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Hashimoto’s thyroiditis, an autoimmune disorder, causes the immune system to mistakenly attack the thyroid gland, leading to decreased thyroid hormone production – known as hypothyroidism. When your thyroid hormone levels are low, you will often experience symptoms like fatigue, weight gain, cold intolerance, and brain fog. While conventional treatments for hypothyroidism have relied mainly on thyroid hormone replacement, in recent years, we’ve seen significant advancements in various treatment areas. From new medications and dietary approaches to genetic testing, patients have more options to optimize treatment, manage their symptoms, and improve their quality of life. Here, we explore the latest treatments for Hashimoto’s and hypothyroidism.
Before delving into newer treatments, it’s essential to understand the current standard of care. Levothyroxine is the primary treatment for hypothyroidism, as it effectively replaces the deficient thyroid hormone thyroxine (T4). Levothyroxine is a synthetic form of the T4 hormone and has a long history of use to resolve symptoms of hypothyroidism in many patients.
The goals of levothyroxine therapy are:
- Resolution of common symptoms and signs of hypothyroidism signs
- Normalization of thyroid stimulating hormone (TSH) and other thyroid hormone levels
However, not all patients feel fully well on levothyroxine tablets, leading researchers to develop alternative formulations. Liquid and gel cap forms of levothyroxine, such as Tirosint and Tirosint-SOL, are now available and show improved absorption for people with sensitivities and gastrointestinal conditions – such as celiac disease – that may hinder regular tablet absorption. These alternatives provide flexibility, allowing for more precise dosing and potentially reducing side effects caused by inconsistent hormone levels.
Combination therapy with T3
Some patients continue to experience symptoms despite treatment of hypothyroidism with levothyroxine. Combination therapy adds liothyronine -- a synthetic version of triiodothyronine (T3) – to standard levothyroxine. T3 is the active form of thyroid hormone that directly influences energy and metabolism. Some studies have shown that some patients may benefit from adding T3 to their treatment regimen.
A 2021 randomized clinical study with 75 patients found that treating hypothyroidism with either desiccated thyroid extract (DTE) or a combination of levothyroxine and liothyronine (LT4/T3) provided similar effectiveness to levothyroxine alone.
Recent research has also found that combination therapy may benefit those with specific genetic mutations (like those affecting the DIO2 gene) that impair the conversion of T4 to T3. This approach has shown promise in reducing persistent symptoms such as fatigue, depression, and brain fog. However, working closely with a healthcare provider is essential, as T3 has a shorter half-life and can cause fluctuations in hormone levels if not carefully monitored.
Natural desiccated thyroid (NDT)
Since the late 1990s, natural desiccated thyroid (NDT) – also known as thyroid extract – has garnered renewed interest from patients who feel that synthetic hormone replacement doesn’t fully address their symptoms. NDT, derived from pig thyroid glands, contains both T4 and T3 and smaller amounts of other thyroid hormones, providing a more holistic hormone profile. However, due to the variability in hormone concentration, NDT remains controversial in some circles.
Extended-release T3 formulations
For patients who struggle with T3 stability due to its short half-life, extended-release T3 is emerging as an alternative. Extended-release formulations allow for a steady release of T3, helping to reduce energy crashes and maintain consistent blood levels throughout the day. While still relatively new, initial studies have shown improved adherence and better symptom management, especially in patients with fluctuating energy levels. As more research is conducted, extended-release T3 will likely become a more widely prescribed treratment for patients struggling with symptom control on standard therapies.
Low-dose naltrexone (LDN)
Low-dose naltrexone (LDN) is gaining attention as an immune system modulator. LDN may reduce autoimmune activity by balancing immune function, making it a promising treatment for Hashimoto’s patients. While more research is needed, some patients report reduced thyroid antibodies, increased energy, and a more stable mood on LDN. Initial studies show that LDN may work by raising endorphin levels, which can positively influence immune function.
Metformin
Metformin, a widely used medication for type 2 diabetes, has shown promising potential as a treatment for Hashimoto’s thyroiditis and hypothyroidism. Recent studies have demonstrated that metformin can effectively reduce levels of thyroid autoantibodies, including thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), in patients with Hashimoto’s thyroiditis. Additionally, metformin has been found to lower thyroid-stimulating hormone (TSH) levels in individuals with both overt and subclinical hypothyroidism without significantly altering thyroxine (T4) or triiodothyronine (T3) levels. The drug’s therapeutic effects are thought to be achieved through multiple mechanisms, including the regulation of immune pathways, suppression of inflammatory responses, and modulation of the gut microbiome. In addition, metformin treatment has been associated with a reduced risk of goiter, thyroid nodules, and thyroid cancer in some patients. While more research is needed to understand its long-term effects and optimal dosing fully, metformin shows promise as a potential adjunct therapy for managing Hashimoto’s thyroiditis and hypothyroidism, particularly in cases where traditional treatments may be insufficient.
Surgical intervention
In severe cases of Hashimoto’s thyroiditis, surgical intervention may be considered. A 2019 study in Norway compared the benefits of thyroidectomy (thyroid removal) to medication alone in patients with Hashimoto’s thyroiditis. The study showed improved results with surgery over medication alone, including better general health scores, reduced fatigue, and lower TPO antibody levels.
However, it’s important to note that thyroidectomy is typically only recommended when the thyroid gland enlarges to the point of causing swallowing and breathing problems. Additionally, patients who undergo thyroidectomy will still require lifelong thyroid hormone replacement therapy for the resulting hypothyroidism.
Immunotherapies
Researchers are exploring the use of various immunotherapies to target the autoimmune response in Hashimoto’s thyroiditis. Some of these include:
- Rituximab: This biologic drug depletes B cells and has shown promise in early research for improving thyroid function and reducing anti-thyroid antibodies.
- Etanercept: This medication blocks TNF-alpha, a key player in the inflammatory response.
- Tocilizumab: This drug blocks IL-6, another critical component of the immune response.
While these immunotherapies show potential, more extensive clinical trials are needed to establish their efficacy and safety for treating Hashimoto’s thyroiditis.
Red light and infrared therapy
Red light therapy (also known as photobiomodulation therapy) is emerging as a novel treatment for thyroid health. Studies suggest that red light therapy can stimulate cellular repair and reduce inflammation in the thyroid gland. This therapy may improve hormone levels and relieve symptoms such as fatigue and joint pain. Patients typically undergo red light therapy sessions at specialized clinics, though at-home devices are becoming increasingly available.
Mesenchymal stem cell therapy
One of the most cutting-edge areas of research for Hashimoto’s thyroiditis is mesenchymal stem cell therapy. Early clinical research suggests that stem cell therapies may hold promise for patients seeking more innovative treatments. Mesenchymal stem cells have immunomodulatory properties that could help regulate the autoimmune response in Hashimoto’s thyroiditis and potentially regenerate damaged thyroid tissue, addressing the root cause rather than simply treating symptoms. However, stem cell therapy is still experimental and requires further research to establish its safety and efficacy.
Thyroid hormone analogs
Researchers are working on developing thyroid hormone analogs that may offer a more favorable benefit-to-risk profile compared to current treatments. One such analog is Tiratricol, similar to thyroid hormones T3 and T4. These analogs may help compensate for hormone deficiency and potentially normalize the autoimmune response, but more research is required to fully understand their effects and optimal use.
Thyroid peroxidase inhibitors
Another avenue of research involves thyroid peroxidase inhibitors. These compounds inhibit a key enzyme needed for thyroid hormone synthesis, which may decrease autoimmune attacks by reducing antigen presentation. However, the effects of these inhibitors on thyroid hormone levels need further study.
Personalized medicine approaches
As our understanding of the genetic and environmental factors contributing to Hashimoto’s thyroiditis grows, there is increasing interest in developing personalized treatment approaches. This may involve:
- Genetic testing: Identifying specific genetic markers that may influence an individual’s response to different treatments.
- Microbiome analysis: Exploring the role of gut bacteria in autoimmune thyroid disease and developing targeted interventions.
- Biomarker development: The current reliance on TSH alone may not fully capture the complexity of thyroid function and patient well-being. There’s a need to identify superior biomarkers of euthyroidism to supplement TSH measurements and guide treatment decisions more accurately.
- Mechanistic research: More studies are needed to understand the intricate relationship between serum T3 levels, tissue concentrations, and clinical outcomes, particularly across different age groups and disease states. This knowledge gap hinders the development of more targeted and effective treatments.
- Long-term clinical trials: Conducting extended studies to evaluate the safety and efficacy of combination therapies, thyroid extracts, and other emerging treatments. The long-term effects of these alternative approaches remain largely unknown.
- Subgroup identification: Ongoing research identifies which patient subgroups are most likely to benefit from alternative treatment approaches. This personalized medicine approach could significantly improve patient outcomes.
- Individualized treatment plans: The evolving treatment landscape suggests a move towards more personalized treatment plans based on individual patient characteristics and responses to therapy. However, implementing such tailored approaches in clinical practice presents logistical and economic challenges.
The role of anti-inflammatory and autoimmune protocol (AIP) diets
The autoimmune protocol (AIP) diet is based on removing foods that can trigger inflammation and immune responses, such as grains, dairy, and certain spices. The AIP diet focuses on nutrient-dense, anti-inflammatory foods, like leafy greens, lean meats, and healthy fats, which support the immune system and promote healing. Emerging research suggests that AIP can significantly reduce thyroid antibody levels, leading to less immune system activity against the thyroid. Some patients report improved energy, mood, and digestive health, making the AIP diet a promising dietary intervention for managing Hashimoto’s.
Gluten-free diet: necessity or trend?
Gluten-free diets have gained popularity among Hashimoto’s patients due to research showing a potential link between gluten and autoimmune flare-ups. Gluten contains a protein similar to that found in thyroid tissue, which may prompt immune cells to attack both. Some studies show that eliminating gluten can reduce symptoms and thyroid antibody levels, especially in patients with coexisting celiac disease or gluten sensitivity. For those interested in trying a gluten-free diet, it’s essential to work with a thyroid-savvy dietitian to ensure balanced nutrition and avoid the common nutrient deficiencies associated with gluten-free diets.
Research is discovering the benefits of vitamins, minerals, and herbal supplements as part of a comprehensive treatment approach for Hashimoto’s and hypothyroidism.
Iodine
Iodine plays a complex role in the treatment of Hashimoto’s thyroiditis and hypothyroidism. While iodine is essential for thyroid hormone production, its use as a supplement for these conditions is controversial. In areas with sufficient iodine intake, additional iodine supplementation is generally not recommended for patients with Hashimoto’s or hypothyroidism. In fact, excessive iodine intake can potentially exacerbate autoimmune thyroid conditions and worsen hypothyroidism in some individuals. Small amounts of supplementary iodine (250 micrograms) have been shown to cause slight but significant changes in thyroid hormone function in predisposed individuals. For this reason, patients with Hashimoto’s or hypothyroidism are often advised to be cautious with iodine intake and should only use iodine supplements under the guidance of a healthcare professional.
Selenium
Selenium, a trace element, is crucial for the proper functioning of selenoproteins, which play important roles in thyroid hormone metabolism and the body’s antioxidant defense systems. Selenium may help reduce antibody levels in some patients with Hashimoto’s thyroiditis when taken as selenomethionine at doses of around 200 mcg per day, and not exceeding 400 mcg from all sources.
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Vitamin D
Vitamin D supplementation has shown promising effects in managing Hashimoto’s thyroiditis and hypothyroidism. Studies have demonstrated that vitamin D can help reduce thyroid peroxidase antibodies (TPO-Ab) levels, elevated in autoimmune Hashimoto’s patients. This reduction in antibodies may help modulate the autoimmune response and potentially slow the progression of the disease. Vitamin D supplementation for periods longer than 12 weeks has also been associated with improved thyroid function, including increases in free T3 and free T4 levels. While vitamin D alone may not reverse HT or cure hypothyroidism, it appears to play a significant role in supporting thyroid health and function.
Magnesium
Magnesium, though less studied in relation to Hashimotto’s and hypothyroidism, is also an essential nutrient for thyroid health. Magnesium deficiency is common in individuals with thyroid disorders and can exacerbate symptoms of hypothyroidism. This mineral is crucial in converting T4 to the more active T3 hormone, and adequate magnesium levels are necessary for optimal thyroid function. While there is less direct evidence for magnesium supplementation in treating Hashimoto’s or hypothyroidism compared to vitamin D, ensuring sufficient magnesium intake through diet or supplementation may support overall thyroid health and potentially enhance the effectiveness of thyroid hormone replacement therapy. It’s important to note that both vitamin D and magnesium supplementation should be done under medical supervision, as excessive intake can lead to adverse effects.
Ashwagandha
Ashwagandha, an herb commonly used in Ayurvedic medicine, has shown potential benefits for thyroid function in some studies. A small clinical trial found that taking 600 mg of ashwagandha root extract daily for 8 weeks significantly improved thyroid hormone levels in people with subclinical hypothyroidism. The study showed increases in triiodothyronine (T3) and thyroxine (T4) levels, as well as a decrease in thyroid-stimulating hormone (TSH), suggesting ashwagandha may help normalize thyroid indices. This effect is thought to be related to ashwagandha’s ability to reduce cortisol levels and stimulate the endocrine system.
However, for those with Hashimoto’s thyroiditis, the most common cause of hypothyroidism, ashwagandha is often not recommended. Hashimoto’s is an autoimmune condition, and ashwagandha has immune-stimulating properties that could potentially worsen the autoimmune response. Additionally, ashwagandha may interact with thyroid medications, so individuals taking synthetic thyroid hormones should consult their healthcare provider before using this supplement. While ashwagandha shows promise for supporting thyroid function in some cases of subclinical hypothyroidism, its use in treating diagnosed hypothyroidism or Hashimoto’s requires careful consideration and medical supervision.
Curcumin and anti-inflammatory herbs
Curcumin, the active compound found in turmeric, has emerged as a potent anti-inflammatory agent with significant potential for treating Hashimoto’s thyroiditis and hypothyroidism. Research has shown that curcumin can help reduce inflammation, support thyroid function, and modulate the immune system. Its anti-inflammatory properties are particularly beneficial in addressing the chronic inflammation associated with autoimmune thyroid conditions. Additionally, curcumin has been found to have antioxidant, antibacterial, and antiviral activities, which can further support overall thyroid health.
When combined with other anti-inflammatory herbs, curcumin’s effects can be even more pronounced. For instance, resveratrol, derived from Japanese knotweed, has been found to work synergistically with curcumin to dampen pathways that activate TH-17, an immune system component implicated in autoimmune diseases. This combination has shown promise in protecting thyroid tissue from inflammation and damage. Other herbs with anti-inflammatory properties, such as those found in traditional Chinese medicine formulations like Yiqi Huayu Recipe and Liqi Xiaoying decoction, have also effectively reduced thyroid antibodies and alleviated symptoms associated with Hashimoto’s. These herbal approaches offer a complementary or alternative treatment option for individuals with thyroid conditions, potentially improving clinical symptoms and thyroid function without significant side effects.
Exercise for thyroid health
While exercise benefits everyone, hypothyroid patients must be mindful of the type and intensity. Strength training is particularly beneficial, as it helps combat muscle weakness and fatigue, both common in hypothyroidism. Moderate-intensity aerobic exercise like walking or cycling supports cardiovascular health without overtaxing the system. High-intensity exercise, however, may increase cortisol levels, which could further disrupt thyroid function. Patients are encouraged to start slowly, gradually increasing the duration and intensity of their workouts.
Stress management techniques
Chronic stress has a profound impact on thyroid health due to its effect on cortisol levels, which can suppress thyroid hormone production. Techniques such as mindfulness, meditation, yoga, and breathwork have significantly reduced stress and promoted overall well-being. Mindfulness-based stress reduction (MBSR) is one method that has gained recognition for its ability to decrease inflammatory markers and improve resilience in chronic illness management, including hypothyroidism.
Sleep optimization strategies
Sleep is crucial for those with hypothyroidism, as poor sleep quality can exacerbate fatigue, brain fog, and mood disturbances. Recent studies highlight sleep hygiene practices, including keeping a consistent sleep schedule and creating a relaxing bedtime routine. These practices can significantly improve sleep quality. For those struggling with sleep, melatonin supplements have shown promise in regulating the sleep-wake cycle and reducing symptoms like insomnia.
The future of Hashimoto’s and hypothyroidism treatment lies in addressing challenges and capitalizing on emerging research. The critical areas of focus include:
- Precision medicine: Developing tools and algorithms to predict individual patient responses to different treatment modalities, allowing for more personalized and effective care.
- Advanced diagnostics: Investing in research to identify new biomarkers and diagnostic techniques to provide a more comprehensive picture of thyroid function and autoimmune activity.
- Novel drug delivery systems: Exploring innovative methods to deliver thyroid hormones more effectively, such as the slow-release T3 formulations currently under development.
- Immunomodulatory therapies: Further investigating the potential of targeted immunotherapies to address the underlying autoimmune process in Hashimoto’s thyroiditis.
- Regenerative medicine: Continuing research into thyroid organoids and other regenerative approaches that could potentially restore normal thyroid function.
- Large-scale clinical trials: Conducting comprehensive, long-term studies to evaluate the efficacy and safety of new treatment approaches across diverse patient populations.
As research into hypothyroidism and Hashimoto’s advances, patients have a growing range of treatments and interventions at their disposal to better resolve hypothyroid symptoms and normalize thyroid function. Standard medication options are evolving, and new approaches such as combination therapy, dietary adjustments, and targeted supplements are providing patients with better symptom control.
The field is also moving towards more personalized treatment strategies, considering individual patient characteristics, genetic factors, and responses to therapy. While many of these newer approaches are still in the research phase, they represent exciting possibilities for the future of Hashimoto’s and hypothyroidism treatment.
If you’re a patient with Hashimoto’s thyroiditis, work closely with your healthcare provider to stay informed about the latest treatment options and determine the most appropriate approach for your individual needs. As research progresses, we can expect to see continued refinement of existing treatments and the development of new therapies that target the underlying mechanisms of autoimmune thyroid disease.
Paloma Health is committed to staying at the forefront of research and innovation in Hashimoto’s and hypothyroidism treatments, ensuring our patients receive the most current and effective care. With a specialized focus on thyroid health, Paloma’s health care providers emphasize an evidence-based approach, continuously reviewing new studies, clinical trials, and advancements in treatment options. This dedication to staying informed allows Paloma Health members to provide cutting-edge treatment protocols, including adjustments in medication options, supplement recommendations, lifestyle changes, and holistic approaches tailored to your unique needs.
With these advancements, consider becoming a Paloma patient, so you can be at the forefront of the latest and best treatment options for Hashimoto’s and hypothyroidism, leading to better thyroid health and an improved quality of life.
Dr Goggin has been excellent. After one visit, she put me on a blended dosage or Armour Thyroid and Levothyroxine and by the next checkup, all of my levels were finally normal. I wish I had done this years ago!
Jeremy D
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