What does the thyroid do?

Thyroid hormones are essential for growth, reproduction, neuronal development, and regulation of energy metabolism.1 These hormones, thyroxine (T4) and triiodothyronine (T3), are released from a small gland located in the neck, the thyroid gland, in response to the stimulation of another hormone from the pituitary gland called the thyroid-stimulating hormone (TSH).2

However, thyroid dysfunction is common. Although it is easily identifiable and treatable, it can have profound adverse effects if undiagnosed or untreated.

What’s Hypothyroidism?

Hypothyroidism is a chronic disease characterized by insufficient production of thyroid hormones, which affects up to one of every 200 people in the population. The patients can suffer from:

• Fatigue and weakness
• Unexplained weight gain
• Poor concentration
• Constipation
• Diffuse muscle pain
• Depression
• Dry skin and hair loss

Causes and Risks

Hypothyroidism can result from autoimmune thyroiditis in the form of Hashimoto’s disease, post-partum, high doses of lithium carbonate, amiodarone, interferon-alpha, or interleukin-(2) thyroid surgery or radiation, or other environmental and infectious causes. (4)

Interestingly, hypothyroidism also rises due to the deficiency of particular essential nutrients such as iodine, selenium, zinc, iron, and many other vitamins, which have a profound role in the synthesis process of thyroid hormones. For example, iodine deficiency is considered as the most common cause of hypothyroidism,(5) although iodine deficiency is uncommon in the United States, its intake is still suboptimal in many parts of Europe, Asia, and Africa. (6)

Treating Hypothyroidism

The gold standard of treatment is thyroid hormone replacement therapy in the form of “levothyroxine”, an exogenous form of T4.(7)

However, though, managing hypothyroidism isn’t just about the prescribed medications. Patients are also in need of dietary supplements and lifestyle changes.

Supplements for hypothyroidism

Iodine

Iodine is a profound component of thyroid hormone synthesis. It presents naturally in seaweed, grain and dairy products, and eggs. Nevertheless, its global distribution is uneven, since some environmental areas are rich in iodine, while others are deficient.(8)

Therefore, many programs were implemented for iodine supplementation through adding iodine to salt, i.e. salt iodization, to reduce the risk of iodine deficiency. (9) Still, over a billion people worldwide live in iodine-deficient areas, such as Southeast Asia, South America, and Central Africa. (5)

Moreover, there are some factors that interfere with the absorption of iodine in those who are with intestinal malabsorption, underwent bariatric surgery, in addition to the increased intake of goitrogens. Goitrogens containing food are soy, flax seeds, broccoli, Brussels sprouts, cauliflower, and cabbage, they counteract iodine, and so if taken in large amounts, or in the presence of iodine deficiency, goitrogens can exacerbate iodine deficiency or worsen hypothyroidism. (9)

Notably, although low levels of iodine affect thyroid hormone production which leads to hypothyroidism, iodine intake is critical, as the excessive high intake of iodine can also cause hypothyroidism. (10) Excess intake of iodine induces some suppression on the thyroid function, especially in those whose thyroid is affected by autoimmunity becoming more sensitive to the inhibitory effect of iodine.

The mechanism of this reaction is still unknown, but iodine is found to have an auto-regulatory inhibitory effect on many processes in the thyroid gland. (11) Therefore, it is important to speak with your healthcare provider to adjust your supplemental dose and test the thyroid function before consuming any iodine supplements.

Iodine recommended daily dose for adequate thyroid function is 150 micrograms per day for most adults(9). This dose in some people is no enough requiring higher doses to get enough iodine in their body.

Selenium

Selenium supports the thyroid function as it is an essential component for the enzyme that converts T4 to the active thyroid hormone T3. In addition, it protects the thyroid gland against oxidative damage and reduces the levels of antibodies against thyroid peroxidase enzyme, which plays an essential role in the production of thyroid hormones, in autoimmune thyroiditis; likewise, the magnesium does, so that correcting magnesium deficiency along with selenium leads to improving Hashimoto’s symptoms. (12)

Selenium is naturally found in cereals, mushrooms, tuna, sardines, shrimp, scallops, beef, eggs, chicken, turkey, and Brazil nuts.13 Otherwise, it could be taken in a supplemental form of 100 to 200 micrograms per day.

Zinc

Similar to selenium, zinc plays a role in the conversion of the thyroid hormone T4 to the active thyroid hormone T3; in addition, it has multiple roles in regulating many aspects of thyroid hormone synthesis and metabolism. Besides, from the other point of view, thyroid hormones are essential for zinc absorption, thus, hypothyroidism may itself results in zinc deficiency, which can worsen the case. (14)

Food sources of zinc include shellfish, mollusks, red meat, poultry, beans, and nuts. The recommended daily intake for adults is 8 – 12 mg per day, which reaches up to 30 mg for patients with hypothyroidism. (15)

But while supplementing with zinc, make sure that you have an adequate level of copper since zinc interacts with copper in a competitive manner in the gut, thus if you take a high dose of zinc supplementation it would reduce the amount of copper your body absorbs. Therefore, many doctors recommend taking 2mg of copper along with zinc supplements to protect against a copper deficiency. (16)

Vitamin A

Vitamin A is a fat-soluble vitamin that is important for healthy thyroid function, and its deficiency is correlated with thyroid dysfunction. (17,18) Additionally, when converting the case, inadequate thyroid function can lead to vitamin A deficiency through impairing the conversion of beta-carotene, the precursor of vitamin A, into the biologically active vitamin A. (19) Therefore, its supplemental intake is necessary since it also has an essential role in vision, immune function, and reproduction. (20)

Food sources of vitamin A are green leafy vegetables, liver, milk, fish oil, and eggs. Evidence has suggested that vitamin A supplementation can reduce the risk of subclinical hypothyroidism in healthy premenopausal women in Iran. (21).

However, it is not recommended to take high doses of preformed vitamin A in long term, instead, beta-carotene, the vitamin A precursor, is better for daily supplementation.

Iron

Iron is an element that is essential for the synthesis and metabolism of the thyroid hormones, playing a role in converting T4 into the active thyroid hormone T3 via the thyroid peroxidase enzyme. (23) Anemia and its deficiency were found to be associated with thyroid dysfunction and hypothyroidism. (24,25)

Since iron is also an important component of hemoglobin, and plays a pivotal role in growth, metabolism, and development, correcting its deficiency is necessary. Iron is naturally found in liver, red meat, beans, nuts, dried, and soybean flour. (26).

In addition, iron supplementation improves the beneficial effects of iodine supplementation, while its deficiency decreases the iodine effect. (27)

Vitamin B

Hypothyroid patients are often experiencing vitamin B deficiency, especially vitamin B12, most commonly among people with Hashimoto’s disease. Therefore, since vitamin B supports red blood cell formation, DNA synthesis, and neurological functions, it is essential to maintain its optimal level by supplementing patients with the entire vitamin B complex. (28) Natural sources of vitamin B include fish, eggs, meat, whole grains, legumes, nuts, milk products, and dark leafy greens. (29)

Although many research studies revealed that there is an association between hypothyroidism and vitamin B12 deficiency, yet, it is not known whether supplementing with vitamin B has a role in improving thyroid function, but still, its deficiency is needed to be corrected. (30)

Vitamin D

Vitamin D is a fat-soluble vitamin that is found to be deficient in hypothyroid patients, especially those with autoimmune thyroid disease, including Hashimoto’s thyroiditis. (31) Some clinical trials have found that vitamin D supplementation, preferably in the form of vitamin D3 (cholecalciferol), improves hypothyroidism, however, though, further long-term trials are needed to investigate its therapeutic role in thyroid disease. (32)In general, vitamin D enhances calcium absorption, supports growth and remodeling of the bone, endorses immunity, and reduces inflammation. Therefore, its deficiency is pivotal to be corrected, even regardless of its effect on the thyroid gland itself. It naturally presents in fish liver oil and fatty fish and is produced via exposure to sunlight. (33)

Vitamin E

Vitamin E is one of the fat-soluble vitamins which is of a protective role against oxidative stress caused by hypothyroidism and thyroid damage.34 Although the research is still limited to animal models, it was found to be effective when paired with levothyroxine replacement therapy. (35)Vitamin E is naturally found in plant oils, nuts, and cereals, and it exists in eight different forms, including alpha-, beta-, gamma-, and delta- tocopherols and tocotrienols, of which the α-tocopherol is the predominant and significantly more potent than any other naturally occurring tocopherol (36)

However, a combination of tocotrienols and tocopherols as the commercially available “Gamma E” is advised as each of which has slightly different activity in the body.

Other Supplements:

Omega-3 Fatty Acids
Research suggests that omega-3 can support thyroid function through decreasing inflammation that compromises thyroid function, thus it can be particularly beneficial for people with autoimmune thyroid disorders such as Hashimoto’s.
Turmeric

Turmeric is a common spice used in Middle Eastern foods that contains anti-inflammatory and antioxidant properties, which is beneficial in managing autoimmune conditions like Hashimoto’s thyroiditis. Daily intake of turmeric was found to reduce inflammation and goitrogenesis, which will improve hypothyroidism. (37)

How to detect if you have a nutrient deficiency?

If you have hypothyroidism, suspect that you have a nutrient deficiency, or if you want to protect yourself against hypothyroidism, a good approach is to monitor your mineral and vitamin levels with a blood test, either through:

A venous blood test: a trained specialist will use a needle to puncture a vein, usually in your arm, to collect a blood sample.

A finger-prick blood test: using a lancet, you can prick your own finger and collect a small blood sample.

It can be done either at your GP’s, laboratory center, or a local hospital. Or you can order a test kit online which is available on several platforms and do it yourself.

If you’re deficient in a certain nutrient, you can either increase your intake of foods that are rich in these nutrients or start taking supplements, which are definitely necessary in some cases.

How long it takes for the supplements to work?

Usually, most of the minerals and vitamins supplements work within days; however, it depends on several factors:

• The deficiency level
• Nutrient Pairing
• Form of the supplement, either liquid or capsulate
• The type of the vitamin, either fat- or water-soluble vitamin
• The digestive health

Lifestyle and the general health state.

Along with your medical treatment, your thyroid hormone levels can return to normal, for which your symptoms will usually disappear. However, you should regularly monitor your hormone and some vitamin levels by blood tests. This is important for your doctor to adjust your doses as necessary.

Tips and Precaution

The best way to choose the best supplement for you is to consult your healthcare provider.

Some supplements may interfere with thyroid medication and affect thyroid hormone absorption, if taken at the same time with the medications, such as calcium, and iron, in addition to medications that contain magnesium or aluminum. So talk to your healthcare provider before taking any of these supplements, as they should be taken at least 4 hours apart from your thyroid medication

Always seek supplements from trusted brands that independently test their products for quality and purity and under the supervision of a doctor.

Take your medication at regular intervals to help the body regulate itself.

Try to eat a balanced diet. (organic vegetables, fruits, grass-fed meats, and wild fish)

Drink plenty of fluids throughout the day.

Avoid caffeine and gluten.

Limit your sugar and alcohol consumption to help control symptoms.

Do regular exercise considering your tolerance.

Stop smoking.

Manage your stress.

In brief, research suggests that certain supplements, including optimized doses of iodine, selenium, zinc, iron, tyrosine, vitamins A, B, D, and E, omega-3 fatty acids, and turmeric may be beneficial for people with hypothyroidism and Hashimoto’s disease. Such supplements could be taken in a well-balanced, nutrient-dense diet rich in these nutrients or in a supplemental form, either way, maintaining a healthy gut is essential for proper absorption.

References:

1.  Dumont J. Ontogeny, anatomy, metabolism and physiology of the thyroid. Thyroid Disease Manager. Published online 2011.

2.  Guglielmi R, Grimaldi F, Negro R, et al. Shift from Levothyroxine Tablets to Liquid Formulation at Breakfast Improves Quality of Life of Hypothyroid Patients. Endocr Metab Immune Disord Drug Targets. 2018;18(3):235-240. doi:10.2174/1871530318666180125155348

3.  Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The Incidence and Prevalence of Thyroid Dysfunction in Europe: A Meta-Analysis. J Clin Endocrinol Metab. 2014;99(3):923-931. doi:10.1210/jc.2013-2409

4.  Carlé A, Laurberg P, Pedersen IB, et al. Epidemiology of subtypes of hypothyroidism in Denmark. Eur J Endocrinol. 2006;154(1):21-28.

5.  Vanderpump MPJ. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1).

6.  Chiovato L, Magri F, Carlé A. Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Adv Ther. 2019;36(Suppl 2):47-58. doi:10.1007/s12325-019-01080-8

7.  Elmor R, Sandulli W, Carter CA. The economic impact of changing levothyroxine formulations in difficult-to-treat hypothyroid patients: an evidence-based model. Pharmacoeconomics. 2017;35(2):113.

8.  Zimmermann MB. Iodine deficiency. Endocr Rev. 2009;30(4):376-408.

9.  NIH. National Institutes of Health. Iodine. Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/

10.  Leung AM, Braverman LE. Iodine-induced thyroid dysfunction. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):414-419. doi:10.1097/MED.0b013e3283565bb2

11.  Laurberg P, Andersen S, Pedersen IB, Carlé A. Hypothyroidism in the Elderly: Pathophysiology, Diagnosis and Treatment. Drugs Aging. 2005;22(1):23-38. doi:10.2165/00002512-200522010-00002

12.  Ventura M, Melo M, Carrilho F. Selenium and Thyroid Disease: From Pathophysiology to Treatment. Int J Endocrinol. 2017;2017:1297658. doi:10.1155/2017/1297658

13.  Mao J, Pop VJ, Bath SC, Vader HL, Redman CWG, Rayman MP. Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency. Eur J Nutr. 2016;55(1):55-61. doi:10.1007/s00394-014-0822-9

14.  Betsy A, Binitha M, Sarita S. Zinc deficiency associated with hypothyroidism: an overlooked cause of severe alopecia. Int J Trichology. 2013;5(1):40-42. doi:10.4103/0974-7753.114714

15.  NIH. National Institutes of Health. Zinc. https://ods.od.nih.gov/factsheets/zinc-healthprofessional/

16.  Hoffman HN 2nd, Phyliky RL, Fleming CR. Zinc-induced copper deficiency. Gastroenterology. 1988;94(2):508-512. doi:10.1016/0016-5085(88)90445-3

17.  Zimmermann. Interactions of Vitamin A and Iodine Deficiencies: Effects on the Pituitary-Thyroid Axis. Int J Vitam Nutr Res. 2007;77(3):236-240. doi:10.1024/0300-9831.77.3.236

18.  Micronutrient Information Center. Vitamin A. Higdon J. Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/vitamin-A#deficiency

19.  Aktuna D, Buchinger W, Langsteger W, et al. [Beta-carotene, vitamin A and carrier proteins in thyroid diseases]. Acta Med Austriaca. 1993;20(1-2):17-20.

20.  Vitamin A. NIH. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/

21.  Farhangi MA, Keshavarz SA, Eshraghian M, Ostadrahimi A, Saboor-Yaraghi AA. The effect of vitamin A supplementation on thyroid function in premenopausal women. J Am Coll Nutr. 2012;31(4):268-274. doi:10.1080/07315724.2012.10720431

22.  Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-1751. doi:10.1089/thy.2014.0028

23.  Ghiya R, Ahmad S. SUN-591 Severe Iron-Deficiency Anemia Leading to Hypothyroidism. J Endocr Soc. 2019;3(Supplement_1). doi:10.1210/js.2019-SUN-591

24.  Khatiwada S, Gelal B, Baral N, Lamsal M. Association between iron status and thyroid function in Nepalese children. Thyroid Res. 2016;9:2. doi:10.1186/s13044-016-0031-0

25.  Yu X, Shan Z, Li C, et al. Iron deficiency, an independent risk factor for isolated hypothyroxinemia in  pregnant and nonpregnant women of childbearing age in China. J Clin Endocrinol Metab. 2015;100(4):1594-1601. doi:10.1210/jc.2014-3887

26.  Iron. Fact Sheet for Health Professionals. NIH. National Institutes of Health. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/#h3

27.  Zimmermann MB, Köhrle J. The impact of iron and selenium deficiencies on iodine and thyroid metabolism:  biochemistry and relevance to public health. Thyroid. 2002;12(10):867-878. doi:10.1089/105072502761016494

28.  Aktaş HŞ. Vitamin B12 and Vitamin D Levels in Patients with Autoimmune Hypothyroidism and Their Correlation with Anti-Thyroid Peroxidase Antibodies. Med Princ Pract. 2020;29(4):364-370. doi:10.1159/000505094

29.  Vitamin B12. Fact Sheet for Health Professionals. NIH. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

30.  Morel S, Georges A, Bordenave L, Corcuff J-B. Thyroid and gastric autoimmune diseases. Ann Endocrinol (Paris). 2009;70(1):55-58. doi:10.1016/j.ando.2008.11.003

31.  Laney N, Meza J, Lyden E, Erickson J, Treude K, Goldner W. The Prevalence of Vitamin D Deficiency Is Similar between Thyroid Nodule and Thyroid  Cancer Patients. Int J Endocrinol. 2010;2010:805716. doi:10.1155/2010/805716

32.  Talaei A, Ghorbani F, Asemi Z. The Effects of Vitamin D Supplementation on Thyroid Function in Hypothyroid Patients: A Randomized, Double-blind, Placebo-controlled Trial. Indian J Endocrinol Metab. 2018;22(5):584-588. doi:10.4103/ijem.IJEM_603_17

33.  Vitamin D. Fact Sheet for Health Professionals. NIH. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

34.  Sarandöl E, Taş S, Dirican M, Serdar Z. Oxidative stress and serum paraoxonase activity in experimental hypothyroidism:  effect of vitamin E supplementation. Cell Biochem Funct. 2005;23(1):1-8. doi:10.1002/cbf.1119

35.  Pan T, Zhong M, Zhong X, Zhang Y, Zhu D. Levothyroxine replacement therapy with vitamin E supplementation prevents oxidative stress and cognitive deficit in experimental hypothyroidism. Endocrine. 2013;43(2):434-439. doi:10.1007/s12020-012-9801-1

36.  Rimbach G, Minihane AM, Majewicz J, et al. Regulation of cell signaling by vitamin E. Proc Nutr Soc. 2002;61(4):415-425. doi:10.1079/pns2002183

37.  Jawa A, Jawad A, Riaz SH, et al. Turmeric use is associated with reduced goitrogenesis: Thyroid disorder prevalence in Pakistan (THYPAK) study. Indian J Endocrinol Metab. 2015;19(3):347-350. doi:10.4103/2230-8210.152768