Hashimoto’s Disease

By Tom Siegenthaler, RPh, DPh, FACA


Hashimoto’s disease is quite simply low thyroid disease or hypothyroidism.  It is a condition in which the body’s immune system attacks the thyroid gland resulting in low thyroid hormone production.  The exact cause or causes of this condition are not known.  Hashimoto’s disease is the most common form of hypothyroidism and affects approximately 14 million people in the United States. It affects women 20 times more than men and the most affected age range is between 36 and 57 years.

Inflammation of the thyroid gland can take place over a very long period of time and may not be diagnosed early on, resulting in a slow gradual progression of symptoms in the patient.   Many times, patients have other auto-immune diseases as well. Normally our body’s immune system is designed to attack viruses or bacteria but in Hashimoto’s, it attacks our thyroid gland.


The diagnosis of Hashimoto’s is made upon a long list of symptoms, blood tests of thyroid hormones and looking at primarily two antibodies: Thyroid Peroxidase Antibody (TPOAb) and Thyroglobulin Antibody (TgAB).  It is important to keep in mind that these two antibodies may be elevated in other autoimmune diseases such as Sjogren’s Syndrome and Rheumatoid Arthritis. Sometimes, the only way to verify it is Hashimoto’s is through a needle biopsy to see if the antibodies are causing the damage to your thyroid.


Thyroid hormones play a role in almost every single function in the human body and the list of symptoms and conditions of low thyroid is very long.  A few of the symptoms and signs are fatigue, constipation, dry skin, joint pain, hair loss, weight gain, brittle nails, increased sensitivity to cold, and prolonged menstrual bleeding.

See your doctor if you experience any of the following: Constipation, dry skin, pale and/or puffy face and suffer from tiredness for no apparent reason.


The treatment of Hashimoto’s disease should be approached from multiple angles and not just one point of attack.  The reason for this is that there is no cure for Hashimoto’s and our best course of action is to mitigate the long-term side effects of low thyroid.

STEP 1: The 4R Program

Positioning our bodies to handle an auto-immune disease is a primary goal.  This can be accomplished by going on an elimination diet and avoid foods that trigger gastrointestinal dysfunction. Gut health is a key to our immune system.  The 4R program of Remove, Replace, Repopulate and Repair developed by Dr. Pamela Wartian Smith, would be a wise course of action for anyone suffering from an auto-immune disease.

Removing the source of the imbalance is the critical first step.  This would include foods you may be allergic to or other pathogenic organisms.

Replacing with hydrochloric acid, digestive enzymes, and herbal therapies is also very important.  Acid is very important in the body.  It has many functions including sterilizing the food you eat, and. Increasing the denaturing of proteins which prepares the protein for breakdown by gastric and pancreatic enzymes.

Repopulate your GI tract with healthy bacteria.  Probiotics are microbial food supplements that beneficially affect your body by improving the intestinal microbial balance.

Repair – There are certain nutrients that will help your GI tract to repair itself.  Glutamine stimulates the intestinal mucosal growth and protects against mucosal atrophy and plays an important role in acid-base balance in the body.  Fasting has also been shown to be helpful in treating leaky gut syndrome.  During fasting the white blood cell activity in the body increases which more effectively removes circulating immune complexes from the body and decreases inflammation and leaky gut syndrome.  Herbal therapies such as quercetin, which is found in onions and blue-green algae has been shown clinically to treat leaky gut syndrome.

STEP 2: Balanced Hormones

Have your hormone levels checked, especially if you are a woman.  High estrogen levels have been associated with thyroid problems in patients.  Estrogen dominance should be checked, and since estrogen levels accumulate in tissues not blood, it is recommended this be done with a salivary test vs a blood test.  Proper estrogen elimination and metabolism is also a key.

STEP 3: Nutritional Supplements

Taking nutritional supplements is important step in addressing low thyroid and Hashimoto’s disease.  Nutritional supplements can help to support the thyroid gland and help to function more efficiently.


Selenium has been shown to decrease TPO antibodies and normalize thyroid levels is some patients.  Selenium suggested dose is 200mcg a day.

B Vitamins

Vitamin B2 (Riboflavin) 50 to 100mg and Vitamin B3 (Niacin) 50 to 100mg a day are beneficial to thyroid functioning and our immune systems.  We can usually take a good pharmaceutical multivitamin or B complex vitamin and get the other benefits from all the B vitamins.


Iodine is necessary for proper thyroid function and is often recommended for patients with low iodine levels.  The thyroid gland uses iodine to make the thyroid hormones.  Supplementation can be done using iodine tablets (Iodoral 12.5mg) or Lugol’s solution at a dose of 2 to 6 drops.  Check with your primary care doctor before adding Iodine to your diet.


Low levels of ferritin should be treated with iron supplementation.  Most often the patients most effected by low iron levels are menstruating women. High levels of ferritin can increase the risk of having heart disease.  Iron supplementation should be based upon blood levels of ferritin.

Zinc and Copper

Zinc and copper help with the synthesis of thyroid hormones and thyroid hormones are needed to absorb these trace minerals. Hair loss has been shown to improve when zinc is added to thyroid medications.  Zinc dosages range from 25 to 50mg a day.  Zinc Picolinate is a better form of zinc to take.  Copper dosages range from 2 to 5mg a day.

DIM (Diindolymethane)

DIM is a form of broccoli and helps with proper metabolism of estrogen.  Estrogen can be metabolized in the human body to several forms, some of which have been shown to be cancer-causing.  It also helps with estrogen dominance.  Estrogen dominance has been thought to increase in Hashimoto’s disease and might be a contributing factor. A good source of this is a product that contains both Indole-3-Carbinol 200mg and DIM 100mg.  Dosage of this is one capsule once or twice a day.  This is very important if a woman is currently taking any kind of estrogen by mouth, especially if they are synthetic estrogens.

Progesterone (Natural Progesterone)

Progesterone taken topically or by mouth a bedtime can help with estrogen dominance and help to normalize estrogen levels.  This applies only to natural progesterone and none of the synthetic progesterone products.  Progesterone topically dosage is usually 20 to 40mg a day, and orally from 50mg to 200mg a day.  Pharmaceutical grade progesterone creams are available over the counter and by prescription.  Do not start using progesterone without consulting with your primary care provider. Oral progesterone is a prescription only item and is available commercially and compounded by compounding pharmacies.  Long acting forms have been shown to be superior to the oil-filled capsules

Treatment with Medication

Thyroid medications are also used in treating Hashimoto’s disease.  Many practitioners feel that replacing a balanced thyroid medication that contains both T3/T4 is a better option for many patients.  Levothyroxine is a synthetic form of thyroid and needs to be converted into T3 to be the active form, most patients feel better taking T3 with T4. Studies have demonstrated that patients do better if they are placed on thyroid supplements that have both T3 and T4. Some commercially available T3/T4 combinations have porcine (from pigs) thyroid in them and studies show it might not be the best form to take for some patients.  Bio-Identical forms of thyroid are available and can be compounded into to any strength.  Once the dosage is reached many of the symptoms are reversed.  There are tests that can be performed to see if the dose is the correct one for you.

Discuss any plans of action with your primary care physician prior to starting any medications, supplements, or extreme dietary changes.

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