If you’ve been diagnosed with hypothyroidism, does this mean you’ll have the condition for the rest of your life? Conventional medicine operates under the belief that hypothyroidism cannot be reversed or cured (but that it can be managed with medication).
However, in functional medicine, we find that with a comprehensive, personalized approach, many patients are able to heal from hypothyroidism.
Here’s where the major disconnect lies between conventional and functional medicine, and not just when it comes to the thyroid.
The general rule in conventional medicine when someone is experiencing health problems or symptoms is to diagnose the disease, and then match the medication to the disease. Following this approach, it’s not surprising that hypothyroidism is thought to be irreversible.
Simply identifying the condition and treating it with thyroid medication may help to manage symptoms, but is not enough to solve the problem. And to be clear, hypothyroidism won’t go away on its own.
But in functional medicine, we go deeper, focusing on treating the root causes of disease. If someone has an underactive thyroid, we are asking the questions: what factors may have caused this? What else is going on in the body? How can we work to repair these underlying issues?
Every hypothyroid case is different, and it’s usually best to work closely with a functional medicine provider who can help you work through a personalized protocol.
In this article, we’ll discuss targeted testing, diet, lifestyle changes, supplements, and pharmaceutical treatment options that may be used in functional medicine to address the source of thyroid dysfunction and, in many cases, resolve it for good.
The Root Causes Of Hypothyroidism
There are a number of layers to look at when it comes to untangling the root causes of hypothyroidism.
The majority (around 90%) of hypothyroidism cases are caused by the autoimmune condition Hashimoto’s, in which the immune system attacks the cells of the thyroid. (1)
Other possible causes include (but are not limited to) under-conversion of the thyroid hormone thyroxine (T4) to the thyroid hormone triiodothyronine (T3), thyroid resistance (an issue with thyroid cell receptors), and dysfunction of the pituitary gland.
Identifying whether the cause of hypothyroidism is an autoimmune disease or a different kind of underlying dysfunction is really just the first step.
If we find that a case of hypothyroidism is caused by an autoimmune condition, the next question is: what’s causing the autoimmune condition? Why is this person’s immune system erroneously attacking the thyroid gland? It’s only by investigating these questions that we can then devise a treatment plan that gets to the core of the problem.
This is the crux of why personalization matters. Conventional medicine treats hypothyroidism the same way no matter what the cause. Functional medicine wants to identify the root cause in order to treat the condition and the person as a whole.
With that in mind, here are a few possible underlying causes of low thyroid levels and hypothyroidism. Note that multiple different causative factors may be at play.
Stress. Elevated levels of the “stress hormone” cortisol may inhibit the conversion of T4 to T3, which can lead to hypothyroidism. (2) Emotional and psychological stress can also increase inflammation, which can lead to thyroid problems. (3, 4)
Nutrient deficiencies. Deficiencies in micronutrients including selenium, iron, vitamin D, copper, and vitamin A can lead to autoimmunity and thyroid hormone imbalances. (5)
Toxin exposure. PFAS chemicals (perfluoroalkyl and polyfluoroalkyl substances, also known as “forever chemicals”) and other toxins can disrupt hormone balance, trigger inflammation of the thyroid and autoimmunity, and contribute to hypothyroidism. (6)
Hormonal imbalances. Our hormones are all connected, and imbalances in thyroid hormone levels can be triggered by other hormonal imbalances. Some of the most common culprits include low estrogen, low testosterone, and insulin resistance. (7)
Gut issues. The majority of the immune system is found in the gut, and any disruption to your gut health can lead to immune system issues, including autoimmune thyroiditis. SIBO and leaky gut (increased intestinal permeability) are two of the biggest issues that we often see being connected to hypothyroidism. (8, 9)
Liver stress. Most of our thyroid hormone conversion from T4 to T3 happens in the liver (some also happens in the gut). Liver problems can disrupt the conversion process, which can lead to hypothyroidism. (10)
Comprehensive testing is important in order to help identify both the nature of the thyroid dysfunction and what may be causing it.
The primary blood tests that are done to diagnose and monitor hypothyroidism look at levels of thyroid-stimulating hormone (TSH), thyroxine (T4), and, less commonly, triiodothyronine (T3).
In functional medicine we look at the same thyroid markers that are looked at in conventional medicine, but we do three key things differently:
We often look at more thyroid markers in order to get a more complete picture of what’s going on.
We use a tighter, narrower reference range, striving to achieve optimal thyroid function rather than just average thyroid function.
We go beyond, with additional testing to identify underlying causes. Depending on the individual, we may recommend testing for hormonal imbalances, gut imbalances, nutritional deficiencies or insufficiencies, and other markers that may help us to understand what’s going on with the whole person.
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Step 1: Dietary Changes
When it comes to healing the root cause of hypothyroidism (or virtually any other chronic illness), diet is an essential and powerful tool.
There are a few different options for thyroid-supportive diets. The two key strategies to keep in mind are to avoid foods that may trigger inflammation, and to boost your intake of nutrients that help with thyroid function.
The Autoimmune Protocol (AIP) diet is a great place to start, especially if your hypothyroidism is autoimmune in nature (i.e. if you have Hashimoto’s disease, the most common cause of hypothyroidism). This is a restrictive but short-term dietary template that works to calm an overactive immune system and help you identify food sensitivities.
Foods to enjoy on the AIP diet include:
Clean animal protein (including poultry, fish, and beef)
Vegetables (EXCEPT for nightshades – see below)
Fruits (except for nightshades) in moderation
Olive oil, avocado oil, and coconut oil
Herbs and spices
Grain-free flours (including those made from almond, coconut, or cassava)
Herbal teas
Bone broth
Dairy alternatives (including ghee and coconut milk)
Foods to avoid on the AIP diet include:
Legumes (including beans, lentils, and chickpeas)
Nightshades (including tomatoes, peppers and eggplant)
Dairy products (including cheese, milk, and butter)
Eggs
Nuts and seeds
Gluten
Gluten-free grains (including rice, quinoa, oats, and corn)
Sugar and artificial sweeteners
Alcohol
Coffee
Seed oils (including canola, sunflower, and vegetable)
This diet is not meant to be followed forever! As you begin to heal, your practitioner will likely recommend that you begin to reintroduce some of the healthy foods on the “avoid” list, keeping an eye out for reactions.
It’s also worth intentionally including foods in your diet that are rich in thyroid-supportive nutrients.
Note that not all of these foods are allowed on an AIP diet (nuts and seeds in particular are to be avoided on the AIP diet, but are also rich in thyroid-supportive nutrients). Again, personalization matters here – depending on your individual case and the root cause of your thyroid disease, your practitioner may recommend avoiding or including certain specific foods.
Here are a few examples of thyroid superfoods:
Iodine-rich foods: Sea vegetables including kelp, nori, dulse, kombu, and arame
Selenium-rich foods: Brazil nuts
Zinc-rich foods: Grass-fed beef, shellfish, nuts, seeds
Vitamin A-rich foods: Grass-fed liver, tuna, sweet potatoes, carrots
Vitamin D-rich foods: Salmon and other fatty fish, beef liver, egg yolks
Step 2: Medication
Medication is often necessary for the management of hypothyroidism and other thyroid disorders, at least until root causes are addressed and thyroid health is restored.
While medications can help to keep symptoms of hypothyroidism and thyroid hormone levels under control (in some cases), they are also essentially acting as a band-aid, and not really fixing the problem. This is why, in functional medicine, when thyroid medication is used it’s just one part of a much more comprehensive strategy.
The most commonly prescribed thyroid medications are synthetic thyroid hormone replacements, primarily Levothyroxine (sold under different brand names, including Synthroid and Levothroid), which is a synthetic version of the hormone T4. (11)
Liothyronine, a synthetic version of T3 most commonly sold under the brand name Cytomel, is less commonly prescribed.
Synthetic medications like Synthroid may help to boost low levels of thyroid hormones, but in some cases they also come with side effects including weight loss, hair loss, headaches, and digestive problems including nausea or diarrhea.
Another option is desiccated thyroid hormone, which is naturally sourced from the thyroid tissue of pigs. Desiccated thyroid hormones naturally contain both T3 and T4, and are preferred by functional medicine practitioners in some (but not all) cases.
Step 3: Lifestyle Changes
There are several lifestyle changes that can make a big difference for your thyroid health.
Getting enough exercise can help to regulate immune system function and reduce inflammation for those with autoimmune conditions, including Hashimoto’s. (12) Some research has also shown that a combination of aerobic and resistance training is especially beneficial for thyroid function. (13) However, it’s important not to overdo it, as working out too hard or too often creates additional stress for your body.
It’s also important to get adequate sleep, and practice mindfulness and healthy stress management. The nervous system plays a massive role in thyroid function. Generally speaking, your goal is to get your body and mind into a balanced, regulated state.
Specific lifestyle changes may be recommended based on what’s causing your thyroid condition.
Step 4: Targeted Dietary Supplements
There are several different kinds of dietary supplements that can help to reduce thyroid inflammation and autoimmunity, optimize thyroid hormone conversion, and improve thyroid health.
Supplements should always be targeted towards the root causes of your individual case for the greatest likelihood of effectiveness.
Here are a few supplements that may be helpful for hypothyroidism:
Iodine. Iodine (which is also found in some foods) is required for the production of thyroid hormones. For those who have low intake of this mineral or an iodine deficiency, iodine supplements may be helpful. However, excess iodine can actually lead to an increase in thyroid antibodies and other negative effects, so it’s important to be cautious with this supplement and only use it if recommended by a trusted healthcare provider. (14)
Selenium. A deficiency in the mineral selenium has also been associated with Hashimoto’s thyroiditis and hypothyroidism, and supplements may help to improve Hashimoto’s and impaired thyroid hormone synthesis. (15)
B vitamins. B vitamins in general may help to support thyroid function. Vitamin B12 and methylfolate (a form of vitamin B9, or folate) in particular can help by supporting healthy methylation, which is essential for our overall hormonal and metabolic function. (16) The Methylator is a comprehensive formula that contains a blend of high quality B vitamins to support methylation.
Vitamin D. Vitamin D is required for the healthy functioning of every cell in the body, and it can also help to lower elevated TSH levels. (17) Most of us don’t get enough vitamin D from sunlight and diet alone, so supplements can help to make up the gap.
Step 5: Peptide Therapy
Peptide therapy, or taking specific, targeted supplemental peptides (small chains of amino acids, the building blocks of proteins), is an increasingly popular approach for everything from boosting longevity to improving brain health.
For some patients with Hashimoto’s and hypothyroidism, peptide therapy may offer various benefits, including helping to repair thyroid tissue, reduce inflammation, and improve symptoms including fatigue and depression. (18)
Peptide therapy isn’t necessary for everyone with hypothyroidism, but it can be a helpful and effective adjunctive treatment in certain cases.
Seek Help From A Functional Medicine Expert
So, is there a “cure” for hypothyroidism? Not exactly, but that doesn’t mean that the condition can’t be reversed with a holistic, multifaceted approach.
I know it can be overwhelming to try to put together all of the pieces of your hypothyroidism puzzle on your own. There is no one-size-fits-all treatment, and everyone has a different combination of underlying causes to address.
Dealing with ongoing symptoms like fatigue, depression, brain fog, dry skin, constipation, high blood pressure, unexplained weight gain, and cold intolerance makes it all the more challenging to dig deep into your health.
A personalized approach really is key, and the best path forward is to work with an experienced functional medicine provider who can help you come up with a comprehensive, but manageable, plan tailored to your individual health profile. To get started, you can book a telehealth consultation with our team – we would be happy to help.
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