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Hypothyroidism

Hypothyroidism happens when your thyroid gland, located at the front of your neck, does not produce enough thyroid hormone (underactive thyroid). There are several types of hypothyroidism. The most common is Hashimoto's thyroiditis, an autoimmune disease where the immune system mistakenly attacks the thyroid gland. The disease affects both sexes and all ages, but is most common in women over age 60. Because the thyroid gland helps regulate your metabolism, low thyroid levels cause your body to slow down, affecting everything from appetite to body temperature. Symptoms can appear over time and can be hard to diagnose. Left untreated, hypothyroidism can cause serious health complications.

People who have hypothyroidism may be at increased risk for other chronic conditions including heart disease, arthritis, age-related macular degeneration, and cognitive impairment.

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Signs and Symptoms

• Slow pulse
• Fatigue
• Hoarse voice, slowed speech
• Goiter (caused by swollen thyroid gland)
• Sensitivity to cold
• Weight gain
• Constipation
• Dry, scaly, thick, coarse hair
• Numbness in fingers or hands
• Confusion, depression, dementia
• Headaches
• Menstrual problems
• In children, slowed growth, delayed teething, and slow mental development

What Causes It?

There are different kinds of hypothyroidism with different causes. In Hashimoto's thyroiditis, antibodies in the blood mistakenly attack the thyroid gland and start to destroy it. Post-therapeutic hypothyroidism occurs when treatment for hyperthyroidism leaves the thyroid unable to produce enough thyroid hormone. And hypothyroidism with goiter happens when you do not get enough iodine in your diet. In the developed world iodine is added to salt so goiter is rare, although it still happens in undeveloped countries.

What to Expect at Your Doctor's Office

Your thyroid gland produces two main thyroid hormones, T3 and T4. In addition, the pituitary gland produces thyroid-stimulating hormone (TSH), which helps control how much T3 and T4 the thyroid makes. Your health care provider will draw blood to measure TSH levels. When thyroid hormones are low, your body produces more TSH to increase production of thyroid hormones. Your doctor may also test your levels of T3 or T4.

Natural medicine practitioners may pay particular attention to levels of T3 hormone. T3 is the active form of thyroid hormone. Your thyroid gland makes some T3, but the body also converts T4 into T3. If you are unable to convert T4 to T3, your laboratory tests for T4 may be normal, but you still may have all the symptoms of hypothyroidism. Talk to your doctor about including T3 laboratory tests in your treatment.

Treatment Options

Drug Therapies

Your health care provider will prescribe a synthetic thyroid hormone called levothyroxine (Levothroid, Synthroid, or Unithroid) that you will take daily. A natural dessicated thyroid hormone drug, made from the thyroid glands of pigs, is also available by prescription. Your doctor will want to adjust your dose over a period of several weeks, after regular blood tests to check the amount of thyroid hormone in your blood. Correcting hypothyroidism improves cardiovascular risk factors.

Complementary and Alternative Therapies

If you have hypothyroidism, you need conventional medical treatment. Nutrition and herbs can help support conventional treatment, but should not be used by themselves to treat hypothyroidism. Studies show, for example, that practicing yoga can help hypothyroid patients manage disease-related symptoms.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), fresh vegetables, and sea vegetables.
• Avoid overconsuming foods that can potentially interfere with thyroid function, including broccoli, cabbage, brussels sprouts, cauliflower, kale, spinach, turnips, soybeans, peanuts, linseed, pine nuts, millet, cassava, and mustard greens. These foods are healthful in general, so do not avoid them completely. Everything is reasonable in moderation.
• If you take thyroid hormone medication, talk to your doctor before eating soy products. There is some evidence soy may interfere with the absorption of thyroid hormone.
• Taking iron supplements may interfere with the absorption of thyroid hormone medication, so ask your doctor before taking iron.
• Eat foods high in antioxidants, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
• Avoid alcohol and tobacco. Talk to your doctor before increasing your caffeine intake, as caffeine impacts several conditions and medications.

These supplements may also help:

• Omega-3 fatty acids, such as fish oil. To help reduce inflammation and enhance immunity. Omega-3 fatty acids may increase the risk of bleeding, especially if you already take blood-thinning medication. Ask your doctor before taking omega-3 fatty acids if you take blood thinners such as warfarin (Coumadin), or if you have a bleeding disorder.
• L-tyrosine. The thyroid gland combines tyrosine and iodine to make thyroid hormone. If you are taking prescription thyroid hormone medication, you should only take L-tyrosine under the direction of your doctor. DO NOT take L-tyrosine if you have high blood pressure or have symptoms of mania. Tyrosine may interact with Levodopa.
• DO NOT take an iodine supplement unless directed to by your doctor. Iodine is only effective when hypothyroidism is caused by iodine deficiency, which is rare in the developed world. Too much iodine can actually cause hypothyroidism.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. You may use herbs may as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures singly or in combination as noted.

Few herbs have been studied for treating hypothyroidism. More research is needed.

• Coleus (Coleus forskohlii). For low thyroid function. Coleus may interfere with certain medications, including some blood pressure medicines, nitrogylcern, and blood-thinning medications, such as warfarin (Coumadin). Talk to your doctor.
• Guggul (Commiphora mukul). For low thyroid support. Guggul may interfere with estrogen, birth control pills, and other medications. Guggul may have an estrogen-like effect on the body and may not be appropriate for people with certain hormone-related conditions. Talk to your doctor.
• Bladderwrack (Fucus vesiculosus). For low thyroid support. DO NOT take bladderwrack unless directed by your doctor. Bladderwrack contains iodine. Although lack of iodine can cause hypothyroidism, most cases of hypothyroidism in the developed world are not caused by iodine deficiency. In fact, too much iodine can actually cause hypothyroidism. Bladderwrack may also contain toxic heavy metals, interfere with pregnancy and fertility, and interact with blood-thinning medications, such as warfarin (Coumadin) among others.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

Contrast hydrotherapy (application of hot and cold) to the neck and throat may stimulate thyroid function. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times for 1 set. Do 2 to 3 sets per day.

Acupuncture

Acupuncture may be helpful in correcting hormonal imbalances, including thyroid disorders.

Following Up

After you start on thyroid hormone replacement therapy, your provider will frequently monitor its effectiveness. It is especially important to have your thyroid levels tested during pregnancy, as your needs tent to increase by about 30% when you are expecting. Over replacement is common, and may increase the risk of other conditions, such as atrial fibrillation and osteoporosis.

Supporting Research

Abrahamsen B, Jorgensen HL, Laulund AS, et al. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register-based time-resolved cohort analysis. J Bone Miner Res. 2015;30(5):898-905.

Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012; 7:97-111.

Bromfield S, Keenan J, Jolly P, McGwin G. A suggested association between hypothyroidism and age-related macular degeneration. Curr Eye Res. 2012;37(6):549-52.

Busnelli A, Somigliana E, Benaglia L, Sarais V, Ragni G, Fedele L. Thyroid axis dysregulation during in vitro fertilization in hypothyroid-treated patients. Thyroid. 2014;24(11):1650-5.

Carayanniotis G. Recognition of thyroglobulin by T cells: the role of iodine. Thyroid. 2007;17(10):963-73.

Conrad SC, Chiu H, Silverman BL. Soy formula complicates management of congenital hypothyroidism. Arch Dis Child. 2004 Nov;89(11):1077.

Deyneli O, Akpinar IN, Mericliler OS, Gozu H, Yildiz ME, Akalin NS. Effects of levothyroxine treatment on insulin sensitivity, endothelial function and risk factors of atherosclerosis in hypothyroid women. Ann Endocrinol (Paris). 2014;75(4):220-6.

Ferri FF. Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Kennedy RL, Malabu UH, Jarrod G, Nigam P, Kannan K, Rane A. Thyroid function and pregnancy: before, during, and beyond. J Obstet Gynaecol. 2010;30(8):774-83.

Khandelwal D, Tandon N. Overt and subclinical hypothyroidism: who to treat and how. Drugs. 2012;72(1):17-33.

Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-35.

Leung AM, Pearce EN, Braverman LE. Iodine nutrition in pregnancy and lactation. Endocrinol Metab Clin North Am. 2011;40(4):765-77.

Lomenick JP, El-Sayyid M, Smith WJ. Effect of levo-thyroxine treatment on weight and body mass index in children with acquired hypothyroidism. J Pediatr. 2008;152(1):96-100.

Lynn WR, Lynn JA. Hypothyroidism is easily overlooked. Practitioner. 2007;251(1699):61-2, 64-5, 67.

Messina M, Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid. 2006 Mar;16(3):249-58.

Resta F, Triggiani V, Barile G. Subclinical hypothyroidism and cognitive dysfunction in the elderly. Endocr Metab Immune Disord Drug Targets. 2012;12(3):260-7.

Sathyapalan T, Manuchehri AM, Thatcher NJ, et al. The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2011;96(5):1442-9.

Scherer T, Wolf P, Winhofer Y, et al. Levothyroxine replacement in hypothyroid humans reduces myocardial lipid load and improves cardiac function. J clin Endocrinol Metab. 2014;99(11):E2341-6.

Schomburg L. Selenium, selenoproteins, and the thyroid gland: interactions in health and disease. Nat Rev Endocrinol. 2011;8(3):160-71.

Singh P, Singh B, Dave R, Udainiya R. The impact of yoga upon female patients suffering from hypothyroidism. Complement Ther Clin Pract. 2011;17(3):132-4.

Speeckaert MM, Speeckaert R, Wierckx K, Delanghe JR, Kaufman JM. Value and pitfalls in iodine fortification and supplementation in the 21st century. [Review]. Br J Nutr. 2011;106(7):964-73.

Swami G, Singh S, Singh KP, Gupta M. Effect of yoga on pulmonary function tests of hypothyroid patients. Indian J Physiol Pharmacol. 2010;54(1):51-6.

Thvilum M, Brandt F, Brix TH, Hegedus L. A review of the evidence for and against increased mortality in hypothyroidism. Nat Rev Endocrinol. 2012;8(7):417-24.

Triggiani V, Iacoviello M, Monzani F, et al. Incidence and prevalence of hypothyroidism in patients affected by chronic heart failure: role of amiodarone. Endocr Metab Immune Disord Drug Targets. 2012;12(1):86-94.

Triggiani V, Tafaro E, Giagulli VA, et al. Role of iodine, selenium and other micronutrients in thyroid function and disorders. Endocr Metab Immune Disord Drug Targets. 2009 Sep;9(3):277-94. Review.

Vanderpas J. Nutritional epidemiology and thyroid hormone metabolism. Annu Rev Nutr. 2006;26:293-322.

Velija-Asimi Z, Karamehic J. The effects of treatment of subclinical hypothyroidism on metabolic control and hyperinsulinemia. Med Arh. 2007;61(1):20-1.

Visser TJ. The elemental importance of sufficient iodine intake: a trace is not enough. Endocrinology. 2006;147(5):2095-7.

Wu P. Thyroid disorders and diabetes. It is common for a person to be affected by both thyroid disease and diabetes. Diabetes Self Manag. 2007;24(5):80-2, 85-7.

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Review Date: 4/27/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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