The 9 Best Supplements for Hashimoto’s Thyroiditis of 2019 (Updated)
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Supplements for Hashimoto’s Thyroiditis to Boost Thyroid Function & Conversion

*Note: This article has been updated on 1/17/2019 to contain new information*

Do you ever get confused with which supplements you should or shouldn't be taking? 

The truth is this:

There are some specific supplements which are VERY helpful to patients with Hashimoto's and Hypothyroidism and there are a lot of others with a bunch of "hype" and no science or legitimacy backing their use. 

Today I want to show you what I consider to be the best supplements for Hashimoto's and hypothyroidism, but more specifically... 

Why I like them. 

Let's look at the facts and the science so you can get on the right track to feeling better and treating your Hashimoto's...

If you want the quick version here are the top supplements I recommend for patients with Hashimoto's in 2019 (keep reading for detailed information on why these are helpful and how to use them)

More...

Not all Supplements are Created Equal

​This should go without saying, but not all supplements are created equal.

Unlike the pharmaceutical industry, the supplement industry is not regulated very well.

As a result, some supplement companies have included sub-par ingredients into their supplements (less biologically active ingredients) and in some cases do not even have the quantities that they claim on the package!

Supplement companies may be lying

​This can be frustrating for patients who don't understand this. 

They get and purchase cheap supplements from places like GNC, Walmart, Target or Walgreens and they don't feel any different after taking them.

Afterward, they feel like supplements either don't work or they are a waste (or both). 

And they are (or rather, they can be). 

Unless you get HIGH-quality ingredients from reputable high-quality brands.

When patients use HIGH-quality supplements that are targeted to their nutritional deficiencies the results can be very impressive. 

In this article, when I make a recommendation you can rest assured that the brands I recommend are high-quality and the same ones that I use in my office. These brands and exact supplements have worked well for me in treating over a thousand patients. 

Your Supplements Should be Targeted to YOUR Body and YOUR Needs

Before we jump into which supplements are the best and why we need to talk about the approach that I take when recommending supplements. 

In general, I don't recommend the shotgun approach.

That is:

Where you take supplements because your friend did or you read online that it helps with every condition under the sun.

Supplements can be very helpful, but they need to be used correctly.

I let a combination of the following guide my judgment when I make supplement recommendations to my patients:

  1. Literary Studies (Meaning have these supplements been shown or proven to actually help reverse disease)
  2. My own personal clinical experience (Meaning do the supplements ACTUALLY work - many supplements show promise in testing and in certain studies but they fall short in clinical practice)
  3. What I've seen works (Including the opinions of other experts and what I've personally seen/used)
  4. What other experts use and recommend​ (With so many supplements it's impossible to know and understand everything about them, but knowing what works with other patients and other providers is very helpful)

This approach makes targeted supplementation a VERY powerful ally when treating Hypothyroidism and Hashimoto's. 

The "Basic" Supplements Every Hashimoto's Patient should Consider Using

In my office, I use a Comprehensive Functional Blood Chemistry Panel to find nutrient deficiencies in EACH patient. 

And this is the ideal approach. 

However, it isn't always necessary. 

Sometimes, certain nutrient deficiencies can be assumed based on your symptoms. Other times you can order direct labs to assess nutrient status. 

In some cases (such as Zinc and Selenium), the best way to test for a deficiency is to use a trial of the supplement!

When you read through this list keep all of these in mind. 

#1. Zinc

Zinc happens to be one of the top 5 most common nutrient deficiencies among all groups of patients including those with Hashimoto's. 

There is a good chance that your zinc levels are low which means that supplementing may be beneficial for you. 

But before you run out and supplement, you need to first consider the various types of Zinc available. 

Not all formulations of Zinc are equally effective because they are not all equally absorbed.

Studies have shown that Zinc bound to picolinic acid or Citrate (1) have superior absorption when compared to other forms. 

For this reason, and because Hashimoto's patients often have gut issues, you'll want to find zinc in either formulation. 

Why it's good for thyroid health & Hashimoto's

Zinc helps thyroid function in several key ways:

  • Zinc can help boost T4 to T3 conversion in those who are deficient (T3 is the most important thyroid hormone in your body so this is very important)
  • Lowers inflammation (2) and acts as an anti-inflammatory agent 
  • Balances and regulates the immune system (3) - those who are zinc deficient often find themselves getting sick repeatedly
  • Reduces free radicals while acting as an anti-oxidant
  • Plays an important role in hair growth - while not important to thyroid function itself, this is still very important for those who suffer from hair loss!
How to Supplement with Zinc
Why I like it

Powerful anti-oxidant with anti-inflammatory capabilities

Many patients are deficient in zinc

Includes other factors that may reduce inflammation

May help increase peripheral T4 to T3 conversion

How to Use/Dosing

  • Dosing Zinc depends on Zinc status in your body. For those who are severely Zinc deficient, you may want to use doses as high as 30 to 60 mg per day. For those on a maintenance dose (those who have repleted Zinc stores) a dose of 5mg is typically sufficient. You'll also find that you are probably getting Zinc already from multiple sources such as protein powders and multi-vitamins. 
  • I find better success when using Zinc in combination with Selenium and other nutrients such as iodine. By using them together you get a synergistic effect which is greater than just using Zinc by itself. 
  • Use Zinc in the morning (or night) and take doses ranging from 5mg to 60mg per day. Do not take with your thyroid medication (if you are taking any). 
My Recommended Brand and Product

#2. Selenium

Selenium is another fantastic nutrient and supplement for those with Hashimoto's or thyroiditis of any type. 

Selenium has been shown in some studies to reduce inflammation and antibody levels in patients with Hashimoto's.

And this is important whether your antibody levels are elevated or not.

Why?

Because it is estimated that about 90% of patients with Hypothyroidism (4) have autoimmune thyroiditis as the cause of their hypothyroidism, even if antibody levels are negative in the serum. 

That means there is a good chance that your hypothyroidism is caused by an autoimmune disease and you may benefit from looking at your immune function. 

Why it's good for thyroid health

Selenium, like Zinc, can help enhance thyroid function in many different ways:

  • First, like Zinc, it can help enhance T4 to T3 conversion (5) in those people who are deficient
  • Second, it can potentially help reduce total  antibody levels (6) in certain individuals with Hashimoto's (this benefit seems to apply to those who have Selenium deficiency or inflammation directly in the gland)
  • Third, it may also help with hair regrowth as it is involved in the hair growth process (again, this probably only applies to those who are deficient)
  • Fourth, using it may make your weight loss efforts easier (it won't directly lead to weight loss but studies show that those who consume more Selenium are lower in weight compared to those who don't)
How to Supplement with Selenium
Why I like it

May reduce thyroid antibodies

May help improve immune function if deficient

May help boost T4 to T3 conversion

High absorption for hypothyroid patients

How to Use + Dosing Information
  • There is a potential risk of Selenium toxicity if you use too much. Because of this, your daily dose should not exceed 400mcg per day. I find that most people are fine with somewhere between 50 to 150mcg per day. 
  • Some individuals with Hashimoto's do well on higher than normal doses (up to 400mcg per day) so you might want to experiment with these higher doses if you don't find benefit at lower doses. 
  • Use Selenium in combination with Zinc for best benefits (see my recommended supplement below)
  • Symptoms of toxicity include: hair loss, fatigue, nail damage, diarrhea, and nausea (if you experience any of these you may be taking too much)
  • Take Selenium each day at least 60 minutes away from your thyroid medication (if you are taking any)
My Recommended Brand and Product

#3. Adrenal Support

After testing Hundreds of Hypothyroid and Hashimoto's patients I've never found a patient that didn't also have adrenal related problems. 

The degree of adrenal fatigue may vary from mild to severe, but almost every patient has it to some degree.

For this reason, I recommend that adrenal support be a part of most hypothyroid (including autoimmune thyroiditis) treatment plans. 

Why it's good for thyroid health

The adrenals and thyroid function are intricately linked.

As TSH levels increase, cortisol levels increase as well.

Thyroid and cortisol levels are linked

Your body uses a combination of cortisol and thyroid hormone to control metabolism and energy production. 

When one system isn't working as intended the other increases to pick up the slack.

In the case of hypothyroidism, cortisol increases to keep pace while thyroid hormone is low.

Unfortunately, this can't and won't last forever.

When your adrenals "poop" out, you get the signs and symptoms of adrenal fatigue: 

  • Extreme fatigue despite regular rest
  • Feeling "wired but tired"
  • Cravings for sugar and salt
  • Difficulty sleeping
  • Anxiety and inability to "shut off" your brain
  • Experiencing a crash in the midafternoon
  • Reliance (or even addiction) on caffeine for energy

Because almost everyone can relate with one or more of the following symptoms, I recommend treatment for Adrenal fatigue in most Hypothyroid patients. 

There are three primary ways to treat the adrenals (with supplements):

1. Using Adrenal Glandulars

I find glandulars to be more effective in patients with extreme adrenal fatigue. They seem to cause an immediate boost to energy while supplying critical nutrients, such as enzymes and hormone precursors, to help the adrenals repair themselves. 

Adrenal glandulars can be used for both low and high cortisol. 

*Note that my preferred adrenal supplement is a Glandular. I find that this works the best in hypothyroid patients. 

2. Using Adrenal Adaptogens​

Adrenal adaptogens help the body tolerate day to day stress levels. I find these may be necessary to use in combination with Glandulars, and in some patients, I prefer a combination of the two. 

Adaptogens are plant-based compounds which help the adrenal glands in an indirect way by reducing the impact stress has on your body. 

Adaptogens can be used for both low and high cortisol (they help balance cortisol). 

3. Using Phosphatidylserine

Phosphatidylserine can help attenuate (or lower) cortisol levels in patients with HIGH serum am cortisol (or elevated salivary/urinary levels). 

This supplement should only be used if you have HIGH cortisol levels. 

Patients with high cortisol tend to experience heart palpitations or a racing heart late at night (usually around 2-3pm). ​

How to Supplement with Adrenal Support
Why I like it

May boost energy and well being

Almost all hypothyroid patients have adrenal problems

Helps the body tolerate continued stress

Most patients experience improvement in 1-2 months

How to tell if you Need it

Not all patients will need cortisol testing prior to using these supplements, but you can utilize these tests if they are available to you. 

You have many options when it comes to cortisol testing but I routinely recommend starting with serum cortisol and then moving to salivary or urinary cortisol only if necessary. 

  • Serum Cortisol - AM cortisol should be between 14-16, anything outside of this range may be an indication of cortisol dysregulation (note: normal serum level doesn't rule out adrenal fatigue)
Increased cortisol causes weight gain
How to Use

  • 1-2 tablets per day if using glandulars (preferably taken in the am and at noon)
  • If using supplements designed to lower cortisol like phosphatidylserine then use at night
  • Adrenal glandulars and adaptogens can be used at the same time but should not be taken at the same time as your thyroid medication
My Recommended Brand and Product:
Thyroid Adrenal Reset Complex mini image

Adrenal Glandulars (for high/low/normal cortisol)

A.R.C II (Adrenal Reset Complex) mini

Adrenal Adaptogens (for high/low/normal cortisol)

Phosphatidylserine - Soy Free (for cases of ELEVATED cortisol)

#4. Probiotics and Prebiotics

But not just any probiotics, mind you...​

Just like supplements, not all probiotics are created equal!

In my patients with Hashimoto's, I prefer to use high potency probiotics which contain at least 10+ different species. 

This variety in probiotic species more rapidly helps improve intestinal bacterial concentration and helps improve immune function more rapidly. 

Another added bonus is that high doses of probiotics also tend to work better for patients who are trying to lose weight. 

The right probiotics can also help promote regular stooling which is ideal for those who suffer from constipation from low thyroid function.  

thyroid metabolism reset poster for side bar
Why it's good for thyroid health

About 20% of thyroid hormone (7) is converted in the gut!

This means that a large portion of thyroid hormone is activated in the gut. 

If you are experiencing any inflammation or gut imbalance, then you may see that 20% decrease down to something less desirable. 

The net effect will be a reduction in free thyroid hormone and persistent symptoms. 

This is also the major reason that your gut can't be ignored if you have Hypothyroidism or Hashimoto's. ​

 How to Supplement with Probiotics
Why I like it

High microbial diversity (18 strains of bacteria)

May also enhance weight loss efforts

Ultra high potency with 350 billion CFU's in each serving

Heat stable packaging and probiotics to preserve potency and increase deliverability

How to tell if you Need it

Most people with Hashimoto's will benefit from the use of probiotics. A trial of probiotics should be undergone if you have elevated antibodies and especially if you have abdominal/gut symptoms. 

You don't necessarily need to use probiotics every day, but a short burst of high-potency probiotics may help with both immune function and weight loss. 

I typically recommend probiotic use off and on for people with Hashimoto's every few months. 

How to Use

  • 1 packet daily x15 days - this will jump start immune function and load the body with beneficial probiotic species
  • Start with ultra potency and multi-species probiotics (very high dose to stimulate immune function and to restore gut function)
  • After 1-3 rounds switch to a high/moderate potency daily probiotic
  • Focus on probiotics with a high concentration of well-studied bifidobacteria and lactobacilli species (like the probiotics listed here)

​#5. Vitamin D3 + K2

*Update: While Vitamin D is still very important for your overall health I now recommend attempting to get all of your vitamin D naturally through sunlight. This can be augmented with daily supplementation of no more than 1,000 IU's per day. 

New research shows that you can increase your vitamin D with supplements but simply forcing your Vitamin D higher doesn't show clinical benefit. 

It's, therefore, better to get your vitamin D up higher but to do it the "all natural way".*

Vitamin D is another one of the 5 most common nutrient deficiencies that I see in my patients. 

Unless patients are supplementing with it already (and in very FEW other cases), I almost always find that Vitamin D levels are low.

Many patients, even those that work in the sun, wonder why their Vitamin D levels are so low.

I'll fill you in:

​In order to get adequate Vitamin D from sun exposure you need to meet the following conditions:

  • Be out in the sun between the hours of noon and 2pm, when your shadow is smaller than you (the time of day with the most UVB rays)
  • 40% of your body must be uncovered
  • There cannot be any clouds obstructing the sun (otherwise UVB rays will bounce off the clouds)
  • You must NOT be wearing any sunscreen (most sunscreens block ALL UVB rays)

​How many people actually meet those criteria? 

Not many...

And that's why I recommend that most patients take Vitamin D as a supplement.

I don't, however, recommend blindly taking Vitamin D.

Please get your levels checked before supplementing as there are downsides to over supplementing. 

Why Vitamin D is good for hypothyroid patients

It is estimated that around 1 billion (8) (yes that's BILLION) people suffer from vitamin D deficiency.

​And vitamin D is critical to several functions in the body:

  • Involved in proper development of bone and muscle (9)
  • Regulates immune function
  • Prevents onset and development of autoimmune disease
  • Acts as a steroid pro-hormone
  • Helps maintain calcium homeostasis in the body
  • And these are functions NOT related to thyroid function

​(Why isn't every Doctor checking EVERY patient for Vitamin D deficiency?)

In addition to these amazing benefits low levels of Vitamin D can actually make your hypothyroidism worse (10)!

Vitamin D Deficiency and hypothyroidism

Because of this, I recommend that EVERY patient gets their Vitamin D levels checked and that they supplement with Vitamin D to achieve a blood level around 50 ng/ml (My updated recommendation is to check your Vitamin D and aim for the same level, but while only using a low dose of D3). 

In my experience patients with Hypothyroidism tend to do better on Liquid Vitamin D due to the potential for absorption issues (this is still true). 

I also recommend the use of vitamin K2 in addition to Vitamin D3 due to potential issues with calcium regulation which can occur if your dose of D3 is excessive. 

Higher levels of Vitamin D3, if accompanied by vitamin K2 deficiency, may increase your risk of developing cardiovascular disease and pathologic calcium deposition into other tissues (like kidney stones, etc.). ​

How to Supplement with Vitamin D3 & K2
Why I like it

Highly absorbable and highly potent

Affordable Pricing

Well Tolerated

No Allergenic Fillers

How to tell if you Need it
  • Check serum levels of Vitamin D and aim for a range around 40-50ng/ml
  • Always supplement with Vitamin K2 to ensure proper calcium signaling (high levels of Vitamin D with low levels of Vitamin K2 may increase your risk of calcification in arteries and in other places in the body)
  • Do your best to increase your D3 by naturally increasing your exposure to sunlight and UVB rays (within reason)
How to Use

  • Use no more than 1,000 IU's per day
  • Take in AM with a fatty meal (Vitamin D is a fat-soluble vitamin)
My Recommended Brand and Product
vitamin d3 k2 liquid

​#6. Vitamin B12

​Vitamin B12 is very important for patients with Hypothyroidism and Hashimoto's. 

Thyroid hormone is required for proper stomach acid production and stomach acid is required for proper B12 absorption.

Low thyroid hormone = low stomach acid = high risk of developing vitamin B12 deficiency.

​In addition to the mechanism mentioned above patients with Hashimoto's are at increased risk for developing the autoimmune condition of pernicious anemia. 

Recall that having 1 autoimmune disease puts you at risk for developing other autoimmune diseases.

This is another mechanism by which hypothyroid patients may be at risk for developing vitamin B12 deficiency.

When you combine these 2 mechanisms some studies show that up to 40% of hypothyroid patients are vitamin B12 deficient (11). 

b12 deficiency and hypothyroidism

In addition to being deficient, it can also be hard to diagnose as standard laboratory studies don't differentiate between cellular deficiency and serum deficiency. 

Many patients may have so-called "normal" serum B12 levels but still, experience the signs and symptoms of B12 deficiency that then improve with proper replacement therapy.

Some patients even report an improvement in vitamin B12 at supraphysiologic levels of vitamin B12.

Supraphysiological levels refer to higher than normal levels - and indeed some patients simply respond better to these levels.

I have many personal patients who notice increased energy levels with vitamin B12 shots and simply continue to use them despite higher than normal serum levels of B12. 

Why B12 is good for Hypothyroid patients

​Replacing Vitamin B12 is very important because many of the symptoms of B12 deficiency may mimic symptoms of hypothyroidism. 

This may explain why some patients who take medication may remain symptomatic. ​

Vitamin B12 deficiency may result in any of the following symptoms: 

  • Fatigue and a subjective sense of having low energy that does not resolve or improve with high-quality sleep or with thyroid hormone replacement
  • Shortness of breath or difficulty catching your breath with exertion or exercise
  • Changes in mood including depression or anxiety
  • Brain fog, difficulty concentrating or inability to pay attention
  • Macrocytic anemia (as measured by MCV)
  • Numbness, tingling or other issues with nerve fibers

​If you have any of the symptoms above, are still symptomatic after starting thyroid hormone or have low levels of vitamin B12 as indicated by laboratory testing then supplementing should be something to seriously consider. 

A couple parting thoughts:

1. Diagnosing vitamin B12 deficiency can be difficult with serum markers so make sure that you check more than just serum B12. Serum levels only indicate how much B12 is in the blood not how much is actually getting into the cells. Use the markers below to help with testing and determining if you are deficient. 

2. I've found that patients with Hypothyroidism and Hashimoto's do far better on B12 injections over oral forms of B12. Theoretically, sublingual B12 should offer similar absorption as B12 injections but in my experience, this just isn't true. 

You can find more info about B12 shots in this post. If you can't find B12 then your second best option is sublingual B12 which should be used over tablet/capsule supplements. ​

How to Supplement with Vitamin B12
Why I like it

May Boost Energy levels and reduce fatigue

May help increase metabolism and fat loss

Helps improve mood and increase concentration

Generally works very quickly (within 1-2 weeks)

How to tell if you Need it

I recommend checking the following lab tests:

  • Serum B12 - Should be > 1,000
  • Homocysteine levels - Should be < 9
  • MCV - Should be < 92

Any values outside of this range (or if you are experiencing the symptoms of B12 deficiency) then a trial of B12 may be appropriate. 

One problem with testing for B12 is that it is highly inaccurate, so it's possible that your serum levels may be "normal" even though you are actually still deficient. 

For this reason, it may be wise to trial a B Complex and assess how you feel before and after. 

Low serum B12 levels
How to Use

  • Take 2 capsules of methylcobalamin each day combined with other pre-methylated B vitamins in a highly absorbable and powerful B complex.
  • If you are severely deficient in Vitamin B12 you may need to use Methylcobalamin injections (B12 shots).
  • Methylated formulations of B12 and V vitamins are safe if you have the MTHFR genetic defect. 
My Recommended Brand and Product:

#7. Supplements to Support High-Quality Sleep

High-quality, deep sleep tends to be underrated in terms of its importance for overall health. 

When I create treatment plans for patients I make improving sleep a priority, so high on the list that the first month is dedicated to improving sleep if it is lacking. 

Low quality sleep will increase inflammatory levels (12), increase blood sugar levels (13)decrease the body's ability to lose weight (14) and overall decrease how quickly patients can get results.

Not only this but sleep plays an important role in regulating your immune system. Decreased sleep may cause an increased risk of TRIGGERING autoimmune disease (15).

In addition, some studies show that lack of sleep leads to an increase in TSH (16) and an increase in circulating levels of thyroid hormone. 

Because the TSH is increasing this is probably due thyroid resistance and elevated reverse T3 levels in this state of chronic stress. ​

Bottom line?

Sleep reduces immune function AND thyroid function.

​If your sleep is suffering then you absolutely need to focus on it and make it a PRIORITY. 

It's just as important (if not more important) than supplementing with active thyroid hormone.

So how do you know if you need to work on improving your sleep?

You should be focusing on the following:

  • 8 hours minimum of high-quality sleep per night
  • Repay your sleep debt if you have one (Lack of sleep builds up like an unpaid credit card, the more you have the worse it gets) -> you may need 9-10+ hours of sleep per night for several weeks to repay this debt
  • Improving your sleeping conditions if you don't have a dark, cool and quiet room to sleep in
  • Ensuring hormone imbalances, medications or other factors are not decreasing the depth and quality of your sleep
  • Address adrenal factors that may be causing increased energy levels at night

The truth is that most patients who don't get enough sleep know it and generally know they need to do something about it. 

I've personally dealt with sleep-related issues and know just how much even 1-2 hours of sleep loss can impact the body's ability to function. Much of the tips I discuss below I actually personally use to improve my overall quality of sleep. 

With that in mind, I want to focus on just a couple of tips that may improve your depth and quality of sleep.

Please note that this is just the beginning, and various factors including hormone imbalances, anatomical issues, medications, etc. can all be impacting the quality of your sleep and may need to be addressed.

How to get started with proper sleep hygiene:

  • Consider the use of earplugs to reduce noise
  • Consider the use of a sleep mask if you can't get your room pitch black
  • Reduce the temperature in your room
  • Use applications or glasses to remove blue light from electronics 3 hours before bedtime
  • Set an alarm for when to go to sleep in addition to waking up
  • If it takes you 30-60 minutes to fall asleep make sure to set your alarm with enough time to get 8 hours of sleep, not just 8 hours in your bed
  • Avoid drinking water or fluid 3-4 hours prior to bed
  • Avoid caffeine after noon and never consume more than 200mg per day
  • Avoid stimulating activities and exercise programs at night
How to Supplement to Boost and Improve Sleeping patterns 
Why I like it

May help to improve energy levels

May helps to reduce levels of inflammation

Helps reduce brain fog and mental fogginess

Required lifestyle change for optimal results

How to tell if you Need these supplements
  • You should be getting 8 hours of high-quality sleep each and every night
  • If you find yourself waking up exhausted then you should consider checking for sleep apnea or a trial of the following supplements to improve sleep
  • Those living at elevation (> 4,000 feet) may need an overnight pulse oximetry test
How to Use

  • Take each supplement as indicated on the bottle or as recommended below
  • Start with supplements that don't contain melatonin, if these supplements don't work then add more supplements until you are getting 8 hours of quality sleep each night
  • In addition to these supplements make sure you practice adequate sleep hygiene, that means: blackout curtains for your bedroom, noise canceling earplugs, glasses that remove blue light and avoiding electronics 3 hours prior to your scheduled bedtime
My Recommended Brand and Products:

For minor sleep issues start with supplements containing 5-HTP which may promote proper melatonin production and induce sleep naturally (take 100mg 30 minutes before your scheduled bedtime): 

For more difficult cases consider the addition of melatonin + 5-HTP, start with 1-3mg of melatonin and don't be afraid to use melatonin if you need it. I've found through urinary testing that MANY patients with sleep issues have low nighttime levels of melatonin. 

For more difficult cases consider using serotonin and GABA potentiators. These supplements help enhance GABA and serotonin neurotransmitters in the brain and help induce deep sleep. 

​#8. GI Supplements (Based on symptoms) 

Patients with hypothyroidism and Hashimoto's are at increased risk for developing GI related issues - usually related to decreased motility from lack of thyroid hormone. 

Thyroid hormone helps to increase intestinal motility which promotes natural breakdown of nutrients and promotes normal levels of bacteria in the small intestines.

When you have a lack of thyroid hormone circulating in the blood you are more prone to developing conditions like constipation, SIBO, SIFO, and acid reflux.

And if you think about it, it just makes sense:

If your GI tract isn't moving properly you will have constipation (too much movement would lead to diarrhea as is seen in hyperthyroidism).

If you over digest your food you allow more bacteria to feed off of it promoting SIBO and SIFO.

If your intestines slow down acid stays in your stomach longer which increases the risk of developing acid reflux.

In addition to all of these, it's important to realize that a majority of T4 is also converted in the GI tract. 

As a result, GI related issues (like those discussed above) may necessarily decrease T4 to T3 conversion.

Downstream these GI issues also result in decreased nutrient absorption due to changes in HCL and increased risk for developing sub-clinical nutrient deficiencies (most notably iron and B12 deficiency).

For this reason, it's essential to treat and reverse these GI conditions as they arise. 

Now consider this:

Some GI conditions WILL require the addition of thyroid hormone to completely eliminate. That's just the way it is.

If you have decreased motility due to lack of thyroid hormone potentiating your SIBO, simply taking herbal antibiotics will NOT fix the problem.

Make sense?

So in addition to the therapies recommended below make sure to treat the underlying cause (if possible), but the management of these conditions is also very important.

It should also be stated that simply replacing thyroid hormone will not necessarily resolve these issues either - so you really need the combination of thyroid hormone replacement + supplement replacement. ​

Don't take the shotgun approach to GI health and supplementation. 

​Treat the conditions that are present: 

How to Supplement with Targeted GI Supplements
Why I like it

May improve overall health

Many thyroid patients have GI issues contributing to overall health

May help to reduce inflammation and autoimmunity

Up to 75% of Hashimoto's patients have some GI related issue

How to tell if you Need these supplements
  • Target your supplements at the GI problem you are experiencing: Constipation, SIBO, gas/bloating, chronic diarrhea, etc.
  • When in doubt consider advanced stool testing to find actionable data including bacterial/fungal sensitivities and more information using comprehensive stool analysis
sibo and sifo examples
How to Use

  • Use as indicated on the bottle/container or as recommended below
  • For constipation use magnesium citrate at night (starting at 300mg) and titrate dose up until you have 1 loose bowel movement every day
  • For SIBO/gas/bloating read this post about SIBO and consider using combination therapy to decrease intestinal bacterial and fungal burden to reduce symptoms
  • For acid reflux use the combination of betaine + HCL to help increase stomach acid to promote nutrient absorption and food breakdown
  • For IBS/IBD/abdominal pain or increased intestinal permeability (leaky gut) consider using combination supplements to cool down inflammation and help heal the intestinal barrier
My Recommended Brand and Products:

Supplements to promote regular bowel movements and to treat constipation: 

Supplements to relieve gas/bloating: 

Supplements to relieve acid reflux: 

Supplements to improve leaky gut and intestinal permeability and to heal the intestinal lining: 

A Word About Iodine

Iodine gets a lot of attention in patients with hypothyroidism (especially with Hashimoto's).

I won't get into a huge discussion about it here but my general feeling is this:

Generally speaking (in most patients) taking Iodine is safe as long as it is coupled with adequate selenium supplementation.

I have however seen a handful of patients with Hashimoto's who have experienced negative symptoms after using iodine. But these cases all occurred in people who were using high doses of iodine without selenium or other nutrients. 

My experience suggests that iodine is both safe and necessary even for those with Hashimoto's. 

Remember:

Your body can't create iodine which means you must get it from your diet or from supplements. 

With that in mind I recommend proceeding with caution, and whenever possible to start low and go slow with iodine while avoiding high doses (higher than 1mg per day). 

The concerns over radiation contamination and heavy metal contamination with sea sources of iodine are largely overblown. You can learn more about why that is here

How to Supplement with Iodine
Why I like it

May improve thyroid function

May help detox harmful halides

If deficient will improve other systemic symptoms

Generally works very quickly in deficient patients

How to Use
  • Doses of around 75mcg to 150mcg per day are optimal for human health. Always use selenium with iodine to avoid harmful reactions. 
My Recommended Brand and Product:

Note: If you are using my recommended T3 conversion booster then you don't need to supplement with additional iodine. 

Wrapping It Up 

​If you have Hashimoto's then there are some supplements that can make a huge impact on your overall health. 

Based on my experience, current scientific literature, and what other experts are using, I've come up with some recommendations for patients:

As I mentioned above it's best to target your supplements based on your own personal nutrient deficiencies, but in the absence of a Comprehensive functional blood chemistry panel - these supplements will definitely help. 

Now It's your turn.

​I want to hear from you!

What supplements have you tried for your Hashimoto's or Hypothyroidism?

What has worked the best for you?

Help other patients out by giving your advice below!

References (Click to Expand)

Westin Childs
 

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

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