Hypothyroidism and Hashimoto's disease, among other thyroid conditions, are complex conditions with numerous possible etiologies and causes, many of which are often not pursued by conventional medicine.  Though there may be a genetic predisposition toward thyroid issues, other concerns can converge to make thyroid disorders express and manifest.  Yet most conventional doctor's recommendations do not going beyond thyroid replacement medications and a single test marker; there is often no attempt to move beyond symptom management.

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However, people deserve more than lifelong medication recommendations!

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Naturopathic Approach to Hypothyroidism and Thyroid Disorders Possible Etiologies and Causes

Possible considerations to the development of thyroid problems include:

• Genetics

• Over-consumption of isoflavone-intensive soy products such as soy protein or powder because isoflavones act as potential anti-thyroid agents, and are capable of suppressing thyroid function, and causing or worsening hypothyroidism.

• Adrenal insufficiency, commonly known as 'adrenal fatigue', and caused by chronic stress and/or Hypothalamic-Pituitary-Adrenal axis ('HPA axis') Dysfunction

• Estrogen Dominance and/or Polycystic Ovary Syndrome ('PCOS') (11)

• Improper usage of Iodine

• Infections

• Nutrient Deficiencies

• Gut Disorders or Liver problems

• Some anti-thyroid drugs, such as lithium (12)

• A history of radiation treatment to the head and neck areas

• Over-consumption of uncooked goitrogenic foods, such as broccoli, turnips, radish, cauliflower, and Brussels sprouts are all substances that suppress the function of the thyroid gland

• Immunologic responses to foods including food allergies, sensitivities or auto-immune responses like Hashimoto's-disease-induced-by-gluten (13)

• Radioactive iodine treatment for hyperthyroidism/Graves' Disease.

• Post-surgical removal of all or part of the thyroid due to nodules or cancer.

• Environmental contaminants including mercury and bisphenol A (14) 

• Inadequate phase 2 liver detoxification mechanisms,

• Gastrointestinal sources of inflammation

• Exposure to external radiation such as occurred after the Chernobyl nuclear plant explosion.

• and more. 

Remember, interventions don't have to be just prescription medications; naturopathic physicians treat with compounds found naturally occurring in the body, including amino acids, neurotransmitters, vitamins and minerals.

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Naturopathic Approach to Hypothyroidism and Thyroid Disorders Thyroid Tests

Beyond broader consideration for what precipitated the hypothyroidism or other thyroid condition, naturopathic physicians are more likely to order comprehensive testing above and beyond just the TSH, as is typical of most medical doctors.  Multiple laboratory values should be ordered to determine overall thyroid function.  For example, we have had patients whose previous doctors had only ordered TSH without T4 and T3, and they therefore missed the hormone conversion issue as the cause for hypothyroidism.  We have also had hypothyroidism patients that did not even know they had an auto-immune condition because other providers had neglected to order auto-immune antibody testing, despite years of annual case management.   

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• Thyroid stimulating hormone (TSH): Secreted by the anterior pituitary gland, TSH regulates thyroid hormone release.  The test is thought to be more sensitive and accurate than testing the T4 and T3 hormones themselves, "... because it can be elevated even with small decreases in thyroid function". (15)  Hence many clinicians' reasoning to order TSH and no other laboratory values.  A blood test with high TSH indicates a high need for the thyroid gland's production of hormones, as is seen in hypothyroidism and Hashimoto's disease, when the gland is underactive.  Meanwhile, a low TSH suggests the excess and abundance of thyroid hormones, as seen in hyperthyroidism and Graves' disease.

• T4 (Tetraiodothyronine)(thyroxine): The primary form of thyroid hormone made by the gland, it is inactive and can be checked with a blood test. It may be 'free' or 'bound', which means it is adhered to a protein and unable to enter tissues to be metabolically active. 

• T3 (Triiodothyronine): This active form of thyroid hormone is made by the gland in lesser amounts and T4 is converted into T3 for use in the body.  T3 may be 'free' or 'bound', which means it is adhered to a protein and unable to enter tissues to be metabolically active.

• Anti-TPO antibodies: In autoimmune thyroid disease, proteins mistakenly attack the thyroid peroxidase (TPO) enzyme, which is used by the thyroid to make thyroid hormones.  This is common in Hashimoto's disease but may also occur in Graves' disease or even other auto-immune conditions like lupus. (16)

• Anti-TG antibodies: Anti-thyroglobulin (TG) antibodies can be a sign of thyroid gland damage caused by the immune system. They may be measured if thyroiditis is suspected and like anti-TPO antibodies, they may be found in patients with Hashimoto's disease, Graves' disease or lupus. (16)

• Reverse triiodothyronine (RT3): This metabolically inactive form of T3 can be problematic if it fills a substantial number of binding sites, leaving the active and proper form of T3 itself unable to bind to receptors and do its job.  Once the binding site receptors are filled, the body signals that it has adequate T3, not recognizing that it instead got the inert and largely unhelpful RT3.  Such a situation could lead to hypothyroidism.

• Thyroglobulin: Thyroglobulin is a protein secreted by the thyroid that can be used as a marker of thyroid cancer. It is often measured during follow-ups in patients who have received treatment for such cancers, with the goal being cessation of all thyroid production capacity.  That's because the goal of treatment is to get rid of all thyroid tissue – both healthy cells and cancer cells. So, if treatment is successful, there should be little or no thyroglobulin in the blood. However, if thyroglobulin levels remain the same or increase, more cancer treatment may be needed, as high levels likely indicate recurrence of the cancer. 

• Thyroid ultrasound: A thyroid ultrasound is a non-invasive imaging test to get information about the thyroid gland. During this procedure, a probe is placed on the skin of the neck, and reflected sound waves can detect abnormal areas of thyroid tissue.  It can be used to help identify nodules, understand what characteristics are present in thyroid tissue, and more.

• Thyroid biopsy: During a thyroid biopsy, a small amount of thyroid tissue is removed, usually to look for thyroid cancer. Thyroid biopsies are typically done with a needle. 

• Thyroid scan (thyroid scintigraphy): A thyroid scan uses a small amount of radioactive iodine, given by mouth, to get images of the thyroid gland and understand how it is functioning. The radioactive iodine is concentrated within the thyroid gland. 

• and more