Thyroid Disease: Getting to the Root of the Problem

A whole health approach to treating thyroid conditions

Thyroid problems affect tens of millions of people worldwide, including more than 20 million Americans.  In the US, an estimated one in four women over age 30 has a thyroid imbalance, and nearly 45% of people over 50 have some degree of thyroid gland inflammation, an early warning sign of a potential thyroid imbalance.

The thyroid is a small, butterfly-shaped gland in the lower front part of the neck that secretes hormones that control how the body uses energy. The thyroid hormones affect nearly every organ in the body and are responsible for regulating important functions such as childhood growth, the body’s metabolism and body temperature, and important neurotransmitters in the brain.

The two most common thyroid imbalance issues are hypothyroidism (an underactive thyroid)—when the thyroid does not make enough thyroid hormones—and hyperthyroidism (an overactive thyroid)—when the thyroid makes more thyroid hormones than the body needs.

Symptoms of hypothyroidism can include weight gain, fatigue, brain fog, depression, dry skin or hair, and frequently feeling cold. An estimated one-third of all depressions are directly related to thyroid imbalance. Nearly 5% of the US population over the age of 11 has hypothyroidism, and women are much more likely than men to develop this condition.

Hashimoto’s disease, the most common cause of hypothyroidism in the United States, is an autoimmune disorder that causes the immune system to attack the thyroid, resulting in a damaged thyroid that cannot make enough thyroid hormones. Hashimoto’s can occur at any age but most commonly appears between ages 40 and 60. It is eight times more common in women than men and can be passed on genetically. In addition, having one autoimmune disorder makes it ten times more likely another, such as thyroid disease, will develop.

In the US, an estimated one in four women over age 30 has a thyroid imbalance.

Symptoms of hyperthyroidism include feeling nervous or jittery, sleeplessness, rapid heartbeat, weight loss, and frequently feeling hot. About 1 in 100 Americans have hyperthyroidism, which, if left untreated, can cause serious problems with the heart, bones, muscles, eyes, and fertility. 

Graves’ disease, the most common cause of hyperthyroidism in the US, is an autoimmune disorder that causes the immune system to attack the thyroid, causing it to make more thyroid hormone than the body needs. Graves’ disease can occur at any age but usually affects people aged 30 to 50. Like Hashimoto’s, Graves’ disease is about seven times more common in women than men and has the same genetic and comorbidity risk factors.

Researchers believe autoimmune disorders such as Hashimoto’s disease are caused by a combination of genes and an outside trigger, such as a virus. Some other underlying causes of thyroid dysfunction include nutrient deficiencies, environmental toxins, and chronic stress. A recent study found that stress on the gastrointestinal system, in the form of ulcerative colitis, can trigger thyroid dysfunction. This finding suggests that other gastrointestinal imbalances could be a source of thyroid dysfunction.

Many symptoms of thyroid conditions are similar to other diseases, so thyroid problems are often misdiagnosed or overlooked all together. As many as 50% of people with thyroid problems do not realize they have a thyroid disease.

Physicians most commonly assess levels of TSH, or thyroid stimulating hormone, to diagnose the condition. The TSH test measures the thyroid levels indirectly, because TSH is a hormone produced by the pituitary gland, the gland that stimulates the thyroid if it detects underactivity. If the pituitary gland produces too much TSH, it is inferred that the thyroid is not functioning properly. TSH results can be influenced by a variety of outside factors, such as stress levels, time of day blood is drawn, and what has been eaten prior to testing. Also, the reference scale for determining normal levels of TSH may not be precise enough to detect thyroid issues in everyone. This scale was adjusted in recent years to be more accurate, but it is thought that this discrepancy resulted in millions of missed hypothyroid diagnoses.

The functional and naturopathic approach to thyroid treatment considers the whole person.

The functional or naturopathic medicine approach to diagnosing thyroid disorders takes a more comprehensive view, typically not relying on a single TSH test but on a panel of tests that assess how the body is functioning with its current supply of thyroid hormone. These tests include measurements of the actual thyroid hormones themselves (Free T3 and Free T4) as well as inactive hormones (reverse T3) that may provide context of thyroid function. If these main thyroid hormones are not in balance, thyroid imbalance symptoms may occur. The panel of tests may also include levels for thyroid antibodies, an iron profile, adrenal cortisol, liver function tests, vitamin levels, sex hormone levels, and a complete blood count and metabolic profile.

Once diagnosed, thyroid imbalances are often effectively treated with thyroid medication, of which there are many, but these may have unpleasant side effects. Calculating the correct dosage can be tricky and requires regular blood tests to ensure medications are not over- or under-correcting the problem. These drugs do not address the root cause of the imbalance and may lead to other health problems in the long run.

The functional and naturopathic approach to thyroid treatment considers the whole person, recognizing that imbalances in one part of the body can cause problems elsewhere. These practitioners will try to diagnose and address the root causes of the thyroid dysfunction. In the case of Hashimoto’s, there may be inflammation in the body that is causing an increase in symptoms. Factors that are evaluated include stress levels, gut health, toxins, infections, food sensitivities, and inflammatory foods.

Dr. Izabella Wentz, PharmD, a leading thyroid expert, was herself diagnosed with Hashimoto’s. After being told she would need lifelong thyroid medication, she decided to follow a functional medicine protocol. With these carefully researched dietary changes, lifestyle strategies, and appropriate supplementation, she was able to successfully reverse the condition.

Factors that are evaluated include stress levels, gut health, toxins, infections, food sensitivities, and inflammatory foods.

In 2020, Dr. Wentz conducted a survey of 2,232 people with Hashimoto’s to evaluate the impact of various functional interventions and identified key areas for successfully managing Hashimoto’s disease: stress, diet, supplements, and lifestyle changes.

Stress

Managing stress levels is a critical component of a healthy immune system. When stress levels are high, the body shifts from a state of rest (or a parasympathetic state) to a “fight or flight” state (a sympathetic state). This shift causes the brain to signal the adrenal glands to pump out stress hormones. When the stress becomes chronic, the body loses its ability to regulate this system, which can result in adrenal fatigue and inflammation, which are often associated with Hashimoto’s disease.

For optimal thyroid health, patients are advised to avoid stressors as much as possible and incorporate relaxing activities such as yoga, meditation, journaling, and affirmations into the daily routine. Dr. Wentz suggests looking for ways to reduce stressful commitments, find ways to add laughter and joy to your life, and consider taking adaptogen herbs such as ashwagandha or rhodiola rosea (also known as golden rod) to combat stress.

Sleep is an important part of managing stress and is essential for overall well-being. Experts recommend getting 7 to 9 hours of sleep per night, and trying to stick to a regular bedtime to support the sleep cycle. A nighttime ritual such as stretching, meditating, or a cup of tea before bed can help calm the mind and aid with sleep.

Diet

Dr. Wentz says, “Nutrition is a key piece in healing Hashimoto’s,” and her research shows that gluten is one of the biggest triggers of the common symptoms. A sensitivity to gluten was reported by 76% of those who took her survey, and only 8% of respondents did not believe themselves to be gluten sensitive. Of the respondents that adopted a gluten-free diet, 88% reported feeling better. Only 3.5% of survey respondents were diagnosed with celiac disease, which Wentz found notable because it confirmed to her that gluten-free diets may benefit more people than those with celiac disease.

Other diets can also help with Hashimoto’s. Of the survey respondents, 81% of those who tried a sugar-free diet, a Paleo diet, or a grain-free diet reported feeling better, while 79% of those who removed dairy from their diet felt better. Respondents reported certain foods—including corn, gluten, dairy, eggs, sugar, and soy—were more likely to trigger symptoms.

The Autoimmune Protocol diet, or AIP, is an elimination diet that has shown promise in treating Hashimoto’s symptoms. A modified version of the Paleo diet, the AIP diet eliminates grains along with other common food triggers that cause inflammation, such as dairy, eggs, soy, legumes, nightshades, sugar, alcohol, and caffeine, as well as highly processed foods, vegetable oils, and additives that may disrupt the gastrointestinal barrier, leading to autoimmunity. In addition, seaweed and other iodine-rich foods should be avoided as they tend to exacerbate thyroid disease.

A small study of women with Hashimoto’s disease who followed an AIP diet over ten weeks showed a statistically significant improvement in health-related quality of life measures and a significant improvement in clinical symptoms such as joint pain, headaches, sleep quality, energy, mood, and cognitive function. The participants also saw a significant 29% decrease in inflammation as measured by c-reactive protein blood tests. Interestingly, the study did not find statistically significant changes in any measure of thyroid function, but the changes in the subjects’ white blood cell counts suggest the AIP diet may decrease systemic inflammation and modulate the immune system. About half of the participants who were on thyroid replacement medication reported decreasing their dose after the 10-week intervention.

“Nutrition is a key piece in healing Hashimoto’s”

The downside of the AIP diet is that it may be difficult to implement, due to its restrictive nature. However, Dr. Wentz encourages people to “take baby steps” if necessary, by removing one food group at a time to ease into the transition. For those taking this approach, she strongly encourages people with Hashimoto’s to begin by removing gluten from the diet. A good rule of thumb for making AIP easier to adhere to is to aim for about 80% vegetables and 20% meat or fish in each meal and drink plenty of filtered water. Dr. Wentz emphasizes the AIP diet is not meant to be a long-term diet; the goal is to reduce inflammation and give the gut a chance to heal. If, after 90 days on the AIP diet, symptoms have not resolved, additional dietary protocols may be recommended, such as a rotation diet, a low-histamine diet, or a low-oxalate diet.

Homemade bone broth, probiotic-rich fermented foods, and green smoothies made of thyroid-friendly ingredients all resulted in improvements to well-being in the Wentz respondents. About 75% of respondents reported probiotics improved how they felt.

Supplements

Nutrient deficiencies are common when nutrition is not optimal. Of the Wentz survey respondents, 68% had low levels of vitamin D, and about a third were deficient in vitamin B12 and ferritin, all of which are vital nutrients for thyroid function. Taking supplements can help restore nutrient levels and reverse symptoms associated with Hashimoto’s, such as fatigue. Dr. Wentz’s respondents overwhelmingly reported an improvement in fatigue after taking certain supplements, including D3 (67%), B12 (88%), and iron/ferratin (82%). Other supplements that respondents found beneficial were digestive enzymes, omega-3 fatty acid, selenium, betaine with pepsin, curcumin, zinc, and L-glutamine. In addition, studies have shown Coenzyme Q10, the herb rosemary, chromium, potassium, and ashwagandha may improve thyroid function.

Magnesium is a nutrient that supports adrenal function, an area that is often compromised for those with thyroid dysfunction. A team of Austrian researchers found that patients who took a magnesium citrate supplement reduced their TSH levels an average of five points. Patients reported feeling and sleeping better, having more energy, less anxiety, and less constipation after starting magnesium supplementation. After eight months on magnesium supplements, the researchers reported a normalization of thyroid ultrasounds for some of the patients. Food sources of magnesium include green leafy vegetables, whole grains, nuts, beans, legumes, and seeds. As many Hashimoto’s patients exclude some of these foods while following an AIP or paleo diet, a magnesium supplement is recommended.

Some dietary supplements may interfere with the absorption of some medications, so experts advise consulting with a healthcare provider or pharmacist before taking supplements.

Lifestyle and Environmental Factors

Underlying factors such as infection, toxicity, and activity level can all significantly impact thyroid health. Additional lifestyle strategies can improve outcomes for those with thyroid dysfunction.

Toxic build-up can damage the thyroid gland and produce an autoimmune response.

Some infections, such as SIBO, Epstein-Barr virus, mumps, or the flu, can lie dormant in the body for years and be activated under stressful situations, triggering an autoimmune response. Working with a functional medicine or naturopathic doctor can help identify and address these hidden infections that may be responsible for a flare in symptoms.

Environmental toxins such as herbicides, pesticides, heavy metals, and personal care products have all been implicated in inflammation and thyroid-related conditions. Toxic build-up can damage the thyroid gland and produce an autoimmune response. Experts recommend minimizing toxic exposure by using natural personal-care and cleaning products, reducing the use of plastics, eating organic foods when possible, and avoiding smoking or secondhand smoke.

Spending time in nature can reduce toxin levels, and regular exercise supports a healthy immune system. Sauna therapy can help eliminate toxins and improve mood and energy levels. Massage therapy and Epsom salt baths can also improve mood and energy levels and reduce pain.

These whole-person strategies can enable those with thyroid conditions to take control of their health and greatly improve day-to-day life. Dr. JoAnn Yanez, the executive director of the Association of Accredited Naturopathic Medical Colleges, encourages working with a team that includes a licensed functional or naturopathic physician and an endocrinologist to manage thyroid conditions safely.