Millions of Americans have thyroid disease and don’t know it. Are you one of them?


When Mary Shomon suddenly found herself exhausted in the middle of the morning, her doctor told her to get more sleep. When she reported that her hair was falling out and she was depressed and moody, her doctor attributed it to the stress of planning her upcoming wedding. When she went for a bridal fitting and could barely zip her size 8 dress, her doctor reminded her that she was 33 years old and her metabolism was changing. So Shomon started dieting, exercising, and making sure she got plenty of shut-eye. But a few months later, when her symptoms hadn’t improved and bridal consultants started gently steering her toward the size 16 dresses, Shomon’s doctor became alarmed.

“She told me she was going to run some tests. A few days later, I got a message from her saying my thyroid was underactive,” Shomon says. “And I thought, ‘What is she talking about? What’s a thyroid?’”

Fifteen years later, Shomon definitely knows what a thyroid is: She has written eight books on the subject, including the New York Times best seller The Thyroid Diet, and is a leading authority on thyroid disease, treatment, and prevention. She realizes that if her doctor hadn’t taken her symptoms seriously, she might not only be pudgy, depressed, and tired today, but frustrated as well. “I’ve talked with people who have gone years with the same symptoms I had, and their doctors have diagnosed them with everything from mental illness to laziness,” she says. “One woman told me her doctor actually said that her only problem was that she was suffering from fork-in-mouth disease.”

According to the American Association of Clinical Endocrinologists (AACE), 27 million Americans have thyroid disease, but more than half remain undiagnosed. The reason? Doctors often confuse thyroid symptoms with other diseases that carry similar symptoms, and testing processes can be antiquated and inaccurate (see “Simple Steps to Accurate Testing,”). Doctors also tend to overlook thyroid disease because, unlike heart disease or diabetes, thyroid problems rarely kill you, and symptoms are non-specific. Even thyroid cancer is one of the most survivable cancers because it grows so slowly. “Some people refer to it as the ‘good cancer,’ which drives thyroid patients crazy,” Shomon says.

But thyroid disease, which includes hypothyroidism, hyperthyroidism, goiters, and nodules, can cause serious health risks besides cancer. The tiny, butterfly-shaped thyroid gland at the base of your throat produces hormones that control every function in your body. “Thyroid hormone improves mood, skin, hair, nails, sex drive, heart function, cholesterol, infertility, and hormonal symptoms such as PMS and menopause. It influences muscle aches, joint pain, body temperature, and metabolism,” says Mark Hyman, MD, founder and director of The UltraWellness Center in Lenox, Massachusetts, and author of The Ultra Thyroid Solution.

A study in the Journal of Clinical Endocrinology & Metabolism reported that hypothyroidism, or under-functioning thyroid, not only contributes to 60 percent of heart attacks in women, but the condition is more of a risk factor for cardiovascular events than smoking, elevated cholesterol, high blood pressure, or diabetes. Thyroid problems have also been linked to birth defects, and studies show that 6 percent of miscarriages are caused by hypothyroidism. What’s more, research has found that children born to hypothyroid mothers have an average IQ 7 points lower than kids born to mothers with normally functioning thyroids and are more than twice as likely to repeat a grade due to learning disabilities. In addition, hypothyroidism has been associated with fibromyalgia, osteoporosis, and depression, according to Jacob Teitelbaum, MD, medical director of the national Fibromyalgia and Fatigue Centers. An overactive thyroid (hyperthyroidism) is just as problematic and can lead to congestive heart failure, osteoporosis, and prediabetes.

Types of thyroid disease

In many ways, Shomon is a poster child for thyroid problems. She’s female—eight out of 10 thyroid patients are women, according to the AACE—and was nearing perimenopause when she was diagnosed. Although no one is sure exactly why women are so disproportionately targeted, Marcelle Pick, RNC, a nurse practitioner and cofounder of the Women to Women Health Care Center in Yarmouth, Maine, theorizes that estrogen and progesterone imbalance can play havoc with thyroid hormones and trigger the disease. In fact, she says, “There is a strong relationship between women in perimenopause in their late 30s or 40s and hypothyroidism.” Shomon also has the most common kind of thyroid problem: According to the National Institutes of Health, five times as many people have hypothyroidism as hyperthyroidism.

Hypothyroidism is a lack of thyroid hormones due to an underactive or missing thyroid. The most frequent cause is Hashimoto’s thyroiditis, an autoimmune disease in which the immune system attacks the thyroid, damaging its ability to produce hormones. Symptoms include weight gain, increased sensitivity to cold, constipation, muscle weakness, joint pain, depression, difficulty concentrating, fatigue, hair loss (especially the outer third of the eyebrows), dry skin, water retention in the hands and feet, low sex drive, hoarse voice, high cholesterol, and excessive menstrual bleeding.

Hyperthyroidism occurs when the thyroid is overactive, producing too much hormone. Its most common cause is the autoimmune disorder Graves’ disease. Symptoms include weight loss, increased appetite, rapid or irregular heartbeat, bulging eyes or eye irritation, anxiety, irritability, insomnia, trembling in your hands and fingers, increased sweating, muscle weakness, diarrhea, and light menstrual flow.

Nodules are a swelling in one part of the thyroid and are extremely common. By the time a woman is 50, she has a 50 percent chance of developing a nodule larger than half an inch, according to the US Department of Health and Human Services. Nodules are a mystery—no one knows what causes them, and most people don’t have symptoms. In rare cases, they can cause hyperthyroidism or become so big that they interfere with swallowing or breathing.

Cancer occurs in less than 10 percent of nodules. It mainly affects women over 40 with a family history of thyroid cancer and generally doesn’t cause any symptoms. In most cases, it grows slowly and rarely spreads, so removing the thyroid usually destroys the cancer.

Goiters are relatively rare enlargements of the thyroid gland usually caused by a lack of iodine, which helps the thyroid produce hormones. Goiters can also be a side effect of Graves’ disease or Hashimoto’s thyroiditis.

Drug therapy

When Shomon was diagnosed with hypothyroidism, her doctor prescribed the drug Levoxyl. Along with Synthroid, Levothroid, and Unithroid, Levoxyl is an artificial thyroid hormone designed to kick-start an underperforming thyroid or help shrink nodules. Although these drugs have virtually no side effects (some can simulate hyperthyroid symptoms if your dosage is too high), Shomon didn’t find them particularly effective. After a year on Levoxyl, she still had hypothyroid symptoms, so she switched to a natural drug made from dried, powdered pig thyroids. Marketed under the names Armour Thyroid, Nature-Throid, and Westhroid, this drug is the closest option to human thyroid hormone available. (Vegetarians and animal-rights advocates take note: There are no vegetarian alternatives to natural thyroid, and because the tissue is harvested from varying sources, there is no way to discern if batches are derived from animals slaughtered humanely.

Shomon and other alternative practitioners believe natural thyroid drugs are more effective for some patients because they supply two key thyroid hormones—T3 and T4—while synthetic drugs provide only T4. Since the body uses T4 to make T3, the active thyroid hormone, synthetic drugs work on the theory that just a dose of T4 will jump-start the thyroid into making its own T3. Integrative-medicine practitioners say that’s a lot to ask from a thyroid that isn’t working properly in the first place. Conventional docs counter that hormone levels in natural thyroid medication can fluctuate due to manufacturing processes, making standardized synthetic drugs more reliable and potent. Teitelbaum says that’s bunk: Natural thyroid drugs must adhere to potency standards set by the US Pharmacopeia, which ensures consistency in all pharmaceuticals.

Hyperthyroid drugs work the opposite of their hypothyroid cousins, blocking the thyroid’s ability to make hormones. The most common medications are propylthiouracil and methimazole (Tapazole). Although these drugs can have serious side effects, including liver and immune-system damage, there aren’t any natural alternatives.

Alternative therapies

Today, Shomon takes Nature-Throid boosted by a synthetic T3 drug. But she’s also learned she needs more than drugs to relieve her symptoms and keep her thyroid healthy. She takes vitamin and mineral supplements, avoids white flour, exercises regularly, makes sure she gets eight hours of sleep a night, and practices stress-reduction techniques like guided imagery, meditation, and yogic breathing. (For more information on how these habits can help keep your thyroid healthy, see “Do You Have Thyroid Disease?”.) Conventional doctors haven’t learned the same lesson. They continue to push Synthroid even when some patients report that they still have thyroid-disease symptoms. “One of the reasons people don’t get completely well when treated with conventional approaches is that those approaches don’t address the underlying causes and factors that interfere with thyroid function,” Hyman says.

The thyroid gland is part of the endocrine system, which stretches from the pituitary gland in the brain to the adrenal glands on the kidneys. The glands work together to produce the hormones that keep us alive. “You can’t push on one gland and not have the other say, ‘ouch,’?” says Mike Bauerschmidt, MD, director of the Full Potential Health Care center in Ft. Lauderdale, Florida. “If you have thyroid disease, you have to ask if it’s purely a thyroid problem or is your thyroid suffering because the adrenals are shot?”

Jennifer Greenfield, DC, managing partner of the Center for Chiropractic & Wellness in Raleigh, North Carolina, says when the adrenal system gets imbalanced—either because of too much mental or physical stress—it alters the production of the hormone cortisol, which encourages the thyroid to slow down its own hormone production. The result? Hypothyroidism. “You can flog that thyroid all you want and make it go faster, but until you deal with the adrenals, you’re not going to get very far,” she says.

Hyperthyroidism, on the other hand, is more likely caused solely by thyroid malfunction, so it responds less to holistic treatments. Even alternative practitioners say it’s best to take conventional drugs to treat hyperthyroidism because of the possibility of a “thyroid storm”—a rare but life-threatening condition that seriously elevates heart rate, blood pressure, and body temperature. “If you have strong hyperthyroidism, you really need to be looking more to traditional medicine before you burn your body out,” says Bauerschmidt.

Natural Remedies

But natural remedies can help manage hyperthyroidism and other thyroid conditions by supporting, balancing, and detoxifying the body. Many natural therapies may also prevent or even cure hypothyroidism, providing the thyroid hasn’t been removed or damaged irreparably. Here’s what alternative-medicine practitioners recommend.

Iodine. Salt was iodized in the 1920s to prevent a goiter epidemic, but iodine deficiency can contribute to all types of thyroid malfunction. Teitelbaum recommends everyone—especially those who use non-iodized salt, such as sea salt, or have a low-sodium diet—supplement with 150 to 250 mcg of iodine daily for general thyroid support, and as much as 12,500 mcg daily to treat any form of thyroid disease. You can purchase iodine as salts, capsules, tablets, or in liquid form, such as the colloidal tincture Thyadine by TriMedica, which also contains homeopathic formulas.

Other minerals and vitamins. Everyone needs zinc (20 to 30 mg a day), magnesium (400 to 600 mg a day), and calcium citrate (800 to 1,200 mg a day) for optimal thyroid function, Hyman says. If you’re hypothyroid, he recommends selenium (200 to 300 mcg a day) to help with thyroid-hormone production. Vitamins A (2,500 to 5,000 IU a day) and D3 (1,000 to 2,000 IU a day for maintenance; 5,000 to 10,000 IU a day for three to six months for treatment) help thyroid hormones bind to the receptors that control metabolism. Daily B-vitamin supplements (25 to 50 mg each of B1, B2, and B6; 50 to 100 mg each of B3 and B12; 100 to 500 mg of B5; 150 to 1,000 mcg of B7; and 800 mcg of B9) help manufacture thyroid hormones. If you’re hyperthyroid, copper (6 to 8 mg a day) helps limit thyroid hormones.

Foods. Sea vegetables such as kelp are good sources of iodine. Foods that contain omega-3 fatty acids, including walnuts, flaxseeds, and fatty fish like sardines and salmon, help produce thyroid hormones. Fatty fish is also a good source of vitamin D and iodine. Brazil nuts are an excellent source of selenium. Gamma oryzanol, found in rice-bran oil (a cooking oil popular for frying), may help boost thyroid-hormone production. But be careful with your morning cup of joe: Caffeine can limit absorption of thyroid medication. Wait at least an hour after taking any thyroid drug before drinking coffee or tea.

Cruciferous vegetables (broccoli, cauliflower, cabbage), peaches, strawberries, peanuts, radishes, spinach, and millet are considered goitrogenic, meaning they can hinder thyroid-hormone production by reducing the amount of iodine in the body. Cook them (heat destroys the goitrogens) or avoid eating large amounts if you’re hypothyroid. “For most people, the occasional uncooked goitrogen, like raw broccoli in a salad, isn’t a problem,” Shomon says. If you’re hyperthyroid, however, be sure to include more of these foods in your diet.

Hyman says 30 percent of people with Hashimoto’s thyroiditis have an abnormal reaction to gluten, a protein found in wheat, barley, and rye. He recommends that people who think they have thyroid disease be tested for gluten sensitivity as well.

Thom E. Lobe, MD, founder and director of Beneveda Medical Group in Beverly Hills, California, says soy may or may not be a culprit in thyroid disease: “I don’t like younger women to eat it because it has an estrogenic effect, but for men, the data is unclear.” Estrogenic nutrients may increase levels of the sex hormone estrogen, which can interfere with your body’s production of other hormones like thyroid. Younger women have more estrogen than older, menopausal women. Soy is also considered a goitrogenic food, but Shomon says researchers are unsure if it contains enough iodine-zapping compounds to affect the thyroid adversely. If you’re concerned, limit your intake of soy to fermented foods such as tempeh, which is less goitrogenic than raw soy like edamame, says Lobe.

Herbs and supplement formulas. To keep your thyroid functioning optimally, Holly Lucille, ND, of West Hollywood, California, recommends regulating the adrenals with ashwagandha (500 mg a day), licorice (400 mg a day), Siberian ginseng (450 mg a day), and rhodiola (200 mg a day). L-carnitine, lemon balm, and lithospermum, or stoneseed, can lower thyroid levels in people with hyperthyroidism—Shomon recommends consulting a doctor or herbalist for specific doses. The ayurvedic herbs guggul and manjistha help detoxify the thyroid by stimulating lymph drainage; doses vary depending on the individual, says John Douillard, PhD, an ayurvedic practitioner in Boulder, Colorado.
Thyroid supplement formulas, such as Gaia Herbs’ Thyroid Support, include a combination of ashwagandha, schisandra, and kelp. Similarly, Now Thyroid Energy blends B vitamins, selenium, zinc, iodine, guggul, and ashwagandha; Solaray Thyroid contains iodine, magnesium, zinc, and copper to help support the thyroid. Consult a naturopath or herbalist to find out which formula might best help your condition.

Heavy metal and chemical detox. Heavy metals, such as lead and mercury, and environmental toxins—chemicals, pesticides, and pollutants—can interfere with thyroid-hormone production. Lucille recommends a two-week liver detox at least twice a year to clean out your system and advises asking your naturopathic doctor for a heavy-metal urine or blood test to make sure your body isn’t overloaded with toxins from lifestyle and dietary choices. (For tips on ridding your body of toxins, see “Detox the Right Way”)

Hyman recommends sweating out heavy metals and other toxins in a sauna or steam bath a few times per week. Start with a 10-minute session, and increase by five-minute increments to a maximum of 30 to 40 minutes. You can also take a hot bath with up to 2 cups of Epsom salts and 8 ounces of baking soda to help draw impurities out of the body.

Water and air filters. According to Hyman, chlorine and fluoride in unfiltered water can interfere with iodine absorption in the thyroid. Airborne mold, allergens, and pollutants can play havoc with the immune system and may cause autoimmune thyroid diseases. To avoid these effects, add a water filter to your faucet and use HEPA air purifiers in your home, suggests Hyman.

Exercise. Regular aerobic exercise and strength training can burn off excess adrenal hormones. But don’t overdo—more than an hour, five days a week, can overstress your adrenals. Some experts also think yoga helps thyroid conditions: Shoulderstand, Camel, and Bridge Poses are especially apt at stimulating the thyroid and increasing hormone circulation.

Mental destressors. Lucille recommends meditation, biofeedback, or taking a 15-minute time-out every day to reduce adrenal stress. Make sure you get at least seven hours of sleep a night to keep stress hormones in check.

Chiropractic. Greenfield says incorrectly aligned neck vertebrae can interfere with nerves that aid thyroid function, so consider scheduling a tune-up with your chiropractor.

Acupuncture. Jeannette Painovich, LAc, an acupuncturist in Los Alamitos, California, says acupuncture can help resolve thyroid problems by correcting imbalances in the body. She treats hypothyroidism as a spleen qi deficiency and uses herbs to relieve phlegm, including kun bu, zhi bei mu and ban xia, and astragalus, bai zhu, and dong quai to boost spleen qi. According to traditional Chinese medicine, hyperthyroidism is due to liver qi depression and can be treated with the herbs chai hu and chen pi.

To see if you might have thyroid disease and what the most common tests are, check out our article on testing.

By Vicky Uhland 

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