ALL ABOUT HYPOTHYROIDISM

What are we going to cover?

What is the Thyroid & What Does it Do? Medications

T4 Hormone Replacement Therapy
What Impacts the Function of our Thyroid? T3 & T4 Combination Hormone Replacement Therapy
What is Hypothyroidism? Side Effects of Thyroid Hormone Replacement
Therapy
What are the Symptoms?
Special Considerations when Taking
What are the Leading Causes of Developing Medications
Hypothyroidism? Calcium
Primary hypothyroidism Iron
Secondary hypothyroidism Fibre
Hashimoto’s Disease Soy
Celiac Disease & Gluten Sensitivities Coffee
Disordered Eating
Vegan Diets Diet – What to Eat
Iodine
How to Get Diagnosed with Hypothyroidism Selenium
Blood Tests Zinc
Urine Samples Copper
Weight Gain & Your Appetite with Iron
Hypothyroidism Tyrosine
B-Vitamins
Pregnancy, Postpartum, Birth Control and
Hypothyroidism Diet – What to Avoid
Goitrogens
The Gut & Associated Organs Connection to the The Ketogenic Diet
Thyroid Natural Supplements
The Esophagus
Ashwagandha
The Stomach
Coleus
The Intestine and Colon
Gota Kula
The Gut Microbiome
Guggal
Leaky Gut
The Kidneys & Hypertension The Bottom Line
Medical & Nutritional Interventions for
Managing Hypothyroidism

What is the Thyroid & What Does it Do?

When people refer to their thyroid they are talking about a small butterfly-shaped gland, which is located near
the base of our necks. Despite its small size and fragile appearance, it is a massively important part of our
everyday lives. Our thyroid is responsible, in part, for maintaining a healthy metabolism, hormone functions,
energy levels, and MUCH more. However, it is most well-known (and necessary) for its function in producing
our two thyroid hormones: triiodothyronine (T3) and thyroxine (T4). While the thyroid does produce both of
these hormones, T4 accounts for about 80% of the thyroid hormones being synthesized. The process of
producing thyroid hormones involves taking iodine (from the diet) and combining it with the amino acid
tyrosine. T4 is the “inactivate” form, meaning that for the body to use it, it must be converted into T3 (the
“activate” form). This can take place in the thyroid as well as within different tissues in the body. The process
of activating our thyroid hormones is an intricate one, involving several nutrients – in the end though, one of the
iodine atoms is removed, converting T4 to T3, and we are then left with the active form that can be used in our
bodies.

Our thyroid hormones are the ones that closely regulate our body weight as well as our metabolism – in other
words, without these hormones our body has trouble keeping us within the closely monitored homeostatic state
that we thrive in. That was a mouth full, but basically, we need these hormones to maintain our overall health
and well-being!

What Impacts the Function of our Thyroid?

Our thyroid gland’s health is closely regulated by the pituitary gland, a small gland that is located in our brain.
The pituitary gland produces a hormone called the Thyroid Stimulating Hormone (TSH), which (as the name
eludes to) stimulates the production of thyroid hormones. The pituitary gland is in turn regulated by another
area of the brain that it is connected to, the hypothalamus, this area of the brain releases another hormone called
the Thyrotrophin-Releasing Hormone (TRH). Because this system is so interconnected, an irregularity in any of
the areas would likely lead to an issue with our thyroid function. Therefore, there are several tests to pinpoint
the root cause of the problem. As you will see throughout this post, there are multiple different diagnoses to be
had when it comes to hypothyroidism, and which area of our bodies is causing the problem is what influences
the diagnoses we will receive.

What is Hypothyroidism?

Hypothyroidism refers to the underproduction, or reduced levels, of thyroid hormones. It is also commonly
referred to as an “underactive thyroid”. In western society, 1-2% of the population has been diagnosed with this
condition. The diagnoses for hypothyroidism can be divided into two different categories: primary and
secondary. Primary hypothyroidism is caused by a failure in the function of our thyroid gland, whereas,
secondary hypothyroidism is either due to an inadequate amount of THS being released from our pituitary gland
or TRH from the hypothalamus. Confusing, I know! Remember when I said this whole system is
interconnected? I wasn’t kidding!

What are the Symptoms?

It is important to note that the appearance of symptoms will depend on the severity of the condition. Most often,
problematic symptoms may not actually impact one’s daily life until the condition is at a clinical (aka severe)
level. This means that for those who are experiencing hypothyroidism, but it is still at subclinical (aka less
severe) level, symptoms may not be as obvious. In fact, one study showed that only 30% of subclinical cases
had any symptoms at all.

So, what is going on “underneath the hood” when we are experiencing hypothyroidism? On a physiological
level, it is associated with a slowed metabolism and changes in energy storage, an increase in cholesterol levels,
fewer fat stores being mobilized for use, and the impaired ability for our bodies to create glucose (our main
energy source) from other food sources like protein or fat. However, unless you are superhuman, you probably
won’t notice your liver creating less glucose than normal. So, on a more obvious level, symptoms may include
tiredness, mental slowness, impaired memory, lethargy or sluggishness, feeling intolerant to the cold,
unexplained weight gain, dry skin or hair, hair loss, and irregularities with bowel movements and/or menstrual
cycles.
OKAY, I know that is a long list – but keep in mind that most of these symptoms are fairly ubiquitous, so a
proper diagnosis is necessary to be able to find the cause of your unique symptoms and begin to treat them!

What are the Leading Causes of Developing Hypothyroidism?

As is to be expected by now, the causes of hypothyroidism will differ depending on if the condition is classified
as primary or secondary.

Primary Hypothyroidism can be caused by an inflamed thyroid (i.e. Thyroiditis, which can happen
postpartum or due to a viral infection), an autoimmune disease which impacts the thyroid (i.e. Hashimoto’s) or
diseases that predispose individuals to other autoimmune diseases (i.e. Celiac), iodine deficiencies or toxicities,
external radiation therapy of the neck or head, various drugs, and/or an underdeveloped thyroid.

Secondary Hypothyroidism can be caused by abnormalities or issues with the pituitary gland or
hypothalamus, external radiation to the head or brain, a history of head injuries or trauma, and/or a tumor in the
area.

Hashimoto’s Disease
Hashimoto’s is the leading cause of hypothyroidism, affecting about 5% of the American population. It is an
autoimmune disorder, wherein which your immune system attacks your thyroid. This, in turn, alters the
thyroid’s ability to synthesize thyroid hormones – leading to an insufficient amount circulating through the
body and a probable diagnosis of hypothyroidism.

The symptoms of Hashimoto’s are the same as those with an underactive thyroid, however, one of the first
symptoms that you may notice is a swelling at the front of your throat (a goiter). The causes of Hashimoto’s are
largely unknown, though there are several risk factors: heredity, sex, and age. This disease is hereditary,
meaning you are at a higher risk if others in your family have this or other autoimmune diseases. Women are
also much more likely to be diagnosed with Hashimoto’s, current literature suggests that the disease is up to 8
times more common in women than men. In addition to this, the most common age range to develop this
disease is between 40 to 60 years old, although it still can be diagnosed earlier on.

There are several ways that you can be diagnosed with Hashimoto’s, many of which mirror the diagnostic
measures for other hypothyroid cases (see below). Your doctor can order several blood tests to assess your
thyroid hormone levels, as well as a test to look for the antithyroid antibodies (thyroperoxidase antibodies
(TPO)) that are commonly present with Hashimoto’s. If these antibodies are not present, but your doctor still
suspects an autoimmune disease, they can also suggest an ultrasound be done of your thyroid.

Once a diagnosis of Hashimoto’s has been made the treatment and recommendation will depend on the severity
of damage to your thyroid. If the disease has not yet damaged the thyroid to a significant enough level for a
hypothyroid diagnosis, your doctor may choose to just monitor your thyroid hormone levels. Whereas if a
hypothyroid diagnosis is made, the treatment will be centered around that. Meaning, the treatment for
Hashimoto’s is the same as the treatment recommendations for any other hypothyroid case, so keep reading to
get an idea of some key nutrients to include in your diet, as well as common medications your doctor may
recommend.

Celiac Disease & Gluten Sensitivities

Celiac is another autoimmune disease, affecting about 1% of western populations. This condition occurs when
an individual has an immune response to gluten in the diet, with the most common symptoms revolving around
severe gut discomfort and bowel irregularities. However, this autoimmune disease may predispose individuals
to develop other autoimmune diseases, such as thyroid disease. An increased prevalence of thyroid dysfunction
has been reported among those individuals living with celiac disease, affecting 4 times more people with celiac
than the general population. This link is thought to be connected to the presence of autoantibodies in the
bloodstream of people with celiac and/or a common genetic predisposition.

For those individuals who have been diagnosed with celiac disease or gluten-sensitivity (in conjunction with an
underactive thyroid) transitioning to a gluten-free diet is recommended and can help regulate thyroid hormones.
However, if you have not been diagnosed with celiac, avoid gluten will not aid in the treatment of
hypothyroidism. While there are lots of “tips and tricks” out there, supporting everyone and their mothers to
transition to a gluten-free diet if they have an underactive thyroid, there is no evidence to support avoiding
gluten if you have no intolerance to it. The majority of the research that supports a gluten-free diet for the
management of thyroid disease is done with individuals who are either diagnosed with celiac disease, gluten-
sensitivity, or have Hashimoto’s, meaning the results cannot be relayed to the general public!

Disordered Eating
Disordered eating can show up in our lives in a multitude of ways, ranging from chronic dieting, restricting
eating, to eating disorders. Many of which lead to a nutrient and calorie deficit, meaning the body is at risk of
becoming malnourished through periods of starvation or restriction. It should be no surprise that this
malnourishment can lead to a plethora of health consequences, including hormone imbalances, metabolism
alterations, and weight fluctuations – all of which impact our thyroid!

States of chronic starvation have been associated with changes in our thyroid hormones, and not in the way we
want. There is a decrease in both T3 and T4, as well as diminished TSH and TRH responses. As you may recall,
these changes are all indicative of the onset of hypothyroidism.

In addition to this, it has been found that individuals living with Anorexia Nervosa often exhibit many of the
symptoms of hypothyroidism, including hair loss, dry skin, cold intolerance, and a reduced metabolic rate. This
is likely linked to the multitude of biochemical changes taking place in the bodies of those struggling. These
changes include several thyroid hormone abnormalities, including diminished T3 and T4 levels. In many of
these cases, nutrition therapy was found to improve thyroid hormone profiles, indicating a close relationship
between disordered eating and abnormal thyroid function.

Vegan Diets
Those individuals who are following a vegan diet may be at a heightened risk of iodine deficiency, a common
cause of primary hypothyroidism, since they are not consuming any seafood or dairy products. As you will see
in the later section, what to eat, the main nutrient sources of iodine are found in these two food categories.
While most studies show that many vegans can maintain a healthy iodine status, there is an increased risk of
deficiency. There are also other essential nutrients for thyroid function that may be of concern for those
following a plant-based diet, mainly because the most concentrated sources of said nutrients come from animal
foods. These nutrients include iron, vitamin B12, and zinc. However, despite these concerns, one study found
that following a vegan diet may be associated with a protective effect against hypothyroidism. It should be
noted though, that this study concluded an insignificant relationship, and that more detailed research was
needed. Supplementing to account for these nutrients of concern may be beneficial for those following vegan
diet patterns and should be done so under the supervision of a health care professional.

Other potential concerns have been noted that connect aspects of a vegan diet with hypothyroid risk, though
more research is needed to support the theories. These concerns involve an increased intake of certain foods that
are known to interact with the thyroid, including soy products and cruciferous vegetables. These foods will be
discussed in more detail in the what to avoid section.

How to Get Diagnosed with Hypothyroidism

A proper diagnosis for hypothyroidism can only be made with a medical professional (i.e. a doctor), using a
patient’s history and laboratory measurements (i.e. blood and urine samples).

Blood Tests
The two most common lab tests that your doctor will order are TSH and T4, these results will confirm if you do
in fact have an underactive thyroid. They can also be used to differentiate between if it is a primary (clinical or
subclinical) or secondary case. If the results show that your TSH is elevated, a primary hypothyroid diagnosis
would be made. The difference between it being a clinical and subclinical case depends on your T4 results. If
your T4 is low, it would be classified as clinical, whereas if your T4 is still normal the case would be classified
as subclinical. Conversely, if TSH is normal and your T4 is low, the hypothyroidism would be diagnosed as
secondary. If this is the case, a further test can be done to assess your TRH levels (the hormone released from
your hypothalamus) to assess where the problem may be coming from.

As eluded to, where you fall within the normal or abnormal ranges of TSH and T4 indicate if your case is to be
treated as clinical or subclinical. This means, there are less severe and more severe results that will direct the
action your doctor will take for treatment or monitoring. Any ranges outside of normal would be flagged as a
problem, but the further out of range they are the more controlled and regimented the recommendations will be.

Table 1. Reading your TSH lab results

Gender Age Range Normal Levels Decreased Elevated
(mIU/L) (mIU/L) (mIU/L)
Female 18-29 0.4-2.34 <0.4 >4.5
Female 30-49 0.4-4.0 <0.4 >4.1
Female 50-79 0.46-4.68 <0.46 4.7-7.0
1st trimester pregnancy 18-45 0.2-2.5 <0.2 2.5-10
2nd trimester pregnancy 18-45 0.3-3.0 <0.3 3.01-4.50
3rd trimester pregnancy 18-45 0.8-5.2 <0.8 >5.3
Male 18-50 0.5-4.15 <0.5 >4.15
Male 51-70 0.5-4.59 <0.5 >4.6
Male 71-90 0.4-5.49 <0.4 >5.5

It should be noted that T3 and T4 tests vary location to location, therefore it is important to speak to your health
care provider about interpreting the results you receive using the lab tests at their facility. For instance, your
facility may interpret results in nanograms (ng), nanomoles (nmol), pictograms (pg), picomoles (pmol),
micrograms (mcg), international units (IU), litres (L), millilitres (ml), or decilitres (dL) – all of which will have
different ranges for normalcy. However, here is an example of what typical ranges may be:

Table 2. Reading your T3 and T4 lab results

Test Acronym Age Range Typical Levels
Serum or Total Thyroxine T4 Newborns 152–292 nmol/L
Children & Teens 83-172 nmol/L
Adults 57-148 nmol/L
Free Thyroxine FT4 N/A 0.7-2.0 ng/dL
Serum or Total Triiodothyronine T3 1-12 years 105–245 ng/dL
13-23 years 82–213 ng/dL
Adults 80–200 ng/dL
Free Triiodothyronine FT3 N/A 260–480 pg/dL

Also, if the suspected cause of someone’s hypothyroidism is an autoimmune disease, such as Hashimoto’s,
certain antithyroid antibodies, such as TPO, can be tested for and will show up in the bloodstream. Table 3
shows the typical and optimal ranges for TPO in the bloodstream, however, again methods may vary clinic to
clinic so your results will need to be interpreted with your doctor.

Table 3. Reading your thyroid antibodies test results

Test Acronym Typical Range Optimal Range
Thyroid Peroxidase Antibodies TPO <35 IU/ml <2 IU/ml
Thyroglobulin Antibodies TgAb <35 IU/ml <2 IU/ml

Urine Samples
Since iodine is another potential cause for an underactive thyroid, tests may be ordered to assess your levels.
This would be done through a urine sample, where iodine deficiencies could be flagged as a potential cause of
primary hypothyroidism.

Weight Gain & Your Appetite with Hypothyroidism

As previously mentioned, the thyroid is key in maintaining a healthy metabolism and energy balance, both of
which closely regulate our weight. When thyroid function is diminished, we see a corresponding decrease in the
body’s metabolic rate. This means it begins burning fewer calories on a day-to-day basis, it does this to reserve
the energy for more immediate and essential bodily functions. Because of this, as is a symptom of
hypothyroidism, some weight gain may occur. However, the weight gain that can be associated with
hypothyroidism is dependent on the severity of the condition and is often modest, averaging at about 5 to 10
pounds – though it should be noted that there is no “set point” mentioned in the literature, and every case will be
individualized. This means that excessive weight gain due to an underactive thyroid is rare, and there is no
validated link to obesity. However, that doesn’t mean that people cannot become overweight or obese if they
have an underactive thyroid, instead, it suggests that if this happens there would likely be more at play. Also,
much of the excess weight gained shortly thereafter developing an underactive thyroid is commonly due to
water and salt retention (vs. actual fat accumulation), meaning if the sole reason for the weight gain was this
retention it would likely be lost following treatment.

However, because weight gain is very multifaceted and often develops over a long period of time, it is not
uncommon for people to struggle to lose a significant amount of weight after treatment for hypothyroidism. One
study found that within the 2 years after hypothyroid treatment started, just over 50% of the study population
was able to lose weight and that this weight loss was moderate – with an average loss of 8.4 pounds.

Something that may surprise you is that a common feature of hypothyroidism is a loss of appetite, which may
seem contraindicated by weight gain. However, both of these changes are impacted by hormone irregularities. It
is common to see your appetite increase again as a result of treatment for hypothyroidism.

If you are concerned by the weight gain that has resulted from a recent, or dated, hypothyroid diagnosis, it may
be beneficial to reach out to a dietitian to create realistic and attainable goals for weight loss, maintenance, or an
overall healthier lifestyle. The best-known mechanisms for attaining a healthy weight are adequate physical
activity, a balanced diet, and the upkeep of thyroid medications if needed.

Pregnancy, Postpartum, Birth Control, and Hypothyroidism

There is no denying that pregnancy causes a plethora of hormone changes, one of which may include the onset,
or worsening, of thyroid conditions during pregnancy or postpartum. While hypothyroidism during pregnancy is
rare, it may also be overlooked due to the coinciding symptoms that pregnancy may impart; weight gain,
tiredness, mental confusion. An untreated hypothyroid condition during pregnancy can pose serious health
concerns to the mother as well as the development of the baby. Adequate thyroid hormones are needed during
pregnancy to prevent high blood pressure, anemia, muscle pain, weakness, as well as increased risks of
miscarriage or premature births.

Women who are at the highest risk of developing hypothyroidism have:

 A history of fertility problems or preterm deliveries
 A family history of autoimmune or thyroid diseases
 Prior radiation to head or neck
 Past thyroid surgery
 A presence of thyroid antibodies such as TPO
 An enlarged thyroid, or goiter

If you fit within the criteria above for being at a heightened risk, it would be recommended that you get your
thyroid function tested at the beginning of and throughout your pregnancy. The testing procedures are identical
to those done for all other suspected thyroid dysfunction cases – however, TSH levels change throughout
pregnancy. Therefore, the normal levels of TSH are different than for other females your age who are not with
child, see Table 1 for a breakdown on TSH ranges during the different trimesters of pregnancy.

For those who have already been diagnosed with hypothyroidism, and are taking medications to treat the
condition, an increase in dose is often required once a pregnancy occurs. This change in dose will, of course,
need to be overseen by a doctor, but it is not uncommon for an increase in medication up to 30% within the first
few months of pregnancy. Therefore, it is highly recommended that you reach out to your health care provider
soon after learning you are pregnant, to talk about your treatment plan and get your thyroid hormones
reassessed.

The most common cause of hypothyroidism during pregnancy is an autoimmune disease, such as Hashimoto’s.
However, regardless of the cause of hypothyroidism, when it occurs during a pregnancy the most immediate
response should be to normalize your hormone levels as soon as possible. An oral thyroid hormone replacement
will often be prescribed (these medications will be discussed in more detail below).

It is relatively more common for women to develop thyroiditis (an inflamed thyroid) postpartum, about 7% of
women are diagnosed with this condition within the first year of giving birth. In most cases, the condition will
last several weeks to months and will resolve itself on its own without treatment – but reaching out to a doctor
for guidance is always recommended, especially since some women can develop permanent complications. The
exact cause of postpartum thyroiditis is unknown, but it is thought to be linked to an underlying autoimmune
condition that flared up during pregnancy.

Hypothyroidism can also be linked to infertility, since the lack of thyroid hormones may interfere with the
ovulation cycle. Some underlying conditions, such as autoimmune diseases, may also impact fertility. One study
found that just under 24% of the infertile women had an underactive thyroid. This same group of women
underwent treatment for hypothyroidism, and within a year over 76% of them were able to conceive. This
research suggests that early in infertility treatment, women’s thyroid levels should be assessed.

Birth control, or oral contraceptives, have also been under speculation for their potential role in thyroid disease.
When looking at the research, we see that most studies cite either a slight increase or no changes in total T3,
total T4, free T4, and TSH. One study did find a decrease in free T3 levels, while another found a slight, but not
significant, decrease in the free proportion of this hormone. So, while the current research does not point to any
alarming data warning women to avoid oral contraceptives, if you are at all concerned or have any questions
about the best birth control method for you, reaching out to your doctor for recommendations would be your
best course of action.
However, while birth control pills have not yet been linked directly to a significant decrease in thyroid
hormones, they have been linked to several nutrient depletions. Some of which may be linked to an underactive
thyroid. Nutrient depletions that may occur as a result of oral contraceptives include vitamins B2, B6, B9, B12,
C and E, as well as minerals like magnesium, selenium, and zinc. Many of these are essential for healthy
thyroid function, so including either supplements (prescribed by a doctor) or foods that are rich in these
nutrients into your diet is important. See the section below on what to eat for more details on what foods to
include into your diet to maximize your thyroid health.

The Gut & Associated Organs Connection to the Thyroid

Hypothyroidism has been linked to several concerns that span the gastrointestinal tract, from the esophagus to
the gut.

The Esophagus
Starting at the top, Hashimoto’s has been connected to a decrease in esophageal motility. This means that
people may have trouble swallowing their food or with gastric reflux (aka heartburn). And while the
relationship between esophageal motility and hypothyroidism is largely unknown, research has proven that
hypothyroidism significantly reduces esophageal motor activity. Some common methods to manage gastric
reflux involve avoiding triggering foods, eating smaller portions, avoiding laying down after eating, quitting
smoking or drinking, and weight loss if possible. Some of the foods to avoid, as they can trigger reflux, include
fried or high-fat foods, caffeine, citrus, carbonated beverages, garlic or onion, chocolate, and peppermint.

The Stomach
Just past the esophagus, we get to the stomach, here we see that hypothyroidism may lead to delayed gastric
emptying. The same study that found a significant decrease in esophageal motility also found a decrease in
gastric emptying time and motor activity – which may lead to symptoms of indigestion, nausea, or vomiting.
This is thought to be linked to water retention within the muscles of the stomach as well as changes in the
electrical activity that signals the muscles to move and digest the food.

The Intestine and Colon

Further down, we see the potential impacts hypothyroidism may have on the intestine and colon. Here, the
effects seem to be multifaceted with different potential causes for dysfunction, including possible changes to
hormone receptors, irregularly functioning muscle fibers, and/or overgrowth of harmful bacteria that alter the
gut microbiome (see below). The most common symptom experienced in the gut with hypothyroid patients is
the decreased movement of food through the intestine, in other words: poor digestion, which can cause
constipation and severe discomfort.

The Gut Microbiome

This underactive state of bowel motility can lead to increased bacteria growth, which may then result in bouts of
diarrhea. This overgrowth of bacteria in the gut is often referred to as small intestinal bacteria overgrowth
(SIBO), which is commonly responsible for chronic gastrointestinal symptoms. One study found that SIBO may
be present in more than half of hypothyroid patients! This same study recommended the use of antibiotics and
some probiotics for the treatment and management of the condition.

Leaky Gut
Numerous autoimmune diseases may put our gut at risk of increased permeability, also known as leaky gut.
This has been found most commonly with celiac disease, irritable bowel disease, and thyroid disease. While
there is minimal scientific research supporting the connection, many naturopathic sites have pondered the
connection between microbiome dysbiosis (i.e. SIBO) and leaky gut. This would mean that if hypothyroidism
puts you at risk of one, it would also put you at risk for the other.
The Kidneys & Hypertension
Our kidneys and the rate at which they filter out waste and water from our bodies are closely regulated by our
thyroid hormones. Therefore, hypothyroidism is associated with a decreased filtration rate, and, in turn,
increased levels of water and salt retention. This retention then leads to hypertension (aka vascular retention)
and high blood pressure, which is now well-known to be associated with an underactive thyroid. Furthering this
effect, due to the autoimmune etiology of many hypothyroidism cases, damage to the small nephrons of the
kidneys may also take place.

Restoring thyroid function, primarily through medications, has been found to have positive effects on blood
pressure in hypertensive patients. One study found results that suggested that Levothyroxine (the most common
thyroid medication) can reduce blood pressure in hypothyroid patients, while another found that it completely
reversed hypertension in 50% of patients.

Medical & Nutritional Interventions for Managing Hypothyroidism

It is important to note that diet alone, in most cases, cannot cure hypothyroidism – but a healthy diet filled with
the right nutrients for your body’s needs, as well as medication or supplements prescribed by a medical
professional, can help to restore the normal functioning of your thyroid and begin to lessen the severity of
symptoms that are being experienced.

Medications

For those people living with hypothyroidism, thyroid hormone replacement therapy is the gold standard for
treatment. Upon obtaining a hyperthyroid diagnosis from your doctor, they will likely recommend one of the
following medications – if the severity of your condition warrants it. Also, depending on the cause of the
hypothyroid diagnosis, thyroid hormone therapy will need to continue indefinitely.

T4 Hormone Replacement Therapy

Most research points towards the T4, thyroxine, supplementation being the best and most effective method for
treating hypothyroidism. This is done most commonly through the medication Levothyroxine. This medication
is taken orally once a day and has found to reverse symptoms in the majority of patients.

T3 & T4 Combination Hormone Replacement Therapy

Some people report ongoing symptoms of fatigue and depression when taking Levothyroxine, for those
individuals, there is a combination treatment with T3 and T4. However, these medications are not as well
researched or supported by evidence, so if you are having trouble with your thyroid medication let your doctor
know and together you can find the best course of action to take.

Side Effects of Thyroid Hormone Replacement Therapy

As with any medications, there is a long list of potential side effects from Levothyroxine, the most common
medication prescribed for hypothyroidism. Potential side effects include:
 Increased appetite
 Weight loss
 Heat sensitivity and excessive sweating
 Headaches
 Anxiety and/or hyperactivity
 Irritability and/or mood swings
 Tiredness and/or trouble sleeping
 Weakness
 Tremors
 Hair loss
 Digestive issues (cramps, diarrhea, vomiting).

Mild side effects may dissipate within a few days or weeks, while more severe or lasting side effects should be
reported to your doctor. More serious side effects could involve heart issues, including heart attack, failure, or
an irregular or fast heartbeat.

As mentioned above, in the kidney and hypertension section, Levothyroxine has also been found to reduce
blood pressure and hypertension in a significant number of cases. This in itself may be associated with weight
loss.

Special Considerations when Taking Medications

There are several nutrients, as well as natural remedies (which will be discussed later), that have been found to
interfere with the absorption and/or bioavailability of thyroid hormone replacement medications. If you have
been prescribed such medications, the foods and supplements containing these nutrients should be consumed
outside of the window that you are taking said medications.

Calcium
Supplements or antacids containing calcium can interfere with thyroid medications, primarily if the two are
taken too closely together. Therefore, in order to alleviate the risk of calcium lowering the effectiveness of your
medication, it is recommended to take calcium-containing supplements at least 4 hours before or after taking
thyroid medications.

Iron
Similar to calcium, supplemental iron can also interfere with the absorption and activity of thyroid medications.
Therefore, it is also recommended you take any iron supplements outside of the 4-hour window of taking
thyroid medications.

Fibre
Fibre, the indigestible form of carbohydrate, is an important part of maintaining regular bowel movements and
healthy blood profile levels. However, when taken with thyroid hormone replacement medications, it can
interfere with the absorption. Fibre is found in a lot of foods, including grains, vegetables, and fruit – meaning it
can be hard to avoid (usually, you really don’t want to!). Therefore, for most individuals, it is recommended that
thyroid medications be taken first thing in the morning, on an empty stomach, and about 30-60 minutes before
eating your first meal. It has been found that taking this medication with breakfast does, in fact, lessen its
bioavailability.

Soy Products
There is some research to suggest that soy-containing foods, such as tofu, tempeh, or soymilk, can interfere with
the absorption of thyroid hormone replacement medications. Therefore, these foods should be consumed at least
4 hours outside of the window that you take your thyroid medication.

Coffee
Research suggests that coffee interferes with the absorption of thyroid medications as well – as such, your first
cup should be consumed at least half an hour after taking your thyroid hormone replacement medication.
 Diet – What to Eat

Iodine
Iodine is a natural mineral that is found within the earth’s soil and seawater, lending itself in the highest
concentrations to the critters and plants living in the ocean (i.e. seafood and seaweed!). It functions to maintain
our overall health and development by regulating our hormones, aiding in fetal development (i.e. during
pregnancy), and much more. Iodine is an essential element that is needed to produce our thyroid hormones,
therefore if we are deficient our bodies are unable to make an adequate amount of the thyroid hormones T3 and
T4. Our bodies do not make iodine on their own, which is why it is coined as an essential nutrient. Therefore,
increasing iodine intake through a variety of foods may help manage the symptoms of hypothyroidism, if the
root cause is an iodine deficiency.

Iodine supplements are usually not recommended, or needed, for individuals living in developed countries. This
is because we can easily increase the iodine in our diet through iodized table salt, and therefore becoming
deficient in the first place is quite rare. Avoiding iodine supplements is especially important if iodine deficiency
is not the cause of hypothyroidism, as excess iodine can either cause or worsen an underactive thyroid!

The recommended daily intake of iodine is 150 micrograms (mcg) for adult males and females. This can be met
through different foods and food items, such as cheese, cow’s milk, eggs, yogurt, iodine-containing
multivitamins, iodized table salt, saltwater fish and shellfish, seaweed products (i.e. kelp, dulce, nori), and soy
sauce.

To put the amount of iodine in some of these foods into perspective, here is the breakdown of some of these
sources of iodine:

 3 oz fillet of cod can contain up to 99 mcg (66% of the daily value (DV))
 1 cup of most milk offers an average of 88 micrograms (59% DV)
 1 serving of nori (the seaweed in sushi rolls) can offer up to 43 mcg (29% DV)
 1 whole egg offers 25 mcg (16% DV)
 ¼ tsp iodized salt contains 71 mcg (47% DV) – however, it also contains sodium – so be mindful of not
adding too much to your cooking!

Selenium
Selenium is another essential nutrient that we must derive from our diets. It is an antioxidant, which protects our
bodies from cellular damage, and is associated with maintaining the health of our thyroid, heart, brain, and
immune system. Selenium helps to maintain our thyroid function in two ways: one, by activating our thyroid
hormones for use in the body, and two, by protecting the gland from the oxidative damage of free radicals
(through its antioxidant properties). Our thyroid also contains more selenium than any other organ in the body,
making it inherently essential for proper functioning. If you recall from before, T4 (the inactive thyroid
hormone) needs to be activated into its active form, T3, to be used in the body – selenium is key in making that
happen. Therefore, not only does selenium deficiency hinder our thyroid’s ability to synthesize thyroid
hormones, but it also decreases its ability to activate said hormones (not good!).

The recommended daily intake of selenium is 55 mcg for adult males and females. Selenium can be found in
high concentrations in foods like oysters and other seafood, brazil nuts, eggs, and sunflower seeds. The
following puts into perspective why the above are such excellent sources of selenium:

 1 brazil nut contains 96 mcg (175% DV)

 ¼ of a can of oysters (3 oz) contains 27 mcg (50% DV)
 3 oz fillet of halibut can contain up to 39 mcg (71% DV)
 1 whole egg has 31 mcg (56% DV)
 ¼ of a cup of de-shelled sunflower seeds offers 29 mcg (53% DV)

Zinc
Zinc is a vital mineral, which we depend on for maintaining numerous aspects of our overall health and cellular
function. It plays a role in enzyme function, creating protein and DNA, wound healing, proper taste and smell,
and immune function. Similar to selenium, it also is required for the synthesis and activation of our thyroid
hormones, making it essential for proper thyroid function. What is unique about this relationship, is that thyroid
hormones are also required for the proper absorption of zinc, so, a deficiency in either will likely result in an
inevitable decrease in the other. When a zinc deficiency is present, influencing hypothyroidism, the most
prominent symptom will likely be severe hair loss. With this in mind, studies have shown that supplementing
with zinc (in addition to thyroid medications) has cleared up the symptoms of hair loss and lesions.

The recommended intake for zinc is 8 -11 milligrams (mg) per day, for adults. Animal products are the most
concentrated source of zinc, but some plant-based options like beans, fortified cereals, and pumpkin seeds also
contain this mineral. The following shows the amount of zinc that certain foods can offer:

 ¼ of a can of oysters (3 oz) has 67 mg (610% of upper DV)

 3 oz of ground beef contains around 4 mg (36% DV)
 4 oz of beef chuck can have up to 8 mg (73% DV)
 3 oz of pork loin offers 3 mg (27% DV)
 ½ cup of vegetarian baked beans and zinc fortified cereal grains both contain approximately 3 mg (27%
DV)
 ¼ of a cup of de-shelled pumpkin seeds offers 2.8 mg (25% DV)

Copper
Along with other trace elements like selenium and zinc, copper helps to maintain thyroid function as well as
many other processes in the body. Copper helps us maintain a healthy metabolism and nervous system, as well
as promotes a strong and healthy skeleton (aka bones!) and eyesight. Without proper copper levels, it is
common to feel fatigued, ill, and cold – which is closely linked to hypothyroidism. Research has found that
copper levels are closely linked to thyroid hormone levels, meaning, if one falls the other is likely to follow.
One supporting study found a significant decrease in copper stores in people who were diagnosed with
hyperthyroidism and therefore recommended eating a diet rich in trace elements (i.e. copper and zinc) to
supplement this deficiency.

The recommended daily intake for copper is 900 mcg (or 0.9 mg) for healthy adults. Similar to the other trace
elements, some of the richest sources of copper are seafood and red meats, however, copper is also found in
several plant-based sources like dark chocolate, potatoes, mushrooms, and nuts/seeds!

 3 oz of beef liver offers 9 mg (1013% DV)

 ¼ can of oysters (3 oz) contains 3.3 mg (367% DV)
 1 oz (square) of unsweetened baking chocolate has 938 mcg (104% DV) (while 1 oz of 85% dark
chocolate offers 501 mcg – 56% DV)
 1 medium-sized white potato can have up to 675 mcg (75% DV)
 1 serving of cashews and sunflower seeds both contain around 610 mcg (74%)
 ½ cup of firm plain tofu has 476 mcg (53% DV)

B-Vitamins
The B-Vitamins are hugely important in maintaining our overall health, wellbeing, and energy levels. However,
when focussing specifically on hypothyroidism, there is one B-Vitamin that has gotten the most attention for
having a potential link to lower thyroid hormones: Vitamin B-12. B-12, also called Cobalamin, plays an
essential role in helping us maintain and regulate our nervous system, it is also closely linked to the healthy
development of red blood cells. Because of this, a deficiency in B-12 can lead to issues with anemia, loss of
sensitivity in our nerve endings, fatigue, and weakness. We will talk about why issues with anemia may be tied
to thyroid problems in the next section, iron. In addition to these symptoms, a B-12 deficiency may also be
linked to hypothyroidism. One study found that approximately 40% of patients with an underactive thyroid
were found to have a deficiency in this B-Vitamin. When B-12 deficiency was found in hypothyroid patients,
supplementation was found to improve symptoms.

B-12 deficiencies can be diagnosed with a blood test, therefore, only a medical professional can officially
suggest that you begin supplementing.

The recommended daily intake of Vitamin B-12 is 2.4 mcg for healthy adults. This particular vitamin is only
found naturally in animal sources, or fortified plant-based products, such as:

 3 oz of clams contains 84.1 mcg (3, 504% DV)

 3 oz of beef liver offers 70.7 mcg (2, 946% DV)
 3 oz of wild salmon or trout have between 4.8 – 5.4 mcg (200 – 225% DV)
 1 serving of fortified nutritional yeast contains 100% DV
 1 cup of fortified non-dairy milk contains 1.2 mcg (50% DV)
 1 whole egg has about 0.5 mcg (21% DV)

Iron
Iron is an essential nutrient that performs a multitude of vital functions, the main one being that it is responsible
for carrying oxygen through the body to our tissues. Those who are diagnosed with an iron deficiency (aka
anemia), often experience symptoms that can mimic (or coincide with) hypothyroidism. These being ongoing
tiredness, cold intolerance, pale and dry skin, hair loss, headaches, and frequent dizziness. The connection
between hypothyroidism and anemia can be closely linked to the decrease in thyroid hormones, which are
needed for the synthesis of bone marrow (where we produce our red blood cells). In short, when our bone
marrow activity is suppressed, our production of red blood cells follows, and this is what triggers the
development of anemia. One study found that 43% of people diagnosed with clinical hypothyroidism were also
anemic, this is compared to the 29% of the general population living with anemia. An iron deficiency must be
diagnosed by a doctor, with a blood test, and the results will indicate the level of supplementation that is
required.

If your doctor recommends iron supplements, the dose and regimen will depend on the severity of the anemia.
However, it is always recommended to take iron supplements at least 3 to 4 hours away from other medications,
this includes any thyroid medications prescribed. This is because iron can interfere with the absorption of other
medications, rendering it much less effective in our bodies. Another thing to note is the Vitamin C helps with
the absorption of iron, therefore taking a supplemental tab of Vitamin C (or consuming a citrusy fruit or juice)
at the same time as taking your iron can help increase its bioavailability. A similar effect is had with B-
Vitamins, so, if your doctor also recommends supplementing with a B-Vitamin it can be taken alongside your
iron.

The recommended daily intake of iron for healthy adults is 8 mg for men and 18 mg for women, this number
increases when anemia is present. The average recommended dosage for mild anemia is 120mg per day. You
can also find iron in many different high-protein foods, such as red meat, seafood, and a variety of plant-based
sources. Check out these food items and how much iron they offer:

 1 serving of iron-fortified breakfast cereals contains 100% DV

 3 oz beef liver offers just under 4 mg (50% of men’s DV; 22% women’s DV)
 1 small (beef) steak has an average of 3 mg (38% DV; 7% DV)
 5 medium mussels offer 2.8 mg (35% DV; 16% DV)
 ½ cup cooked black beans has 2.3 mg (28% DV; 13% DV)
 ½ cup cooked chickpeas or kidney beans have 1.8 mg (23% DV; 10% DV)
 ¼ cup of almonds has 1.3 mg (16% DV; 7% DV)

Tyrosine
Tyrosine is an amino acid that we naturally produce in our bodies if we have enough of its precursor (i.e.
phenylalanine), making it conditionally essential since we do not need to derive it from our diet. However, it is
essential to our bodies for proper functioning. Tyrosine, being an amino acid, is part of building proteins and
hormones in our body, as well as ensuring our nerves are functioning properly. This amino acid is a building
block for the thyroid hormones, meaning it is essential for the synthesis of T3 and T4. However, supplementing
with tyrosine could quickly elevate these hormones above healthy ranges, and therefore supplementation would
not be readily recommended – especially in combination with thyroid medications (unless prescribed by your
doctor). There is also minimal evidence to suggest that supplementing with tyrosine would reserve
hypothyroidism.

Instead, including a variety of protein-rich foods in your diet will help with your overall balance and intake of
tyrosine and its precursor phenylalanine. It is recommended that the daily intake of phenylalanine and tyrosine
add up to 11 mg per pound of body weight, meaning if both account for half of that we should be consuming
around 5.5 mg per pound of each. Essentially then, if a person weighs 150 pounds, their recommended daily
intake would be 825 mg of tyrosine per day.

Since these are amino acids they are only found in protein sources, such as beef, pork, salmon, chicken, tofu,
milk, beans/lentils, nuts, and seeds! Selecting a variety of sources and including an adequate amount with each
meal you eat will likely ensure you are getting enough of this thyroid hormone building block in your diet. The
following examples show the percent of the recommended daily value for a 150-pound individual.

 6 oz of beef steak contains 2174 mg (264% DV)

 6 oz fillet of salmon offers 2052 mg (248% DV)
 6 oz lean chicken breast has 1964 mg (238% DV)
 ½ cup of firm tofu has 884 mg (93% DV)
 2 oz of pumpkin seeds offer 612 mg (74% DV)
 ½ cup of cooked white beans contains 245 mg (30% DV)

Diet – What to Avoid

Goitrogens
Goitrogens are compounds that are found in a variety of foods, which have been found to interfere with thyroid
function – if there is already a thyroid dysfunction, an iodine deficiency, and/or the foods containing these
compounds are consumed in excess. They impact our thyroids by interfering with the uptake of iodine, meaning
the thyroid is unable to produce a sufficient number of thyroid hormones. The term goitrogens actually comes
from the word goiter, which is another name for an enlarged thyroid gland!

Goitrogens is an umbrella term, which envelopes three main types of this compound: goitrins, thiocyanate, and
flavonoids. The enzymes that give rise to both goitrins and thiocyanates are found within a variety of foods
(which we will list after), and when the cells within these foods are “damaged” (i.e. by cutting or chewing) the
goitrogen is formed. Some research suggests that cooking with high temperatures will inactive said goitrogens,
rendering them safe for those with thyroid problems. Whereas, flavonoids are found naturally present in plant
pigments, and therefore do not need to be broken down or hydrolyzed for the compound to be used by the body.
However, flavonoids are generally considered to be healthy antioxidants, and only some may be converted into
goitrogens via our gut microbes!
The foods containing goitrogens, or the pre-formed versions, can be separated into 5 different categories:
cruciferous (aka Brassicaceae family) vegetables, soy-based foods, fruits in the Rosaceae family, certain starchy
foods, and beverages. See the list below for foods that fall within these categories, that should be eaten in
moderation (and ideally cooked):

 Cruciferous (Brassicaceae) vegetables: bok choy, broccoli, brussels sprouts, cabbage, cauliflower, choy
sum, collard greens, horseradish, kale, kohlrabi, mustard greens, radishes, rapeseed, rapini, rutabagas,
spinach, and turnips.
 Soy-based foods: tofu, tempeh, soy/edamame beans, soymilk, soy yogurt, etc.
 Rosaceae fruits: almonds, apricots, cherries, peaches, pears, plums, raspberries, and strawberries.
 Certain starchy foods: bamboo shoots, millet, sweet potato, tapioca, and yuca (cassava or manioc).
 Certain beverages: coffee, green tea, and red wine.

Don’t panic yet though – if some of your favourite foods or food items are listed above, there are ways to
continue incorporating them in your diet in a safe way! Also, limiting these foods should only ever be a concern
if an iodine deficiency is present. If not, there should be no immediate concern over limiting intake. The only
exception to this is millet, where it has been found that even in the absence of an iodine deficiency it can
suppress thyroid function. Therefore, choosing an alternative grain is recommended.

As eluded to, cooking or steaming your cruciferous vegetables has been found to denature much of the
goitrogenic effect, rendering them safe for consumption. One study found that eating 3 to 4 servings of cooked
crucifers per week had little to no effect on thyroid function – if iodine levels were adequate. This means that
you can continue consuming your favourite cruciferous vegetables, however, keep in mind that cooking them
may be the better option to avoid any adverse effects.

When consuming moderate levels of soy-based foods, in conjunction with normal iodine levels, it has also been
reported that there is no reason for concern. However, the concern does still exist for those supplementing with
soy phytoestrogens, where it was found that there is a 3-fold increased risk in developing hypothyroidism if
doing so. Therefore, eating soy-products in moderation (i.e. a few times a week) does not seem to be a cause of
concern if you are not iodine deficient, but regardless, supplementation should be avoided. It should also be
noted that soy-products may still interfere with the uptake of thyroid medications, and therefore should be
consumed at least 4 hours away from the time you take said medication.

Flavonoids, as mentioned before, are natural plant pigments that are found in foods like fruits, grains, nuts,
wine, coffee, and tea. They are antioxidants that are usually toted upon for their multitude of health benefits,
however, there has been speculation over the potential negative impact they can have on thyroid hormone
status. While there has been research done that reflected flavonoids showing antithyroid effects, this effect has
only seemingly been found in labs (rather than with human participants). And even these research findings have
concluded that finding these adverse effects is rare in humans consuming flavonoid-containing vegetables.
Similar to the finding with soy, the supplementation of flavonoids has been strongly tied to antithyroid and
goitrogenic activity. Therefore, supplementation should be avoided in individuals with hypothyroidism. That
being said, more research is definitely needed in this area to create better guidelines surrounding the dietary
intake of flavonoids. However, being that there is no strong research to encourage people to avoid such foods, I
would say that enjoying them in moderation should not be linked to any adverse effects (again, if a person has
not been diagnosed with an iodine deficiency). It is important to recognize though that the compounds found in
coffee and tea may interfere with the absorption of thyroid medications, and therefore should be consumed at
least half an hour after taking your medications.
With that being said, there is research to support avoiding alcohol consumption with an underactive thyroid.
This is because alcohol can affect virtually all functions of the thyroid gland. Therefore, avoiding alcohol or
drinking it in moderation is recommended.

What does drinking in moderation mean?

 Up to 1 drink per day for women
 Up to 2 drinks per day for men

One drink is equal to:

 12 oz or 1 can of beer
 One 5 oz glass of wine
 1 oz of hard liquor (i.e. vodka, gin, rum)

The Ketogenic Diet

The keto diet, as you likely know, is a way of eating that involves high fat intake and low carbohydrate intake.
This, in turn, changes how our body uses its energy stores and therefore alters our metabolic state. Instead of
running off glucose (our main energy source from carbs) our body switches to running off ketones (which
mimic glucose but are synthesized from fat). The metabolic state our bodies function in when we are in ketosis
(a state induced by the keto diet) closely resembles a state of starvation – which can wreak havoc on our thyroid
according to some research. As mentioned above in the disordered eating section, during periods of starvation
(i.e. calorically restrictive diets or prolonged fasting) our bodies experience a downwards shift in the production
of thyroid hormones. So, the assumption is that eating on a ketogenic diet for a prolonged period of time would
have similar effects on one’s thyroid.

One 2017 study, actually the first study ever to look at the keto diet and thyroid function, looked at epileptic
children who were following a strict keto diet in order to control their seizures, and how their thyroid hormones
were being affected. They found that after 6 months just under 17% of the patients developed hypothyroidism,
signaling a significant correlation between the keto diet and thyroid function decline.

However, more research is still needed in this area to be able to generate clearer guidelines and
recommendations surrounding adults without epilepsy and/or with thyroid dysfunction. For now, though, I
would not recommend trying the keto diet to manage your hypothyroidism (or ever – but that’s a story for
another time), as there simply is no evidence to support it.

Natural Supplements

As you likely would have seen, if you have been google-diagnosing (do not recommend), there are several
natural remedies on the market that have been getting attention as natural alternatives to thyroid hormone
replacement therapy medications. While I am all for supporting an as-natural-as-possible lifestyle, I think a
warning should be issued here: these natural remedies have much less science and research backing them up
and have been found to interact with a variety of medications. Therefore, if you are opting for the natural route
to deal with your hypothyroidism, I would strongly urge you to seek out a medical professional who is willing
to take this journey with you, to keep you as safe and healthy as possible.

Some of the most popular natural supplements, as well as their proposed interactions with and benefits for the
thyroid, are listed here:

Ashwagandha
Ashwagandha, also known as Indian ginseng or winter berry, is a natural herb that has long been believed to
help the body manage stress. It has also gained more recent popularity as a potential alternative treatment for
managing hypothyroidism. While more research is needed, one promising study found that supplementing with
this herb significantly improved TSH, T3, and T4 levels within 8 weeks. However, it was undetermined if the
improvement in thyroid hormone levels was because of action on the thyroid, or its proposed stress-relieving
properties. Chronic stress is known to increase cortisol levels, which in turn negatively impacts our thyroid –
therefore, supplementing with ashwagandha may either help our thyroid function directly (through acting on the
thyroid) or indirectly (through helping us manage our stress levels)!

The average recommended dose of ashwagandha is 600mg a day (separated into 2 300mg doses) – this is the
dosage that was measured in the above study as well.

Ashwagandha is considered safe for the majority of the population – but, should be avoided if you are a
pregnant or breastfeeding mother, as well as by those who have an overactive thyroid. It should also not be
taken by those who are prescribed certain medications, such as those for hypothyroidism, diabetes, high blood
pressure, or an autoimmune disorder (i.e. rheumatoid arthritis, multiple sclerosis, or lupus). This is because
Ashwagandha can interact or interfere with the uptake of these medications, which could have detrimental
health effects for those who rely on said medications for their health and safety.

Coleus
Coleus, also commonly referred to as forskolin, is another natural herb that is thought to potentially impact the
thyroid gland. There is very limited and old (i.e. 1984) research suggesting a potential connection between
forskolin supplementation and improved thyroid function – but this herb also interacts with many medications
and its use should 100% be guided by a health professional.

Gota Kula
Gota kula, or Centella asiatica, is a leaf that has been positioned as beneficial for the treatment of
hypothyroidism. It is suggested that gota kuta offers a property that stimulates the thyroid gland to produce
more T4. However, there is minimal scientific evidence to support these claims.

Guggal
Guggal, an extract from the tree Commiphora mukul, is a herbal remedy that may act in the body as a thyroid-
hormone stimulant. It is also suspected to increase the synthesis of T3, by supporting the conversion of T4 to
T3. But, similar to gota kula, there is limited research that supports the supplementation of guggal for an
underactive thyroid.

Due to the fact that there is limited scientific evidence to support the supplementation of most of these natural
remedies for the treatment of an underactive thyroid, and because these herbs interact with various medications,
their use should always be overseen by a medical professional.

One study prefixes this concern with this warning: “We recommend against the use of dietary supplements,
nutraceuticals, or other over-the-counter products either in euthyroid individuals or as a means of treating
hypothyroidism. We particularly caution against the use of pharmacologic doses of iodine because of the risk of
thyrotoxicosis and hypothyroidism in those with intact thyroid glands susceptible to becoming further
dysregulated because of underlying thyroid pathology.”

The Bottom Line

Hypothyroidism, an underactive thyroid, can cause an array of metabolic and overall health disturbances. The
most common symptoms include fatigue, cold intolerance, hair loss, and weight gain. This condition can be
linked to many different health concerns, including gastrointestinal problems, hypertension, infertility, anemia,
and more.
Luckily, several tests can be used to diagnose this condition and thyroid hormone replacement therapy has
proven to improve thyroid function and reverse symptoms. In addition to taking medications, there is an
abundance of foods that can be incorporated into the diet to help optimize your recovery from hypothyroidism.
There are also recommendations made for those who want to approach their hypothyroidism with alternative
medicine, but caution should be taken with this route since there is less supportive evidence for it, and it should
still be done do under the direct supervision of a medical professional. This is because the misuse or dosing of
any medications, natural or not, could have serious and detrimental health consequences.

Following a “hypothyroid friendly” diet, in combination with medications like Levothyroxine, is the best-
known way to alleviate symptoms and effectively treat an underactive thyroid.