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Hashimoto’s thyroiditis and hypothyroidism are two of the most common thyroid disorders, often going hand in hand. Hashimoto’s is an autoimmune condition where the body attacks the thyroid gland, leading to chronic inflammation and eventual hypothyroidism, which occurs when the thyroid cannot produce sufficient hormones. The thyroid, a small butterfly-shaped gland in the neck, plays a crucial role in regulating metabolism, energy levels, and overall health. When it underperforms, symptoms like fatigue, weight gain, muscle weakness, and mood changes can arise, significantly affecting quality of life.
Managing thyroid conditions like Hashimoto’s and hypothyroidism involves more than just medication. Nutritional support for hypothyroid patients, including adequate intake of vitamins and minerals, is essential to maintaining thyroid function and overall well-being. One nutrient that has garnered attention for its role in thyroid health is magnesium. Known for its involvement in hundreds of enzymatic reactions within the body, magnesium plays an integral role in regulating thyroid hormone conversion and thyroid function, energy production, immune response, and inflammation. When your magnesium level is even slightly low, it can disrupt everything from your sleep to your bowel habits. Here's a look at why magnesium is popular and why it is especially crucial for people with Hashimoto’s and hypothyroidism.
Hashimoto’s thyroiditis is the leading cause of hypothyroidism, especially in developed countries. It is an autoimmune disorder where the immune system mistakenly attacks and damages the thyroid gland, leading to reduced hormone production. Hypothyroidism, on the other hand, is a condition of low thyroid hormone production, whether due to Hashimoto’s or other causes such as iodine deficiency or thyroid surgery. Common symptoms of hypothyroidism include persistent fatigue, sensitivity to cold, weight gain, dry skin, hair loss, muscle weakness, and depression. Left untreated, these conditions can result in more severe complications like cardiovascular issues, mental health disturbances, and infertility.
Thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), regulate various metabolic processes and energy production in the body. T3 is the active form of thyroid hormone, while T4 is converted to T3 in the body. People with hypothyroidism may struggle with this conversion process, leading to decreased levels of T3 and other low thyroid hormone levels. Nutrient deficiencies, particularly in selenium, zinc, and magnesium, can further impair thyroid function. For individuals with Hashimoto's, chronic inflammation and antibody production contribute to the progressive destruction of thyroid tissue. As such, nutrient balance and inflammation management become crucial components of managing these conditions.
Magnesium is one of the most abundant minerals on Earth. It is the fourth most common cation in the human body, and is involved in more than 300 biochemical reactions in the body. Our bodies typically contain over 25 g of magnesium. We store over 99% of the body's magnesium in the bones, muscles, and soft tissues.
Magnesium plays an essential role in energy production, muscle and nerve function, and the regulation of blood sugar and blood pressure. It is a cofactor for many enzymes, meaning that without sufficient magnesium, various physiological processes can become inefficient or impaired. Magnesium is also important for maintaining electrolyte balance and proper muscle function, which explains why deficiencies can lead to muscle cramps, fatigue, and overall weakness.
Beyond its role in physical processes, magnesium supports the nervous system by regulating neurotransmitters that affect mood, relaxation, and sleep. This makes it particularly valuable for individuals experiencing symptoms of stress, anxiety, or sleep disturbances—issues that are often prevalent in people with thyroid dysfunction.
Additionally, magnesium plays a role in hormone regulation, including those related to the thyroid. The mineral supports enzymatic processes that influence the production and conversion of thyroid hormones. Without adequate magnesium, the body may struggle to convert inactive T4 into the more active T3, potentially leading to worsened hypothyroid symptoms. Thus, maintaining adequate magnesium levels is critical for both thyroid function and overall metabolic health.
When magnesium levels are too low, it can lead to several challenging symptoms. In severe cases, it can be life-threatening. Symptoms of a magnesium deficiency include:
- Muscle cramping, especially with exercise
- Restless leg syndrome (RLS) or muscle spasms
- Headaches and migraines
- Anxiety
- Depression
- Constipation
- Fatigue
Generally, magnesium deficiencies are due to a low dietary intake of this mineral in healthy people. Only an estimated 2% of the population has a true magnesium deficiency. However, one study declared that at least 75% of Americans do not have adequate magnesium intake. This is partly due to poor eating habits and the mineral content in our food. Thus, the standard American diet may be a risk factor for magnesium deficiency.
There are other risk factors for magnesium deficiency, including:
- Taking certain medications
- Chronic alcoholism
- Having a condition that causes chronic diarrhea such as Crohn's disease, celiac disease, and IBD
- Type 2 diabetes
In many of these conditions, magnesium deficiency occurs because you either have excessive losses of the magnesium you ingest or cannot absorb it.
Older adults are also more susceptible to magnesium deficiency because the gut has a more challenging time absorbing it, and the kidneys often excrete too much magnesium.
Severe magnesium deficiency, or hypomagnesemia, occurs when magnesium levels in the body drop to dangerously low levels. Symptoms of severe magnesium deficiency include:
- Muscle symptoms: Cramping, muscle spasms, tremors, and weakness. In extreme cases, it can cause muscle contractions known as tetany.
- Neurological issues: Severe deficiency can lead to numbness, tingling, seizures, and personality changes, including mood swings, irritability, or anxiety.
- Cardiovascular symptoms: Irregular heartbeat (arrhythmia), chest pain, and a higher risk of heart attacks or heart failure.
- Hypocalcemia and hypokalemia: Low magnesium levels often lead to low calcium (hypocalcemia) and potassium (hypokalemia) levels, further contributing to muscle and heart-related issues.
Severe magnesium deficiency is typically caused by factors such as insufficient magnesium intake, chronic gastrointestinal diseases (e.g., Crohn’s disease, celiac disease), chronic diarrhea, type 2 diabetes, and excessive alcohol consumption. It may also occur due to medications that interfere with magnesium absorption, like diuretics.
If left untreated, patients with the lowest serum magnesium levels can experience life-threatening complications like heart arrhythmias, seizures, or respiratory distress. Treatment often involves intravenous magnesium in acute cases and dietary or supplemental correction over the long term.
T4-T3 conversion
Magnesium is directly linked to thyroid hormone production and conversion. Thyroid hormones need magnesium for their production and activation. Specifically, we need magnesium to convert the inactive thyroid hormone T4 into the active thyroid hormone T3. Without this conversion, cells do not receive the more potent T3 thyroid hormone. Therefore, when magnesium levels are low, our thyroid is not able to function correctly. This deficiency of T3 can worsen symptoms like fatigue, brain fog, and low metabolism in patients with hypothyroidism.
TSH release
A magnesium deficiency can also affect the pituitary gland's ability to release thyroid-stimulating hormone (TSH), which prompts the thyroid to produce more T4. If the pituitary gland’s function is compromised due to low magnesium levels, the thyroid may not be adequately stimulated, further decreasing hormone production.
Thyroid-related magnesium deficiency
People with autoimmune thyroid disease commonly have sub-optimal magnesium levels. Specifically, people with Hashimoto's thyroiditis tend to have deficiencies in key micronutrients partly due to autoimmune processes in the body. One of the hallmark signs of an autoimmune disease is inflammation. People with Hashimoto's have inflammation of the thyroid gland, which can lead to eventual thyroid failure. However, autoimmune diseases often occur together in a situation called polyautoimmunity, resulting in system-wide inflammation.
Reduced gut health issues
When the body is chronically inflamed, it can lead to more frequent infections and food sensitivities, which can off-set your gut health. Some speculate that autoimmune diseases sometimes start in the gut through "leaky gut syndrome." A leaky gut is where the tight junctions between your intestinal cells widen, allowing toxins to enter your bloodstream.
Nutrient deficiencies due to malabsorption
When you have disturbances in your gut, it can change your stomach acid's acidity, cause fat malabsorption, disrupt your gut microbiota, and weaken digestive enzymes. Thus, people with Hashimoto's and other autoimmune disorders may struggle with deficiencies in nutrients, including magnesium, because they cannot absorb them in their gut.
Managing autoimmunity
Several studies have examined the relationship between magnesium levels and thyroid autoimmunity. Some research has reported that magnesium supplementation can lead to a reduction in thyroid antibodies (anti-TPO antibodies), which are responsible for the immune attack on the thyroid in Hashimoto’s. Ensuring sufficient magnesium intake through diet or supplements can be an essential strategy for managing autoimmune thyroid disorders and improving overall thyroid function.
Immune cell regulation
In autoimmune conditions, immune system regulation is crucial to managing symptoms and slowing disease progression. Magnesium supports immune function by balancing the activity of immune cells, particularly by moderating the production of inflammatory cytokines. When the immune system is less reactive, there is less thyroid tissue destruction, potentially reducing the severity of hypothyroidism.
Anti-inflammatory benefits
Magnesium has significant anti-inflammatory properties, making it a vital nutrient for people with autoimmune conditions like Hashimoto’s. Chronic inflammation is a hallmark of autoimmune diseases, and magnesium’s ability to reduce inflammatory markers can lead to improved outcomes for those managing Hashimoto’s. In particular, magnesium can lower levels of C-reactive protein (CRP), a marker of inflammation that is often elevated in individuals with Hashimoto’s thyroiditis. Magnesium's calming effects on the nervous system can also help reduce stress, which is known to exacerbate autoimmune conditions, including Hashimoto's.
Magnesium supplementation can provide relief from several common symptoms of Hashimoto’s and hypothyroidism, particularly those related to fatigue, muscle pain, and sleep disturbances.
Managing fatigue and low energy levels
One of the most debilitating symptoms of hypothyroidism is chronic fatigue. Since magnesium plays a critical role in energy production, maintaining optimal magnesium levels can help reduce fatigue and improve overall energy. Magnesium is involved in the production of adenosine triphosphate (ATP), the body’s main energy currency, and its deficiency can lead to reduced energy metabolism.
Muscle pain, cramps, and relaxation
Hypothyroid patients often experience muscle cramps and stiffness due to an imbalance of electrolytes, including magnesium. Supplementing with magnesium can ease muscle tension, reduce pain, and promote muscle relaxation. It can also help regulate calcium levels, another mineral that influences muscle contraction and nerve signaling.
Improving sleep quality and reducing insomnia
Insomnia is a common complaint among those with thyroid issues, partly due to the disruption of hormonal balance. Getting adequate levels of quality sleep affects everything from how the body processes food to how it regulates blood sugar, remembers information, controls inflammation, and more. However, a magnesium deficiency may cause occasional sleeplessness or insomnia. A research study shows that people who received 500mg of magnesium daily experienced improved sleep efficiency. Research also shows that magnesium can increase the production of melatonin, the hormone responsible for regulating sleep-wake cycles, making it an essential supplement for those struggling with sleep disturbances due to hypothyroidism.
Mood and stress regulation
Hypothyroid patients are often prone to mood swings, depression, and anxiety. And chronic stress can negatively impact thyroid health by increasing cortisol levels, which can interfere with thyroid hormone production.
Magnesium’s ability to modulate the nervous system makes it a natural calming agent. Studies have shown that magnesium supplementation can reduce stress and symptoms of anxiety and improve mood by regulating neurotransmitters like serotonin and GABA, which are responsible for promoting relaxation and well-being.
Fewer migraines and headaches
One symptom of hypothyroidism may be headaches or migraine headaches. A research study of 50 migraine sufferers and a control group of 50 people without any history of migraines shows that magnesium levels are much lower in patients with migraines than in the healthy group. Another study shows that supplementing with magnesium may help lower the frequency of migraines.
Lower blood pressure
Secondary hypertension is high blood pressure caused by another medical condition. When the thyroid gland is underactive and doesn't produce enough thyroid hormone, high blood pressure can result. An article in an American Heart Association journal summarized results from over 30 different clinical trials to establish the effect of magnesium supplementation on blood pressure. Results show that supplementing with magnesium for one month helps to elevate magnesium levels in the body and reduce blood pressure.
Your diet is the primary way to boost your magnesium intake. If you wish to boost your magnesium intake through diet, try increasing your intake of the following foods:
- Leafy green vegetables (spinach, kale, etc.)
- Legumes
- Nuts (like almonds and cashews)
- Seeds (pumpkin seeds, chia seeds)
- Whole grains
- Milk, yogurt, and other milk-based products
- Fortified breakfast cereals
Other good sources include avocados, bananas, and dark chocolate.
Tap, mineral, and bottled waters can also be sources of magnesium, but the amount varies by source and brand.
Ensuring a varied and balanced diet with these foods can help maintain adequate magnesium levels and support thyroid health.
For those who cannot meet their magnesium needs through diet alone, supplementing with magnesium may be necessary. Common forms of magnesium supplements include magnesium citrate, magnesium glycinate, and magnesium malate. Magnesium glycinate is often preferred for its high bioavailability and its gentle effects on the digestive system, making it less likely to cause diarrhea compared to other forms like magnesium citrate. Magnesium malate, meanwhile, is known for its energizing properties and is particularly helpful for reducing muscle pain and fatigue. To help you choose, we recommend you read the Paloma article, What’s The Best Type Of Magnesium For Hypothyroidism?
The average daily magnesium intake that's sufficient to meet the nutrient requirements is 400 mg for adult men and 310 mg for women ages 19 to 30. People over the age of 31 are recommended 420 mg daily for men and 320 mg for women. People with hypothyroidism may benefit from slightly higher daily magnesium intakes, especially if blood tests show a deficiency. You can review the recommended daily intake for women who are pregnant or breastfeeding here.
Magnesium deficiency is common, but it’s particularly prevalent in individuals with thyroid disorders. Symptoms of magnesium deficiency include muscle cramps, fatigue, irritability, headaches, insomnia, and poor concentration. People with hypothyroidism are more prone to magnesium depletion due to metabolic inefficiencies and the increased need for this mineral in thyroid hormone production.
To determine whether you are deficient in magnesium, it’s important to undergo proper testing. Blood tests can measure serum magnesium values, though they are not always the most accurate reflection of total body stores. A more reliable method is testing for red blood cell (RBC) magnesium levels, which give a better indication of intracellular magnesium status. Consulting with a healthcare provider who understands thyroid health, such as those at Paloma Health, can help you determine if magnesium supplementation is necessary and how to tailor it to your specific needs.
While magnesium offers a range of benefits for thyroid health, particularly for individuals with Hashimoto’s and hypothyroidism, it’s important to be aware of potential downsides associated with magnesium supplementation. As with any supplement, moderation and individualized care are key to avoiding side effects and ensuring that supplementation is both effective and safe.
Typically the kidneys eliminated any excess magnesium in the urine. As a result, there is no real risk of getting too much magnesium from food. However, high doses of magnesium from supplements or medications may cause some symptoms.
GI upset from taking too much
One of the most common side effects of excessive magnesium intake is gastrointestinal (GI) upset. Magnesium supplements, particularly those in the form of magnesium citrate or magnesium oxide, can cause diarrhea or loose stools, especially when taken in higher doses. This occurs because magnesium acts as an osmotic laxative, pulling water into the intestines and speeding up bowel movements. For some, even small amounts of magnesium supplements can lead to discomfort, including cramping, bloating, and nausea.
To reduce this problem, it’s crucial to select the right form of magnesium and to start with lower doses, gradually increasing as tolerated. Magnesium glycinate and magnesium malate are often recommended for individuals sensitive to GI distress because these forms are gentler on the digestive system. However, the need to balance optimal intake with potential side effects underscores the importance of working with a healthcare provider to determine the most suitable magnesium type and dose.
Interaction with thyroid medication
Another important consideration is the interaction between magnesium supplements and thyroid medications. Thyroid hormone replacement medications such as levothyroxine (Synthroid) are commonly prescribed for individuals with hypothyroidism, including those with Hashimoto’s disease. Magnesium can interfere with the absorption of these medications, reducing their effectiveness.
If magnesium and thyroid medication are taken too close together, the magnesium may bind with the hormone in the digestive tract, preventing it from being properly absorbed into the bloodstream. This interaction can result in suboptimal levels of thyroid hormone, which may worsen hypothyroid symptoms such as fatigue, weight gain, and sluggish metabolism.
To avoid this interaction, it’s recommended that magnesium supplements be taken at least four hours apart from thyroid medication. Ideally, thyroid hormone should be taken first thing in the morning on an empty stomach, and magnesium can be consumed later in the day, typically in the evening to support relaxation and sleep. As always, it’s essential to consult with a healthcare provider to determine the best timing for medications and supplements.
Other downsides of magnesium
Though magnesium is generally considered safe for most people, there are some additional risks to be aware of, especially for individuals with certain health conditions. For example, people with kidney disease or impaired kidney function should be cautious about magnesium supplementation. The kidneys are responsible for filtering excess magnesium from the bloodstream, and if they are not functioning properly, magnesium can accumulate to toxic levels. This can lead to a condition called hypermagnesemia, characterized by symptoms like low blood pressure, irregular heartbeat, confusion, and, in severe cases, cardiac arrest.
In rare cases, individuals may experience allergic reactions to magnesium supplements, such as itching, swelling, or difficulty breathing. If any of these symptoms occur, it’s important to seek immediate medical attention.
It’s crucial to approach magnesium supplementation with care, ensuring that doses are tailored to individual needs and health status. Working with a thyroid specialist or a knowledgeable healthcare provider can help mitigate these risks and ensure that supplementation is both safe and beneficial.
To optimize thyroid function and overall well-being, it’s essential to tailor a treatment program to your unique symptoms, lab results, and health history. This is where Paloma Health can play play a crucial role. Paloma Health’s team of thyroid experts is uniquely equipped to guide you in making informed decisions about your hypothyroid care, including assessing your nutritional status, and incorporating dietary supplements like magnesium. They understand the intricate relationships between nutrients, thyroid hormones, and immune system function, helping create a personalized treatment plan that not only addresses your symptoms but also supports your long-term health and well-being.
Paloma Health’s comprehensive thyroid care also includes convenient at-home lab testing, and options to include nutritional and health coaching services. Through tailored care plans, ongoing monitoring, and access to the latest in thyroid disease research and knowledge, Paloma Health empowers you to take control of your thyroid wellness.