I often talk about various root causes that can trigger Hashimoto’s.
In summary, root causes can be categorized as:
- Food sensitivities
- Nutrient deficiencies
- Impaired ability to handle stress
- Impaired ability to handle toxins
- Chronic infections
- Intestinal permeability
Some of the root causes can be somewhat elusive and may take a whole lot of digging, but addressing nutrient depletions is usually pretty straight forward. Best of all, when we address nutrient depletions, we can feel better really quickly, even when other underlying root causes are still present!
In this article, you’ll learn more about the top nutrient deficiencies in Hashimoto’s, and which nutrients can be taken safely by most people without necessary testing, and which supplements should only be taken after finding a deficiency on a lab test.
I’ll also share the supplements I have taken to address my deficiencies as well as the ones I recommend to clients and how to understand your lab tests.
Why Do We Have Nutrient Depletions
Nutrient depletions are always a factor in Hashimoto’s. In fact, I would argue that due to our current farming practices and Western diet, nutrient depletions are a factor for most people!
Eating conventionally grown foods, taking medications and having food sensitivities, gut inflammation, poor digestion, malabsorption, gut infection, an altered flora, and even hypothyroidism in itself, can lead to nutrient depletions.
Even people who are eating organic, nutrient dense diets are at risk for nutrient deficiencies, as factors like low stomach acid, fat malabsorption, and a deficiency in digestive enzymes will result in many of us not being able to properly break down the nutrients from the foods that we’re eating. This is where supplementation comes in.
The 6 Most Important Nutrients in Hashimoto’s
The most common nutrient depletions in Hashimoto’s are selenium, vitamin D, B12, ferritin (the iron storage protein), thiamine and magnesium (in no particular order).
Selenium, thiamine, and magnesium deficiencies are NOT reliably found on blood testing, and I do not recommend testing before you supplement. Most people with Hashimoto’s have deficiencies in thiamine, selenium, and magnesium.
These supplements are safe for most people with Hashimoto’s, and I’ve seen very limited adverse reactions. I’ve written separate articles for each supplement that summarize all of the research related to each supplement. For the purposes of this blog post, I’m only including a short summary for each supplement.
The Three Thyroid Supplements Safe and Helpful for Most
Thiamine (also known as B1), is a vitamin that has been found deficient in people with Hashimoto’s and Crohn’s disease.
I wrote an entire article about thiamine back in 2013. I still get hugs from readers at conferences as well as messages from people who have turned their life around with using thiamine 🙂 I recently received a letter from a reader who started on disability due to her thyroid fatigue and, with the use of thiamine, was able to return back to work!
Personally, for me, thiamine helped me resolve my fatigue and the low blood pressure I battled for as long as I could remember (sometimes as low as 80/50)! My blood pressure has always tested normal after I started this supplement a few years ago.
A dose of 600mg per day has been found to turn fatigue around in 3-5 days.
Clues that you may have a thiamine deficiency: having Hashimoto’s or another autoimmune condition; IBS; fatigue; low blood pressure; low stomach acid; feeling worse after drinking alcohol or after taking L-glutamine; brain fog; adrenal or blood sugar issues.
Recommended Supplement: Benfomax from Pure Encapsulations
Dose: 600 mg per day (three capsules)
Expected benefits: more energy, better brain function, stabilized blood pressure, and improved blood sugar tolerance
How long to see benefits: usually 3–5 days
How long to take: 3 months–2 years
Special considerations: If you have an adverse reaction to thiamine (which is RARE), I recommend doing the Liver Protocol in Hashimoto’s Protocol. Sensitivity to B vitamins is a symptom of “liver congestion,” a condition that can lead to multiple chemical sensitivities and numerous symptoms.
I used to have panic attacks… and then came selenium + blood sugar balance, and they were no more. True story. I’ve seen this time and time again, and it makes me so happy to see improvements with this one inexpensive nutrient!
Selenium deficiency has been recognized as an environmental trigger for Hashimoto’s, and most people with Hashimoto’s are at risk for this deficiency. Other populations at high risk include those with IBS, celiac disease, and people who consume grain-free diets!
Numerous studies support using selenium in Hashimoto’s, Graves’, and pregnancy. In fact, selenium can prevent postpartum Hashimoto’s. 🙂
A dose of 200 mcg per day has been found to reduce TPO antibodies by about 50% within 3 months!
Recommended Supplement: Selenium Methionine from Pure Encapsulations
Dose: 200–400 mcg per day
Expected benefits: less anxiety, better T4 to T3 conversion, lower thyroid antibodies, more energy, less hair loss, fewer palpitations
How long to see benefits: usually 3–5 days for symptoms to start improving; three full months to see a reduction in thyroid antibodies
How long to take: 3 months–2 years
Special considerations: If you have an adverse reaction to selenium (which is RARE), you may have iodine deficiency. While iodine can be a trigger for Hashimoto’s and can exacerbate Hashimoto’s, some people may be deficient and may benefit from a low dose iodine supplement (up to 250 mcg has been well tolerated in people with Hashimoto’s. Most multi and prenatal vitamins will contain anywhere from 150-250 mcg). I have more information about iodine in the Advanced Protocols in Hashimoto’s Protocol…
Magnesium has often been called the “miracle nutrient,” and I couldn’t agree more! I’m a big fan! Magnesium deficiency can cause migraines, headaches, insomnia, menstrual cramps, anxiety, joint pain, and a whole host of other symptoms (like intolerance to loud noises!).
I have witnessed the miracle of magnesium for myself, personally, in the realm of menstrual cramps. I used to get cramps so horrific I often had to miss school and work on the first day of my menses. I remember a time during my pharmacy internship where I had to physically lay down in the back of the pharmacy because my menstrual cramps were unbearable! With enough magnesium onboard, my menstrual cramps are a thing of the past!
My clients have also resolved migraines, insomnia, anxiety, and all kinds of cramps with magnesium.
Studies show that long-term use can also help with normalizing the thyroid gland appearance on ultrasound, and magnesium may also help for thyroid and breast nodules.
Dose: 1–4 capsules per day, in divided doses, with meals.
Expected benefits: reduced anxiety, reduced palpitations, more energy, improvement on thyroid ultrasound (when used long-term), no more menstrual cramps, relief of constipation, migraines, cramps and pain, better sleep.
How long to see benefits: this really depends on the symptom. You may see benefits with anxiety, insomnia, and even migraines/headaches, within the first week. With menstrual cramps, they will reduce by 80-90% within month one and will lessen with continued use. With regard to normalizing thyroid ultrasound, this may take a few years of use.
How long to take: 3 months–lifetime
Special considerations: Make sure to space your magnesium by at least 4 hours from thyroid medications, as magnesium can block their absorption. I prefer taking magnesium at bedtime because it promotes a restful sleep.
Magnesium citrate can cause loose stools, which may be a good thing or a bad thing depending on which direction you tend to swing 🙂 Consider glycinate if you tend to me more on the diarrhea side, citrate if you tend to be more constipated. Keep in mind that for some people glycinate can worsen anxiety symptoms. If you are prone to anxiety, citrate would be a better choice.
The 3 Most Important Thyroid Nutrient Tests
As I already mentioned, vitamin D, B12, zinc, and ferritin require testing. Most doctors will order these tests for you if you ask, and the tests should be covered by your insurance. If you do not have a doctor that is willing to order the tests for you, or if you have a high-deductible insurance plan, I’ve provided links for self-ordering options for each of the tests below, as well as a guideline for your optimal reference range and my preferred supplement choice.
Please note: the lab interpretation guide I provide below is based on functional labs. In some cases, doctors may consider your numbers “normal” when you are indeed deficient. Make sure to be an educated and empowered patient, and always ask for a copy of your own labs so that you don’t miss out on the life-changing effects of these important nutrients!
1. Vitamin D
Overview: Vitamin D deficiency is more commonly found in people with Hashimoto’s—68% of my readers with Hashimoto’s reported also being diagnosed with vitamin D deficiency—and deficiency has been correlated with the presence of antithyroid antibodies. Research done in Turkey found that 92% of Hashimoto’s patients were deficient in vitamin D, and another 2013 study found that low vitamin D levels were associated with higher thyroid antibodies and worse disease prognosis.
Vitamin D supplements can improve our mood and can help us reduce thyroid antibodies. Both TPO and TG antibodies were reduced in a Polish trial of 18 women who were supplementing with vitamin D to reach a target of 60 ng/ml. I’ve personally found that most of my clients who are in remission from Hashimoto’s keep their levels of vitamin D between 60-80 ng/ml.
Who is at Risk for Deficiency: Pretty much anyone who is not a full-time lifeguard in Southern California 🙂 Vitamin D deficiency is rampant—very common in most North Americans, Europeans, and Australians—and affects a large number of people with Hashimoto’s! A low-fat diet or fat malabsorption increases the risk.
Recommended Test: I recommend testing for vitamin D deficiency using the Vitamin D, 25-OH and retesting within 3 months once you start supplementing to make sure that you are getting enough—but not too much. In contrast to most vitamins which are water-soluble and are excreted by the body in excess, vitamin D is fat soluble and can build up.
Understanding Your Results: Vitamin D levels should be between 60 and 80 ng/L for optimal thyroid receptor and immune system function.
Recommended Supplement: Vitamin D, Pure Encapsulations
Dose: I generally recommend a dose of 2000 IU-5000 IU for my clients, with a recheck in 3 months.
Special Considerations: I also recommend spending time in the sunshine to get more vitamin D if you have Hashimoto’s. If you don’t live in a warm climate, get to one! You have an official prescription for a beach vacation from yours truly! Tanning beds will also do in a bind. Yes. I said tanning beds.
2. Vitamin B12
Overview: Vitamin B12 helps us with our energy production, and low levels are commonly associated with Hashimoto’s and may lead to fatigue, depression, neurological issues, impaired digestion, brain fog, tingling extremities, nerve damage, seizures, and anemia.
Who is at Risk for Deficiency: Vegans and vegetarians are at greatest risk due to the fact that B12 is only found in animal foods and cannot be synthesized by the human body. Those with pernicious anemia (a type of autoimmune condition), H. pylori, and SIBO may also be at risk.
Recommended Test: Ask for B12 by name or by cobalamin. This is not a routine test but is covered on insurance. Levels may be low, even if all other screening tests for iron and anemia come out within the reference range. B12 is something that can be ordered individually or added to a blood panel. [You can self-order the B12 test via Ulta Lab Tests]
Understanding Your Results: Optimal B12 levels should be between 700-900 pg/ml. Please note: most labs will not flag B12 levels unless they are under 200pg/ml.
Recommended Supplement: B12 5000 mcg liquid (methylcobalamin by Pure Encapsulations)
Dose: 5000 mcg sublingually daily for 10 days; then 5000 mcg weekly once per week for 4 weeks; then 5000 mcg monthly for maintenance.
Monitoring: You can’t really overdose on B12—it’s water soluble—but I always recommend doing the initial test and retesting 3 months later to track and monitor your progress.
Special Considerations: Be sure to use the sublingual version—swallowing B12 may result in inadequate absorption. Injections are also available and highly effective, however, the sublingual form is just as effective, much less expensive, and pain-free 🙂
If you have pernicious anemia, please note that it’s often caused by H. pylori, which can trigger both Hashimoto’s and pernicious anemia. Treatment can reverse both conditions! Make sure to read my article on H. pylori for the 411 on this gut infection.
If you have the COMT V158M gene mutation or mitochondrial issues, the Adenosyl/Hydroxy B12 liquid from Pure Encapsulations may work better.
Overview: Ferritin is our iron storage protein, and low levels are commonly associated with Hashimoto’s and may lead to fatigue, difficulty breathing, and big time hair loss.
Who is at Risk for deficiency: Women who menstruate and are postpartum may be at increased risk due to blood loss. Additionally, SIBO, H. pylori, low stomach acid, vegan/vegetarian diet, manganese deficiency, and copper and heavy metal toxicity can cause low ferritin levels.
Recommended Test: Ferritin levels may be low, even if all other screening tests for iron and anemia come out within the reference range. You need to request for ferritin to be tested specifically. This is something that can be ordered individually or added to a blood panel. [You can self-order the ferritin test via Ulta Lab Tests.]
Understanding Your Results: Normal ferritin levels for women are between 12 and 150 ng/mL. According to some experts, Ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90-110 ng/ml.
Recommended Supplement: OptiFerin-C by Pure Encapsulations
Dose: 1–3 capsules per day, in divided doses, with meals.
Special Considerations: Ferritin is often something that can be deficient due to numerous root causes, so if supplementing didn’t address your levels, you will need to do some more digging. I have more information in Hashimoto’s Protocol in the Advanced Protocols 🙂
If you have elevated ferritin levels, you may have iron overload and may benefit from blood donations.
Be sure to retest your levels of ferritin, as it can build up in the body and be toxic.
Keep this supplement out of reach from children and pets!
All of the above labs can be ordered by your primary care doctor or endocrinologist and are covered by most insurances. Research supports that they should be the standard of care for everyone that has Hashimoto’s, but oftentimes you will need to request these tests from your doctor.
Please note: if you don’t have a doctor that can order the labs for you, you can order each of the labs separately, or you can order the test I have set up specifically for my readers courtesy of Ulta Lab Tests. This is the first company that not just lets patients order their own labs (and receive the results), but also allows you to submit your receipts to your insurance for billing! Please be sure to check with your insurance as each company has different rules.
- Thiamine, selenium, and magnesium (citrate or glycinate) are safe and helpful for most people with Hashimoto’s and most people will see a significant benefit from these supplements.
- If you have Hashimoto’s, you should also request tests for ferritin, B12, and vitamin D to see if you would benefit from supplementing.
Have you tried these nutrients? How have they helped? What other nutrients have you found to benefit you?
I hope this helps you on your journey!