Supplement Options

• • This micronutrient has a crucial role in the maintenance of immune-endocrine function, metabolism, and cellular homeostasis [1] which can help reverse Hashimoto’s.
  • Helps to convert T4 (the “storage” hormone) to T3 (the “active” form)

Recommendation

Douglas Laboratories Selenium

Innate Response Selenium

NOTE: 200 mcg is generally recommended by integrative practitioners to help lower antibodies
​[2, 3].

• Intestinal permeability is one of the root causes for developing autoimmune issues. Probiotics help repopulate the good bacteria in the intestines and help build a healthy terrain for immunity [4-5].
• Be sure to avoid gluten and to address food sensitivities if you are trying to heal intestinal permeability. See the “intestinal permeability” table below for more information [6].

Recommendation

VSL 3

Klaire Labs Ther-Biotic Complete

NOTE: Rotate probiotics every few months to populate a variety of strains in the intestinal tract. Aim for a multi-strain brand that has at least 50 billion colony-forming units [4].

• Known as the highly concentrated “milk” in the first feeding of a nursing mammal mother which contains large amounts of immune-supporting compounds. </li
• Research demonstrates that colostrum allows for the transfer of passive immunity, and may offer disease protection [7].

Recommendation

Sovereign Laboratories Colostrum-LD

​​Immune Tree Colostrum

NOTE: Look for a high quality bovine colostrum sourced from grass-fed cows.

• ​Helps promote a balanced immune system by improving the balance of T-helper 1 to T-helper 2 cells, enhancing cellular immunity, and down-regulating an overactive immune response.
• Promotes balance of adrenal hormones, cortisol, and DHEA, and works to protect against negative stress reactions [8].​

Recommendation*

Thorne Moducare
​
​Moducare Immune Support

NOTE: May lower blood sugar.Diabetics should monitor their levels closely. May require a reduction in insulin requirements [12].

• ​Regulates immune responses and helps with the inhibition of NF-kappaB (the protein complex that fuels inflammatory responses) in chronic disease, including autoimmune conditions [9].
• Has demonstrated to counteract oxidative stress in thyroid disease [10].

Recommendation

Terry Naturally Curamin

NatureWise Organic Curcumin

Note: Curcumin may affect iron absorption. Take away from iron supplements [11].

• ​​Omega-3s have anti-inflammatory properties and its use in autoimmune disease is significantly beneficial as they decrease disease activity [13].
• Contains important vitamins and minerals that act as antioxidants and also assists to burn fat and protect against heart disease.

Recommendation

OmegaVia Pharmaceutical Grade Omega 3

Nordic Naturals Omega-3

​NOTE: The nutrients in fish oil are fat soluble, so

• ​​Low dose naltrexone (LDN), a compounded prescription medication, assists the immune system by inhibiting cells that disrupt it.
• Known to limit the release of inflammatory chemicals and neurotoxins. Other benefits include reduced antibodies for those with autoimmune conditions [14].

Recommendation

Available through a compounding pharmacy only.

NOTE: See your doctor for a trusted compounding pharmacy that is experienced with LDN.

• ​​​Low vitamin D levels are associated with increased rates of autoimmunity and reported cases of infections [15]. ​
• Research recommends screening all hypothyroid patients for vitamin D levels. Supplementation is needed to restore levels [16].

Recommendation

Seeking Health Optimal Vitamin D3 Liquid

Thorne Research Vitamin D3

​NOTE: D3 (cholecalciferol)​, versus D2 (ergocalciferal), is preferred for increasing vitamin D levels [16].

• ​​​Vitamin B12 plays an essential role in red blood cell formation, cellular processes, nerve function and the production of DNA. 40% of patients with hypothyroidism have a deficiency [17, 18].​
• B vitamins work together; consider a B-complex as well since your body may need the support of other beneficial B vitamins [20].

Recommendation

aSquared Nutrition Methyl B12 Drops

Bio-Tech B12-Methyl

NOTE: Sublingual methylcobalamin, is best absorbed, second only to injection [18]. 40% of patients with B12 deficiencies have a MTHFR gene polymorphism; therefore, should be screened [19].

• ​​​B complex vitamins are involved in mitochondrial adrenal, and neurological functions and the stress response of the body.
• The thyroid gland uses all B vitamins to convert and use energy and prevent the accumulation of fat [15, 16].
• A deficiency in B-vitamins can lead to hypothyroidism. Folate is also important as it is related to TSH levels [35].​​

Recommendation

Ortho Molecular B Complex

Core Med Science Active B-Complex

NOTE: Biotin (Vitamin B7) may cause falsely high or falsely low results in a variety of lab tests, including thyroid tests. It’s recommended to stop taking biotin 3-5 days prior to lab testing. [34].

• ​​​Iodine deficiency is the leading cause of hypothyroidism since it is a core component of thyroid hormone; approximately 40% of the world’s population is at risk [21]​. ​
• Iodine has been shown to affect autoimmune activity. Therefore, is is important to find a clinician experienced with iodine treatment [20].​​​

Recommendation

J. Crow’s Lugol’s Solution of Iodine, 2%

​Life Extension Sea-Iodine

NOTE: Iodine supplementation often requires companion nutrients and salt loading. See The Guide to Supplementing with Iodine by Dr. Stephanie Buist.

• ​​​​​​Thyroid peroxidase, the enzyme needed to convert T4 to T3, contains iron. Therefore, iron is essential for thyroid hormone conversion and availability [24]. ​​
• Low stomach acid as a result of hypothyroidism can prevent the absorption of certain nutrients, including iron, causing deficiencies [24].
• Follow your doctor’s recommendation for iron dosing. Too much iron can cause serious health issues.​

Recommendation

Ancestral Supplements Grass Fed Beef Liver

Solgar Gentle Iron

NOTES: Vitamin C should be taken at the same time as your iron supplement to increase iron’s absorption. Iron should be taken 4 or more hours apart from thyroid medication since it can block absorption.

• ​​​​​​Magnesium assists in stimulating the thyroid gland to produce more T4 and helps to convert the inactive T4 thyroid hormone into the active form of T3 [29].
• The World Health Organization reported that less than 60 percent of adults in the United States are not meeting the adequate intake values for magnesium [25].​

Recommendation

Integrative Therapeutics Magnesium Glycinate Plus

Pure Micronutrients Magnesium Glycinate
​
NOTE: Many patients prefer magnesium glycinate as it is the most tolerated form for the stomach.

• Zinc and other trace elements such as copper and selenium are required for the making of thyroid hormones, and deficiency of these can result in hypothyroidism [27].
• Thyroid hormones are essential for the absorption of zinc, and hence hypothyroidism can result in acquired zinc deficiency [26].

Recommendation

Douglas Laboratories Zinc Picolinate

​Thorne Zinc Picolinate

NOTE: Look for zinc picolinate as it is high absorbable. Always take with a meal to prevent nausea.

• Adaptogenic supplements are herbs used to manage the body’s hormonal response to stress. They act by tonifying and rejuvenating the adrenal system and promote the regulation of cortisol [30].
• Common adaptogens include: Ashwaghanda, Rhodiola, Holy Basil, Eleuthero, Panax, Schisandra, Astralagus, Licorice Root, Reishi, and Cordyceps.
• Holy Basil is known to help lower cortisol while other adaptogens are more balancing.

Recommendation

Gaia Adrenal Health

​Innate Response Formulas Adrenal Response

NOTE: Each adaptogenic herb has its own properties, but blends are available to cover multiple bases.

Ashwaghanda can improve thyroid function. You may need to lower your thyroid medication as you begin taking this herb [31].

• Nutritional support for the adrenal glands serves many purposes. Essential vitamins and minerals are needed for cell metabolism by the adrenal glands, while other nutritional support helps to raise or lower cortisol levels [32].
• Common vitamins and supplements that can support the adrenals are Vitamin C, ​Vitamin B5, Vitamin B6, Vitamin B12,​Magnesium, Zinc, CoQ10, Alpha Lipoic Acid, Sea Salt Phosphatidylserine, L-Tyrosine and ​L-Theanine.
• Vitamin C, B vitamins (especially pantothenic acid) and sea salt are some of the most critical nutrients you can take for adrenal fatigue.

Recommendation

Dr. Wilson’s Super Adrenal Stress Formula

Thorne Research Stress B Complex

Thorne Buffered Vitamin C

Integrative Therapeutics Phosphatidylserine

​Life Extension CoQ10

NOTE: Phosphatidylserine is used primarily to lower cortisol. Do not use if you have low cortisol.

• Glandular extracts are usually taken from bovine or porcine adrenal gland tissue with the hormones taken out, providing proteins, nucleic acids, and building blocks for cortisol production.
• Glandulars are typically not intended for high cortisol since it can raise already-high cortisol. However, in some cases, it can modulate a high/low pattern seen in 4xs/day saliva cortisol testing or DUTCH testing.

Recommendation

Dr. Wilson’s Adrenal Rebuilder

​Vital Nutrients Adrenal Support

Ortho Molecular Adren-All

NOTE: Always work with a qualified practitioner and test using a 4xs/day saliva cortisol test or the DUTCH to assess cortisol patterns throughout the day. Glandular supplementation can make a high cortisol pattern worse.

• With the right dose, cortisol replacement can greatly benefit patients with adrenal dysfunction. Low-dose, long-term use has been proven as safe and effective for patients with low cortisol [36].
• Glandulars are typically not intended for high cortisol since it can raise already-high cortisol. HoweveReplacement use of cortisol at doses of 5mg to 15mg a day are safe, with little or no associated risk [36]

Recommendation

Hydrocortisone (Cortef, Hydrocortone)

NOTE: ​Hydrocortisone can be difficult to wean off of for some patients. Therefore, always work with a qualified physician experienced in prescribing and treating adrenal dysfunction.

• Supplementing with probiotics or “good bacteria” is both a preventative and therapeutic measure, in order to restore the health composition and function of gut microbiome [37].​
• Most of the immune system is housed within the gastrointestinal (GI) tract. Poor gut health is a factor in triggering and exacerbating autoimmune diseases [38].​

Recommendation

VSL 3

Klaire Labs Ther-Biotic Complete

Renew Life Ultimate Flora

NOTE: Rotate probiotics every few months to populate a variety of strains in the intestinal tract. Aim for a multi-strain brand that has at least 50 billion colony-forming units [4].

• Restore is a carbon-rich, alkaline liquid comprised of a formulation of aqueous humic substances and trace mineral amino acid complexes. It has been shown in lab testing to increase and strengthen the tight junctions in the gut lining.
• Restore is not a probiotic nor a prebiotic [39].

Recommendation

Restore

NOTE: Take Restore thirty minutes before a meal because of Restore’s protective effects against gluten and sensitivities [39].

• Digestive enzymes help break down proteins, fats, sugars, and starches, which can reduce intestinal inflammation and help heal the intestinal lining.
• By assisting in breaking down food, digestive enzymes help ensure that there will be fewer food toxins passing through the gut and causing further damage [40].

Recommendation

Ortho Molecular – Ortho Digestzyme

Rainbow Light Advanced Enzyme System

NOTE: If you have a gluten or dairy sensitivity, you can buy a digestive enzyme targeted for that use. Broad spectrum enzymes available [40].

• Glutamine is an abundant amino acid in the bloodstream and research demonstrates its ability to help restore gut health [41].
• Thyroid hormone imbalance has been shown to have a great impact on the metabolism of glutamine [42].

Recommendation

Jarrow L-Glutamine Powder

Thorne L-Glutamine Powder

NOTE: Some people may experience anxiety or heart racing with L-Glutamine. If this happens, it is advised to start at a very small amount and increase slowly.

• Licorice is a well-researched medicinal plant with many uses from reducing inflammation to aiding in the metabolism of cortisol to balancing gastrointestinal issues.
• Licorice root has compounds that promote regulatory T cell induction, which plays a critical role in controlling immune responses and preventing autoimmunity [43].

Recommendation

Designs for Health Gastro-Mend

Integrative Therapeutics Rhizinate

NOTE: Look for licorice root that is deglycyrrhizinated (or DGL). This form of licorice has glycyrrhizin removed. Glycyrrhizin can cause edema and hypertension in some individuals.

• Quercetin is a flavonoid and is well-known for many things, including its anti-allergy properties, anti-cancer effects, and as an antioxidant.
• Quercetin helps to heal the gut by its role in the assembly and expression of tight junction proteins [44].

Recommendation

Jarrow Quercetin

Thorne Research Quercetin Phytosome

NOTE: Use caution if you take Quercetin with antibiotics, chemotherapy, or blood-thinner medications, as it may reduce their effectiveness.

• Pregnenolone is synthesized by cholesterol and made by the adrenal glands and liver. It is an important precursor to other hormones, including DHEA, progesterone, estrogen, testosterone, and cortisol. By late adulthood, pregnenalone will decline by nearly 60% for most people (47,48).
• Pregnenolone assists in the conversion of T4 to the more active T3. Many people with thyroid disease are low in pregnenolone and may benefit with trial supplementation (49).

Recommendation

Douglas Laboratories Pregnenolone

Ortho-Molecular Pregnenolone

NOTE: Buy pregnenolone that states “pregnenolone” as the ingredient, rather than wild yam or diosgenin. Wild yam contains diosgenin that must be converted in a laboratory to make pregnenolone.

• DHEA is a hormone that is produced by the adrenal glands. Levels of DHEA naturally drop as we age and low DHEA is associated with a number of diseases including thyroid disease.
• DHEA is frequently low with weak adrenals, and weak adrenal function is typically seen in many hypothyroid patients. Chronic illness or stress can cause spiked or depleted cortisol patterns, which also depletes production of DHEA (52).

Recommendation

Douglas Laboratories DHEA

​Ortho-Molecular DHEA
​
NOTE: DHEA should be taken on a temporary basis while addressing the true cause of the dysfunction such as adrenal stress (52).

• Primarily produced by the ovaries, estrogen is responsible for the growth of a women’s uterine lining. Estrogen replacement therapy can reduce or resolve symptoms of menopause or other estrogen imbalance issues. Estrogen therapy can also lower the risk of osteoporosis for those who are deficient (45).
• The link between estrogen dominance and hypothyroidism is well-researched. The estrogen/progesterone hormone imbalance directly affects thyroid function (46).​​

Recommendation

Replacement therapy includes patches, transdermal methods, vaginal suppositories, rings, etc.​ Discuss with your doctor about available options.

While prescription bioidentical formulas are preferred, a widely used over-the-counter bioidentical transdermal cream is available: Emerita Estriol Natural-Balancing Cream.

• Made from pregnenolone and secreted by the ovaries in women and by the testes in men, progesterone serves as a precursor to DHEA, testosterone, estrogen and cortisol.
• Progesterone directly affects thyroid hormone levels. Research concluded that progesterone therapy increases lab levels of Free T4 (50). Other important functions include (but aren’t limited to) regulating a women’s menstrual cycle along with estrogen, regulating blood sugar, converting fat into energy, increasing brain function, and activating GABA receptor sites.

Recommendation

Replacement therapy includes patches, transdermal methods, vaginal suppositories, rings, etc. Discuss with your doctor about available options.

While prescription bioidentical formulas are preferred, a widely used over-the-counter bioidentical transdermal cream is available: Emerita Pro-Gest Cream

• Testosterone, an important hormone for metabolism, is made in the testes and adrenal glands in a male. In a woman, testosterone is made in the ovaries and adrenal glands.
• Testosterone and thyroid hormones are responsible for similar bodily functions, so when one is not working, the other is affected. When hypothyroid states return to normal, testosterone levels tend to return to normal as well (51).

Recommendation

Replacement therapy includes patches, transdermal methods, injections, and subcutaneous pellets. Discuss with your doctor about available options.

While prescription formulas are preferred, a widely used over-the-counter herbal formula is available: Prime Labs Testosterone Booster

• There are many natural supplements on the market that have been researched to help bring hormones into balance (53).
• Individual herbs or nutrients are available while other supplements contain a synergistic blend of ingredients to help restore the body’s natural hormonal balance in a variety of ways.
• Research each product and product ingredients for its particular use to see if it’s right for you.

Recommendation

Gaia Herbs Chaste Tree Berry

Gaia Maca Root

Gaia Black Cohosh

New Chapter Estrotone

Himalaya Shatavari

Allergy Research Group DIM