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Evidence Based

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Support Your Thyroid With These Supplements for Hashimoto’s

Written by Dr. Michael Ruscio, DC on June 7, 2022

Written by Dr. Michael Ruscio, DC on June 7, 2022 — Reviewed by Dr. Hannah Hamlin

Give Your Thyroid Gland the Nutrition It Needs

• Best Supplements for Hashimoto’s Disease|
• Other Hashimoto’s Thyroiditis Supplements|
• Why Do These Supplements Work?|
• Target Your Gut: Probiotics for Hashimoto’s|
• Are There Ineffective Supplements for Hashimoto’s?|
• Use Supplements for Hashimoto’s Wisely|

Could your thyroid autoimmunity be caused by something as “basic” as a nutrient deficiency?

A quick review: Hashimoto’s disease or autoimmune thyroiditis is an autoimmune disorder where the immune system attacks the thyroid gland, causing inflammation, reduced thyroid-hormone production, and eventually thyroid tissue damage. 

Typical symptoms of Hashimoto’s include constipation, fatigue, hair loss, weight gain, dry skin, and cold intolerance. Potential causes of Hashimoto’s disease include deficiencies in nutrients like vitamin D, zinc, selenium, and iodine [1, 2, 3, 4].

It’s unlikely that one of these deficiencies will be the sole root cause behind your Hashimoto’s, but correcting any low vitamin and mineral concentrations may have a major impact on your symptoms and your overall well-being. This is where supplements come in (in addition to a healthy diet). 

Even if you don’t have a clear-cut deficiency, you may find some of these supplements helpful since they’re known to modulate the immune system, reduce inflammation, and regulate hormones. They often support each other and may be most beneficial when used together. 

In this article, we’ll discuss which supplements for Hashimoto’s are the most effective and well-researched, as well as some additional options that have less research supporting them, but may still be effective. We’ll address supporting gut health for thyroid autoimmunity, too. 

Best Supplements for Hashimoto’s Disease

There are a few key supplements that have a large volume of high-quality research supporting their effectiveness for relieving symptoms of Hashimoto’s disease. These include:

• Selenium
• Inositol (myo-inositol)
• Vitamin D

Let’s take a look at each of these supplements and their benefits for Hashimoto’s disease.

Selenium

Out of any other supplement, selenium has the largest body of evidence showing improvement in Hashimoto’s, with three systematic reviews and meta-analyses showing a reduction in thyroid peroxidase (TPO) antibodies [5, 6, 7].

One of these studies examining nine randomized controlled trials (a total of 787 patients) found evidence that selenium supplements reduced TPO antibodies when taken for six months and 12 months, and they improved mood and well-being [6]. At the 12-month mark, researchers noted that thyroglobulin (TG) antibodies dropped significantly.

Based on research showing potential side effects and decreased effectiveness with long-term use, selenium shouldn’t be continuously used over the long term (best for six to 12 months max) [8, 9, 10].

Inositol

Another supplement that’s best taken along with selenium is myo-inositol. Several studies found that taking myo-inositol along with selenium reduced thyroid-stimulating hormone (TSH) and thyroid antibody levels [11, 12, 13, 14].

A study was performed to assess the effectiveness of inositol and selenium on autoimmune thyroiditis (Hashimoto’s). A total of 48 women with Hashimoto’s were assigned to receive 83 micrograms per day of selenium either alone or in combination with 600 mg/day of myo-inositol for six months. At the end of the study, the results showed the following [11]:

• More patients in the selenium + myo-inositol group had greater improvements on thyroid ultrasound and well-being than the selenium-only group.
• TSH levels specifically improved by 31% in the combined treatment group compared to 0% in the selenium-only group. (Selenium seems to have a greater effect on specifically reducing antibodies, not directly improving hormone output, when used on its own.)
• Both groups had significant improvements in anti-TPO and anti-TG antibodies, but the combined treatment group had slightly greater improvements.

Studies like this one show that inositol and selenium are most effective when used together. But, this doesn’t mean that each can’t be effective on its own as well, depending on the patient. 

There are a couple different forms of inositol. While all of the studies used myo-inositol vs. d-chiro inositol, it’s likely that benefits extend to both forms. Consult with your healthcare provider to determine which form and how much to take for Hashimoto’s thyroiditis.

Vitamin D

Vitamin D also has a significant body of evidence demonstrating improvements in Hashimoto’s [15, 16, 17], and it may be more effective when taken along with selenium [18].

A 2022 systematic review and meta-analysis of six clinical trials involving 258 Hashimoto’s patients found that vitamin D supplementation was associated with significant improvements in TPO antibody levels, but not free T4, free T3, or TSH levels, compared to the control group [15].

This suggests that vitamin D supplementation may have a positive effect on the immune system and regulating autoimmunity, but not necessarily thyroid hormone production or the thyroid itself [19, 20].

Another study involving 652 patients with Hashimoto’s thyroiditis found that vitamin D3 supplementation for more than three months significantly improved TPO and TG antibody levels [16].

A clinical trial wanted to see if improving vitamin D status could improve thyroid autoimmunity. A total of 47 euthyroid (healthy thyroid) women with Hashimoto’s and low vitamin D levels were given 4,000 IU of vitamin D per day for six months. Prior to the study, 23 of the women had also been taking selenium for 12 months. The results showed that vitamin D supplementation improved TPO and TG antibody levels [18].

The researchers concluded that combining vitamin D and selenium appeared to be more effective for improving thyroid antibody levels than vitamin D alone [18].

Other Hashimoto’s Thyroiditis Supplements

Less studied but still potentially beneficial supplements for Hashimoto’s include: 

• Dehydroepiandrosterone (DHEA)
• The herb Nigella sativa (black seed or black cumin)
• Zinc
• Iron
• Magnesium

The androgen hormone dehydroepiandrosterone (DHEA), which is produced in the adrenal glands, ovaries, and testes, was shown in two studies to reduce thyroid antibodies [21, 22].

However, these studies were conducted on very select populations, including elderly men with already low DHEA levels [21], and women of reproductive age with reduced sex drive [22]. As it’s unclear if DHEA would be helpful for other populations, especially those with normal levels of DHEA, it’s best to get your DHEA levels checked prior to taking this supplement.

A randomized controlled trial evaluated the effect of the potent herbal medicine Nigella sativa on thyroid function. A total of 40 patients with Hashimoto’s (all taking levothyroxine, a thyroid medication) were randomly assigned to receive 2 grams per day of Nigella sativa powder or placebo for eight weeks. The results showed that Nigella sativa supplementation was associated with a significant reduction in anti-TPO antibodies and TSH, as well as a significant increase in T3 compared to placebo [23].

A literature review provided a summary of research investigating the role of various minerals in Hashimoto’s thyroiditis. The review found the following regarding minerals and autoimmune thyroid disease [24]:

• Zinc has shown to improve hypothyroidism in general, but there are no studies on its role in Hashimoto’s.
• Magnesium helps improve iodine uptake into the thyroid, which is a critical step needed for thyroid hormone production.
• Iron is needed for thyroid hormone production and its deficiency is associated with thyroid disorders.

Each individual’s need for these minerals will be different, and you should discuss your mineral status with your healthcare provider. Note that magnesium and iron supplements should also be taken three to four hours after any thyroid medication, since they may interfere with medication absorption. 

Should You Take Iodine for Hashimoto’s Disease? 

There’s a lot of controversy around iodine use in the alternative medicine world. In my clinical experience, iodine supplements should only be given when a patient has a true iodine deficiency that needs to be corrected. This is backed by research that shows that hypothyroid conditions and thyroid autoimmunity may actually worsen with iodine supplementation [25, 26, 27].

If you’re concerned about how much iodine you’re getting through your diet, you can use the food-tracking app Cronometer to assess your intake for a couple of weeks. If it looks like you aren’t getting enough dietary iodine, you can first increase your intake of iodine-rich foods. Magnesium also supports iodine uptake in the body, so magnesium supplementation may be recommended.

If you’re still concerned about iodine levels, you can consult your doctor about doing a 24-hour urinary iodine-creatinine ratio test. This is the most accurate option for testing iodine levels [28].

Why Do These Supplements Work?

There are many possible mechanisms that these supplements may be activating in your body to reduce Hashimoto’s symptoms. Some of these include: 

• Increasing antioxidants [29]
• Lowering inflammation [30, 31]
• Lowering oxidative stress [32]
• Modulating immune function [19, 33]
• Increasing thyroid cell signaling and hormone conversion [34]

It’s also worth noting that many of these supplements are simply replacing essential nutrients that the body needs to function and may have been missing due to an insufficient diet, chronic stress (which uses up vitamins and minerals like selenium and vitamin D), or exposure to toxins and pollutants in our everyday environment that either require more nutrients to detoxify or block nutrients from being absorbed well. 

This is why patients with a notable selenium deficiency, iodine deficiency, zinc deficiency or any other low nutrient levels observed alongside their thyroid symptoms will often have dramatic improvements just by increasing these levels to an optimal range.

Another critical component of any autoimmune condition is excessive inflammation, so lowering inflammation (which might look like lowering oxidative stress and increasing antioxidants) will also have a positive effect on symptoms. 

Target Your Gut: Probiotics and Other Gut Supplements for Hashimoto’s

We’ve talked about the gut-thyroid connection many times — we know that gut health has a significant impact on thyroid function and vice versa. So it stands to reason that improving gut health with targeted supplements could improve thyroid health as well. Of course, supplements will only work as they’re intended if you’re also prioritizing a gut-healing diet, so you’ll ideally spend some time dialing that in first before adding supplements to your routine. 

Research shows that gut infections may occur alongside Hashimoto’s disease, so taking probiotics and antimicrobials when necessary may improve autoimmune thyroid symptoms and reduce TPO antibodies [35, 36, 37].

Other research indicates that Hashimoto’s may be correlated with dysbiosis, SIBO, and leaky gut [38, 39]. Probiotic use can help improve these conditions, restoring the microbiome and repairing the gut lining [40, 41, 42].

Another branch of the digestive system to consider is the stomach, specifically stomach acid levels. Gastric disorders occur in about 10-40% of Hashimoto’s patients, and about 40% of people with autoimmune gastritis also have Hashimoto’s [43]. Autoimmune gastritis can result in low stomach acid, which can lead to certain nutrient deficiencies such as iron, vitamin B12, vitamin D, and calcium [44].

Low stomach acid can contribute to nutrient deficiencies and poor digestion, which may in turn affect thyroid health. 

Taking betaine HCl may be helpful for improving stomach acid levels and nutrient absorption for patients with Hashimoto’s and autoimmune gastritis [45, 46, 47]. Taking a multivitamin may also be helpful for improving nutrient deficiencies associated with Hashimoto’s, since multivitamins have been shown to improve nutrient status [48]. Just make sure to take your multi three to four hours apart from thyroid medication.

Finally, L-glutamine can help restore a leaky gut and increase nutrient absorption and medication absorption, improving thyroid health [49, 50, 51, 52, 53].

Are There Ineffective Supplements for Hashimoto’s?

There isn’t much research around which supplements are ineffective for Hashimoto’s disease. 

However, supplements such as zinc, magnesium, and iron are often recommended as a first-line treatment for Hashimoto’s because these are key components for creating thyroid hormone. This likely makes them a good first-line choice when treating hypothyroid conditions, including Hashimoto’s, despite a lack of research directly demonstrating their effectiveness for reducing TPO antibodies [24].

This doesn’t mean they aren’t helpful for Hashimoto’s, only that there’s a lack of evidence currently. We also know that supplements like selenium, myo-inositol, and vitamin D have much more research backing their effectiveness for lowering TPO antibodies specifically, so these are another good starting point when trialing supplements for Hashimoto’s. What supplement(s) end up being most effective will be largely individual.

It’s better to start with a few tried-and-tested supplements when beginning a healing protocol, and then move on to other less-researched options down the road if needed. Addressing specific nutrient deficiencies can also be helpful where needed.

Use Supplements for Hashimoto’s Wisely

Taking certain supplements for Hashimoto’s disease, like selenium, inositol, and vitamin D, can be a key part of a comprehensive treatment plan for healing autoimmune thyroid disease. 

Of course, you should discuss with your healthcare provider what options may work best for you, depending on your symptoms, labs, and health goals. 

If you want more guidance on supplementation for Hashimoto’s disease and a clearly defined treatment plan, reach out to us at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.