How Hashimoto's Disease Is Treated

Table of Contents
View All
Table of Contents

Hashimoto's disease, also known as Hashimoto's thyroiditis, is an autoimmune condition that attacks your thyroid, often resulting in an underactive thyroid (hypothyroidism).

Treatment for this condition depends on whether it has progressed to mild hypothyroidism, known as subclinical hypothyroidism, or overt hypothyroidism. The standard treatment is a daily thyroid hormone replacement, and there are lifestyle changes, supplements, and complementary alternative medicine options to consider as well.

Alternative medicine and lifestyle changes to help manage symptoms of Hashimoto's disease
 Verywell / Ellen Lindner

Considerations

Hashimoto's disease can cause two types of hypothyroidism—overt and subclinical.

Overt Hypothyroidism

You're diagnosed with overt hypothyroidism when your thyroid-stimulating hormone (TSH) level is elevated (generally above 4.5 mIU/L, depending on the laboratory) and your free thyroxine (T4) level is low (under 0.8 ng/dL).

Overt hypothyroidism is typically accompanied by symptoms such as sensitivity to cold, weight gain, enlarged thyroid, and dry skin.

  • When your TSH levels are above 10 mIU/L, treatment with thyroid hormone replacement is required.
  • If your TSH is between 4.5 and 10, it's important to discuss with your healthcare provider whether thyroid hormone replacement would be helpful or not.

Subclinical Hypothyroidism

Subclinical hypothyroidism can cause mild symptoms, but many people have no symptoms at all. It's diagnosed when your TSH level is above normal, but your free T4 level is normal.

Subclinical thyroidisim
Verywell / Emily Roberts

Treatment for subclinical hypothyroidism is a controversial topic because TSH level doesn't always correlate well with symptoms or prognosis. If your TSH level is 10.0 mIU/L or higher, most experts agree that treatment is necessary. It's when your TSH is above the normal range (usually around 4.6) but less than 10.0 mIU/L that things get harder to classify.

Hashimoto's Disease Without Hypothyroidism

Hashimoto's disease doesn't always cause hypothyroidism. The majority of people with this condition have thyroid peroxidase (TPO) antibodies present in their blood.

You may have TPO antibodies present with normal TSH and free T4 levels, which shows that your thyroid is functioning as it should. The presence of these antibodies indicates that you may have Hashimoto's disease, but that you don't have hypothyroidism.

In this case, treatment with thyroid hormone is unnecessary, but there are things you can do to possibly improve the underlying thyroid autoimmune condition:

  • Minimizing or eliminating gluten intake
  • Avoiding nicotine (even second-hand exposure)
  • Consuming 100-200 mcg of selenium per day
  • Boosting your omega-3 fatty acids intake
  • Keeping your vitamin D level in the normal range

Prescriptions

The standard treatment for hypothyroidism is synthetic thyroxine (T4), but there are other options for specific situations.

Levothyroxine (T4)

Synthetic thyroxine (T4), generically known as levothyroxine with brand names Synthroid, Tirosint, Levothroid, Levo-T, Levoxyl, and Unithroid, is typically the only necessary treatment for hypothyroidism.

This medication is generally taken once a day, every day, usually for the rest of your life, in order to supplement your thyroid's inability to make enough hormones and put a stop to your hypothyroid symptoms. It may take some trial and error to find the right dose for you.

Subclinical Hypothyroidism

Treatment recommendations vary for subclinical hypothyroidism, depending on your TSH level, age, and other factors. In subclinical hypothyroidism, your free T4 level is normal.

TSH of 10.0 mIU/L or Greater

In people with TSH levels that are 10.0 mIU/L or above, treatment with levothyroxine is recommended by most experts, including the American Thyroid Association (ATA), for a couple of reasons, including:

  • Studies have found that around 33 to 55% of people with subclinical hypothyroidism go on to develop overt hypothyroidism. Your chances of overt hypothyroidism increase when your TSH level is higher than 12.0 to 15.0 mIU/L and you also have TPO antibodies.
  • Subclinical hypothyroidism may be associated with a higher risk of heart diseases, such as atherosclerosis (a condition in which plaque builds up in the arteries), heart attack, heart failure, coronary artery disease, and stroke. This risk is even higher when your TSH level is above 10.0 mIU/L.

Taking levothyroxine may slow down or halt progression into overt hypothyroidism, as well as decrease your risk of heart disease.

So far, research has found that treating subclinical hypothyroidism in patients whose TSH is under 10.0 mIU/L doesn't improve any hypothyroid symptoms they may have all that much. However, it does seem to help reduce the risk of heart disease and overall mortality in people under the age of 65 years old.

TSH of 7.0 to 9.9 mIU/L

Treatment with levothyroxine may be appropriate for people under the age of 65 with a TSH level in this range, especially considering the potential link between subclinical hypothyroidism and heart disease.

For patients who are 65 and older, levothyroxine is usually only prescribed when they also have hypothyroid symptoms.

TSH of 4.5 to 6.9 mIU/L

The upper limit of the normal range of TSH depends both on the testing laboratory and on which expert you talk to, but is generally around 4.5 mIU/L. In people under the age of 65 whose TSH falls in this range, treatment with levothyroxine may be helpful if they also have symptoms of hypothyroidism, an enlarged thyroid (goiter), and/or high levels of TPO antibodies.

Treatment usually isn't necessary for those who are 65 years or older because TSH levels tend to increase with age even in people with normal thyroid function.

Untreated Patients

For those people with subclinical hypothyroidism whose TSH falls in the 4.5 to 9.9 mIU/L range but who don't need levothyroxine, the ATA recommends close monitoring to check TSH and free T4 levels regularly (usually yearly).

Attempting Pregnancy

For women with subclinical hypothyroidism who are having problems with infertility and/or are trying to get pregnant, the ATA recommends treatment with levothyroxine if your TSH is above 2.5.

Liothyronine (T3)

Most people respond well to levothyroxine, so the ATA doesn't advise that people routinely add triiodothyronine (T3), called Cytomel (liothyronine), to their daily dose of T4. However, adding T3 can be helpful for people who still have hypothyroid symptoms while taking T4, such as:

  • Those who've had part or all of their thyroid removed, known as a thyroidectomy
  • People who've had their thyroid treated with radioactive iodine therapy
  • Those whose T3 level is at or below the normal range

Desiccated Thyroid Extract

Made from the thyroids of pigs, desiccated thyroid extract is a natural combination of T4 and T3, rather than synthetic like the other options. It goes by the brand names Armour Thyroid, Nature-Throid, NP Thyroid, and WP Thyroid, and it's available only by prescription. The ratio of T4 to T3 is 4:1.

Desiccated thyroid is an old treatment that was used for decades before levothyroxine came out. It isn't recommended by the ATA, but some experts believe that it's a good alternative for people who aren't responding well to levothyroxine alone or a combination of synthetic T4 and T3.

The Need for Close Monitoring

A major part of your treatment plan will be regular follow-ups with your healthcare provider to test your TSH and free T4 to make sure that your medication is keeping your thyroid hormone levels within normal ranges and that your symptoms are well-controlled.

Supplements

Making sure you're getting adequate levels of various nutrients can help in managing your hypothyroid symptoms. But before you start taking supplements, it's important to be aware of potential interactions and overdoses.

If you're taking supplements, whether on your own or because your healthcare provider has recommended them, your healthcare provider will most likely need to keep a closer eye on your thyroid hormone levels since can affect your required doses of thyroid hormone replacement.

Be wary of supplements that claim to support thyroid function such as kelp, bovine thyroid extracts, and herbal preparations, as these can interact with your medication.

Selenium

Though selenium deficiency is rare in the United States due to our selenium-rich soil, it's still a possibility, especially if you have digestive issues, human immunodeficiency virus (HIV), you're undergoing kidney dialysis, or you've had gastric bypass surgery. Selenium deficiency can make some autoimmune thyroid disease worse, so you may want to ask your healthcare provider check your level if this hasn't been done already.

1:33

What is Selenium and How Does It Work?

There's no official recommendation for selenium supplementation in people with autoimmune thyroid disease, but research has shown that it lowers TPO antibody levels. Selenium supplements may also help pregnant women who have TPO antibodies avoid developing thyroiditis in the postpartum period.

Though selenium supplements may be helpful when your selenium level is low, if it's normal to high, taking selenium supplements could lead to an overload.

This toxicity has a whole host of unpleasant symptoms ranging from garlicky-smelling breath to hair and nail loss and skin lesions, which is why you should have your healthcare provider check your selenium level before you start taking selenium supplements.

Iodine

Like selenium, the majority of people living in the United States don't have an iodine deficiency. However, some may have low iodine levels due to dietary restrictions, an iron deficiency, or medication use.

If your healthcare provider thinks you may be iodine-deficient, you'll likely have a urine test to check it out. Your healthcare provider may put you on iodine supplements for a short period of time if you're found to have an iodine deficiency since this causes thyroid dysfunction.

Iodine supplementation should be at 100 mcg per day, or 250 mcg per day during pregnancy.

Make sure you talk to your healthcare provider before you take iodine supplements. Too much iodine in a short amount of time when you're hypothyroid can actually lead to an overactive thyroid (hyperthyroidism) and/or make your condition worse, so it's important that you only take these with your healthcare provider's approval.

Iron

Scientific studies have found that lower iron levels are linked to an increased prevalence of subclinical hypothyroidism and lower levels of T4 and T3. Because Hashimoto's disease is an autoimmune disease, you're also at higher risk of developing other autoimmune conditions, including celiac disease and autoimmune gastritis, both of which can impair iron absorption.

Low iron levels are associated with persistent symptoms in people who are being treated for hypothyroidism, and several studies have shown that adding iron supplementation to levothyroxine treatment can more effectively help relieve symptoms. Iron supplements should be taken at least 4 hours away from thyroid medication to avoid interactions. Talk to your healthcare provider about testing your iron level if it hasn't been checked already.

Vitamin D

Research has shown that vitamin D deficiency is more common in people who have autoimmune thyroid disease—Hashimoto's disease or Graves' disease—and may even contribute to these diseases developing. Studies have also found that vitamin D supplements may significantly reduce TPO antibodies and thyroglobulin (Tg) antibodies.

Like all the supplements discussed here, the research regarding vitamin D's effect on the thyroid isn't definitive, and having too much in your body can lead to toxicity. Talk to your healthcare provider about checking your vitamin D level to see if you're deficient and need to take a supplement or increase your intake of vitamin D-rich foods.

Vitamin B12

There may be a link between vitamin B12 deficiency and autoimmune thyroid disease as well, so talk to your healthcare provider about testing your B12 level and taking supplements, if needed.

A note about taking multivitamins or B-complex supplements: Be sure to avoid biotin (sometimes found in multivitamins) for at least three days before any thyroid blood tests, as biotin can interfere with the thyroid assay.

Probiotics

Because hypothyroidism slows down your digestive system, which can lead to constipation, diarrhea, gas, and bloating, adding probiotics may not be a bad idea. Probiotics are found in food and supplements and contain a good type of bacteria or yeast that help balance your digestive system and boost your immune system. They don't appear to affect your thyroid hormone levels but talk to your healthcare provider before you start using them to be on the safe side.

Complementary Alternative Medicine

Complementary alternative medicine (CAM) should never be used as the only means to treat an underactive thyroid, but it can be used in conjunction with your medication to help relieve your symptoms.

Acupuncture

The use of acupuncture to help treat a variety of health conditions has evidence of at least some effectiveness for 117 different medical conditions and moderate to strong evidence for 46 of those conditions. This evidence comes from a 2017 summary of nearly 1,000 systematic reviews of acupuncture performed by the Acupuncture Evidence Project.

Considered to be a safe procedure as long as you go to a trained professional, acupuncture may help with some of your hypothyroid symptoms like constipation, insomnia, and depression.

Yoga

A small 2016 study looked at 22 women taking levothyroxine for hypothyroidism who did yoga for an hour, four times a week, for six months. The researchers found that at the end of the trial period, the women's cholesterol levels were significantly lower, their TSH levels were slightly lower, and that the yoga may have reduced how much levothyroxine the women required.

Though more research needs to be done on the effectiveness of yoga for hypothyroidism, it doesn't hurt to give yoga a try as long as you don't have any medical conditions that prevent you from doing it. At the very least, yoga can boost your mood, improve your sleep, and help you relax.

Involve Your Healthcare Provider

It's vitally important that you talk to your healthcare provider if you're using or considering using CAM or supplements, even if you think they're safe.

Not only can some of these methods interfere with the effectiveness of your treatment, but many of them aren't regulated by the government like standard treatments are. Your healthcare provider can help you navigate the waters and answer questions you may have about CAM and supplements.

Home Remedies and Lifestyle

Along with taking your medication to regulate your thyroid hormones, you can implement some lifestyle changes that may help you prevent other medical conditions, reduce stress, lose or maintain weight, and feel your best.

Healthy Diet

Eating plenty of fruits, vegetables, and whole grains for your overall health is recommended for just about everyone, and people with hypothyroidism are no exception.

However, you do need to be careful when it comes to foods that contain goitrogens, most of which are cruciferous vegetables like broccoli, cauliflower, cabbage, and kale. Ingesting large amounts of goitrogens regularly can slow down your thyroid and/or create swelling in your thyroid called a goiter.

Talk to your healthcare provider also about the connection between gluten and thyroid issues—going gluten-free may be helpful in some situations.

Exercise

Regular exercise not only improves your general health, but it can also help relieve hypothyroid symptoms like fatigue, lack of energy, sleep problems, low mood, sluggish metabolism, and bone loss. It can also lower your risk of developing heart disease, which is important since having hypothyroidism increases your risk.

Stress Management

Stress can exacerbate your hypothyroid symptoms, so it's important to find healthy ways to cope and to minimize your stress. Make time for doing activities that you enjoy. Ask for help if you need it. When you're feeling stressed, try meditation, journaling, painting, listening to music, deep breathing, taking a bubble bath, calling a friend, or going for a walk.

A Word From Verywell

There is an overwhelming number of options for treating Hashimoto's disease hypothyroidism, as well as treating the symptoms that accompany it. Be sure to talk to your healthcare provider about any supplementary treatments you're considering that they haven't recommended in order to make sure that you aren't going to end up doing harm instead of good.

Frequently Asked Questions

  • Are there foods you shouldn’t eat if you have Hashimoto disease?

    Avoiding raw cruciferous vegetables and soybean-derived foods is often suggested because they contain goitrogens that interfere with the thyroid.A gluten-free diet may be beneficial in some cases due to potential interactions with thyroid medication, so some healthcare providers recommend avoiding gluten.

  • Do I need to take hormones for Hashimoto disease?

    If your blood tests show that your thyroid hormones are deficient, your healthcare provider will recommend thyroid hormone replacement, usually levothyroxine taken daily. However, you may have Hashimoto and have normal hormone levels, which means you might not need medication.

Was this page helpful?
38 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2019 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/

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

  3. Chakera AJ, Pearce SH, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilitiesDrug Des Devel Ther. 2012;6:1–11. doi:10.2147/DDDT.S12894

  4. Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocr Pract. 2013 Jan-Feb;19(1):175]. Endocr Pract. 2012;18(6):988-1028. doi:10.4158/EP12280.GL

  5. Gosi SKY, Garla VV. Subclinical Hypothyroidism. [Updated 2019 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536970/

  6. Promberger R, Hermann M, Ott J. Hashimoto's thyroiditis in patients with normal thyroid-stimulating hormone levels. Expert Rev Endocrinol Metab. 2012;7(2):175-179.

  7. Tipu HN, Ahmed D, Bashir MM, Asif N. Significance of Testing Anti-Thyroid Autoantibodies in Patients with Deranged Thyroid ProfileJ Thyroid Res. 2018;2018:9610497. Published 2018 Apr 11. doi:10.1155/2018/9610497

  8. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacementThyroid. 2014;24(12):1670–1751. doi:10.1089/thy.2014.0028

  9. Fu A, Zhou R, Xu X. The synthetic thyroid hormone, levothyroxine, protects cholinergic neurons in the hippocampus of naturally aged miceNeural Regen Res. 2014;9(8):864–871. doi:10.4103/1673-5374.131602

  10. Tng EL. The debate on treating subclinical hypothyroidismSingapore Med J. 2016;57(10):539–545. doi:10.11622/smedj.2016165

  11. Ross, MD Douglas. Subclinical hypothyroidism in nonpregnant adults. UpToDate. uptodate.com 2019.

  12. Suh S, Kim DK. Subclinical Hypothyroidism and Cardiovascular DiseaseEndocrinol Metab (Seoul). 2015;30(3):246–251. doi:10.3803/EnM.2015.30.3.246

  13. Kim MI. Hypothyroidism in the Elderly. [Updated 2017 Mar 15]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279005/

  14. Knobel M. Which Is the Ideal Treatment for Benign Diffuse and Multinodular Non-Toxic Goiters?Front Endocrinol (Lausanne). 2016;7:48. Published 2016 May 23. doi:10.3389/fendo.2016.00048

  15. Baumgartner C, da Costa BR, Collet TH, et al. Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial FibrillationCirculation. 2017;136(22):2100–2116. doi:10.1161/CIRCULATIONAHA.117.028753

  16. Maraka S, Singh Ospina NM, Mastorakos G, O'Keeffe DT. Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How?J Endocr Soc. 2018;2(6):533–546. Published 2018 May 3. doi:10.1210/js.2018-00090

  17. Celi FS, Zemskova M, Linderman JD, et al. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxineJ Clin Endocrinol Metab. 2011;96(11):3466–3474. doi:10.1210/jc.2011-1329

  18. Padur AA, Kumar N, Guru A, et al. Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic ReviewJ Thyroid Res. 2016;2016:7594615. doi:10.1155/2016/7594615

  19. Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2013;98(5):1982-90.

  20. Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. Thyroid. 2017;27(5):597-610.

  21. Santos LR, Neves C, Melo M, Soares P. Selenium and Selenoproteins in Immune Mediated Thyroid DisordersDiagnostics (Basel). 2018;8(4):70. Published 2018 Oct 4. doi:10.3390/diagnostics8040070

  22. MacFarquhar JK, Broussard DL, Melstrom P, et al. Acute selenium toxicity associated with a dietary supplementArch Intern Med. 2010;170(3):256–261. doi:10.1001/archinternmed.2009.495

  23. Yoon SJ, Choi SR, Kim DM, et al. The effect of iodine restriction on thyroid function in patients with hypothyroidism due to Hashimoto's thyroiditis. Yonsei Med J. 2003;44(2):227-35.

  24. Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N. Chronic anemia and thyroid functionActa Biomed. 2017;88(1):119–127. Published 2017 Apr 28. doi:10.23750/abm.v88i1.6048

  25. Ravanbod M, Asadipooya K, Kalantarhormozi M, Nabipour I, Omrani GR. Treatment of iron-deficiency anemia in patients with subclinical hypothyroidism. Am J Med. 2013;126(5):420-4.

  26. Chahardoli R, Saboor-yaraghi AA, Amouzegar A, Khalili D, Vakili AZ, Azizi F. Can Supplementation with Vitamin D Modify Thyroid Autoantibodies (Anti-TPO Ab, Anti-Tg Ab) and Thyroid Profile (T3, T4, TSH) in Hashimoto's Thyroiditis? A Double Blind, Randomized Clinical Trial. Horm Metab Res. 2019;51(5):296-301.

  27. Ness-abramof R, Nabriski DA, Braverman LE, et al. Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease. Am J Med Sci. 2006;332(3):119-22.

  28. Liu Y, Alookaran JJ, Rhoads JM. Probiotics in Autoimmune and Inflammatory DisordersNutrients. 2018;10(10):1537. Published 2018 Oct 18. doi:10.3390/nu10101537

  29. Brake MK, Bartlett C, Hart RD, Trites JR, Taylor SM. Complementary and alternative medicine use in the thyroid patients of a head and neck practice. Otolaryngol Head Neck Surg. 2011;145(2):208-12.

  30. McDonald J, Janz S. The Acupuncture Evidence Project: A Comparative Literature Review (Revised Edition). Brisbane: Australian Acupuncture and Chinese Medicine Association Ltd; 2017.

  31. Cheng FK. An overview of the contribution of acupuncture to thyroid disorders. J Integr Med. 2018;16(6):375-383.

  32. Nilakanthan S, Metri K, Raghuram N, Hongasandra N. Effect of 6 months intense Yoga practice on lipid profile, thyroxine medication and serum TSH level in women suffering from hypothyroidism: A pilot study. J Complement Integr Med. 2016;13(2):189-93.

  33. 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;11(4):e4556.

  34. Chandra, Amar K. Iodine, thiocyanate and the thyroidBiochem Pharmacol (Los Angel) 4:171. 2015. doi:10.4172/2167-0501.1000171

  35. Masaki M, Koide K, Goda A, Miyazaki A, Masuyama T, Koshiba M. Effect of acute aerobic exercise on arterial stiffness and thyroid-stimulating hormone in subclinical hypothyroidism. Heart Vessels. 2019;34(8):1309-1316.

  36. Markomanolaki ZS, Tigani X, Siamatras T, et al. Stress Management in Women with Hashimoto's thyroiditis: A Randomized Controlled TrialJ Mol Biochem. 2019;8(1):3–12.

  37. Wojtas N, Wadolowska L, Bandurska-Stankiewicz E. Evaluation of qualitative dietary protocol (Diet4hashi) application in dietary counseling in Hashimoto thyroiditis: Study protocol of a randomized controlled trial. IJERPH. 2019;16(23):4841. doi:10.3390/2Fijerph16234841

  38. 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 Jun 19;27(2):184-193. doi:10.26444/aaem/112331

Additional Reading