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Remission in Hashimoto’s Disease and Hypothyroidism

What does remission mean for hypothyroidism and Hashimoto’s disease, and how can you achieve it?
Remission in Hashimoto’s Disease and Hypothyroidism
Last updated:
8/27/2024
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Those of us with Hashimoto’s or hypothyroidism know that while a “cure” is the holy grail, it’s far more realistic to aim for remission. Is remission possible in Hashimoto’s or hypothyroidism? And if so, what do you need to do to reach this goal? In this article, we look at the issue of remission in Hashimoto’s and hypothyroidism.

What does “remission” mean?

Generally, the term “remission” means that the signs and symptoms of a disease have decreased, reduced in intensity, or disappeared. It doesn’t mean that a disease is officially considered cured or won’t recur again in the future. Rather, remission implies that the situation is temporary and the disease is not actively causing symptoms or diagnosable using laboratory tests.

For hypothyroidism, remission includes relief from symptoms as well as:

  • Thyroid Stimulating Hormone (TSH) levels in the reference range (also known as the “normal range”) 
  • Free Thyroxine (Free T4) levels in the reference range
  • Free Triiodothyronine (Free T3) levels in the reference range

For Hashimoto’s disease to be considered in remission, in addition to relief from symptoms – and thyroid hormone levels including TSH, Free T4, and Free T3 in the reference range – the Thyroid Peroxidase Antibody (TPOAb) levels also need to fall within the reference range.

Is remission possible for Hashimoto’s and hypothyroidism?

There’s good news! If you have Hashimoto’s and/or hypothyroidism, remission is possible. The challenge is that remission takes time, requires trial-and-error approaches, and isn’t always entirely achievable.

But even if you don’t achieve full remission by laboratory measurement, there’s no question that it can be worthwhile to try. Following a program designed to achieve remission helps to address the root causes of the thyroid disease, can often help improve your symptoms of Hashimoto’s and hypothyroidism, and, ultimately, improve your thyroid health, well-being, and quality of life!

Typically, a protocol for Hashimoto’s/hypothyroidism remission includes any or all of the following approaches:

Let’s look at each of these components.

Finding your optimal thyroid hormone replacement dose

A crucial first step is optimizing your thyroid hormone replacement treatment. Research shows that being on thyroid hormone replacement can help slow or stop thyroid destruction in patients with Hashimoto’s and lower thyroid antibodies.

The impact of changing your diet

Various dietary changes have been found to help reduce thyroid antibodies and autoimmunity and help put Hashimoto’s into remission. These include:

Gluten-free diet: Eliminating all gluten and wheat products from the diet can, according to research, reduce thyroid antibody levels significantly. However, the effect is not immediate, and studies show that the results are often evident after six or more months following a gluten-free approach to eating.

Paleo diet: According to research, a Paleo diet appears to significantly reduce symptoms, lower antibodies, and improve TSH, Free T4, and Free T3 levels. In an informative Speaker Series video, Paloma discussed the benefits of the Paleo diet for people with Hashimoto’s and hypothyroidism.

Autoimmune Protocol (AIP) diet: The AIP diet also can reduce thyroid antibodies and improve TSH, Free T4, and Free T3 levels, according to research. To learn more about the Autoimmune Protocol (AIP) diet, the Paloma blog has an excellent overview article: What Is The Autoimmune Protocol (AIP) Diet?

For additional information, it’s helpful to read Paloma’s article, “What Is The Best Diet For Hypothyroidism?”

## 5-day meal plan

Supplements to support and consider

Numerous studies have shown that supplementation with Vitamin D may help slow down the progression of Hashimoto’s, reduce TPOAb levels, and improve overall thyroid function. The end result is an improvement – or even remission – in Hashimoto’s and hypothyroidism. A good starting point to learn more about Vitamin D and thyroid function is the Paloma article on the “Relationship Between Low Vitamin D And Hypothyroidism.”

Selenium

According to numerous studies, selenium supplementation can reduce TPOAb levels and, in some cases, normalize thyroid function in people with borderline or subclinical hypothyroidism. According to recent research, selenium supplementation can also enhance the effect of vitamin D on thyroid autoimmunity. For more information on the benefits of selenium for thyroid patients, read Paloma’s Quick Guide: Selenium.

Iodine

Iodine deficiency can contribute to hypothyroidism. So in some patients whose borderline or subclinical hypothyroidism is caused by a lack of this essential nutrient, supplementing with iodine can return thyroid levels to normal and result in remission. You can learn more at the Paloma blog, in “The Iodine Hypothyroidism Connection,” and “Iodine Intake And The Risk Of Hypothyroidism: What You Need To Know.” You may also want to download a copy of the Paloma Quick Guide: Iodine.

Iron

The body needs iron to convert T4 into the active thyroid hormone, T3. If you don’t have enough iron, this can cause – or worsen – hypothyroidism.

Some studies have found that correcting and normalizing low iron may be the only treatment necessary to reverse some thyroid conditions and achieve remission. One study, in particular, looked at patients – half had normal iron levels, and the other half were deficient in iodine. Among them, more than half had subclinical or overt hypothyroidism. After supplementing with iron, the treated patients went into remission and had normal thyroid levels.

For more information on the benefits of iron supplementation for patients with Hashimoto’s and hypothyroidism, read “Iron Deficiency, Anemia, And Hashimoto’s Hypothyroidism.”

Low Dose Naltrexone (LDN)

The prescription medication known as Low Dose Naltrexone (LDN) has been shown anecdotally to reduce thyroid antibodies and symptoms in some patients. To learn more about LDN therapy for Hashimoto’s, check out Paloma’s article: “Low-Dose Naltrexone For Hashimoto’s” and a helpful Speaker Series video on “LDN for Hashimoto’s and Hypothyroidism.”

A note from Paloma

A starting point on the road to remission is finding a healthcare provider who knows how to optimize your hypothyroidism treatment. Paloma’s thyroid-savvy practitioners have demonstrated expertise in diagnosing hypothyroidism and prescribing effective treatments. Paloma doctors across the nation have successfully worked with many hypothyroid patients to achieve remission or resolve persistent hypothyroidism symptoms and improve their quality of life, using the full range of thyroid treatment options.

Monitoring improvements on the way to remission also involves regular blood tests to evaluate thyroid function. One convenient way to get your thyroid tested is with the Paloma Complete Thyroid Blood Test kit. The affordable and convenient at-home thyroid test kit from Paloma comes with everything you need to test Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPO). You also have the option to add on tests for Reverse T3 (RT3) and Vitamin D.

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References:

Liu J, Chen Z, Liu M, Jia Y, Yao Z, Wang G. Levothyroxine Replacement Alleviates Thyroid Destruction in Hypothyroid Patients With Autoimmune Thyroiditis: Evidence From a Thyroid MRI Study. Frontiers in Endocrinology. 2019;10. doi:10.3389/fendo.2019.00138‌ https://www.frontiersin.org/articles/10.3389/fendo.2019.00138

Hollywood JB, Hutchinson D, Feehery-Alpuerto N, Whitfield M, Davis K, Johnson LM. The Effects of the Paleo Diet on Autoimmune Thyroid Disease: A Mixed Methods Review. J Am Nutr Assoc. 2023 Jan 4:1-10. doi: 10.1080/27697061.2022.2159570. Epub ahead of print. PMID: 36598468.
https://pubmed.ncbi.nlm.nih.gov/36598468/

Krysiak R, Szkróbka W, Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto's Thyroiditis: A Pilot Study. Exp Clin Endocrinol Diabetes. 2019 Jul;127(7):417-422. doi: 10.1055/a-0653-7108. Epub 2018 Jul 30. PMID: 30060266.
https://pubmed.ncbi.nlm.nih.gov/30060266/

Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis. Cureus. 2019 Apr 27;11(4):e4556. doi: 10.7759/cureus.4556. PMID: 31275780; PMCID: PMC6592837.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592837/

Krysiak R, Szkróbka W1, Okopien B. The Effect of Vitamin D on Thyroid Autoimmunity in Levothyroxine-Treated Women with Hashimoto's Thyroiditis and Normal Vitamin D Status. Exp Clin Endocrinol Diabetes. (2017) 125:229–233. doi: 10.1055/s-0042-123038
https://pubmed.ncbi.nlm.nih.gov/28073128/

Gorini F, Sabatino L, Pingitore A, Vassalle C. Selenium: An Element of Life Essential for Thyroid Function. Molecules. 2021 Nov 23;26(23):7084. doi: 10.3390/molecules26237084. PMID: 34885664; PMCID: PMC8658851.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658851/

Krysiak R, Kowalcze K, Okopień B. Selenomethionine potentiates the impact of vitamin D on thyroid autoimmunity in euthyroid women with Hashimoto’s thyroiditis and low vitamin D status. Pharmacol Rep. 2019 Apr;71(2):367-373. doi: 10.1016/j.pharep.2018.12.006. Epub 2018 Dec 14. PMID: 30844687.
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Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto’s Thyroiditis. Thyroid. 2017 May;27(5):597-610. doi: 10.1089/thy.2016.0635. Epub 2017 Apr 6. PMID: 28290237.
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Demir C, Gökdeniz E, Dilek İ. The effects of iron deficiency anemia on the thyroid functions. Journal of Clinical and Experimental Investigations. 2010;1(3). doi:10.5799/ahinjs.01.2010.03.0033
https://www.jceionline.org/article/the-effects-of-iron-deficiency-anemia-on-the-thyroid-functions-3153

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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