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Despite being the number one most common cause of hypothyroidism in developed countries, there are very few treatments available for patients with Hashimoto. Why? Because, as far as most doctors are concerned, it's an autoimmune disease with an easy solution: prescription thyroid medication.
But there's one problem with this. While thyroid medication can definitely help you feel better by supporting thyroid function, it typically does nothing for the thyroid gland destruction that occurs secondary to the autoimmune component of Hashimoto's. On top of this, very few people actually feel better when they take it. For these reasons, it should come as no surprise that patients with Hashimoto are looking and demanding new treatments. And if that's you, I've got some good news. Today, we're going to explore some of these newer treatment options.
Let's start by talking about some levothyroxine alternatives. As you probably already know, levothyroxine is considered the gold standard when treating Hashimoto's. This medication contains bioidentical T4 thyroid hormone and it's intended to replace the lost thyroid hormone that occurs due to thyroid gland destruction. Unfortunately, most people do not like it, and studies have shown that only 19% of patients taking it say they prefer it over other alternatives. Fortunately, nowadays, there are lots of other options, including some better-designed T4-only options, as well as new NDT medications.
Let's talk about some of the newer T4-only medications that are now out. Medications in this class contain the exact same thyroid hormone, which is T4, but differ in their route of administration, as well as their inactive ingredients. These small changes are sufficient enough to improve how well that medication will help you feel. Two of these come from the line of Tirosint medications. The first is Tirosint, which comes as a gel cap, and the second is Tirosint-SOL, which comes as a liquid. Both of these options contain the fewest inactive ingredients out of all other thyroid medications currently available. This makes them cleaner and less likely to cause reactions, which means you will feel better when you take them compared to something like levothyroxine. Research has shown that Tirosint, unlike levothyroxine, can even be taken at the same time as a meal without impacting its absorption. Even though this is true, only about 50 to 60% of patients who switch to Tirosint actually see improvement. Right now, the biggest downside to these Tirosint options is their cost, but there are generics available, especially for Tirosint, but not yet for Tirosint-SOL.
On top of these, we also have levothyroxine injections, which entered Phase 2 clinical trials in 2023. These injections bypass the intestinal tract, which is often a site of malabsorption, and they only need to be used once per week. Right now, they're still undergoing dosing trials, but they may emerge as a potential option in the coming years.
Next, let's talk about the new forms of NDT that are now available. The new medication that I'm referring to here is called Adisal. Adisal, like other NDT formulations, contains a combination of T4 and T3 thyroid hormones. It claims to be lactose-free, corn-free, dye-free, and latex-free, which gives you another option in addition to NP Thyroid and Armour Thyroid. This is a welcomed addition to the NDT family, giving that Nature-Throid and WP Thyroid are still unavailable. And we know from research that thyroid patients consistently prefer NDT formulations over T4-only thyroid medications like levothyroxine.
And third, we have combination thyroid hormone replacement. The idea here is to provide the body with multiple forms of thyroid hormone to more closely mimic the thyroid hormone production of the healthy thyroid gland. This strategy has become more popular as T2 thyroid hormone has gained notoriety as an active thyroid hormone. T2 has been shown to support metabolic function, fat oxidation, and enhance T3 binding on the thyroid nuclear receptor. Some studies have shown that it also may help with weight loss. By combining T2, T3, and T4 together, you are more closely mimicking that thyroid hormone production from the healthy thyroid gland. This strategy does require that you get usually multiple medications and the use of T2 in supplement form, but people who do this often feel much better than just taking T4-only.
Patients with Hashimoto's can also look into off-label prescription medications to treat their condition. Instead of targeting the thyroid specifically, these medications tend to target the immune system. And by doing so, the idea is that they may help prevent thyroid gland destruction, which means they may have some benefit in reversing your disease state. Their use is considered off-label, though, because they are not technically approved for the treatment of Hashimoto's. But even though they aren't technically approved for their use, there are still some studies and anecdotes to support that they actually help.
The first medication on this list is Metformin. Metformin is typically used to treat diabetes and insulin resistance, but it's often used off-label to treat other conditions like weight loss and longevity. We can probably also add Hashimoto's to that list. Seventeen studies over the last five years have shown that Metformin has a positive impact on TSH as well as thyroid antibodies, and studies in mice have shown the exact same thing. It's worth noting that these studies are small, though, so it's hard to draw direct conclusions. But given that Metformin is so cheap and that insulin resistance is often made worse by the hypothyroid state, it's certainly worth a try for most patients with Hashimoto's.
The second medication on this list is called low-dose Naltrexone. This medication was originally created to treat alcohol dependence, but it's often used off-label and in much smaller doses to treat various autoimmune diseases like Hashimoto's. And when it's used this way, it's often referred to as low-dose Naltrexone. Unfortunately, it doesn't have any large-scale studies showing that it can be effective for this condition, but there are plenty of anecdotes, both from providers as well as patients, saying that it does work. It's currently thought that taking low-dose Naltrexone has an immunomodulatory effect on the immune system. This helps reduce inflammation in the thyroid gland, as well as reduces thyroid antibodies. Traditional dosing of Naltrexone is as high as 50 milligrams per day, but if you're using it to treat Hashimoto's, then your dose will range from 1.5 to 4.5 milligrams per day. Based on my own experience and the experience from others, I would say that taking this gives you about a 50% chance of seeing some improvement in your symptoms and in your thyroid lab tests. Of the 50% who experience some benefit, 25% of those people will experience a large benefit, and about 25% of those will experience a modest benefit. Given that low-dose Naltrexone has few side effects and it's generally very well tolerated, it's worth a try for most patients with Hashimoto's, especially if other treatments haven't helped them.
The next medication on this list are steroids. Steroids like prednisone are some of the most powerful anti-inflammatory agents that exist in terms of medications, and they are often used to treat other autoimmune diseases like lupus or rheumatoid arthritis. But due to their huge list of undesirable side effects, they can never really be used for longer than seven to twenty-one days. There really isn't a place for their use in the setting of Hashimoto's, except for two exceptions. The first is that they may have some benefit in an acute flare-up, and the second is in the presence of a condition called Hashimoto's encephalopathy. But given the fact that they've actually been shown to reduce thyroid function, they are not a good option for patients with Hashimoto's.
The next set of medications on this list include immunomodulators as well as immunosuppressants. These are sometimes floated as a potential treatment option for patients with Hashimoto's, but they have the same problem as steroids, which is a huge list of side effects. Because Hashimoto's is primarily localized to the thyroid gland inside of your neck, it doesn't often make sense to suppress the immune system of the entire body just to impact that one gland. Doing this sets you up for an increased risk of serious infections. The current thought by most doctors, including me, is that the risks outweigh the benefits, and right now, there's limited evidence to suggest that they can actually be helpful. So I would recommend avoiding these.
On top of thyroid hormones and off-label medications, you also have some surgical options. These include the complete removal of the thyroid gland, called thyroidectomy, or a partial removal of the thyroid gland, which is called a partial thyroidectomy. Some doctors are exploring the idea that it may be better to take out the thyroid gland if you have Hashimoto's with an antibody level of greater than 1,000. And some research has shown that patients in this setting do experience an improvement of symptoms after their thyroid gland has been removed. Fortunately, this treatment is being reserved for patients who have tried everything else and haven't been able to find any relief. But I'm going to add my two cents here and say that it is never a good idea to remove your thyroid gland unless it is absolutely necessary. It may seem like a good idea in the moment, but there are no shortage of people who lament the fact that they ever had their thyroid removed, especially when they feel rushed into the decision. The truth is that thyroid hormone replacement is never as good as the real thing, and patients who don't have a thyroid consistently report problems with weight gain, sexual dysfunction, and body image issues afterward.
The next group of treatments are probably my favorites, and they include natural treatments. Whatever you do, don't make the mistake in thinking that you must take a medication to treat your problem if you have Hashimoto's. In my opinion, natural treatments are some of the most effective options for patients with Hashimoto's, and usually, they just glance over them. Not only are they both safe and effective, but they can and do work, and believe it or not, there's also a fair amount of research that supports their use.
The first natural treatment that I want to talk about here is red light therapy. Red light therapy, which is sometimes referred to as low-level laser therapy, has been shown to be an effective treatment for patients with Hashimoto's in several studies. Light with a wavelength of 600 to 1300 nanometers can penetrate up to two inches into the skin. Because your thyroid gland is so superficial, meaning so close to the skin, two inches of penetration is sufficient for your thyroid to be bathed in this red light. When red light hits your thyroid gland, it activates the mitochondria found within, as well as helps your body produce anti-inflammatory cytokines. One study of over 70 women showed that the combination of red light therapy with some specific supplements was enough to reduce TSH, reduce thyroid antibodies, and help reduce BMI. The red light used in the study had a wavelength of 830 nanometers.
The next natural treatment that I want to talk about is diet. The food that you put into your mouth can have a profound impact on your health and may help treat and reverse conditions like Hashimoto's. One study suggested that "data from biomedical and clinical studies provide evidence that an appropriate dietary and lighting regimen could significantly improve the function of the thyroid gland and reduce the reactivity of autoantibodies in the thyroid." In other words, eating the right foods and combining it with red light, in the case of the study I just mentioned, can dramatically help improve your thyroid. Dietary recommendations can get complicated in a hurry, but the most simple way to look at it is whether or not a food either increases inflammation or reduces it. If you are somebody who is looking to reduce inflammation, eat plenty of protein, fiber, and omega-3 fatty acids. If you're looking for your diet to cause inflammation and make Hashimoto's worse, then you want to eat plenty of processed foods, artificial flavors and dyes, as well as refined carbohydrates. Other food groups that have been known to cause issues in patients with Hashimoto's include gluten, dairy, and soy. Your diet is one of the most powerful tools at your disposal to treat your condition, and some patients have even reported that changing their diet was enough to put their disease into remission.
The next natural treatment that you need to know about are supplements. Vitamins, minerals, and botanicals have all been shown in several studies to be effective in treating Hashimoto's. Here's some of the most well-studied and proven. First is Nigella sativa. One double-blind, placebo-controlled trial of over 40 patients with this condition saw an improvement in taking two grams of Nigella sativa each day. They found that people who took this treatment saw a reduction in TSH, a reduction in thyroid antibodies, and a reduction in BMI. Second is selenium. A meta-analysis of over six different studies showed that taking selenium can reduce thyroid antibodies after three and six months. And third is a compound called anacardic acid. One study of over 80 patients with Hashimoto's showed that combining anacardic acid with selenium was enough to reduce TSH and thyroid antibodies.
These new treatments hold a lot of promise for patients with this condition. Many of these treatments are much better than the alternative, which is to take levothyroxine and sit and wait. Even though I know a lot of you out there have a big desire for more treatments with Hashimoto's, the truth is you don't actually need them. There are plenty of natural and conventional treatments that are available to you right now that will be enough to help you feel better and potentially put your disease into remission. What's important here is awareness, because most doctors, and patients included, have no idea that other treatments exist outside of levothyroxine. If you are somebody who is interested in getting your Hashimoto's under control, then the best place to start is with your diet. And if you want to see a list of specific diets that can help put Hashimoto's into remission, check out this video next.