Comprehensive Guide to Hashimoto’s Treatment
Thyroid DiseaseHashimoto's Thyroiditis

Hashimoto’s Thyroiditis Treatment: A Complete Guide

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Updated on November 13, 2024
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There’s no cure for Hashimoto’s thyroiditis, but treatment can help you manage symptoms. Hashimoto’s thyroiditis is an autoimmune disease that causes inflammation in the thyroid gland that can damage thyroid cells. As the damage progresses, it can result in an underactive thyroid, known as hypothyroidism, which can cause symptoms like fatigue, mood problems, and others.

Not everyone with Hashimoto’s thyroiditis develops hypothyroidism, in which case treatment isn’t necessary. But about 20 to 30 percent of people with Hashimoto’s develop hypothyroidism and most need treatment to help manage their condition.

Medication and caring for your mental health may all help.

Medication

Hormone replacement medication is the mainstay treatment for Hashimoto’s thyroiditis. There are a few options.

Levothyroxine (Synthetic T-4 Hormone)

The U.S. Food and Drug Administration–approved drug currently available for Hashimoto’s thyroiditis is called levothyroxine (Synthroid).


Levothyroxine is identical to thyroid hormone T-4, which the body produces naturally. People with hypothyroidism don’t produce enough T-4, though, so treatment with levothyroxine can restore healthy levels of this hormone.

Levothyroxine is available as a:

  • Tablet
  • Soft gel capsule
  • Liquid solution
If your doctor prescribes you levothyroxine, you’ll likely need to take it daily for the rest of your life, because once the thyroid fails, it doesn’t typically return to normal function.

Too much or too little can lead to complications, so always take levothyroxine precisely as your doctor recommends. Your doctor may ask you to take levothyroxine in the morning, 30 to 60 minutes before eating to lower the risk of absorption problems, which may happen if certain foods, drinks, or substances are in your stomach when you take your dose.

The following may keep your body from absorbing levothyroxine properly:

  • Iron supplements
  • Calcium supplements
  • Proton pump inhibitor drugs, used for acid reflux
  • Iodine supplements or iodine-rich food, such as kelp
  • Coffee
  • Soy
  • The weight loss drug orlistat (Xenical)
Tell your doctor about any other health conditions and medications, including herbal supplements and over-the-counter drugs.

You should also see your doctor if you notice unusual symptoms or if symptoms worsen. They may need to adjust your dosage.

If you’re taking levothyroxine, you’ll also need regular follow-up to ensure your dosage is still appropriate. You can expect a blood test 6 to 8 weeks after you start the drug, and the doctor will adjust the dose if necessary. Then they will test again after another 6 to 8 weeks and adjust if needed. Each time you change the dosage, you’ll need another blood test. When you find a dosage that works for you, you’ll then need follow-up testing just once per year.

Liothyronine (Synthetic T-3 Hormone)

In people without hypothyroidism, the body converts hormone T-4 into another thyroid hormone, called T-3. Generally, levothyroxine will help people with hypothyroidism create enough of the T-3 hormone from T-4 hormone, but some people may need additional supplementation.

In those cases, a doctor may prescribe both levothyroxine and liothyronine (Cytomel), a synthetic form of T-3 hormone available as a tablet you can take by mouth.

Natural Desiccated Thyroid

Some people use natural desiccated thyroid (Armour Thyroid, NP Thyroid) for hypothyroidism. The active ingredient comes from pig thyroid glands. Some people have found it beneficial if levothyroxine or combination therapy with liothyronine hasn’t helped.

 Experts caution people to use it with care and only under medical supervision, as it can have severe side effects. Your doctor may prescribe it if there are no other options.

Lifestyle Changes

A healthy diet is good for your overall physical and mental health — that said, there is little evidence that specific dietary changes, like an anti-inflammatory diet

 or a gluten-free diet,

 may be beneficial for managing Hashimoto’s thyroiditis.

Complementary and Integrative Approaches

Some supplements, vitamins, and herbal remedies may not be beneficial if you have Hashimoto’s thyroiditis, and some can even be harmful.

 Check with your doctor before trying any new supplement or remedy. Your doctor can also advise you on how to find qualified practitioners if you need one.

Here are some complementary approaches that may help.

Vitamin D Supplements

People with Hashimoto’s tend to have low vitamin D levels in their blood. Limited evidence suggests that vitamin D supplements can improve thyroid function, which can help relieve symptoms.

Talk to your doctor for their guidance if you’re interested in taking vitamin D.

Selenium

Hashimoto’s is also associated with low levels of selenium in the blood. Selenium helps the body make thyroid hormone. Some research suggests that supplementing with selenium can help lead to healthier levels of certain hormones and Hashimoto’s antibodies, while also leading to few side effects.

 More research is needed on how effective it is, however.

Stress Reduction Practices

If Hashimoto’s disease affects your stress levels, you may benefit from activities such as yoga, tai chi, or meditation.

Mental Health Treatment

In the United States, almost 24 percent of people living with an autoimmune thyroid disease such as Hashimoto’s have depression, and over 40 percent have an anxiety disorder.

These rates are higher than in people without these diseases and suggest a link. It’s not clear if anxiety and depression are due directly to thyroid changes or if life with a long-term health condition increases the risk.

If you have Hashimoto’s disease and notice signs of depression or anxiety, reach out to your doctor, who can help you get mental health treatment like counseling and medication. You can also join an online support group.

The Takeaway

Not everyone with Hashimoto’s thyroiditis develops hypothyroidism, and treatment isn’t typically needed unless they do. In cases of hypothyroidism, the main treatment is a medication called levothyroxine, which helps replace the hormone T4 lost due to thyroid damage. You’ll need to take this drug daily for the rest of your life, and it may help to complement your treatment with stress reduction and mental health therapies.

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Elise M. Brett, MD

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Elise M Brett, MD, is a board-certified adult endocrinologist. She received a bachelor's degree from the University of Michigan and her MD degree from the Icahn School of Medicine ...
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