Functional Medicine And Hypothyroidism: 4 Lifestyle Essentials

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Written By

Rhea Dali

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Expert Reviewed By

Dr. Lauryn Lax, OTD, MS

Dr. Lauryn, OTD, MS is a doctor of occupational therapy, clinical nutritionists and functional medicine expert with 25 years of clinical and personal experience in healing from complex chronic health issues and helping others do the same.

A functional medicine approach to hypothyroidism begins first with a holistic assessment of thyroid function, followed by personalized diet, supplement, lifestyle and stress management recommendations targeted at the root cause(s) of low thyroid function.

In this review, we will address a thyroid-functional medicine approach and how to manage hypothyroidism including:

  • Hypothyroidism Assessment (including the 8 Common Root Causes of Hypothyroidism)
  • The Best Foods for Hypothyroidism 
  • Supplements for Hypothyroidism
  • Lifestyle Hacks for Hypothyroidism

And…if you don’t have time to read…

Get Functional Medicine Support 

Got hypothyroidism or want a proper clinical workup and customized treatment plan? Book a 20 minute complimentary call so we can discuss next steps to help you take back your health into your own hands.

Hypothyroidism Assessment 

“Test, don’t guess” is a core value of a functional medicine approach to hypothyroidism and anecdotal to many of the assessment histories of patients who walk in the door with a previous diagnosis of hypothyroidism based on a TSH or T4 level, or the opposite, thyroid symptoms—hair loss, weight gain, bloating, constipation, brain fog, fatigue—with a history of doctors telling them, “it’s normal” or “there’s nothing wrong!”

Thyroid assessment via functional medicine begins with an in depth intake, understanding symptoms and health history, followed by any helpful followup testing to rule out or in additional root causes and drivers.

The thyroid is related to the autonomic (non-thinking) nervous system and our metabolic function that keeps our body balanced. If our thyroid is out of whack, we often feel out of whack. Common hypothyroidism symptoms to be aware of include:

  1. Hair loss or brittle hair; thinning eyebrows
  2. Weight imbalances (namely weight gain)
  3. Body fat retention
  4. Constipation and bloating
  5. Fatigue 
  6. Brain fog
  7. Sometimes, insomnia 
  8. Cold sensitivity
  9. Lower heart or breath rate
  10. Dry skin
  11. High cholesterol
  12. Sluggishness
  13. Lowered libido

Once we establish if hypothyroidism symptoms are at play, we then move into “health detective” work—figuring out the root causes of these symptoms–is it the thyroid or something else? 

Thyroid dysfunction is often a symptom or result of a deeper underlying problem. 

Common “root causes” of hypothyroidism symptoms (beyond overt thyroid decline) include:

  1. Immune dysregulation (Hashimoto’s, celiac disease, or other autoimmunity)
  2. Chronic infections (EBV, bacterial infections, latent viruses)
  3. Nutrient imbalances
  4. Xenoestrogens and environmental toxins
  5. GI Dysfunction
  6. HPA Dysregulation
  7. Blood sugar dysregulation
  8. Reduced oxygen deliverability

Lab testing paired with a multi-symptom burden questionnaire may be utilized to rule in and out the core drivers at play. 

Bloodwork

Hypothyroidism - Hands Of A Lab Technician With A Tube Of Blood Sample

Bloodwork is typically the first place to start to assess hypothyroidism on paper and determine which type of hypothyroidism is at play. There are several “shades” of hypothyroidism including:

  • Overt hypothyroidism (high TSH and low T4/T3)
  • Subclinical hypothyroidism (TSH > 10)
  • Subclinical hypothyroidism (TSH = 2-10)
  • Normal thyroid with thyroid antibodies

In fact, 90% of all cases of hypothyroidism are actually Hashimoto’s (autoimmune) in nature and completely missed since most conventional endocrinologists and doctors do not run the thyroid antibodies lab marker. 

A complete thyroid panel will include:

  • TSH: 05.-2.0 ug/dL
  • Total T4: 6-12 ug/dL
  • Total T3: 100-180 ng/dL
  • Free T4: 1-1.5 ng/dL
  • Free T3: 2.5-4 ng/dL

If A patient only has high TSH and/or high thyroid antibodies, you can use the THEA (Thyroid Events Amsterdam) assessed to predict the progression of overt hypothyroidism. THEA is based on TSH, TPO antibodies, and family history of autoimmune thyroid disease. 

Thyroid ultrasound or imaging may also be indicated in some instances where hypothyroidism or Hashimoto’s are suspected, but not detected, via bloodwork, and in the case of nodules or enlarged goiters on the neck. 

If thyroid abnormalities or symptoms are detected, further workup and treatment should consider the possible root causes at play such as environmental toxins, GI dysfunction, HPA axis dysregulation, blood sugar dysregulation, reduced oxygen deliverability or anemia, nutrient imbalance, immune dysregulation, and chronic infections. 

From there, other lab testing that may be helpful include:

  • Environmental toxic burden testing (mycotoxin, metals, chemicals)
  • Comprehensive stool analysis + parasitology & H. Pylori
  • SIBO breath testing
  • Micronutrient testing
  • Celiac testing
  • Autoimmune testing (Cyrex Arrays)
  • Comprehensive blood chemistry
  • Blood sugar monitoring
  • HPA Axis testing (like the DUTCH test)

Not all lab testing will be indicated, just those that match the clinical symptom picture.

Also, addressing lifestyle factors such as poor sleep quality and deprivation, chronic stress, too much or too little physical activity, lack of meaningful connections, and adequate and play are essential and lead to improvement in hypothyroid related conditions.

The Best Foods for Hypothyroidism 

Hypothyroidism- Essential Nutrients For A Healthy Thyroid

Essential nutrients for a healthy thyroid include:

  • Iodine – sea vegetables, kelp flakes, raw dairy, iodized salt
  • Selenium- Brazil nuts, ocean fish especially halibut and tuna, ham, turkey, chicken, egg, beef
  • Iron – oysters, clams, liver, red meat
  • Zinc – liver, oysters, crab, lobster, beef
  • B vitamins (especially B12 and B2) – liver, red meat, mushrooms, seaweed, sardines, spinach, mackerel
  • Vitamin A – liver, cod liver oil, sea food, raw dairy
  • Vitamin C – red pepper, kiwi, oranges, broccoli, citrus, dark leafy greens
  • Vitamin D – cod liver oil, fatty fish (wild caught), sun light
  • Magnesium – dark leafy greens, chocolate, clams, beet greens, avocado

Foods often told to use “caution” with include goitrogens— substances that cause goiter, which is swelling of the thyroid gland. Goitrogens include: cruciferous vegetables, strawberries, kale, collards, mustard greens, Bok choy, spinach, peaches, soybeans, tofu, millet, cassava, peanuts, radishes, rutabagas, cabbage and sauerkraut. 

Large amounts of goitrogens impairs uptake of iodine into the thyroid hormone itself, which means that even the iodine that gets taken up by the thyroid gland, it can’t be properly utilized. Interestingly, boiling  and well-cooking goitrogen foods for 30 minutes and then discarding the water destroys 90 percent of the goitrogens. Consumption is really all about the “load.” Goitrogens in small amounts are generally fine.

For patients with an autoimmune thyroid (90%), consider experimenting with the autoimmune paleo protocol for at least 30 to 60 days to see if that helps. Remove gluten, grains, dairy, soy, sugar, legumes, nuts, eggs and nightshade spices and vegetables. lThen reintroduce foods one by one if patient did have an improvement. 

Additionally, depending on the “key drivers” of hypothyroidism—is it blood sugar? SIBO? Mycotoxins and mold? etc.—dietary recommendations should follow suit. If dysglycemia is a core driver, for example, then aiming to eat enough protein (0.8-1 g/lb healthy bodyweight) should be considered. Whereas if SIBO is at play, a short term low FODMAP diet paired with SIBO supplement protocol should be used. And for mycotoxins, a short term low histamine/low mold diet plus cleanse and detox is indicated.  

Supplements for Hypothyroidism

Supplements for hypothyroidism also depend greatly on the core drivers of hypothyroidism. 

One more time, is it…

  1. Immune dysregulation (Hashimoto’s, celiac disease, or other autoimmunity)
  2. Chronic infections (EBV, bacterial infections, latent viruses)
  3. Nutrient imbalances
  4. Xenoestrogens and environmental toxins
  5. GI Dysfunction
  6. HPA Dysregulation
  7. Blood sugar dysregulation
  8. Reduced oxygen deliverability

By and large, general supports most all hypothyroidism-related cases will benefit from include the following:

  • Lipsomal Glutathione for healthy T-regulatory cell function
  • Lipsomal Curcumin to decrease inflammation
  • Vitamin D, as most hypothyroid cases are low (along with plenty of sunshine exposure)
  • Adequate essential fatty acids, probiotics, and prebiotics (foods and supplements)
  • Prescribing physicians may also integrate Low-dose naltrexone or LDN to improve T-reg cell production and support and decrease systemic inflammation

As for hormonal thyroid replacement, this is best utilized after a complete hypothyroidism assessment  and nutrient, supplement, lifestyle hacks have been implemented.

Nevertheless, if overt hypothyroidism is indicated or a patient comes to us currently on thyroid meds, the best options most patients report are a T4-T3 combo therapy. This is primarily because T4 medication alone does not address “conversion” issues of T4 to active T3 thyroid hormone. The best option for T4-T3 combo for most people is natural desiccated thyroid, or NDT.

Lifestyle Hacks for Hypothyroidism

Hypothyroidism- Woman In A Sauna Room

Lastly, lifestyle hacks for hypothyroidism cannot be overlooked. Very rarely does a patient say that a long list of supplements or elimination diet was the “panacea” for feeling better. It usually has something to do with lifestyle factors. 

Helpful lifestyle hacks to improve hypothyroidism symptoms and remission include lifestyle hacks that, once again, address the PRIMARY core driver of hypothyroidism—regardless of the root cause, which is: stress.

Some helpful lifestyle hacks include:

  • Mind body therapies (heart math, Healy, bioresonnance, qi gong, yoga, mediation, breathwork)
  • Sunshine
  • Sauna therapy and detox baths
  • Regular exercise—but not too much
  • Lymphatic cleansing (dry brushing, rebounding, massage)
  • Incorporating laughter, joy, play, hobbies
  • Meaningful social life and connections

When given the right tools, the body (and thyroid), naturally want to heal itself. 

Get Functional Medicine Support 

Got hypothyroidism or want a proper clinical workup and customized treatment plan? Book a 20 minute complimentary call so we can discuss next steps to help you take back your health into your own hands. 

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