Hashimoto’s thyroiditis treatment

Treatment¹⁶ for Hashimoto's thyroiditis may require watchful waiting (observation of the condition) before the use of life-long medications. Your provider may suggest this wait-and-see approach if there is no evidence of hormone deficiency and if your thyroid is functioning normally.

Hashimoto’s thyroiditis medication

Your healthcare provider may prescribe the following medication for Hashimoto's thyroiditis:

Thyroid hormone replacement therapy

Thyroid hormone replacement therapy is the most common treatment for Hashimoto’s thyroiditis. This type of therapy usually involves daily use of levothyroxine, a synthetic thyroid hormone.

Levothyroxine replaces the hormones that your thyroid can no longer make. This medication is identical to thyroxine. It can restore adequate hormone levels and reverse the symptoms of hypothyroidism.

Levothyroxine is taken orally, usually for life. Your provider may recommend that you take this medicine consistently in the mornings on an empty stomach, at least 30–60 minutes before eating.

The initial dose¹⁷ of levothyroxine may depend on your age, weight, and the presence of illnesses such as cardiac disease. Pregnant women may also need to have their doses adjusted throughout the course of their pregnancy.

To determine the right dosage of levothyroxine, your provider generally checks your TSH level after 6–8 weeks of treatment. After this, they will adjust your dose, if needed. You’ll need to have another blood test each time your dose is adjusted. After you reach a dose that works well, your provider will probably repeat the blood test in 6 months, then once every year.

It’s important for you to know the potential side effects of hormone replacement therapy. Receiving too much thyroid hormone can accelerate bone loss and cause heart rhythm disorders (arrhythmias).

If you have heart disease or severe hypothyroidism, your provider may start treatment with a small dose of medication and gradually increase as needed. Through progressive hormone replacement, your heart will be able to adjust to the increase in metabolic rate.

When used in the appropriate dose, levothyroxine causes almost no side effects. It is relatively inexpensive. If you are taking levothyroxine, take care not to skip doses or stop taking the drug. If you do, the signs and symptoms of Hashimoto’s thyroiditis will gradually return.

Certain medications, supplements, and foods may affect your ability to absorb levothyroxine. In some cases, however, taking levothyroxine four hours before or after other medications can remedy the problem.

Talk to your provider if you take any of the following:

• Aluminum hydroxide, which is found in some antacids to treat heartburn
• Calcium supplements
• Iron supplements
• Sucralfate, which treats ulcers
• Cholestyramine (Prevalite), a medication for lowering blood cholesterol levels

While most people with Hashimoto’s disease are treated successfully with levothyroxine alone, some people don't feel completely normal on this medication.

Some researchers have found evidence that T-3 may benefit a certain subset of people. T-3 can be given alone in the form of liothyronine or in combination with T-4.

Hashimoto’s thyroiditis diet

Some clinical evidence has shown that a gluten-free diet¹⁸, grain-free diet, paleo diet, or soy-free diet may bring benefits to people with Hashimoto’s thyroiditis.

An excess of iodine¹⁹ may trigger Hashimoto's thyroiditis. People with Hashimoto’s hypothyroidism may be more sensitive to the harmful side effects of iodine.

Eating foods with large amounts of iodine, such as different kinds of seaweed, may make hypothyroidism worse. Taking iodine supplements can have the same effect.²⁰

Talk with your provider about what foods you should limit or avoid. Let them know if you take iodine supplements, eat large amounts of soy products, or if you have a high-fiber diet.