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Hypothyroidism: Causes, Treatments, and Natural Solutions

It seems that thyroid issues are being talked about more often these days, which unfortunately makes sense as there is evidence that the number of people with thyroid disorders is increasing, and that 10-12% of the population may suffer from some form of thyroid dysfunction (1, 2). The most common type of thyroid disorder is due to an underactive thyroid, called hypothyroidism (3). While there is a standard hormonal medication that can help, there are also a number of more holistic, functional approaches that can help to manage hypothyroidism and get the whole body into greater balance and health.

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Thyroid Location and Function

The thyroid is a butterfly-shaped gland located in the middle of the lower neck, about an inch above the collarbones. While it is relatively small, it creates hormones called thyroxine (T4) and triiodothyronine (T3) that affect every cell, tissue, and organ, making it essential to each of your body’s processes (4, 5, 6). This is because thyroid hormones control how the body uses energy (also called the body’s metabolic rate) so it affects vital processes such as breathing, heart rate, digestion, mood and mental health, energy levels, and more (5). Because symptoms tend to develop slowly over months and years, it can be difficult to notice how bad symptoms have gotten until the thyroid is functioning very poorly. This also accounts for the high prevalence of people with thyroid dysfunction (up to 60% of all those who have thyroid problems!) who are undiagnosed (4, 5).

The thyroid also interacts closely with the pituitary gland. The pituitary gland secretes a hormone called the thyroid-stimulating hormone (TSH) that tells the thyroid the quantity of hormones it should produce and release (7).

The liver is similarly associated with the thyroid, though the relationship is more complex. The two hormones secreted by the thyroid differ in that T3 is active (and accounts for only 20% of thyroid hormones released), and T4 is an inactive prohormone (7). The liver plays an important role in metabolizing and transporting thyroid hormones, as well as transforming inactive T4 into active T3 (7, 9). Thyroid hormones similarly affect the liver, affecting its enzymes and metabolism, meaning that either thyroid dysfunction and/or liver dysfunction can negatively affect the other (9).

Hypothyroidism Causes and Symptoms

While the causes of primary hypothyroidism are mostly unknown, there are many links to other conditions that may cause secondary hypothyroidism. The biggest link is to Hashimoto’s disease, which is an autoimmune disorder that causes the immune system to attack the thyroid, resulting in poor hormone output (4, 5, 6, 8). In fact, autoimmune disorders are the cause of about 90% of the cases of hypothyroidism in adults (8). The link between thyroid issues and autoimmune disorders is very common, as the most common secondary cause of hyperthyroidism, known as an overperforming thyroid, is another type of autoimmune disease called Graves’ disease (3).

Other conditions such as inflammation of the thyroid (thyroiditis), congenital hypothyroidism (which is a genetic condition that is present at birth), or pituitary or liver disease can also lead to hypothyroidism (5, 9). Additionally, radiation treatment on the neck or chest, certain medicines such as those including lithium, surgical removal of all or part of the thyroid, or too much or too little iodine can also contribute to hypothyroidism (5, 6). Additionally, pregnancy can be a factor, though most cases of postpartum hypothyroidism resolve themselves with time (8).

The symptoms of hypothyroidism are many and varied and may show up differently for each person. They include (4, 5, 6, 7):

  • Weight gain

  • Fatigue

  • Joint and muscle pain, or muscle weakness

  • Heavy or irregular menstrual periods

  • Fertility problems

  • Constipation

  • Dry skin or dry, thinning hair

  • Depression

  • Decreased sweating

  • Puffy, swollen face

  • Slowed heart rate

  • Development of a goiter (a swelling or lump on the neck)

  • Hoarseness

  • Cognitive changes (Brain fog, Impaired memory)

Risk Factors and Complications of Hypothyroidism

There are a number of risk factors that are associated with an increased risk of developing hypothyroidism. Unfortunately, one of the most prevalent risks includes being a woman, since they are at a higher risk of developing autoimmune disorders, as well as have the added risk of developing postpartum hypothyroidism (5, 6, 8). Other risks include having other autoimmune disorders (like lupus or rheumatoid arthritis) or type 1 diabetes, being older than 60, having a family history of thyroid disease, or having a past history of goiter, surgery, or radiation on the thyroid (5, 6). Additionally, other disorders such as Turner syndrome, pernicious anemia, Sjorgen’s syndrome may all increase hypothyroidism risk (5).

Aside from the symptoms above, there are a number of complications that can come from untreated or under-treated hypothyroidism. These may include heart disease or failure, high cholesterol and blood pressure, mental health issues, peripheral nerve damage, and problems with pregnancy including premature birth, miscarriage, slowed development, and birth defects (5, 6).

Treatment Options for Hypothyroidism

Standard treatment for hypothyroidism is some form of levothyroxine, which is a synthetic version of your thyroid hormone (T4) that helps to balance the body (6). Treatment is usually lifelong, and will need frequent monitoring and adjustment, though can bring the benefit of reducing complications and symptoms, including gradually lowering thyroid-related high cholestero, weight gain, and many others (6).

However, there are some side effects of levothyroxine, including weight gain or loss, gastrointestinal upset, risk of osteoporosis, and changes to menstrual cycle or appetite, among others (10). For some, these side effects interfere with life, and other people may desire to not need to take medication every day. Others are interested in holistic healing, and seek out what they can do to support their health and health issues with more natural means like diet, supplements, and exercise. This is where functional medicine can shine, because it utilizes a variety of treatment methods (including medication, if needed) to help resolve health issues, but medication isn’t always the automatic first choice.

Indeed, in the case of hypothyroidism, there are a number of treatment options that can all contribute to increased thyroid function. For those with very severe hypothyroidism, medication will likely be required alongside the other functional changes, at least for a time until the body can begin to heal. But for those with mild to moderate dysfunction, solely focusing on functional treatments can make a world of difference.

The first step in treating hypothyroidism is to determine potential root causes. If other autoimmune disorders, liver or pituitary dysfunction, or any of the syndromes listed above are present, then treatment for those will take precedence and in being treated, should help increase thyroid function. Because 90% of those with hypothyroidism have Hashimoto’s disease, there is a good likelihood that treatment will center around treating the autoimmune disorder. Though genetics are a factor, other environmental triggers do impact its development, including viral infection, exposure to toxins and pollution such as BPAs, phthalates, pesticides, and petrochemicals, and excess consumption of iodine (11, 12, 13). So, reducing exposure to toxins, switching to organic foods, washing produce well, and potentially even doing a medically supervised detox could all help eliminate triggers.

Next, adjusting diet is a key factor that can help promote thyroid health. Because leaky gut has been associated with autoimmune diseases, including Hashimoto’s, restoring and protecting the lining of the gut is key to reducing symptoms and improving total health (14). Additionally, focusing on foods with nutrients such as selenium (like brazil nuts, fish, healthy animal proteins, and oatmeal) and zinc (such as seafood, legumes, and pumpkin seeds), as well as avoiding foods that cause inflammation, such as dairy, sugar, soy, gluten, and processed foods can all make a big difference in both gut health and reducing thyroid triggers (15). Adding in supplements such as vitamin B, iron, and potentially selenium and zinc may also be a good idea (16, 17). Based on your lifestyle, current diet, and test results, working with one of our Functional Doctors as well as our Functional Nutrition Lifestyle Practitioner is the best way to determine what you need and how to adjust your diet to fuel your body well.

Additionally, based on your specific health history and current needs, we will work together to determine if there are any other treatment options that could benefit you. We would love to help you mitigate symptoms, feel better, and achieve greater health. Reach out to us today to schedule a consultation!


Jonathan Vellinga, M.D.

Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.​

Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.




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