How Hashimoto's Thyroiditis Is Treated

Hashimoto's thyroiditis, also known as Hashimoto's disease, 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.

Treatment Considerations

Hashimoto's disease can cause two types of hypothyroidism—overt and subclinical—and most people with either type have Hashimoto's. Whether you have overt or subclinical hypothyroidism will likely affect your treatment plan.

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. Treatment is always necessary for this condition.

Symptoms of Hypothyroidism

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.

Treatment for subclinical hypothyroidism is a controversial topic because experts can't agree on what the high end of a "normal" TSH level entails. 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 sticky.

The TSH Test and Its Controversies

Hashimoto's Disease Without Hypothyroidism

Hashimoto's disease doesn't always cause hypothyroidism, but 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 for your thyroid is unnecessary.

How Hashimoto's Disease Is Diagnosed

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.

Brand Name vs. Generic Levothyroxine

Subclinical Hypothyroidism

Treatment recommendations vary for subclinical hypothyroidism, depending on your TSH level, age, and other factors. Remember, 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 percent to 55 percent 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 present, an indication of Hashimoto's disease.
  • Subclinical hypothyroidism may be associated with a higher risk of heart disease, such as heart attack, heart failure, coronary artery disease, stroke, and atherosclerosis, a condition that causes plaque to build up and harden in your arteries. This risk is even higher when your TSH level is above 10.0 mIU/L.

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

So far, the 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 or 70 years old.

TSH of 7.0 to 9.9 mIU/L

Treatment with levothyroxine may be appropriate for people under the age of 65 to 70 years old with a TSH level in this range, especially considering the potential link between subclinical hypothyroidism and heart disease. For patients who are 65 to 70 years or older, prescribing levothyroxine is usually only considered when they also have hypothyroid symptoms.

TSH of 4.5 to 6.9 mIU/L

Again, 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 to 70 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 to 70 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.

How Thyroid Challenges Can Affect Pregnancy

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

Liotrix

This synthetic thyroid hormone replacement is a combination of T4 and T3 in one pill that goes by the brand name Thyrolar. The ratio of levothyroxine (T4) to liothyronine (T3) is 4:1.

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. Like liotrix, 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.

Taking T3 or Natural Desiccated Thyroid Drugs

The Need for Close Monitoring

A major part of your treatment plan will be regular follow-ups with your doctor 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 popping supplements, it's important to be aware of potential interactions and overdoses.

If you're taking supplements, whether on your own or because your doctor has recommended them, your doctor will most likely need to keep a closer eye on your thyroid hormone levels since taking specific types can result in needing less 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. Since having a selenium deficiency seems to make autoimmune thyroid disease worse, you may want to have your doctor check your level if this hasn't been done already.

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 doctor check your selenium level before you start taking selenium supplements.

Selenium and Your Thyroid

Iodine

Like selenium, the majority of people living in the United States don't have an iodine deficiency. However, some may due to dietary restrictions, an iron deficiency, or medication use. If your doctor thinks you may be iodine-deficient, you'll likely have a urine test to check it out. Your doctor 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.

Make sure you talk to your doctor 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 doctor'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 thyroiditis 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. Talk to your doctor about testing your iron level if it hasn't been checked already.

Iron and Your Thyroid

Vitamin D

Research has shown that vitamin D deficiency is more common in people who have autoimmune thyroid disease—Hashimoto's thyroiditis 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 doctor 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 D and Your Thyroid

Vitamin B12

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

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 foods 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 doctor before you start using them to be on the safe side.

How to Choose the Right Probiotic for You

Complementary Alternative Medicine (CAM)

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.

Getting Started With Yoga

Involve Your Doctor

It's vitally important that you talk to your doctor 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 doctor 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.

If You're Hypothyroid, You May Want to Limit Goitrogenic Foods

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.

Exercising With Thyroid Disease

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.

Stress Management Techniques

A Word From Verywell

There are an overwhelming number of options for treating the hypothyroidism that often results from Hashimoto's disease, as well as treating the symptoms that accompany it. Be sure to talk to your doctor about any treatments you're considering that he or she hasn't recommended in order to make sure that you aren't going to end up doing harm instead of good. And if you don't feel that you can have that kind of conversation with your doctor, it may be time to find a new one with whom you can be open and honest.

Was this page helpful?
Article Sources