-year degree from an unaccredited and nontraditional school.
To find a naturopathic doctor near you, search this directory.
Testing for Hashimoto’s
You can order lab work yourself, if you don’t have the option of working with a practitioner who will order the right tests for you.
Thyroid #3 Plus Reverse T3 Panel
This thyroid panel is very thorough and includes TSH, free T3, free T4, T3 uptake, free thyroxine index, reverse T3, Thyroid Peroxidase Antibodies, and Thyroid Antithyroglobulin Antibody.
As such, it can help diagnose hypothyroid and Hashimoto’s Thyroiditis. It’s also helpful for monitoring thyroid hormone and antibody levels.
This thyroid panel includes TSH, free T3, free T4, T3 uptake, and free thyroxine index. It’s helpful for monitoring your thyroid hormone levels.
Hashimoto’s Thyroiditis Antibodies Only (can help diagnose Hashimoto’s Thyroiditis and monitor antibodies during treatment)
TSH Only (helpful for monitoring the result of your treatment)
When you place an order with Walk-in-Lab, they send it for approval to one of their physicians. Once you get the approval email, you print your test requisition form (found in your order history) or fax it to the lab draw you plan to stop by.
If you purchase a LabCorp test, you need to go to a LabCorp location to get your blood drawn. If you purchase a Quest test, you need to go to a Quest location. You can walk in at any time if you don’t mind the wait time, or you can make an appointment online at the LabCorp or Quest location of your choice. Bring your test requisition form with you to your appointment, or if you faxed it, tell them so they can find it.
Once you get your blood drawn, you’ll get your results emailed to you when they’re ready.
How do you interpret your results?
High TSH indicates hypothyroidism. Even if your result falls in the “normal” range, functional medicine doctors consider optimal results to be below 2.5 mlU/L.
Low free T3 and/or free T4 indicate hypothyroidism.
High reverse T3 indicates the body is converting too much T4 (the storage form of thyroid hormone) to reverse T3 instead of free T3 (the active form of thyroid hormone). This can cause symptoms of hypothyroidism, even if your TSH and T4 levels are normal. This is another marker where it’s important to know whether you’re in the optimal range, not just the “normal” range. Functional medicine doctors consider optimal reverse T3 to be below 15 ng/dl.
Abnormal antibody results indicate an autoimmune thyroid condition like Hashimoto’s Thyroiditis.
Your test results will note if any of your levels fall outside the normal range.
If your levels fall outside the optimal range, even if they’re not “abnormal”, it’s a sign your thyroid may not be functioning optimally.
A Holistic Approach to Treating Hashimoto’s Thyroiditis
1. Addressing Your Root Cause
Functional medicine is all about finding the root cause of your health conditions. When you treat the cause, the symptoms often improve as a result.
With Hashimoto’s Thyroiditis, the root cause can vary from person to person.
For some people, they have a genetic predisposition to Hashimoto’s Thyroiditis.
Chronic stress and the often resulting adrenal fatigue are BIG contributors for many individuals.
You can order a 4-point cortisol test to screen yourself for adrenal fatigue, but you don’t need lab work to know whether you’re experiencing chronic stress.
Successfully treating adrenal fatigue can require a comprehensive approach, but step #1 is stress management. This may mean making changes in your life to eliminate your stress triggers, changing the way you cope with your stress triggers, or a combination of both.
If you’d like to learn more, check out my post about how to heal from adrenal fatigue.
Similarly, lifestyle can be a huge factor.
Are you eating enough? Getting the nutrients you need from your diet? Are you living in a safe environment? Do you have a working toolbox of stress management techniques? Are you adequately resting? How is your sleep quantity and quality? Do you get time outside? Fresh air and sunlight? How often do you get physical activity you actually enjoy? Are you over exercising or starving yourself through “dieting”?
Sometimes, it’s possible to make positive lifestyle changes on your own. Other times, you might need a therapist, dietitian or nutritionist, or certified health coach to help.
To find an affordable therapist, I recommend searching the physician directory provided by your insurance company. If your insurance doesn’t cover therapy or you’re uninsured, Open Path is another good option. Therapists who join the Open Path network offer sessions for $30-60 to make therapy doable for people who can’t otherwise afford it.
You can search for a registered dietitian here, or for a licensed/qualified nutritionist here (DACBN), here (CNS), and here (BCHS). *When searching for a registered dietitian, after typing in your zip code, select “specialty” and click the box for Integrative-Complementary-Alternative Nutrition.
If you work full time, your company might offer complementary health coaching. Sometimes health insurance companies offer health coaching as member benefit, as well. If you can’t find a health coach through either of those avenues, you can find a National Board Certified Health and Wellness Coach (NBC-HWC) here.
Another common contributor is nutrient deficiency.
This can occur for a variety of reasons. If you aren’t eating enough, or you’re not eating a nutrient dense diet, you may not be getting enough calories, protein, fat, complex carbohydrates, vitamins, and minerals from your food.
If you have experience with dieting to lose weight, you may not be getting enough calories. Low-calorie diets don’t support the body’s nutritional needs. For example, even when mostly sedentary I need 1800 calories per day to keep my body in homeostasis. When I exercise 4-5 times per week, I need closer to 2000 calories per day.
When you’re used to prioritizing your weight over your health, it can be scary to give yourself permission to eat enough. I know this on a very personal level. However, once your body has healed and your lifestyle is optimal, you will reach your body’s set point (ideal weight range). It might not be what you envision as your best weight, but your body is intelligent and knows what it’s doing, so it’s important to trust that. You can do so much harm to your health with chronic dieting and attempting to force yourself into a size your body was never meant to be.
A nutrient dense diet contains enough calories, complex carbohydrates like whole grains, beans/lentils, vegetables, and fruit; varied sources of protein like nuts, seeds, beans/lentils, eggs, and meat; and adequate healthy fat.
Try to include a serving of whole grains, beans/lentils, or starchy vegetables; fruit or vegetables; a high protein food; and at least one good source of fat in every meal.
Some people need to supplement certain nutrients to maintain an optimal level in their body.
Many individuals in the United States have vitamin D insufficiency or deficiency. This is because we make vitamin D from sunlight rather than getting it from our food. If you wear sunscreen to protect your skin or don’t get a lot of time outside daily, your vitamin D level is probably sub-optimal. Most people need to supplement 1000-4000 IU per day to maintain an optimal level (which functional medicine doctors deem to be at least 50, and preferably between 60-90 ng/mL).
Personally, I need to take a multivitamin with iron, 4500 IU of vitamin D3, omega 3, and extra beta carotene in addition to consuming nutrient dense food. Everyone is different, though, so please don’t assume you’re like me. Track your vitamin and mineral intake from your diet, get your nutrient levels tested, and work with a health practitioner to determine what’s right for you.
- Naturelo Prenatal is my go-to whole food multivitamin that contains enough iron for me to maintain a healthy level
- I get 1000 IU of vitamin D3 from my multivitamin, and the additional 3500 IU I get in combination from Whole Earth and Sea Vegan D3 1000 IU and Doctor’s Best Vegan D3 2500 IU
- I take NutraVege Omega 3 Plant (algal oil) to get adequate DHA and EPA (essential fatty acids)
- My multivitamin contains some beta carotene, but I also add 1/8 tsp of Aki Beta Carotene Powder to my smoothies to make sure my body has enough to convert to active vitamin A
You can order lab work to test your nutrient levels and determine if you’re getting enough. If you aren’t, increasing the nutrient density of your diet may alleviate the problem. In some cases, you might need to supplement.
Iron Panel (can help detect iron-deficiency anemia)
B12 & Folate (can help detect B vitamin deficiencies and anemia)
Homocysteine (can help detect a functional B vitamin deficiency, ie. B12 and folate levels are normal or high, but homocysteine is high, indicating that the body can’t use the available B12 and/or folate)
Vitamin D (a clinical deficiency is 20 ng/mL or less, and a clinical insufficiency is less than 30 ng/mL; however, optimal levels for immune function and prevention of disease in functional medicine are 60-90 ng/mL)
Vitamin A (clinical deficiency is rare; however, if your blood level is on the lower end of normal, it may be a sign your liver stores of vitamin A are depleted because you aren’t getting enough in your diet)
Magnesium (clinical deficiency is rare, but sub-optimal intake is common, so some people prefer to get their level tested from time to time)
A fourth potential root cause is poor gut health.
The gut microbiome (the beneficial and opportunistic bacteria, viruses, and fungi that colonize in the large intestine) play an important role in immune system health. When the gut microbiome is imbalanced, autoimmunity can develop. You might also experience Irritable Bowel Syndrome or digestive problems.
A gut microbiome imbalance, also known as gut dysbiosis, happens when you have an overgrowth of opportunistic bacteria or yeast in the gut.
Opportunistic bacteria and yeast are part of the natural gut microbiome and either provide benefit, or at least don’t cause harm, when kept in check by the beneficial bacteria and yeast in the gut. When they aren’t kept in check, however, they can multiply in numbers and start causing negative health effects and unpleasant symptoms.
Harmful microbes shouldn’t be in the gut at all, and if they enter the gut they usually come from drinking or eating contaminated water or food, or touching contaminated surfaces without washing your hands afterward.
Gut dysbiosis can also refer to an insufficient level of certain beneficial bacteria or yeast (probiotic) strains in the gut.
Beneficial microbes help keep opportunistic bacteria and yeast under control, so when you don’t have enough of them, it can mean opportunistic microbes take over and wreak havoc in the gut.
Another theory involving the gut microbiome is molecular mimicry, because of the similarity between microbial and human antigens.
If you have bacterial overgrowth in your gut, the body may mistakenly make antibodies to your own tissues (autoimmunity) instead of to the bacterial overgrowth it’s trying to fight.
If you’d like to find out how to test for and address a gut microbiome imbalance, you can check out my post about gut dysbiosis.
A third way poor gut health can contribute to autoimmunity is damage to your small intestine from eating gluten.
Even if you don’t have Celiac Disease, gluten consumption can trigger the overproduction of natural chemical called zonulin. People with autoimmune diseases are more at risk of this phenomenon than the average healthy person. Increased zonulin in the gut triggers the loosening of the tight junctions in the small intestine, which is correlated with autoimmune disease onset and exacerbation.
Normally, the junctions in the small intestine only allow fully digested food molecules through into the lymphatic system (lipids) and hepatic portal (amino acids, sugars). When these junctions loosen, the result is called leaky gut or hyperpermeable intestines. A hyperpermeable small intestine allows partially-digested food molecules, bacteria, and yeast into the lymphatic system and hepatic portal. From there, the immune system makes antibodies to these foreign substances, which causes systemic inflammation.
For this reason, people with autoimmune diseases may find their antibody levels and inflammation improve when they eat a gluten-free diet.
Thankfully, it’s possible to heal your gut through balancing your gut microbiome, eating a nutrient dense diet, and eliminating food triggers like gluten.
2. Thyroid Hormone Supplementation
When you have hypothyroidism, your thyroid isn’t producing enough thyroid hormone. This is the one part of Hashimoto’s Thyroiditis that modern medicine actually treats, typically through a synthetic T4 (Levothyroxine, Synthroid) prescription.
One problem with Levothyroxine is that it’s a T4 replacement hormone. Many people with hypothyroidism have trouble converting enough T4 (the storage form of thyroid hormone) to T3 (the active form). For people with this issue, Levothyroxine doesn’t help enough.
Alternatives to Levothyroxine exist, however.
- A T3 replacement hormone prescription, such as Liothyronine
- A T3 and T4 combination prescription, such as Liotrix
- A desiccated thyroid gland supplement (these come in the porcine and bovine variety, so be sure to look for a bovine version if you don’t eat pork for religious or health reasons)
Several studies have shown that hypothyroid patients have a better treatment outcome when they take desiccated thyroid gland instead of Levothyroxine (source 1, 2).
It can be difficult to determine the thyroid glandular or medication dose you need to normalize your thyroid hormone levels. Also, the dose you need may change over time and require regular monitoring and adjustment. For this reason, it’s a good idea to work with a health practitioner to help you determine the right dose.
In years past, it was believed that people with hypothyroidism might need to avoid soy in their diet, due to a natural chemical in the plant that inhibits thyroid hormone absorption. More recent studies have shown this not to be the case, but you have to listen to your body and determine what works best for you.
3. Herbal Immune Modulation
One final aspect to consider when holistically treating Hashimoto’s is immune modulation.
While addressing your root cause will go a long way in restoring immune system balance, your immune system may need additional support to stop attacking your thyroid gland.
Adaptogens like Curcumin and Ashwagandha have constituents that suppress Th17 cell activity, which are T helper cells involved in the development of autoimmune disease. For this reason, they can help reduce inflammation and downregulate harmful cytokine pathways.
Rosmarinic acid (high in Rosemary, Lemon Balm, Thyme, Sage, Oregano, and Mint) has been shown to regulate T cell activity, also reducing inflammation and harmful cytokine pathways.
Blue Flag has been shown to have lymphatic anti-inflammatory action and helps mitigate thyroid enlargement.
Guggul resin has been shown to modulate T3 levels, increasing them in hypothyroid patients and decreasing them in hyperthyroid patients.
Selenium decreases thyroid peroxidase (TPO) antibodies and supports glutathione production. It also decreases hydrogen peroxide, a substance that can damage the thyroid gland.
Lastly, iodine is a critical agent of thyroid hormone metabolism, and it has been shown to prevent and inhibit the growth of benign thyroid nodules.
Books Recommendations
If you’d like to do a deep dive into thyroid health and holistic treatment, these books are an excellent resource.
Stop the Thyroid Madness: A Patient Revolution Against Decades of Inferior Treatment
