Hypothyroidism and Hashimoto’s: Optimizing Thyroid Health

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Have you ever said to yourself or your doctor, “I think I have a problem with my thyroid…” Chances are that you are right! Your concern may be that imbalanced thyroid health may have something to do with feeling fatigued and having immense difficulties with an inability to lose weight. While it sometimes means that you may need some form of thyroid hormone replacement, it is always a sign of other underlying causes and issues in your body which require care and attention. When the appropriate support is provided, then the thyroid gland can function optimally to contribute to your overall sense of being well and feeling good. Let’s discuss hypothyroidism and Hashimoto’s disease to discover the tools and power you have to optimize your thyroid health!


Thyroid hormone is the conductor of the symphony of the body because it regulates metabolism, energy consumption, growth, and reproductive function. The production of thyroid hormones is controlled by feedback loops from thyroid gland hormone production back to the hypothalamus (the connection between our nervous system and our hormonal signaling system) and the pituitary gland in the brain.  

When in balance, thyroid maintains mood, brain function, hormonal health, and energy levels, as well as regulates weight gain/loss and digestive function. What many do not realize is that thyroid function is intimately linked with inflammation, as well as adrenal gland and gut function/nutrient deficiencies. While some may have primary thyroid issues which require thyroid hormone replacement, most can regain balanced function of the thyroid by addressing the primary issues of inflammation and imbalanced function of the gut and adrenal gland.

What does thyroid out of balance look like?

Symptoms of hypothyroidism:

  • Weight gain
  • Fatigue
  • Depression
  • Digestive problems
  • Hair loss and dry skin
  • Irregular periods
  • Problems with concentration and cognition
  • Fertility issues

Physical signs of hypothyroidism:

  • Being overweight and having difficulty losing weight
  • Dry, coarse skin and hair
  • Brittle nails
  • Cool extremities
  • Thinning of the lateral eyebrows and hair
  • Decreased basal body temperature (< 97.4 degrees F)

Sound familiar?


Hypothyroidism is caused by decreased in the production of hormone or decreased action of thyroid hormone in the body. They can be broadly categorized as autoimmune (Hashimoto’s thyroiditis) or non-autoimmune. 90% of hypothyroidism is autoimmune in nature. (Iodine deficiency accounts for more primary hypothyroidism in countries where this is more prevalent.)

Autoimmune hypothyroidism or Hashimoto’s thyroiditis occurs when the immune system begins to attack thyroid tissue after mistaking it as something foreign to the body.  This may result from exposure to toxins and infections along with leaky gut (increased small intestinal wall permeability). This can be discovered by checking for antibodies to thyroid in the blood (read below about testing for hypothyroidism).

Non-autoimmune hypothyroidism is most often caused by nutrient deficiencies either from low intake or poor gut health with maldigestion and malabsorption. The major nutrients which contribute to the proper production of thyroid hormones and receptivity to thyroid hormone are:

  • Iodine (required for the production of thyroid hormone). Usual dosage 150 mcg.
  • Selenium (required for the conversion of T4 to the active form of thyroid hormone, T3). Usual dosage 200 mcg (4 whole Brazil nuts provides 300 mcg)
  • Vitamin A (needed for the production of T4 and intracellular receptor formation for T3). Usual dosage varies by the form of Vitamin A. 1 mcg retinol, 12 mg beta-carotene, or 3,000-10,000 IU preformed Vitamin A (be careful of toxicity)
  • Vitamin D (enhances proper immune function and inhibits autoimmune inflammation). Dosage should be based on testing to achieve a serum 25 (OH)D level of 60-80 ng/mL. Depending on sun exposure and dietary intake and absorption, needs can vary from 400 IU to 5000 IU/daily.
  • Iron (needed for thyroid hormone synthesis).  If iron deficiency present, consider supplementation with up to 45 mg elemental iron/day.
  • Zinc (involved in the conversion of T4 to T3, as well as transport of Vitamin A to body tissues and binding of T3 to intracellular receptors).  Dosage up to 40 mg/day.

Please note that, as always, the optimal way to maintain optimal nutrient needs is through a whole foods, plant-based diet when the digestive system is balanced and working well.

Other causes for non-autoimmune hypothyroidism are excessive alcohol, exposure to heavy metals, and hypothalamic/pituitary/adrenal (HPA) axis imbalance (dysfunctional cortisol secretion).


Laboratory testing should include:

  • TSH (thyroid-stimulating hormone) which is secreted by the pituitary gland to stimulate the synthesis of thyroid hormone. From a functional perspective, people feel best when their TSH< 1.5 – 2 mU/L. An elevated TSH results from the increased need for thyroid hormone.
  • Free T4 and T3 (free thyroid hormone levels) which indicate how much thyroid hormone is being produced. “Free” means unbound by carrier proteins, which makes it available to act at cell receptors. T4 is produced at a much larger amount and is then converted to T3, which is the active form of the hormone. Optimal levels of free T3 are >3.2 pg/dL and T4 >1.0 ng/dL.
    • An elevated TSH with low free T3 and T4 indicates hypothyroidism.
    • A normal TSH with normal free T4 and low free T3 indicates issues with conversion of T4 to T3.
    • A normal or elevated TSH with normal free T4 and high free T3 indicates a problem with cellular receptivity,  which can then still lead to symptoms of hypothyroidism because the hormone signal is not being received by the cell.
  • Thyroid antibodies: anti-TPO (thyroid-peroxidase) and anti-TG (thyroglobulin) antibodies. The presence of antibodies against thyroid tissues indicates an autoimmune cause for hypothyroidism.
  • rT3 (reverse T3) is an inactive form of thyroid hormone which is produced when the body wants to conserve energy (when we are sick, stressed, or malnourished). A value >20 ng/dL often indicates that rest and repair are needed.


This is a huge topic so I encourage you to read books by Aviva Romm MD, Amy Myers MD and Isabella Wentz PharmD for more details about a comprehensive, holistic approach to optimizing thyroid health. Meanwhile, here are the main areas to consider when optimizing your thyroid health.

  • Food triggers
    • Consider completing 3-4 weeks of an elimination diet. Remove sugar, gluten, dairy, soy, eggs, nuts, and processed foods. These are foods that commonly cause inflammation in the gut. If you are diagnosed with Hashimoto’s thyroiditis, the generally accepted recommendation is to eliminate gluten and dairy which can contribute to the development of leaky gut.
    • Realize that eating a pro-inflammatory or anti-inflammatory diet has profound effects on our health and the development of chronic disease.
  • Gut imbalances (dysbiosis and leaky gut)
    • Balance the gut microbiome and decrease dysbiosis. This is a complicated topic to consider because it’s not simply about taking a probiotic. The beneficial microbial environment of the digestive tract is dependent on providing the proper fuel (pre-biotics), eliminating bacterial/yeast overgrowth and infection, and having a relaxed nervous system. It’s all about what signals the body is receiving. Balance is about sending the right signals to our body.
    • Repair the small intestinal wall lining as a barrier (treat leaky gut) to reduce/eliminate the triggers for autoimmunity.
  • Toxic overload
    • Reduce exposure to heavy metals (mercury, lead, cadmium), fluoride and other halogens (which can interfere with thyroid function by mimicking iodine), and endocrine (hormone)-disrupting chemicals.
    • Optimize detoxification through the support of liver and kidney health.
  • Immune disruption and hidden infection/inflammation
    • Consider testing for the presence of Epstein-Barr virus, Cytomegalovirus, parasitic, bacterial, and fungal infections in the gut, and Lyme disease
  • Chronic emotional and mental stress
    • This is the most important and foundational issue to recognize and address. Modern life is stressful, beyond what we were ever intended to experience.
    • The chronic activation of our stress response through the hypothalamic-pituitary-adrenal axis modulates not only thyroid function, but every function in our body.
    • Ultimately, finding ways to relax our minds and bodies is the key to true healing.


There is much you can do on your own, especially using the guidance of the amazing women I mentioned before. As for further testing and evaluation (especially of your gut health), consider working with a functional/integrative medicine practitioner who will listen carefully to your story and use lab work information as leverage to guide you back the balance you were intended to have in your body. Know that you can be free of the symptoms of low thyroid function to live the energetic and joyful life we all are meant to live. This is the first step.

Schedule a 15-minute discovery call with Dr. Wei today!

Jessica Wei, MD

Owner and Certified Functional Medicine Physician Women’s Holistic Health, LLC

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Women's Holistic Health, LLC

18 North Main Street, West Hartford, CT • 860-904-9728

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