A Functional Approach to Hashimoto’s
Functional medicine takes the whole person into account when treating disease, and the case of autoimmune disease is no different. Because of the complexities of autoimmune disease development, we must carefully and systematically address the different contributing factors, like peeling layers of an onion. This blog highlights the general framework we follow when taking a functional approach to Hashimoto’s.
Address the gut
If you are at all familiar with functional medicine, you probably won’t be surprised that a large part of any therapeutic plan focuses on restoring the gut. Remember, more than two-thirds of the immune system is in the gut, so those with autoimmune disease must address this critical component of health. Studies have shown increased intestinal permeability in Hashimoto’s patients when compared to controls1 and a significantly increased relative abundance of pathogenic bacteria and a decreased proportion of beneficial bacteria in people with autoimmune thyroid disease (ATD).2 The goal is to identify and correct any gut dysfunction and dysbiosis. You can read more about the link between intestinal permeability and Hashimoto’s here.
Gut testing, or stool testing, is currently the most comprehensive way to get a glimpse into what is going on in the gut. Results show levels of beneficial bacteria, opportunistic bacteria, fungi, parasites, viruses, autoimmune triggers, and intestinal health markers related to digestion, inflammation, and immunity. The provider can then personalize a therapeutic plan based off an individual’s results that corrects and heals the gut using food, herbs, supplements, and medication if needed.
Inflammation is a common thread between most chronic diseases, including Hashimoto’s. There are many sources of inflammation so it’s important to work with a provider to identify yours in order to calm it. Sources of systemic inflammation include highly-processed foods, food sensitivities or intolerances (these can include “healthy” foods), obesity, chronic stress, environmental toxins, gut infections, dysbiosis, and more.
There are many lifestyle modifications one can make that help reduce systemic inflammation. Going on an elimination diet and cutting out inflammatory foods will not only benefit the gut but will also lower inflammation. Other things to address include healthy weight loss, incorporating stress management practices, reducing environmental toxin exposure (this past blog contains some lifestyle strategies to reduce your toxin burden), regular physical activity, removing toxic relationships, and taking certain supplements (when appropriate).
Stress does a number on the thyroid. It suppresses release of thyrotropin-releasing hormone (TRH) and thyroid stimulating hormone (TSH), while also decreasing the production of thyroid hormone from the thyroid gland.3 Furthermore, chronically elevated cortisol, the stress hormone, decreases the amount of free, active thyroid hormone.4 Because the HPA axis (our stress management system!) and the thyroid are intertwined, when one experiences dysfunction, the other may suffer. Incorporating stress-relieving practices into your regular routine is critical to regulating the HPA axis and the thyroid cascade. To read more about quieting the stress response, you can visit our blog post Flip the Switch on Stress: Simple Ways to Nurture your Body.
Correct nutrient depletions
Certain vitamins and nutrients are needed for proper thyroid function and hormone production.
In functional medicine, we prefer to start with food as medicine, but when that is not enough, supplementation may be necessary. A provider may empirically recommend certain supplements to support a low functioning thyroid and/or advise testing to look at nutrient levels. There are a few reputable companies that offer micronutrient testing that we use at PharmToTable to assess an individual’s specific nutrient levels and make personalized recommendations for dietary and/or supplement changes.
Below are specific thyroid-supporting nutrients and their role in thyroid function.
Selenium concentrations in the thyroid gland are higher than any other tissue in the body. This mineral has antioxidant activity in the thyroid and is essential for thyroid hormone metabolism. Studies in patients with Hashimoto’s already on levothyroxine have shown that supplementing with 200 μg selenomethionine per day decreases thyroid peroxidase antibodies (TPO).5,6
Zinc is needed for over 300 enzymatic reactions in the body. It affects the synthesis of thyroid hormones and is a co-factor (along with selenium) for reactions that convert T4 into T3. A study that looked at zinc and/or selenium supplementation on thyroid function in overweight or obese females with hypothyroidism found supplementation with zinc alone (30 mg zinc as zinc gluconate) and in combination with selenium resulted in increased levels of serum free T3.7
Iron is an important component of TPO which is an enzyme responsible for thyroid hormone biosynthesis. Iron deficiency leads to a reduction in the synthesis of thyroid hormones, increases TSH secretion, and enlarges the thyroid. Up to 60% of patients with hypothyroidism are diagnosed with iron deficiency,8 and those with Hashimoto’s are particularly at risk due to autoimmune gastritis, a common co-morbidity that impairs iron absorption.9 One study, which looked at iron supplementation on thyroid function in iron-deficient girls, found that those receiving iron supplementation (300 mg ferrous sulfate 5 times/week for 12 weeks), had a significant increase in total thyroxine (TT4) and total triiodothyronine (TT3), and a significant decrease in reverse triiodothyronine (rT3).10
Iodine, an essential component of thyroid hormones, is a bit controversial when it comes to thyroid health. Interestingly, both iodine deficiency and excess can lead to thyroid disorders. A deficiency of iodine leads to goiter which releases thyroid antigens and may result in the presence of thyroid antibodies. On the other hand, excess iodine for long periods of time can induce autoimmune thyroiditis.11 Main sources of iodine are seafood, iodized salt, and supplementation. It’s important to have adequate levels of selenium which helps neutralize the free radicals released by the processing of iodine.
Vitamin D is critical for immune function, which is imbalanced in those with Hashimoto’s and other autoimmune disease. Lower vitamin D levels have been found in those with autoimmune thyroid diseases when compared to healthy controls12 and vitamin D deficiency is correlated to the presence of antithyroid antibodies and abnormal thyroid function tests.13 It’s advised to have your vitamin D level checked and to supplement if needed. Levels above 30 ng/ml are considered sufficient but levels between 40-50 ng/ml may be more appropriate for those with autoimmune conditions.
There are other nutrient deficiencies that influence thyroid function disturbances and are worth mentioning. Vitamins A and C, B vitamins, and magnesium, which all play some part in immune function and/or metabolism, have been found in those with AITD. Other deficiencies include protein and minerals (phosphorus, potassium, sodium, chromium).8
Additional thyroid support
Ashwagandha is an herb known as an adaptogen meaning it helps the body adapt to physiological and psychological stress.14 It possesses many beneficial health effects including anti-inflammatory, anti-stress, anti-diabetic, neuroprotective, immunoprotective and cardioprotective effects.15 One study in patients with subclinical hypothyroidism found that 8 weeks of treatment with ashwagandha (600 mg daily) improved serum TSH, T3, and T4 levels significantly compared to placebo.16 Ashwagandha is generally well-tolerated when taken orally, with the most common adverse effects being GI upset.14
Black cumin seed oil
Nigella Sativa, also known as black cumin or black seed, is a medicinal plant known for itsantioxidant, anti-inflammatory, and immunomodulatory effects. In one study of patients with Hashimoto’s, treatment with 2 g Nigella sativa for 8 weeks showed a decrease in both TSH and anti-TPO antibodies and an increase in T3 compared to placebo.17 Black seed may increase the risk of bleeding so caution is advised in those with a bleeding disorder or those on antiplatelet or anticoagulant drugs.18
There are many layers to address when working to identify and correct underlying causes of disease, including Hashimoto’s, but the payoff is immeasurable. Working with someone knowledgeable about functional and lifestyle to address the factors mentioned above can help prevent further damage to the thyroid, restore function, minimize symptoms and even put autoimmune disease into remission for some.
Our pharmacists at PharmToTable specialize in functional medicine using a lifestyle-based approach and we also have health coaches on our team who can help you make changes towards improving your health. We’d be honored to help you on the journey of improving your thyroid health. Book an appointment or schedule a free 15-minute discovery call today!
**Monday, February 28, 2022, is our last Table Talk session that we will be focusing on the book Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause by Izabella Wentz, PharmD. This is a great way to learn more about thyroid disease, listen to our pharmacists share ways to improve thyroid health, and get your health questions answered. Join us here for our thyroid health Table Talk and get your first 2 sessions FREE!
- Ihnatowicz P, Drywień M, Wątor P, Wojsiat J. The importance of nutritional factors and dietary management of Hashimoto’s thyroiditis. Ann Agric Environ Med. 2020;27(2):184-193. doi:10.26444/aaem/112331.
- Gong B, Wang C, Meng F, Wang H, Song B, Yang Y, Shan Z. Association Between Gut Microbiota and Autoimmune Thyroid Disease: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021 Nov 17;12:774362. doi: 10.3389/fendo.2021.774362. PMID: 34867823; PMCID: PMC8635774.
- Sapolsky RM, Krey LC, McEwen BS. The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocr Rev. 1986;7(3):284-301
- Steingold KA, Matt DW, DeZiegler D, Sealey JE, Fratkin M, Reznikov S. Comparison of transdermal to oral estradiol administration on hormonal and hepatic parameters in women with premature ovarian failure. J Clin Endocrinol Metab. 1991;73(2):275-280.
- Duntas L. H., Mantzou E., Koutras D. A. Effects of a six month treatment with selenomethionine in patients with autoimmune thyroiditis. European Journal of Endocrinology. 2003;148(4):389–393.
- Turker O., Kumanlioglu K., Karapolat I., Dogan I. Selenium treatment in autoimmune thyroiditis: 9-month follow-up with variable doses. The Journal of Endocrinology. 2006;190(1):151–156. doi: 10.1677/joe.1.06661.
- Mahmoodianfard S, Vafa M, Golgiri F, Khoshniat M, Gohari M, Solati Z, Djalali M. Effects of Zinc and Selenium Supplementation on Thyroid Function in Overweight and Obese Hypothyroid Female Patients: A Randomized Double-Blind Controlled Trial. J Am Coll Nutr. 2015;34(5):391-9. doi: 10.1080/07315724.2014.926161. Epub 2015 Mar 11. PMID: 25758370.
- Kawicka A, Regulska-Ilow B, Regulska-Ilow B. Metabolic disorders and nutritional status in autoimmune thyroid diseases. Postepy Hig Med Dosw (Online). 2015;69:80-90. Published 2015 Jan 2. doi:10.5604/17322693.1136383
- 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.
- Eftekhari MH, Eshraghian MR, Mozaffari-Khosravi H, Saadat N, Shidfar F. Effect of iron repletion and correction of iron deficiency on thyroid function in iron-deficient Iranian adolescent girls. Pak J Biol Sci. 2007;10(2):255-260. doi:10.3923/pjbs.2007.255.260
- Rayman, M. (2019). Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society, 78(1), 34-44. doi:10.1017/S0029665118001192
- Ma J, Wu D, Li C, et al. Lower Serum 25-Hydroxyvitamin D Level is Associated With 3 Types of Autoimmune Thyroid Diseases. Medicine (Baltimore). 2015;94(39):e1639. doi:10.1097/MD.0000000000001639
- Kivity S, Agmon-Levin N, Zisappl M, et al. Vitamin D and autoimmune thyroid diseases. Cell Mol Immunol. 2011;8(3):243-247. doi:10.1038/cmi.2010.73
- Ashwagandha. Natural Medicines Comprehensive Database. TRC Healthcare; Updated December 10, 2021.Accessed February 16, 2022. https://naturalmedicines.therapeuticresearch.com
- Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya S. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial. J Int Soc Sports Nutr. 2015;12:43. Published 2015 Nov 25. doi:10.1186/s12970-015-0104-9
- Sharma A, Basu I, Singh S. Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. 2018. https://doi.org/10.1089/acm.2017.0183
- Farhangi MA, Dehghan P, Tajmiri S, Abbasi MM. The effects of Nigella sativa on thyroid function, serum Vascular Endothelial Growth Factor (VEGF) – 1, Nesfatin-1 and anthropometric features in patients with Hashimoto’s thyroiditis: a randomized controlled trial. BMC Complement Altern Med. 2016;16(1):471. Published 2016 Nov 16. doi:10.1186/s12906-016-1432-2
- Black Seed. Natural Medicines Comprehensive Database. TRC Healthcare; Updated October 14, 2021. Accessed February 16, 2022. https://naturalmedicines.therapeuticresearch.com